Neurodevelopmental Disorders Flashcards
What are the two categories of brain dysfunction?
Two categories for brain dysfunction:
a) Neurodevelopmental disorders – onset in the developmental period
b) Neurocognitive disorders – onset in later life
What are neurodevelopmental disorders ?
Onset in the developmental period
• Present during early childhood, typically before child enters grade school
• Characterized by developmental deficits producing impairment of personal,
social, academic or occupational functioning
• Range of disorders from specific limitations to global impairments
• In some disorders, the clinical presentation includes symptoms of excess as well as
deficits and delays in achieving expected milestones
• Not due to visual/auditory/neurological problems, lack of/inadequate academic instruction
What are the types neurodevelopmental disorders?
- Intellectual disability
- Global developmental delay
- Specific learning disorders
- Communication disorders
a) Language disorder
b) Speech disorder
c) Social (pragmatic) communication disorder - Autism spectrum disorder
- Attention-deficit/hyperactivity disorder [ADHD]
What are the diagnostic criteria of intellectual disability?
Diagnostic Criteria:
1. Deficits in intellectual functioning AND
• Confirmed using:
a) Clinical assessment
b) Standardized intelligence testing
2. Deficits in adaptive functioning that lead to • Limitations in communication, social participation, independent living across multiple environments (home, school, work, community).
- Begins before 18 years
What is the normal area of intellectual ability of a normal person?
Standardized intellectual assessment:
➢ Wechsler intelligence tests (versions for adult and children)
• Neurotypical mean:
➢ 100 (SD = +/- 15)
• Intellectual Disability:
➢ An IQ score at least 2 SD BELOW
the mean
➢Score ≤ 70 +/- 5
Describe the defects in adaptive functioning
Failure to achieve developmentally appropriate daily living skills in at least one of the
following domains:
* Conceptual (e.g. academic skills) * Social (e.g. relational skills) * Practical (e.g. self management skills)
- Assessed using a standardized rating scale:
- Vineland Adaptive Behavior Scales
What are the mild intellectual disability features ?
About 85%
Can live independently with minimum levels of support
Immature social interactions
What are the features of moderate intellectual disability?
About 10%
Varying degrees of support needed such as those available in group homes
- Limited communication and socialization skills
- Aware of their limitations
What are the features of profound intellectual disability?
3-4%
Requires daily assistance with self-care activities and safety supervision
- Use simple speech & gestures
- Have maladaptive behaviour
What are the features of Profound intellectual disability ?
1-2%
Requires 24-hour care
Nonverbal communication
What is global developmental delay?
Child is less than 5 years old
- Has not met developmental milestones in several areas of functioning:
* Learning to walk/talk
* Social and emotional interactions - Clinical severity level cannot be reliably assessed with standardized tests
- Will require reassessment later, if possible
What are the types of neurodevelopmental disorders?
- Intellectual disability
- Global developmental delay
- Specific learning disorders
- Communication disorders
a) Language disorder
b) Speech disorder
c) Social (pragmatic) communication disorder - Autism spectrum disorder
- Attention-deficit/hyperactivity disorder [ADHD
What are the types of Specific Learning Disorders?
- Difficulty learning and using academic skills AND
2. Academic skills less than expected for age
How do we diagnose difficulty in learning and using academic skills as. Part of “specific learning disorders”?
- Difficulty learning and using academic skills
• At least one symptom for at least 6 months
a) Slow/inaccurate/effortful word reading
b) Difficulty understanding meaning of what is read
c) Difficulty spelling
d) Difficulty with written expression
e) Difficulty with numbers/calculation
f) Difficulty with mathematical reasoning
How do we diagnose “Academic skills less than expected for age” for a specific learning disorder?
- Academic skills less than expected for age
a) Causes significant interference with academics/occupation/daily living
b) Confirmed with standardized tests & clinical assessment
c) Present during school age when demands > capacity
What are the specifiers of specific learning disorders?
Impairment in reading (dyslexia)
Impairment in written expression
Impairment in mathematics (dyscalculia)
Severity:
Mild: Mild difficulties; may learn to function well with initial support services
Moderate: Marked difficulties; needs accommodations/support to complete tasks
Severe: Severe difficulties; needs intensive and individualized teaching
What are the requirements in communication?
Children must have a mastery of multiple aspects of language:
• Receptive (receiving and understanding) and expressive (production of verbal or gestures) language skills
• Express themselves in vernacular language
What are the types of communication disorders?
- Language disorder
- Speech disorder
a) Speech sound disorder
b) Childhood-onset fluency disorder - Social (pragmatic) communication disorder
What are the diagnostic criteria of language disorder?
Diagnostic Criteria:
A. Persistent difficulty in acquisition and use of language across modalities (speaking,
reading, writing, signing, etc.)
There is: 1. Decreased vocabulary 2. Limited sentence structure 3. Impairments in conversing (limited vocabulary, cannot connect sentences) AND
B. Language ability below expectations for age (typically present before 4 years)
What is Speech sound disorder?
Persistent difficulty with speech sound production that interferes with speech
intelligibility or prevents verbal communication • Blue→bu
• Rabbit→wabbit
• School→coo
• Play→puhlay • Radio→wadio
- Speech should be intelligible by age 3-4
- Milder cases spontaneously recover by age 8
- With speech therapy, almost all cases completely recover
What are the diagnostic criteria of Fluency Disorder?
