Neurodevelopmental Disorders Flashcards
1
Q
Neurodevelopmental disorders are
A
neurologically based
2
Q
Normal and abnormal development
Why is developmental delay problematic?
A
- Critical developments occur during childhood
- Relatively standard, typical progression of development as child ages
- Develop one skill before the next
Why is developmental delay especially problematic?
- Because it implies that any disruption in the development of early skills will, by the very nature of this sequential process, disrupt the development of later skills
- Although, there are times when people believe normal development are actually symptoms of abnormality such as echolalia which involves repeating the speech of others
- Disorders here are typically diagnosed in infancy, childhood, or adolescence
- Often persist into adulthood
3
Q
Attention Deficit/Hyperactivity Disorder (ADHD): Diagnostic Criteria
A
- A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):
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Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities
* Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities
* Often has difficulty sustaining attention in tasks or play activities
* Often does not seem to listen when spoken to directly
* Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
* Often has difficulty organizing tasks and activities
* Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
* Often loses things necessary for tasks or activities
* Is often easily distracted by extraneous stimuli
* Is often forgetful in daily activities
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Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities
-
Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
* Often fidgets with or taps hands or feet or squirms in seat
* Often leaves seat in situations when remaining seated is expected
* Often runs about or climbs in situations where it is inappropriate
* Often unable to play or engage in leisure activities quietly
* Is often “on the go,” acting as if “driven by a motor”
* Often talks excessively
* Often blurts out an answer before a question has been completed
* Often has difficulty waiting his or her turn
* Often interrupts or intrudes on others
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Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
- B. Several inattentive or hyperactive-impulsive symptoms present prior to age 12 years
- C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings
- D. Clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning
- E. Symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder
- Specify whether:
- Combined presentation
- Predominantly inattentive presentation
- Predominantly hyperactive/impulsive presentation
4
Q
ADHD: Clinical Features
A
- Primary characteristics: pattern of inattention (disorganized, forgetful) and/or hyperactivity and impulsivity
- Symptom presentation
- Inattention
- Hyperactivity
- Impulsivity
- Impairment on functioning
- Academic performance
- Comorbid learning disorders
- Unpopular with and rejected by peers
- Some research shows that having a specific genetic mutation and a low birth weight predicts later behaviour problems in children with ADHD
5
Q
ADHD: Demographics and Course
A
- Overall prevalence: 5.2% children worldwide
- Male-to-female ratio: 3:1
- Sex differences in presentation externalizing (acting out and being more aggressive) for boys vs. internalizing (anxiety and depression) for girls
- Course
- Typically identified as “different” at ages 3-4
- Symptoms more obvious during school years
- Teens with ADHD are at higher risk for teenage pregnancy and contracting sexually transmitted infections, they are also more likely to having driving difficulties, such as speeding, crashing or being suspended
- Problems continue into adulthood
- 50% Impact on adult life
- Disorders similar to ADHD in children are oppositional defiant disorder, conduct disorder and bipolar disorder
6
Q
ADHD: Aetiology
Genetics
Environmental factors
Substance ingestion?
A
-
Genetics
- Highly influenced by genetics
- Smaller brain volume (3-4%)
-
Environmental factors
- Maternal prenatal smoking, stress, and alcohol use
- Parental relationship instability and discord
-
Substance ingestion?
- Little evidence to support contribution of allergens
- May be a small impact of artificial food colours and additives, pesticides
- ADHD is much more influenced by genetics than environment
7
Q
ADHD: Treatment
psychosocial interventions
biological interventions
A
-
Psychosocial interventions
- Behavioural interventions
- Social skills training
- Adults: CBT
-
Biological interventions
- Documented effectiveness of stimulants (ritalin, adderall)
- Concerns?
