Neurodevelopmental Disorders

Question 1

ADHD epidemiology

Answer 1

*~5% prevalence rate
*5-10% for children under 12
*2.5-4% for adolescents
*2.5% of adults

Question 2

genetics + risk factors for ADHD

Answer 2

*heritability:
-up to 90% concordance in monozygotic twins
-20-55% chance of having ADHD if one parent with ADHD
-polygenic with likely epigenetic modifiers

*environmental risk factors:
-pre and perinatal risks (prematurity, low birth weight, in utero exposure to tobacco or alcohol)
-head trauma
-screen time
-toxins (lead, BPA?)

Question 3

ADHD - dx criteria

Answer 3

persistent sxs interfere with function or development, > 6 months
(1) inattentive: careless, can’t sustain attention/focus, zones out, doesn’t finish tasks, disorganized
(2) hyperactive/impulsive: fidgets/squirms, out of seat, runs/climbs, unable to play quietly, talks excessively

*note - can be inattentive, hyperactive/impulsive, or both
*need at least 6
*sx must be present in at least 2 settings

Question 4

which symptom of ADHD is most likely to persist into adulthood?

Answer 4

being disorganized and having difficulty concentrating for long periods of time

Question 5

common comorbidities with ADHD

Answer 5

*ODD
*anxiety
*learning disorders
*mood
*smoking
*substance use disorder
*tics

Question 6

stimulants as tx for ADHD

Answer 6

*effective: 70-85% of pts w/ ADHD will improve
*safe
*methylphenidate
*amphetamines (adderall, etc)

Question 7

standardized assessment tool for ADHD

Answer 7

*Vanderbilt assessment (assessment tool with all of the symptoms)
*parents AND teachers assess on a scale from 0-3

Question 8

treatment for ADHD

Answer 8

always medication stimulants (methylphenidate or amphetamines)

Question 9

side effects for ADHD meds (stimulants)

Answer 9

*common: DECREASED APPETITE, SLEEP PROBLEMS, transient headache, transient stomachache
*uncommon/serious: increased HR/BP, dizziness, hallucinations, mania
*also possible: growth suppression, oversedation, stimulant dysphoria

Question 10

prevalence of autism spectrum disorder (ASD)

Answer 10

*prevalence - 1 in 44 (and increasing)
*sex breakdown - 4:1 M:F
*intellectual disability (~58% below average)

Question 11

risk factors for autism spectrum disorder (ASD)

Answer 11

*advanced paternal age
*assistive reproductive technology
*VPA exposure in utero
*SSRI exposure in utero
*particulate matter in environment
*oxidative stress
*NOT vaccines

Question 12

genetics of autism

Answer 12

*concordance (monozygotic 60-70%, dizygotic 5-10%)
*recurrence risk in siblings ~10%
*over 100 genes identified (Fragile X, Rett’s, Down, 22q11 deletion, tuberous sclerosis complex)

Question 13

autism spectrum disorder (ASD) - DSM-5 criteria domains

Answer 13

(1) social communication & interaction
(2) repetitive interests & behavior

*specify if intellectual impairment present
*specify if language impairment present
*specify if associated with known medical, genetic, or environmental factors

Question 14

autism spectrum disorder (ASD) - deficits in social communication and interaction

Answer 14

*social-emotional reciprocity (reduced sharing of interests/emotions, failure to initiate or respond to social interactions, difficulty with back and forth convo)

*nonverbal behaviors (limited eye contact, deficits in use of gestures or other body language, lack of understanding or use of facial expressions)

*developing, maintaining, understanding relationships (can’t adjust behavior to social context, no sharing imaginative play or making friends, lack of interest in peers)

Question 15

autism spectrum disorder (ASD) - repetitive interests, behaviors, activities

Answer 15

*stereotyped activity (motor: spinning, rocking, flapping, finger waving, lining up toys; speech: scripts, echolalia)

*inflexibility with routines

*highly restricted, fixated interests that are abnormal in intensity or focus (clocks, wheels, water)

*hyper- or hypo-reactivity to sensory input (adverse response to sounds, textures, excessive smelling/touching of objects, visual fascination with lights or spinning)

Question 16

medications used in autism spectrum disorder (ASD)

Answer 16

*SSRIs and atypical antipsychotics (for obsessive sx, anxiety, depression)
*stimulants and alpha agonists (for ADHD sx)
*RISPERIDONE and ARIPIPRAZOLE (for aggression and irritability)
*melatonin (for insomnia)

Question 17

behavioral interventions to treat autism spectrum disorder (ASD)

Answer 17

*applied behavioral analysis
*emotion regulation therapy
*structured expectations and schedules
*social skills training groups

Question 18

intellectual disability - DSM-5 criteria

Answer 18

*deficits in intellectual functioning
*deficits in adaptive functioning
*onset must be during developmental period (< 18 yo)
*severity categories: mild, moderate, severe, profound

Question 19

epidemiology of intellectual disability

Answer 19

1-3% of population

Question 20

etiology of intellectual disability

Answer 20

*genetic (Down syndrome, Fragile X, Williams, Prader-Willi, Angelman’s)
*environmental (fetal alcohol syndrome, lead poisoning, infections leading to encephalitis)

Question 21

specific learning disorder

Answer 21

*difficulties learning or using academic skills despite targeted interventions to address the deficit, with 1+ of:
-inaccurate or slow word reading
-difficulty with reading comprehension
-difficulty with spelling
-difficulty with written expression
-difficulties mastering number sense, number facts, or calculation

Question 22

educational interventions for intellectual disability

Answer 22

*accommodations within the classroom
-additional time on tests/assignments
-preferential seating in classroom
-prompts to remain on task, record homework, turn in HW, etc