Neurodevelopmental Disorders

Question 1

Intellectual Development Disorders

Answer 1

• Definition:
  
  • neurodevelopmental disorder characterized by deficits in intellectual functioning, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, & learning from experience
• Types:
  
  • Mild (85%): academic skills to 6th grade, minimum self-support
  • Moderate: academic skills to 3rd grade, provide self-care hygiene
  • Severe: rudimentary communication, simple skills
  • Profound: sensory motor problems
• DSM-V Criteria:
  
  • Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, learning from experience, confirmed by assessment & testing
  • Impairment in adaptive functioning; failure to meet developmental goals
  • onset of intellectual & adaptive deficits – developmental period
• Children’s IQ no longer used

Question 2

Autism Spectrum Disorder

Answer 2

• Definition:
  
  • spectrum of developmental disorders characterized by impairment in social interaction, communication, restricted repetitive stereotyped behaviors, and other signs leading to impaired social functioning
• Etiology: unknown
  
  • NOT d/t poor maternal bonding/parenting or immunizations
  • Hypotheses: obstetric complications, infection, genetics, & toxic exposures
• Risks:
  
  • age of parent, maternal use of valproate during pregnancy, sibling with ASD
• S/sxs:
  
  • Developmental regression at 15-30 months
  • Absence of pointing
  • -Abnormal reaction to environmental stimuli (not easily consoled)
  • -Absence of symbolic play & social interaction (ex. Stop playing with blocks)
  • -Repetitive behavior (fixated interest, resistance to change)
• Deficits in Social Interaction:
  
  • Social/emotional reciprocity deficits (ex. Smiling back)
  • Social non-verbal communication deficits
  • Deficits in understanding, developing, & maintaining social relationships
  • Language development & verbal IQ more positive prognosis
• Screening Tools:
  
  • Autism screening checklist (MCHAT): 19-item screening, quick yes/no for parents
• Tx:
  
  • *Refer to specialty practice for neuropsychological testing, behavioral modification strategies, and medications
    
    • Special education
    • -behavior modification
    • -pivotal response treatment
    • -neuroleptics for aggression or self-injury
    • -long-term parental support & psychoeducation

Question 3

Attention-Deficit Hyperactivity Disorder: Definition, S/sxs, & DSM

Answer 3

• Definition:
  
  • neurodevelopmental disorder characterized by problems paying attention, impulsivity, & hyperactivity that is not age appropriate
• S/sxs:
  
  • -Trouble paying attention
  • -Hard to stay still
  • -Trouble finishing schoolwork
  • -Hard not to blurt out things or interrupt
  • -Trouble finding or keeping track of things
  • -Trouble finishing chores/tasks at home
  • -got into arguments or fights with others
  • -got into trouble for not listening
• DSM-V Criteria:
  
  • -Inattention (6+ for 6+ months)
    
    • fails to pay attention, difficulty sustaining attention in task, does not seem to listen, does not follow through on activities, difficulty organizing tasks, avoid tasks, loses items for tasks, easily distracted, forgetful in daily activities
  • Hyperactivity & Impulsivity (6+ for 6+ months):
    
    • fidgets, leaves seat when sitting is expected, runs or climbs when not appropriate, unable to engage in leisure activities, often “on the go”, talk excessively, blurts out answers, difficulty waiting for turn, interrupts frequently

Question 4

Attention-Deficit Hyperactivity Disorder: Dx & Tx

Answer 4

• Evaluation of ADHD in Primary Care:
  
  • dx takes time: minimum of 60 minute eval may be over 3+ sessions
  • Dx tool include Vanderbilt or Conners forms from multiple settings (home, school, etc.)
  • Neuropsychiatric EEG-Based Assessment Aid (NEBA) system
• Screening Tools:
  
  • Vanderbilt
  • Conners Forms
• Prognosis:
  
  • ⅔ persist into adolescence, ⅓-⅔ persist as adults
• Tx:
  
  • Refer to specialty care for assessment (takes a long time to complete)
  • Medication: 1st line treatment; stimulants, alpha-agonists, Strattera, Wellbutrin (bupropion) Strattera & wellbutrin are for pts refractory to tx
  • Psychosocial Tx:
    
    • help with organization, family understanding, tips for teachers

Question 5

Childhood Anxiety

Answer 5

• Types:
  
  • Specific phobias: 15% lifetime prevalence
  • Social Anxiety Disorder: 9% lifetime prevalence
  • Separation Anxiety: 2-4%, F > M
  • Generalized Anxiety Disorder: 1% lifetime
  • Selective Mutism: 0.5-0.75%
• Risks:
  
  • behavioral inhibition, access to support system, insecure attachment, cognitive factors, developmental events, traumatic events
• Tx:
  
  • Psychotherapy = 1st line, child & parent counseling, CBT
  • Pharmacotherapy: SSRI = 1st line, trazodone, hydroxyzine, buspirone, mirtazapine
  • 2nd line); avoid benzos & atypical antipsychotics
  • Normalize sxs:
    
    • framing sxs in positive manner (“it’s your body getting ready to take care of you if something scary happens”)
  • Wellness:
    
    • sleep, nutritional intake, physical activity, social support