neurodevelopmental disorders Flashcards
communication d/o
impair academic and socialization, self care
speech = making sounds
lang = understanding or using words in context and appropriately
don’t follow directions
expressive lang d/o (verbal or ASL), social comm d/o (interrupt, minimally verbal)
motor d/o: developmental coordination
impair in motor skill dev, coordination -> interfere with academics, ADLs
delayed sit, walk, cant jump, tying shoes
tm = pt/ot
motor d/o: stereotypic movement d/o
interfere with ADLs
repetitive, purposeless movements
>4wk -> hand flap, wave, rock, head bang, nail bite, teeth grind
tm = safety, injury prevent, helmet mittens, behavioral therapy -> habit reversal
motor d/o: tic
some can suppress for brief time, s/s tend peak early adolescence, diminish adult
sudden nonrhythmic and rapid motor movements or vocalization -> spont production of words or sounds
usually involves head torso limbs
can also be tongue protrusion, touch, squat, hop, skip, twirl
motor d/o: tic - types
tourettes: more severe, usually multiple motor and 1+ vocal
persistent motor/vocal >1yr
provisional <1yr
motor d/o: tic - tm
behavioral techniques (habit reversal), relaxation strategies (anx about fitting in), DBS (last resort)
meds: antipsych, clonidine, klonopin, fluoxetine, sertraline
specific learning d/o
dyslexia (read), dyscalculia (math), dysgraphia (written expression)
usually found during school years when child has persistent difficulty
intervene with IEP
intellectual dev d/o
deficits in intellectual functioning, social and daily F
M > F
cog and social stim can increase level of F if begun before 5yr, try closer to 3
motivational support largely determines adult productivity and indep, tend to feel like failures
early ID and intervention increase QOL
autism spectrum d/o
non progressive, pervasive, withdrawn
appears in early childhood
unsure of cause, lots of theories
w/n first 3 years
M > F, but F more severe
look at hearing
lead poison can mimic -> screen
autism spectrum d/o: cm
s/s in socialization, communication, behavior
deficits in social interactions and relationships
stereotypical repetitive speech and/or behaviors -> hand flap, rock
obsessive focus on objects -> fixed interest, unusual attachments
over adherence to routines/rituals
hyper or hypo reactivity to sensory input -> safety and reinforcement, ignore
extreme resistance to change
poor sensory integration -> 1 sense at a time
can be aggressive towards self/others
autism spectrum d/o: tm
build on child’s interest, predictable schedule, teach tasks in series of small step, actively engage, highly structured activities, reg positive reinforcement, comm/social interactions skills, involve parents, SLP
recognize social cues, decrease stress, role play at play like peers
ADHD
persistent pattern of inattention, hyperactivity, impulsiveness that is pervasive and inappropriate for dev level
in 2+ settings, cause work, social, edu difficulties for at least 6 mo before age 12
types: hyperactivity - impulsivity, inattentive, combo
ADHD: hyperactivity - impulsivity type
6+ for 6 mo
hyperactive and impulsive cm
ADHD: hyperactive cm
fidget, move feet, squirm cant sit still
leave seat before excused
run/climb excessively or at inappropriate times
difficulty playing quietly
often on the go, acts like driven by motor
excessive talk/non stop takers
ADHD: impulsive cm
blurt answers before question is finished, speak before think
interrupt or intrude on others (butt in)
problem with waiting for turn
ADHD: inattentive type
6+ for 6 mo
no attention to details or make repeated careless mistakes
trouble keeping attention on tasks or activities
often dont follow through on completing tasks/activity
often trouble organizing activities
avoid, dislike tasks that involve mental effort
lose things, distracted, forgetful
easily bored
disorganized
ADHD: tm
emphasize self regulation, social F, [], attention, focus
behavioral management and meds best result
parent management training
increased problem solving, coping mech
group therapy 8 - 12 sessions
play and CBT not as effective
pharm: stimulants
stimulants
work fast
increase attention and focus, decrease hyperactivity, dose low and titrate up, not weight dependent, most respond well to one (3 tries before non stim)
long acting = 1/day, 8 - 12 hr
stimulants: SE
decreased appetite, HA, stomach ache, insomnia, jittery, social withdrawal
nervous, overstim, tachy/brady, htn, restless, dry mouth, unpleasant taste, d
can usually be managed by adjusting doage or when med given
child appears dull or overly restricted (decrease dose or change med)
drug holidays to give body breaks and counteract SE
ADHD: tm - practical tips
schedule
organize every day items, use homework and notebook organizers, be specific, clear and consistent, give praise and reward when rules are followed, set and reward small attainable goals
stimulants: long acting
dextroamphetamine/amphetamine -> capsule, sprinkles
* lisdexamfetamine
* dexmethylphenidate
* methylphenidate (Daytrana, Metadate CD, Ritalin LA (capsule, sprinkles), Concerta)
stimulants: intermediate
- dextroamphetamine
- methylphenidate (Ritalin SR, Methylin ER, Metadate ER)
stimulants short acting
- methylphenidate (Ritalin -> crushed, chewed)
- dexmethylphenidate
- dextroamphetamine
amphetamine sulfate
dextroamphetamine/amphetamine
Approved for use in children over the age of six years; capsule can be opened and sprinkled onto applesauce if can’t take pill
methylphenidate: daytrana
- May cause permanent skin color changes.
- Available in patch form.
- Worn for about nine hours on child’s hip. Continues to work for a few more hours once removed.
- Benefit: flexibility in amount of time worn and therefore dose
take patch off earlier if dont want full dose
methylphenidate: methylin
comes in chewable tablet and oral solution
methylphenidate: Ritalin LA
Unlike the other long-acting forms of methylphenidate, capsules can be opened and sprinkled on food
methylphenidate: concerta
only approved for children over the age of six years.
ADHD meds: non stim
- atomoxetine (SNRI)
- Not used as often as stimulants, slow therapeutic response
- Used for children (> 6 yrs.) especially helpful for children with ADHD
who also have some anxiety. - bupropion (NDRI)
- clonidine (Alone or with a stimulant; especially good if tics present with
ADHD) - guanfacine
- imipramine (Tca)
non stim: nc
given when too many SE with stim or stim not tol, or expect drug abuse or diversion
drug screen, VS, weight
clonidine: SE
Dry mouth, dizziness, mild sedation, constipation. Symptoms usually resolve
after several doses
buproprion: SE
Dry mouth, dizziness, nausea, appetite changes, stomach pain, headache,
ringing in ears, sore throat, and muscle pain
atomoxetine: SE
Dry mouth, dizziness, nausea and vomiting, decreased appetite, and trouble
sleeping; ***observe CLOSELY for SI
