Neurodevelopmental and Attention Disorders Flashcards
Neurodevelopmental disorders (not motor) must be present before a child _______
enters grade school
so manifests early development
What do neurodevelopmental and motor disorders do?
produces impairments of personal, social, academic, or occupational functioning
For intellectual disability diagnosis, you have to have adaptive functioning deficits in what domains?
conceptual (especially problem-solving)
social (especially difficulty regulating emotion and behavior in social situations)
practical (need help making healthcare and legal decisions)
Severity of intellectual disability is based on?
adaptive functioning
NOT IQ scores!
–> use DDST (Denver developmental screening test) and Wechsler intelligence scale
Define global developmental delay
meet criteria of intellectual disability but child too young for DDST or so poor it wouldn’t be indicative
have severe head injury or insult during developmental period
What do you need to take into account when evaluating possible communication disorders?
cultural and language context
Define language disorder
difficulty with spoken, written, and sign language
Define speech sound disorder
difficulty making speech sound that are intelligible and limits verbal communication
***not attributable to limited opportunity for language acquisition or other issues
Define childhood-onset fluency disorder (stuttering)
difficulty with fluency and patterns of speech sound
–> problems transitioning from sounds
causes anxiety about speaking and limits effective communication/academic and social participation
not attributable to sensory or motor deficit, neuro insult, or other mental disorder
Describe social (pragmatic) communication disorder
difficulty with social use of verbal and nonverbal communication
–> speaking differently in classroom vs playground, hard to understand metaphors and inferences
basically trouble communicating with other people in a socially acceptable way
defects often not obvious until social demands exceed capacities (later childhood or adolescence)
not attributable to neuro disorder or better explained by autism spectrum disorder, intellectual disability, etc
Diagnostic features of social (pragmatic) communication disorder
primary difficulty with social use of language
Associated features that support dx of social (pragmatic) communication disorder
delay in reaching language milestones
–> know language basics but have difficulty using it socially
Developmental course of social (pragmatic) communication disorder
may not be apparent until early adolescence when language and social interactions become more complex
Define the 7 problem areas that are characteristic of autism spectrum disorder
-problems with social communication and interaction across multiple contexts
~~~failure of back and forth conversation, reduced sharing of emotions or interests, don’t initiate or respond to social interactions
-problems with nonverbal behaviors used for social interaction
~~~~lack MEANINGFUL eye contact, limited use of body language or gestures/facial expressions
-problems with developing, maintaining, understanding relationships (parallel play vs social play)
-restricted, repetitive patterns of behavior/interests/activities
~~~idiosyncratic phrases, repetitive motor movements, obsessively line up toys to deal with sensory overload
- insistence of sameness, inflexible adherence to routines, ritualized patterns
- obsessive and intense fascination or fixation with objects or subjects of interest
- abnormal reaction to sensory input (overreacts or underreacts)
How to diagnose autism spectrum disorder
diagnosed when not better explained by intellectual disability alone or global developmental delay
—>often autism and intellectual disability coexist
autism alone has restricted interests or repetitive behaviors
–> if intellectual - with this, comorbid dx
–> if normal intellectual (no deficit in conceptual, social, practical domains), autism spectrum dx
How to make dx of comorbid autism spectrum disorder and intellectual disability?
social communication must be well below that expected for general developmental level
What are the only FDA approved meds to treat irritability and agitation associated with autism?
risperidone
aripiprazole
others (valproic acid, etc) can be affective
Is Tourette’s Syndrome Neuropsychiatric Spectrum a diagnostic disorder?
NO, just describes clinical triad of tourette’s, ADHD and OCD sx
–> if answer, don’t pick
Autism kids have this characteristic of ADHD
filtering out extraneous info when trying to problem solve or assess a situation
all info seems extraneous
Things to remember with ADHD
ADHD has defect in EXECUTIVE FUNCTIONING
associated with processing dysfunction in the prefrontal cortex
–> specifically anterior midcingulate cortex
d/t deficiency of dopamine and norepinephrine
Criteria to diagnose ADHD
in kids: must have 6 symptoms of inattentive OR hyperactive (if 6 of both–> combined ADHD)
people over 17: must have 5
What is first-line treatment for preschool kid (4-5) with ADHD?
***evidence-based parent/teacher administered behavior therapy
methylphenidate if doesn’t improve
What is first-line treatment for elementary kid (6-11) with ADHD?
FDA-approved meds AND/OR evidence-based parent/teacher administered behavior therapy
prefer both together
What is first-line treatment for adolescent (12-18) with ADHD?
***FDA-approved meds with their consent
may have behavior therapy
Prevalence of ADHD in kids
females present more commonly with inattentive subtype
less disruptive behavior in females with ADHD may contribute to referral bias–> lack of treatment/identification of ADHD
Comorbidities associated with ADHD
mood disorders
anxiety disorders
substance disorders
intermittent explosive disorder
TIC disorders
Explain tic disorders in ADHD
tics may be missed in initial evaluation because sporadic or subtle
tics can become worse with stimulant meds used to treat ADHD–> counsel parents on this
Define tourette syndrome
childhood onset of multiple motor and vocal tics lasting more than 1 YEAR
Describe tourette’s syndrome clinical triad
sx of ADHD, OCD and tourette (may not meet full dx criteria for OCD or ADHD)
part of tourette’s syndrome neuropsychiatric spectrum (not a diagnosis)
What to watch out for in kids with ADHD
suicide
Signs of executive functioning deficit
problems with:
-ability to assess situation, prioritize, filter out extraneous info, develop action plan, execute
Diagnostic tools to evaluate ADHD
computer: TOVA (tests of variables of attention) and Conners Continuous Performance test
standardized checklist: vanderbilt, conners
Define developmental coordination disorder
problems with coordinated motor skills
–> clumsiness, catching object, using scissors or cutlery, handwriting, riding a bike, participating in sports
interferes with self-care and maintenance
interferes with school, vocation, leisure, play
***not a/t cerebral palsy, muscular dystrophy, other degenerative disorders
Define stereotypic movement disorder
repetitive, COMPULSIVE, purposeless motor behavior
–> hand shaking/waving, body rocking, head banging, self-biting, etc
interferes with social, academics–> self-injury in severe cases
not a/t neurodevelopmental, hair-pulling or OCD
Define tic disorder
sudden, rapid, recurrent, NONRHYTHMIC motor movement or vocalization
What must be present to diagnose tourette’s disorder
multiple motor tics AND 1+ vocal tic
must occur many times a day, every day or intermittently throughout 1 year
tics change over time and occur BEFORE 18
Comorbidities of Tourette’s disorder
ADHD
OCD
anxiety disorder
mood disorders and risk of suicide
disruptive behaviors
learning disabilities and poor school performance
sleep disorders
Tourette’s disorder meds
antidopaminergic–> can cause tardive dyskinesia
dopamine depleters–> don’t cause tardive dyskinesia
antipsych, alpha agonist, botox, anticonvulsants
Define persistent/chronic motor or vocal tic disorder
single or multiple motor or vocal tics, BUT NOT BOTH
–> if both, tourette’s
tics wax and wane but over 1 year since onset
before 18
