Neurodevelopmental Disorders

Question 1

When are neurodevelopment disorder first diagnosed?

Answer 1

Infancy, childhood or adolescence

Question 2

What must be included for diagnosis?

Answer 2

-ADHD
-ODD (oppositional defiant disorder)
-conduct disorder
-specific learning disorder
-ASD (autism spectrum disorder)
-intellectual disability
-communication and motor disorders

Question 3

Overview of Specific Learning Disorders

Answer 3

-academic problems in reading, math and or writing
-performance is below expected age level
-problems persist for 6+ months despite targeted intervention

Question 4

Dyslexia

Answer 4

*impairment in reading
-word reading accuracy (phonological awareness - decoding)
-reading fluency (rate)
-reading comprehension

Question 5

Dysgraphia

Answer 5

*impairment in written expression
-graphomotor
-spelling accuracy
-grammar punctuation and accuracy
-clarity/organization of written expression

Question 6

Dyscalculia

Answer 6

*impairment in math
-number sense
-memorization of arithmetic facts
-accurate or fluent calculation
-accurate math reasoning

Question 7

Prevalence of specific learning disorders

Answer 7

-6.5 million children have been diagnosed in US
-highest rate is in wealthier regions
-reading difficulties are most common (4-10% of the general pop)

Question 8

Stats of specific learning disorders

Answer 8

students are most likely to drop out, unemployment, suicidal thoughts, negative school experiences
*may also be related to communication disorders

Question 9

Causes of specific learning disorders

Answer 9

-genetic and neurobiological contributions
(runs in family, decrease functioning of areas responsible for word recognition, genetic risk factors)
-psychosocial is important (some languages are more difficult to read)
-performance is influenced by motivational factors, socioeconomic status, cultural expectations, parental interactions, child management practices

Question 10

Treatment of specific learning disorders

Answer 10

-requires intense educational interventions (focused on basic processing problems, cognitive skill, compensatory skills - examples: phonics, learning vocab, discerning meaning, fact finding, decision making, critical thinking)
-behavioral educational interventions
-biological interventions usually with those with ADHD

Question 11

Autism Spectrum Disorder

Answer 11

-in DSM-5, categorized as neurodevelopment disorder
-problems in language, socialization and cognition
-pervasive
-areas of impairment: communication & social interaction and restricted, repetitive patterns of behavior, interests or activities
-previously classified as pervasive developmental disorders (autistic disorder, asperger’s disorder, childhood disintegrative disorder, rett syndrome)

Question 12

What are the levels of severity for ASD?

Answer 12

Level 1 - requiring support
Level 2 - requiring substantial support
Level 3 - requiring very substantial support

Question 13

DSM-5 of ASD

Answer 13

A. Persistent deficits in social communication and social interaction across multiple contexts by: deficits in social-emotional reciprocity& conversations, deficits in nonverbal communication behaviors, deficits in developing and maintaining relationships
B. Restricted, repetitive patterns of behavior, interests, activities as manifested by at least two:
1. stereotyped or repetitive motor movements, use of objects, or speech
2. insistence or sameness, inflexible to routines, patterns of verbal or nonverbal behavior
3. Highly restricted, fixated interests that are abnormal in intensity or focus
4. hyper- or hypo- reactivity to sensory input or unusual interest in sensory aspects of the environment
C. Symptoms must be present in the early developmental period
D. Symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning
E. The disturbances are not better explained by intellectual disability or global developmental delay

Question 14

Impairment in social communication and interaction

Answer 14

*difficulties developing age-appropriate social relationships
-trouble initiating and maintaining relationships
-trouble with nonverbal communication
-trouble with social reciprocity

Question 15

Restricted or repetitive behaviors and interests

Answer 15

-preference for the status quo - maintenance of sameness
-intense, circumscribed interest in very specific subjects

Question 16

Stereotyped or ritualistic behavior

Answer 16

-toe-walking
-pacing back and forth or in circles
-flapping hands
-clapping hands repeatedly
-rocking
-spinning objects