Diagnostic Criteria:
A. Persistent disturbances in the normal fluency and time patterning of speech that
are inappropriate for age and level of language skill
- Sound and syllable repetitions
- Sound prolongations of consonants and vowels
- Broken words
- Blocking – pauses in speech
- Words produced with excessive tension
- Monosyllabic whole-word repetitions (e.g., “I-I-I-I see him”)
AND
B. The disturbance causes anxiety about speaking or limits effective communication
What is the epidemiology of Childhood onset Fluency Disorder?
Usually diagnosed by age 6
• May not be present during oral reading, singing or talking to inanimate
objects
• 80% recover without intervention before age 16
What are the diagnostic criteria of social (pragmatic) communication disorder?
Diagnostic Criteria:
1.Persistent difficulties in the social use of verbal and nonverbal communication (all of the following):
➢ Deficits in using communication for social purposes (greeting, sharing info) ➢ Impairment in ability to change communication to match context
➢ Difficulty following the rules for communication
➢ Difficulty understanding implicit meanings
AND
- The deficits result in functional limitations in effective communication that
• Diagnosis rarely made before age 4-5
What are the diagnostic criteria of Autism Spectrum Disorder?
- Persistent deficits in social communication and social interaction across multiple contexts
AND - Restricted, repetitive patterns of behavior (RRBs), interests, or activities
- Persistent deficits in social communication and social interaction across multiple contexts, as manifested by:
A. Deficits in social-emotional reciprocity
• Limited back-and-forth conversation
• Failure to initiate or respond to social interactions • Does not share experiences/emotions
B. Deficits in nonverbal communicative behaviours
• Limited eye contact, use of gestures, facial expressions
• Limited understanding of body language & facial expressions
C. Deficits in developing, maintaining, and understanding relationships (problems with sharing, imaginative play, making friends)
What are the autism specifiers?
- With or without accompanying intellectual impairment
• With or without accompanying language impairment
• In the old DSM-IV, there was a classification – “Asperger’s disorder”• However, in the new DSM-5, persons would be diagnosed as Autism Spectrum Disorder without language impairment and without intellectual impairment.
What are the diagnostic criteria of ADHD?
Affects preschoolers, children, adolescents, adults
- Symptoms that result in impairment are present before age 12 years
- 6 or more specific symptoms of inattention AND/OR
- 6 or more specific symptoms hyperactivity-impulsivity AND
- Persisted for at least six months
What are the inattention symptoms of ADHD?
A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) or (2)
- Inattention: 6 or more specific symptoms of inattention have persisted for at least six months to a degree that is inconsistent with developmental level, and that negatively impacts directly on social and academic/occupational activities:
a) Lack of attention to details
b) Difficulty in remaining focused
c) May seem not to be listening
d) Lack of follow through
e) Difficulty organizing tasks
f) Avoids tasks that require sustained effort
g) Loses things
h) Easily distracted
i) Forgetful
What are the hyperactive and impulsive symptoms for ADHD?
A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) or (2):
Hyperactivity and Impulsivity: 6 or more specific symptoms of hyperactivity- impulsivity have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational functioning:
a) Fidgets, squirms in seat
b) Leaves seat, when being seated is expected
c) Runs about, inappropriately (adult may feel restless)
d) Unable to remain quiet while at play or leisure
e) On-the-go; motor driven
f) Talks excessively
The above are hyperactive symptoms
g) Blurts out
h) Cannot wait for turn
i) Interrupts, intrudes
The above are impulsive symptoms
What are the types of ADHD types?
- ADHD,
Presentation [inattention and hyperactivity-impulsivity] Both Criteria 1 and 2 are met for the past 6 months
6 or more symptoms of inattention AND 6. Or more symptoms of hyperactivity-impulsivity - Predominantly Inattentive
Criteria 1 met for the past 6 months
≥6 symptoms of Inattention BUT <6 symptoms of hyperactivity-impulsivity - Predominantly hyperactive-impulsive
Criteria 2 met for the past 6 months
6 or more symptoms of Hyperactivity-8mpulsivity BUT less than 6 symptoms of inattention
What is the stimulant treatment for ADHD?
A combination of medication and behavioral psychotherapy are recommended
✓(if child <6 years old, then behavioral interventions are first-line)
- Stimulant
• Drugs affecting catecholamines
• Amphetamine (Adderall), methylphenidate (Ritalin)
• Mechanism: increases dopamine and norepinephrine in prefrontal cortex
• Adverse effects: appetite loss, insomnia, edginess, GI upset • Blackbox warning: potential for abuse
What is the Non-stimulant treatment for ADHD?
Non-stimulant
• Drugs selectively inhibiting norepinephrine reuptake
• Atomoxetine (Strattera)
• [AT-oh-MOX-ih-teen]
• Mechanism: selectively inhibits norepinephrine reuptake in the
prefrontal cortex
• Used in stimulant failures or if there are contraindications for using stimulants (e.g. coexisting anxiety, tics, abuse liability
Non-stimulant
• Drugs selectively inhibiting norepinephrine reuptake
• Viloxazine
• Received FDA approval in 2021 for use in Paediatric patients • Contraindications: monoamine oxidase inhibitors
• Warning: higher rates of suicide thoughts and behaviors