Neurodevelopmental/child disorders Flashcards
What are the main characteristics of intellectual disability (formerly mental retardation)?
Severely impaired cognitive and/or adaptive/social functioning
Diagnostic criteria for intellectual disability
Deficits in intellectual functioning (reasoning, problem solving, planning, abstract thinking, judgment, learning)
Deficits in adaptive functioning (communication, social participation, and independent living)
Deficits affect multiple domains: conceptual, practical, social
Onset during developmental period
Intellectual deficits confirmed by clinical assessment and standardized tests (scores <2SD below mean)
Requires ongoing support for ADLs
Genetic causes of mental retardation
Down syndrome (1/700 live births) Fragile X syndrome (second most common cause of ID)
Prenatal causes of mental retardation
Infection and toxins TORCH infections Toxoplasmosis Other (syphilis, AIDS) Rubella CMV Herpes simplex
Perinatal causes of mental retardation
Anoxia Prematurity Birth trauma Meningitis Hyperbilirubinemia
Postnatal causes of mental retardation
Hypothyroidism Malnutrition Toxin exposure Trauma Psychosocial causes
What is global developmental delay?
Failure to meet expected developmental milestones in several areas of intellectual functioning
Diagnosis reserved for pts <5yo
What is specific learning disorder?
Delayed cognitive development in a particular academic domain (reading, writing, ‘rithmetic)
Diagnostic criteria for specific learning disorder
- Academic skills significantly impaired/below expected for chronologic age, causing interference in school, occupation, or ADLs
- Begins during school age
- Affected areas: Reading (dyslexia), writing, or arithmetic (dyscalculia)
- Not better accounted for by intellectual disabilities, sensory disabilities, language barriers, or poor education
What is speech sound disorder?
Difficulty producing articulate, intelligible speech
What is language disorder?
Difficulty acquiring and using language due to expressive or receptive impairment
What is childhood-onset fluency disorder?
Stuttering
What is social communication disorder?
Challenges with the social use of verbal and nonverbal communication.
*If restricted/repetitive behaviors, activities, or interests also present –> autism spectrum disorder
What are the main characteristics of ADHD?
Persistent inattention, hyperactivity, and impulsivity
Diagnostic criteria for ADHD
At least 6 inattentive symptoms and/or at least 6 hyperactivity symptoms
>6 months
Symptoms interfere with or reduce quality of social/academic/occupational functioning
Inattentive symptoms of ADHD
Fails to give attention to details/makes careless mistakes
Has difficulty paying attention
Does not appear to listen
Struggles to follow through on instructions
Difficulty with organization
Avoids or dislikes tasks requiring a lot of thinking
Loses things
Easily distracted
Forgetful in daily activities
Hyperactivity symptoms of ADHD
Fidgets with hands/feet or squirms in chair
Has difficulty remaining seated
Runs about or climbs excessively in childhood; extreme restlessness in adults
Difficulty engaging in activities quietly
Acts as if driven by a motor
Talks excessively
Blurts out answers
Difficulty waiting or taking turns
Interrupts/intrudes
Pharmacologic treatments for ADHD
First line: stimulants (methylphenidate, dextroamphetamine, mixed amphetamine salts)
Second-line: atomoxitene (norepi reuptake inhibitor)
Alpha-2 agonists (clonidine, guanfacine) can be used instead or as an adjunctive treatment
Nonpharmacologic treatments of ADHD
Behavior modification techniques and social skills training
Educational interventions
Parent education
What are the characteristic features of autism spectrum disorder (ASD)?
Impairments in social communication/interaction
Restrictive, repetitive behaviors/interests
Diagnostic criteria for ASD
Problems with social interaction and communication
–Impaired social/emotional reciprocity
–Deficits in nonverbal communication
–Interpersonal challenges
Restricted, repetitive behaviors/interests/activities
–Intense, peculiar interests
–Inflexible adherence to rituals
–Stereotyped, repetitive motor mannerisms
–Hyper/hyporeactivity to sensory input
Begin in early development period
Not better accounted for by ID or GDD
Significant social or occupational impairment
Etiology of ASD
Prenatal neurologic insults, advanced paternal age, LBW
Genetic
Fragile X –> single gene cause of ASD
Management of ASD
Early intervention Remedial education Behavioral therapy Psychoeducation Low dose atypical antipsychotic meds for disruptive behavior, agitation, aggression, irritability
Characteristic features of operational defiant disorder
Irritability/anger, defiance, vindictiveness
Diagnostic criteria for ODD
At least 4 symptoms present for at least 6mos (with at least 1 person not a sibling)
–Anger/irritable mood: loses temper, touchy/easily annoyed, often angry/resentful
–Argumentative/defiant behavior: breaks rules, argues with authority figures, deliberately annoys others
–Vindictiveness: spiteful at least 2x in past 6mos
Distress or impairment in functioning
Treatment for ODD
Behavior modification, conflict management training, problem-solving skills
Parent management training (setting limits, enforcing consistent rules)
Meds for comorbid conditions (e.g. ADHD)
Diagnostic criteria for conduct disorder
Pattern of recurrently violating the basic rights of others or societal norms, with at least 3 behaviors over 6 months:
- -Aggression to people and animals
- -Destruction of property
- -Deceitfulness or theft
- -Serious violations of rules (stays out late before age 13, runs away at least 2x, skips school before 13)
Diagnostic criteria for Tourette’s disorder
Multiple motor and at least 1 vocal tic present for >1 year
Onset prior to age 18
Not cause by a substance or medical disease (e.g. Huntington’s)
Epidemiology of tic disorders and Tourette’s
Transient tic behaviors common in kids
Tourette’s in 3/1000 school-aged children
Boys>girls
Etiology of Tourette’s
Genetic
Prenatal/perinatal factors: older paternal age, obstetric complications, maternal smoking, LBW
Course/prognosis of Tourette’s
Onset between 4-6yo, with peak severity 10-12yo
Tics wax and wane, change in type
Symptoms tend to diminish in adulthood
High comorbidity with OCD and ADHD
Management of Tourette’s
Psychoeducation Behavioral interventions - habit reversal Meds only if tics are impairing Alpha-2 agonists: guanfacine, clonidine Anti-psychotics if severe
What are elimination disorders?
Developmentally inappropriate elimination of urine or feces
Diagnostic criteria for enuresis
Recurrent urination into clothes or bed-wetting
2x/wk for at least 3 consecutive months, or clinical distress or marked impairment
At least 5 years old (developmentally)
Not due to a substance or medical condition
Diagnostic criteria for encopresis
Recurrent defecation into inappropriate places
Occurs at least 1x/month for at least 3 months
At least 4 years old (developmentally)
Not due to a substance or another medical condition (except via constipation-related mechanism)
Treatment for enuresis
Limit fluid and caffeine intake at night
Behavioral monitoring and reward system, bladder training exercises, or urine alarm
Drugs: DDAVP first-line, imipramine second-line
Treatment for encopresis without constipation
Comprehensive behavioral program (bowel retraining) for appropriate elimination
Treatment for encopresis with constipation
Initial bowel cleaning followed by stool softeners, high-fiber diet, and toileting routine