Question 17

Prevalence in ASD

Answer 17

-thought to be very rare but is not
-1 in 50 school-ages children meet criteria
-more common in males (4-5:1)
-IQ interaction (38% show intellectual disabilities)
-occurs globally

Question 18

Psychological and social dimensions of ASD

Answer 18

historical: failed parenting, cold, parents have high socioeconomic status, lack of self-awareness,

Question 19

Bio Etiology of ASD

Answer 19

highly heritable, significant polygenetic component, concordance rates vary from 60 to 95% for monozygotic twins, numerous genes on several chromosomes involved
-amygdala is larger size at birth = higher anxiety and fear, elevated cortisol, neuronal damage from high stress which affects processing of social situations
-limbic system and cerebellum (too many cells)
- prenatal illness may predispose child to autism
-brain growth is rapid at 2 or 3 then arrested

Question 20

Treatment of ASD

Answer 20

psychosocial treatments
-behavioral approaches (skill building, reduce problem behaviors, communication and language training, increases socialization, emotion identification and recognition) *early intervention is critical
bio treatments
-medical intervention has little positive impact on core dysfunction
-drugs decrease agitation (tranquilizers, SSRIs)
integrated treatments
-preferred model is multidimensional, comprehensive focus (children in special education, use of medication, family support)

Question 21

What are the comprehensive treatment programs for ASD?

Answer 21

1. Behavior Modification (Applied Behavioral Analysis): used to teach a variety of skills along with speech, occupational and physical therapy
2. TEACCH: focuses on developing the child’s communication and social interaction skills
3. Lovaas’s approach: focuses on using intensive operant conditioning

Question 22

Intellectual Development Disorder

Answer 22

-impaired intellectual functioning
-impaired adaptive functioning
-must have both impairments
-standard scores on both assessments at or below 70 (average is 90 to 109)

Question 23

What are the levels of intellectual disability?

Answer 23

Level of ID:
Mild - 50 to 69
Moderate - 35 to 49
Severe - 20 to 34
Profound - below 20

Question 24

Stats for Intellectual Disability

Answer 24

-prevalence is 2% of general pop (9 in 10 have mild impairment)
-chronic course
-highly variable individual prognosis

Question 25

Intellectual Disability DSM-5 identifiers

Answer 25

1. Conceptual - deficits in language, reasoning, knowledge and memory
2. Social - problems with social judgement and ability to make and retain friendships
3. Practical - difficulties managing personal care or job responsibility

Question 26

DSM-5 of Intellectual Disability

Answer 26

*a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social and practical domains
A. Deficits in intellectual functions
B. Deficits in adaptive functions that results in failure to meet developmental and sociocultural standards for personal independence and social responsibility
C. Onset of intellectual and adaptive deficits during the developmental period

Question 27

Causes of Intellectual Disability

Answer 27

-genetic markers
-environmental (neglect)
-prenatal (exposure to toxins and drugs in womb)
-perinatal (problems with delivery)
-postnatal (head injury)
-genetic influences (chromosomal disorders, genetic mutations, recessive genes are more responsible)
-lead poisoning
-physical trauma

Question 28

Genetic Cause of ID

Answer 28

down syndrome, fragile x, klinefelter’s syndrome, tay sachs disease

Question 29

Down syndrome

Answer 29

(1 in 900 births)
-trisomy 21
-slanting eyes, flat nose, thick tongue, short fingers
-moderate ID
-risk increases with age

Question 30

Fragile X

Answer 30

-weak or break on the X sex chromosome
-men at higher risk
-learning disabilities
-hyperactivity
-short attention span
-gaze avoidance

Question 31

Klinefelter’s Syndrome

Answer 31

*males only
-extra X chromosome on the 23rd pair
-underdeveloped testes and sterile
-about 1/4 have intellectual disabilities that are usual mild

Question 32

Tay Sachs Disease

Answer 32

-found in individuals of Jewish or Eastern European ancestry
-a recessive gene causes deficit in lipid metabolism
-usually detected at age 4 to 6 months and progressively deteriorates until dying by age 4 to 6 years

Question 33

Treatment of ID

Answer 33

special education with early intervention, behavior modification techniques, consultation with specialized therapists