Neurodevelopmental and Attention Disorders Flashcards
What are the five categories of Neurodevelopmental Disorders
- Intellectual Disability
- Communication Disorders
- ASD
- ADHD
- Motor Disorders
When do most neurodevelopmetnal disorders manifest?
Early in development
Except for motor disorders, they must be present before the child enters grade school
In which three domains will those with intellectual disabilities exhibit adaptive functioning deficits?
- conceptual
- social
- practical
What sort of deficits will be seen with disability of the conceptual domain?
Deficits in:
Reasoning
Problem Solving
Planning/Experiential learning
Abstract thinking/judging
Academia
What signs of intellectual disability appear in preschoolers and school age children?
Preschool: language and pre-academic skills develop slowly
Children: progress in reading/writing/math, time and money lags behind others
What are the signs of an intellectual disability in adults?
Academic skills typically at an elementary level
support is required for work and personal life
may need assistance in day-to-day task
Caregivers need to take over these responsibilities fully
What deficits will be seen with the social domain of intellectual disabilities?
Difficulty in the following:
social interactions with age-mates
social cues
communication/conversation (immature)
regulating emotion
risk of being manipulated/gullible
What deficits will be seen in the practical domain of intellectual disability?
Difficulty with the following:
age-appropriate personal care
“adult things”
good decisions on well-being
often placed in jobs that do not emphasize conceptual skills
Need help making health care and legal decisions
What are two diagnositc tools for Intellectual Disability?
What is severity based upon?
DDST
WISC-V
Not on IQ, but on adaptive functioning
What is a Global Developmental Delay?
unable to undergo systematic assessments of intellectual functioning but meet observational diagnostic criteria of intellectual disability disorder
Often seen in children who are too young to participate in standardized testing as a result of a severe head injury during development
What are the four main communication disorders?
Language Disorder
Speech Sound Disorder
Social Communication Disorder
Childhood-Onset Fluency Disorder (stuttering)
When attempting to diagnose a Communication Disorder, what must be considered?
Considerations of an individual’s culture and language context must be taken
What is Language Disorder?
Difficulty with spoken, written and sign language
*These difficulties are not due to hearing or sensory impairment, motor dysfunction, or neurological condition, or from foreign language.
What is Speech Sound Disorder
Difficulty making speech sounds that are intelligible and limits verbal communication
Not attributable to limited opportunity for language acqiusition
What is Childhood-Onset Fluency Disorder (stuttering)
Difficulty with fluency and patterns of speech sound
Not attributable to a speech-motor or sensory deficit, neurological insult or other mental disorder
What is Social Communication Disorder?
Difficulty with social use of verbal and nonverbal communication
NOT the same as ASD, or other developmental delays
What is the most common associated feature associated with Social Communication Disorder?
Delay in reaching language milestones
this disorder may not become apparent until early adolescence when language and social interactions become more complex
What are the main features of ASD?
Problems with Social communication
Problems with Nonverbal Behaviors
Problems with Relationships
Restricted, Repetitive Patterns
Inflexible Routines/Patterns
Obsessive Interest/Fixation
Abnormal Reaction to Sensory Input
What are the requirements for making a diagnosis of ASD?
How can Intellectual disability and ASD be diagnosed together and differentiated?
Problems are not better explained by intellectual disability or global developmental delay
May be accompanied by an intellectual disability and as such, communication should be below that expected for general development
The best way to differentiate the two is by the presence of restricted interests and repetitive behaviors
What sort of behavioral interventions can take place for those with ASD?
Education and support for parents and caregivers
Learn about parallel process and how to use it for behavioral management
Controlling the environment to limit sensory overload
Allow for difficulty with transitions
What are the two FDA approved medications for irritability and agitation associated with ASD?
Risperidone
Aripiprazole
How do females with ADHD tend to present?
more commonly with the inattentive subtype than boys
Why are females likely underdiagnosed with ADHD?
Females exhibit less disruptive behavior than males leading to a referral bias and under-identification and undertreatment of female patients
ADHD is a comorbid condition with what other psychiatric disorders?
Mood Disorders
Anxiety Disorders
Substance Disorders
Intermittent Explosive Disorder
Tic Disorder (may be worsened by ADHD meds)
What is the Tourette’s Syndrome Triad
(not a technical diagnostic category)
TS
OCD
ADHD
Is ADHD a risk factor for suicide?
Yes
What sort of executive function deficits can be seen with ADHD?
Difficulties in the following:
Situation assessment
Prioritizing
Filtering extraneous information
Developing a plan
Executing a plan
Assessing an action fluidly
Where in the brain is the area of dyfunction in ADHD?
Prefrontal Cortex
Specifically, the Dorsal Anterior Midcingulate Cortex (daMCC)
This is primarily due to deficiency of DA and NE
What are the criteria to diagnose ADHD in children and adults?
Children must have 6+ symptoms
Those 17+ must have 5+ symptoms
Describe the behaviors of Inattentive ADHD
Careless Mistakes, lack of attention for deails
Difficulty sustaining attention
Appears to not listen
Struggles with instructions and organization
Avoids a lot of thinking
Loses things
Easily distracted or forgetful
Describe the Hyperactive ADHD
Fidgets
Difficulty staying seated
Runs/Climbs, seems restless
Difficulty with quiet tasks
Acts as if driven by a motor
Talks excessively
Blurts answers
Difficulty waiting
What computerized and standardized tests can be used to assess for ADHD?
Computer: TOVA and Conners Continuous Performance Test
Standardized: Vanderbilt, Conners
What is the first line of treatment for preschool aged children with ADHD (ages 4-5)
First line: Evidenced-based patient and/or teacher administered behavior therapy
If not improved, Rx Methylphenidate
What is the treatment of ADHD for elementary aged children (6-11)
Medication and Therapy
What is the treatment of ADHD in Youths (12-18)
Medications and behavior
What is Developmental coordination Disorder?
Problems with coordinated motor skills
Issues with clumsiness, handwriting, ride a bike, sports
Not attributable to a neurologic condition such as CP, muscular dystrophy, or other degenerative disorder
What is Stereotypic Movement Disorder?
Repetitive, compulsive and purposeless movement
Not related to other conditions
What is the criteria for Tourette’s?
What are the comorbid conditions?
Multiple motor tics and one or more phonic tics must be present at some time but not necessarily at the same time.
onset prior to age 18
Comorbid conditions include: ADHD, OCD, anxiety disorders, sleep disturbance, learning disabilities, disruptive behavior, and mood disorders with risk of suicide.
What are the only approved drugs for the treatment of Tourettes in the US?
Haloperidol, Pimozide, and Aripiprazole
(may cause Tardive Dyskinesia)
What are some other treatments for Tourettes?
DA depleters (deplete DA by inhibiting VMAT)
Antipsychotics-Fluphenazine and Respiridone
Alpha Adrenergic Agonists-Guangfacine and Clonidine
BOTOX
Anticonvulsants-topiramate, Valproate, gabapentin
What is Persistent (Chronic) Motor or Vocal Tic Disorder?
A single or multiple motor or vocal tics present during illness but not both at any time
Wax and Wane, but persist for more than 1 year, onset prior to age 18
Not attributable to other conditions