- Potential for abuse of stimulants such as Ritalin and Adderall for their ability to create elation and reduce fatigue
- Some unpleasant side effects such as insomnia, drowsiness or irritability
- The ethical issue of psychopharmacogenetics
- Combined approach recommended if medication is indicated
8
Q
Specific Learning Disorder: Diagnostic Criteria
A
- A. Difficulty learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties:
- Inaccurate or slow and effortful word reading
- Difficulty understanding the meaning of what is read
- Difficulties with spelling
- Difficulties with written expression
- Difficulties mastering number sense, number facts, or calculation
- Difficulties with mathematical reasoning
- B. The affected academic skills are substantially and quantifiably below those expected for the individual’s chronological age and cause significant interference with academic or occupational performance, or with activities of daily living, as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment
- C. The learning difficulties begin during school-age years but may not become fully manifest until the demands for those affected academic skills exceed the individual’s limited capacities
- D. The learning difficulties not better accounted for by intellectual disabilities, uncorrected visual or auditory acuity, other mental or neurological disorders, psychosocial adversity, lack of proficiency in the language of academic instruction, or inadequate educational instruction
- Specify if:
- With impairment in reading
- Word reading accuracy
- Reading rate or fluency
- Reading comprehension
- With impairment in expression
- Spelling accuracy
- Grammar and punctuation accuracy
- Clarity or organization of written expression
- With impairment in mathematics
- Number sense
- Memorization of arithmetic facts
- Accurate or fluent calculation
- Accurate math reasoning
- With impairment in reading
9
Q
Specific Learning Disorder: Clinical Features
A
- Major defining feature: academic performance that is substantially below what would be expected given the person’s age, IQ, and education
- Should not be caused by a sensory difficulty, such as poor sight or hearing and not be the cause of poor or absent instruction
-
Response to intervention criterion is being used now instead of identifying when someone has a discrepancy of more than 2 standard deviations from achievement and IQ (because this may only show up later in life)
- Response to effective intervention significantly inferior to performance by peers
- Provides an early warning system, and focuses on providing effective instruction
10
Q
Specific Learning Disorder: Demographics
A
- Prevalence statistics
- Impairment in reading: 4% - 10%
- Impairment in mathematics: 1%
- Impairment in written expression: unknown
- Male-to-female ratio: relatively equal
- Potential long-term consequences
- Communication disorders
- Childhood-onset fluency disorder (stuttering)
- Language disorder (expressive and mixed receptive-expressive language disorders)
11
Q
Specific Learning Disorder: Aetiology
Genetic
Brain Impairment
Environmental
A
-
Genetic
- Runs in families
-
Subtle brain impairment
- Present particularly for reading and word problems
- Brain impairment in:
- Broca’s area (articulation and word analysis)
- Left parietal temporal area (word analysis)
- Left occipital temporal area (recognition of word form)
-
Environmental
- Reading habits of families
- Specific learning disrders are more often diagnosed in English-speaking countries (english very complex language to learn as a possible reason)
- Also take into account: socioeconomic status, cultural expectations, parental interactions and expectations, and child management practices (in combination with existing neurological deficits and support available in schooling)
The outcome of children with specific learning disorders seems to be effected by socioeconomic status, cultural expectations, parental interactions and expectations and child management practices together with existing neurological deficits and the types of support provided in schools
12
Q
Specific Learning Disorders: Treatment
A
-
Educational intervention
- Specific skills instruction
- Strategy instruction (improves cognitive skills through decision making and critical thinking)
-
Behavioural interventions
- Direct Instruction
- Systematic instruction (using highly scripted lesson plans that place children together in small groups based on their progress)
- Teaching for mastery (teaching students until hey understand all concepts)
- Efficacy in improving academic skills
- Direct Instruction
Studies show that behavioural interventions can change the way the brain works (to be more similar to normal functioning) and that we can use such interventions to help individuals with significant problems
13
Q
Autism Spectrum Disorder (ASD): Diagnostic Criteria
A
- A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:
- Deficits in social-emotional reciprocity; ranging, for example from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, and affect; to failure to initiate or respond to social interactions
- Deficits in nonverbal communicative behaviours used for social interaction, ranging for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication
- Deficits in developing, maintaining and understanding relationships, ranging for example from difficulties adjusting behaviour to suit various social contexts; to difficulties in sharing imaginative play and in making friends; to absence of interest in peers
- B. Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least two of the following, currently or by history:
- Stereotyped or repetitive motor movements, use of objects, or speech
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behaviour
- Highly restricted, fixated interests that are abnormal in intensity or focus
- 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 functioning
- E. Disturbances not better explained by intellectual disability or global developmental delay. Intellectual disability and ASD frequently co-occur; to make comorbid diagnosis of both, social communication should be below that expected for general developmental level
14
Q
ASD: Clinical Features
A
- Essentially a neurodevelopmental disorder that affects how one perceives and socializes with others
- Two major characteristics:
- Impairments in social communication and interaction
- Restricted, repetitive patterns of behaviour, interests, or activities
- Degree of impairment rated for social/communication interaction and restricted/repetitive behaviours separately
- Level 1: requiring support
- Level 2: requiring substantial support
- Level 3: requiring very substantial report
15
Q
ASD: Demographics
A
- Current estimates: 1/50 children
- Increasing prevalence?
- Male-to-female ratio: 4.4 : 1
- Over 1/3 have associated intellectual disabilities
- Language performance often predicts prognosis
- 38% of people with ASD have intellectual disabilities
- Estimated that 1/3 of those with ASD have savant abilities (superior working memory and highly focused attention) although they are only present in those who do not have a severe form of ASD
Usually, language abilities and IQ scores are reliable predictors of how children with ASD will fare later in life: the better the language skills and IQ test performance, the better the prognosis
