Neurodevelopmental Disorders Flashcards
Neurodevelopmental Disorders
- children experience some of the same mental health problems as adults (mood, anxiety disorder, eating disorder - anorexia in teen years)
- consistent failure to meet developmental milestones should prompt a medical workup
- ex) intellectual disability, autism, ADHD
Intellectual Disability
intellectual and adaptive functioning deficit
- conceptual/language
- social/interpersonal
- practical skills/ADL’s
have an effect on all areas of life
essential feature of IQ < 70
several causes of intellectual disabilities exist
-you may see specifiers of mild to profound
ex) Down syndrome, fragile X, fetal alcohol syndrome = causes of genetic intellectual disability
Autism Spectrum Disorder
persistent deficits in social communication AND interaction (restricted interest) across environments
spectrum = wide range of symptom severity and functional abilities
ASD
onset = infancy, in 20% of cases there is regular development until 2-3 YO then there is regression or loss of abilities
more common in boys
cause: unknown, genetic link
ASD: Presentation
- avoidance of eye contact
- delayed speech or language skills
- rigidity in thinking (upset by change)
- repetition of words or phrases
- stereotyped motor behaviors: hand flapping, head banging, body twisting, spinning the wheels on a toy care for hours
ASD: Safety
-wondering (nearly 50% of children w/ autism wonder form safe supervision)
often wonder towards bodies of water, therefore safety includes swimming lessons
ASD: Tx
- early intervention
- goals: reduce behavioral symptoms, promote learning and development (language skills)
- special programs
- no meds FDA approved for ASD
meds for symptoms:
- antipsychotics
- naltrexone (possible association w/ autism and opioid receptors in brain)
- clonidine (sleep, attention, focus)
ASD: Related Disorders
Tic disorders Chronic motor or tic disorders Learning disorders Motor skills disorders Elimination disordes
Tic Disorders
Tic - sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization
-can have motor, vocal, or combination of both
- exacerbated by stress
- genetic component
- dopamine though to play a role
Tourette Disorder
experience both motor AND vocal tics and have symptoms for at least ONE YEAR
assess self-esteem of pt because this can negatively impact self-esteem
child may experience blurting out of obscene words, insults, or making obscene gestures but this is not something they can control and they should not be blamed
Tic Disorder: Tx
CBT
Habit reversal training: awareness training to bring greater attention to tic/behavior so a person can gain better control over it
Meds:
- antipsychotics
- clonidine
Rest
Exercise
Manage Stress
Learning Disorders
problems in achievement in a specific area
- poor writings skills, reading comprehension, math
- unlike intellectual disabilities, LD are limited to specific domains
achievement is below what is expected for age, education, and intelligence
low self esteem and poor social skills
Early intervention and assistance:
-IEP (individualized education program): schools plan to help a child improve
Motor Skill Disorders
essential feature is impaired coordination severe enough to interfere with academic achievement or ADL’s
Stereotypic Movement Disorder:
- not secondary to a medical condition that affects motor function
- onset <3 YO
- comorbid ADHD, tics, OCD
Communication Disorders
deficits in language, speech, and communication
dx occurs when deficit hinders development, academics, or social development
speech disorder = speech and language therapist - help improve communication
Elimination Disorders
- Enuresis: voiding of urine during the day or night into clothing or bed >5YO
- Encopresis: passage of feces in inappropriate places (usually clothing) >4YO, can be intentional or involuntary
- ages are chronological or developmental
Enuresis: Tx
meds:
-imipramime: TCA (SE = anticholinergic)
behavioral approach to tx: positive reinforcement for continence
ADHD
marked by:
- inattentiveness
- overactivity
- impulsivity
difficult to dx in children < 4YO b/c you can’t confirm the behavior isn’t normal
can be predominant inattentive pattern, hyperactive/impulsive pattern, or combined type
children sent to specialist to be diagnosed b/c we don’t want them to be misdiagnosed
-pediatric neurologist, psychologist, or child psychiatrist
the key is that it’s consistent, the symptoms occur daily in multiple settings
-r/o bipolar disorder, stress, anxiety
ADHD: Etiology
cause is unknown
brain images show: decreased metabolism in frontal lobes (which is essential for attention and impulse control)
genetic link
environmental factors
abnormalities in catecholamine or serotonin
ADHD: Tx
no one tx is more efficacious
medications target impulsiveness and improving attention
stimulants:
- methylphenidate (Ritalin)
- amphetamine salts (Adderall)
- dextroamphetamine
CBT
Stimulants: SE
insomnia
loss of appetite
weight loss
ADHD: Other Tx
antihypertensives:
- clonidine
- guanfacine
SNRI:
-atomoxetine
Atypical Antidepressant:
-buproprion (welbutrin)
