Neurodevelopmental Disorders Flashcards
1
Q
What is Autism Spectrum Disorder? (ASD)
A
- Characterized by wide range of impairments in 2 domains: social communication and restrictive and repetitive behaviors
- onset in first 3 years of life
- seizure disorders are a common comorbidity
2
Q
Neuropsychological Affect - ASD
A
- Attention
- Mood
- Sensory Perception
- Intellectual functioning: 1/3 display ID
3
Q
Social Interaction - ASD
A
- Lack of interest in sharing joy or pain
- Deficits in interacting with peers
- Failure to establish same age friendships with children
- Marked lack of empathy
- Difficulty assessing emotions of others
- little to no attachment to significant people in their lives
- Impaired eye contact
4
Q
Communication Deficits - ASD
A
- Repetitive Language
- Problems starting a conversation or maintaining it
- Failure to catch nuances of conversation
- Language development impaired
- Difficulty communicating needs and problems
- Difficulty with non-verbal communication
5
Q
Behavioral Symptoms - ASD
A
- Disturbance in language development and usage
- Intellectual disability
- instability in mood and affect
- Response to sensory stimuli
- hyperactivity and inattention
- Precocious skills
- Insomnia
6
Q
Severity Levels of ASD
A
- Level 1 requiring support
- Level 2 requiring substantial support
- Level 3 requiring very substantial support
7
Q
ASD etiology
A
- Exact cause is unknown
- Impaired structural connectivity patterns in the frontal and tempero-limbic brain regions
- Increased brain volume in the occipital, parietal, and temporal lobes
- Increased platelet serotonin, excessive dopaminergic activity
8
Q
Genetic Factors - ASD
A
- Significant heritability
- Polygenetic heritability
- 15% of known ASD associated with a known mutation
- alterations in specific cellular and molecular neurodevelopmental pathways
- sibling 50-100x more likely to develop
9
Q
Risk Factors - ASD
A
- Paternal Age
- Prematurity, low birth weight
- Rubella, cytomegalovirus
- Prenatal, Perinatal insults
- NO evidence that immunizations are linked to ASD
10
Q
Assessment - ASD
A
- Diagnosis most valid when based on multiple sources
- Motor deficits present
- Self injury
- Disruptive/challenging behaviors
- Anxiety and depression
- Catatonia
11
Q
Development and Course - ASD
A
- Lifelong
- Typically recognized in 2nd year of life
- Heterogeneous disorder on a spectrum
- Small proportion of high IQ ASD children will no longer meet criteria for dx in young adulthood
- Ritualistic and repetitive behaviors most refractory
- Prognosis improvement with supportive home environment
12
Q
Treatment Goals - ASD
A
- Improve social interactions
- Develop meaningful peer relationships
- Integration into school systems
- Increase long term skills in independent living
- Reduction of irritable and destructive behaviors
13
Q
Treatment - ASD
A
- Early and intense intervention
- Behavioral
- Social Skills
- Insomnia Management
- Educational Interventions
14
Q
Psychosocial treatment - ASD
A
Behavioral Therapy
- Reinforce wanted behaviors and reduce unwanted behaviors
- Highly structured environment rules and expectations are clear, consistent and predictable
- Redirecting
- Teach self-care skills
- Ensure Safety: environmental alterations, protective headgear
Social Skills Training
- Promote Interaction, teach to read social cues
15
Q
Pharmocologic Interventions - ASD
A
Goal is to ameliorate impairing behavioral symptoms
- irritability
- aggression
- self-injurious behavior
- hyperactivity
- impulsivity
- Inattention
- Repetitive and stereotypic behaviors
16
Q
What are the FDA approved agents for irritability in ASD?
A
Risperidone (Risperdal): ages 5-16
- first line of treatment for severe irritability
Aripiprazole (Abilify): ages 6-17
- tantrums, aggression, and self injury
Both approved for irritability in ASD
17
Q
Nursing Care - ASD
A
- Assign consistent care givers
- Minimize change
- Positive reinforcement
- Diversion or replacement activities may be needed
18
Q
What is ADHD - Attention Deficit Hyperactivity Disorder?
A
- Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
- hyper-impulsive type
- inattention type
- combined type
Most common in males: 3:1
19
Q
What are the behavioral characters of ADHD?
A
- inattention
- irritability
- distractibility
- excessive motor activity
- impaired academic or work performance
20
Q
What are the Predisposing factors of ADHD?
A
- Genetic
- Biochemical: dopamine, norepinephrine abnormalities
- Neuroanatomical - alterations in prefrontal lobes, basal ganglia, globus pallidus, cerebellum
21
Q
Prenatal and Perinatal Factors - ADHD
A
- Maternal smoking
- Intrauterine exposure to toxins, ETOH, lead
- Low birth weight
- Prolonged labor
- Perinatal asphyxia (deprived of oxygen)
22
Q
Environmental Factors - ADHD
A
- Lead exposure
- Dietary: food coloring, additives
- Disorganized chaotic households
- Poverty
- Head trauma
23
Q
Development and Course - ADHD
A
- Toddler and preschool: excessive motor activity
- Schoolage: inattention more prominent
- Hyperactivity less obvious in adolescence and adulthood, restlessness, impatience, poor planning feeling like one is driven by a motor, and impulsivity
24
Q
Comorbidity - ADHD
A
- Oppositional defiant disorder
- conduct disorder
- Learning disorders
- Disruptive mood dysregulation disorder
- anxiety
- depression
- substance use
25
Q
Consequences of ADHD
A
- Decreased school/occupational performance and academic/occupational attainment
- increased social and peer rejection
- children more likely to develop conduct disorders
- increased substance use disorders
- increased accidental injuries, traffic violations
