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Birth and Early Years > Neurodevelopmental Disorders in Children > Flashcards

Neurodevelopmental Disorders in Children Flashcards

1
Q

What are the symptoms and features of ADHD?

A
  • Present from childhood
  • Persistent
  • Impairing
  • Pervasive
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2
Q

What causes ADHD?

A
  • Genetic
    • ​70-80% heritable
    • Genes (dopaminergic pathways)
  • Neurobiology
  • Risk factors
    • Intrauterine: nicotine, alcohol.
    • Perinatal: prematurity, low birth weight, hypoxia.
    • Early life: emotional neglect, brain insult.
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3
Q

What is the impact of ADHD at the following stages:

  • Preschool
  • School age
  • Adolescence
  • College age
  • Adulthood
A
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4
Q

What should be focussed on in the history when considering ADHD as a diagnosis?

A
  • Core symptoms:
    • ​Onset and nature of difficulties
    • Pervasiveness (home and school)
    • Sleep, apetite and sensory issues
    • Comorbidity
  • Areas to focus on:
    • ​Family and history and functioning
    • Education and peer relationships
    • Obstetric history and development
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5
Q

Describe the management of ADHD.

A
  • Approach
    • Long-term
    • Multimodal
    • Multidisciplinary
  • Psychosocial interventions
    • Younger: behavioural parenting training
    • Older: behaviour management programme for comorbidities (e.g. conduct disorder)
    • Individualised school interventions
  • Medication ± Behavioural intervention
    • Psychostimulant > Atomoxetine > Other
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6
Q

What are the common side effects of ADHD medication?

A
  • These side effects are often dose-related:
    • Headache, nausea, appetite suppression, dizziness, insomnia, mood swings, hypertension, lack of ‘spontaneity’.
    • Atomoxetine: increased suicidal ideation, liver damage.
    • Dexamfetamine / Lisdexamfetamine: diarrhoea.
    • Guanfacine: hypotension, sedation, increased weight gain.
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7
Q

What are the core features of Autism Spectrum Disorder?

And the other difficulties often seen?

A
  • Diagnostic criteria:
    • ​Deficits in social communication and social interaction.
    • Restricted, repetitive patterns of behaviour, interests or activities.
  • PLUS:
    • Must be present from early childhood
    • Must limit and impair everyday function
  • Other difficulties often seen:
    • ​Sensory
    • Circadian rhythm
    • Executive function e.g. planning, motivation
    • Anxiety
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8
Q

Describe the aetiology of Autism Spectrum Disorder.

A
  • Genetic
    • ​Heritability: 50%
    • Multiple susceptibility genes acting synergistically
    • Large number of candidate areas in the brain
  • Environmental
    • ​Prenatal: rubella, ?cocaine, ?alcohol, ?valproic acid
    • Perinatal: ?obstetric complications
    • Postnatal: ?immunological abnormalities
  • Genetic and environmental interaction
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9
Q

How is Autism Spectrum Disorder Assessed?

A
  • Core assessments:
    • Detailed developmental hx
    • Information from school
    • Observations in clinic / school
  • Useful extras:
    • Questionnaires e.g. social responsiveness scale
    • RAADS for teenagers
  • If inconclusive, can add in:
    • Autism Diagnostic Observation Schedule (ADOS-2)
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10
Q

What are the interventions for ASD?

A
  • Make things easier:
    • Psychoeducation, environment
    • Alternative communication
    • Routines: ‘Social stories’
  • Psychological:
    • ​Behaviour therapy
    • Modified CBT
  • Pharmacological:​
    • ​SSRIs (sertraline) for co-morbid anxiety or OCD
    • Antipsychotics (risperidone) for aggression
    • Melatonin for circadian dysregulation
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11
Q

What are the co-morbin presentations of ASD?

A
  • Anxiety
  • OCD
  • ADHD
  • Tic disorder
  • Eating disorders
  • Depression
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12
Q

What is the definition of a tic?

A
  • Motor movement or vocalisation that is:
    • Involuntary
    • Sudden
    • Rapid
    • Reccurent / repetitive
    • Non-rhythmic
    • Short burtsts or series
    • Various muscle groups
    • Simple or complex
    • Transient or chronic
    • Premonitory urge
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13
Q

What is copropraxia?

A

Copropraxia is a tic consisting of involuntarily performing obscene or forbidden gestures, or inappropriate touching.

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14
Q

What is echopraxia?

A

Involuntary repitition or imitation of another person’s actions.

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15
Q

What is palilalia?

A

A speech disorder characterised by involuntary repetition of words, phrases, or sentences.

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16
Q

What are some of the common motor and vocal tics?

A
17
Q

What are the characteristics of transient tic disorder?

A
  • Symptoms less than 12 months
  • Mostly school age
  • Usually no specific symptoms
18
Q

What are the characteristics of Tourette syndrome?

A
  • Several motor tics
  • At least 1 vocal tic
  • Not at the same time
  • Almost every day > 1 year
  • Onset usually < 18 years
19
Q

Describe the usual course of tic disorders.

A
  • Onset 2-15 years
  • Peak: 6-8 years
  • Motor tic of face first
  • Shoulders, torso, extremities after
  • Vocal tics 2-4 years later
  • Fluctuations every 6-12 weeks in location, complexity, type, intensity, frequency.
20
Q

What are the indicators for poor prognosis in tic disorders?

A
  • Familial history
  • Existence of vocal or complex tics
  • Comorbid hyperkinetic disorder
  • Obsessive compulsive symptoms
  • Aggressive behaviour vs self or others
21
Q

What are the environmental factors which can have psychosocial effects on tic disorders?

A
  • Can decrease during:
    • Distraction
    • High concentration job
    • Cannabis use
    • Alcohol use
    • Intentional movements
  • Can increase during:
    • Stress
    • Fear
    • Emotional trauma
    • Social presure
    • Joy
    • Tension
    • Caffeine use
22
Q

Describe the aetiology of tic disorders.

A
  • Multifactorial: genetic, neurobiological, psychological, environmental.
  • Dysregulation in cortico-striato-thalamo-cortical circuits.
  • Deviations in dopaminergic and serotonergic systems.
  • Increased dopamine activity in basal ganglia → deficient subcortical inhibition → impaired autonomic control of movement.
23
Q

Describe the diagnosis of tic disorders.

A
  • Detailed medical history
  • Standardised questionnaires:
    • Child behaviour checklist
    • Strengths and difficulties questionnaire
  • Interviews:
    • Yale Global Tic severity scale
    • Tourette’s Syndrome Severity Scale
  • Parents / self rating scales
    • Yale Tourette Syndrome Symptom List - Revised
  • Physical and neurological exam
  • EEG
24
Q

What are the differential diagnoses of tic disorders?

A
25
Q

Tic disorders have high comorbidity. Which other common disorders are associated with Tic disorders?

A
26
Q

What are the cognitive behaviour methods of treatment for tic disorder?

A
  • Habit reversal training
  • Exposure response presention
  • Mased (negative) practice
  • Relaxation training
  • Contingency management
  • Family therapy
27
Q

Describe the use of medication in the treatment of tic disorders.

A
  • Most treatment is ‘off-label’
  • Only when interfering with function or subjective discomfort
  • Start slowly
  • Only discontinue after a year
  • Reduce in late adolescence
  • Pre-medication work-up:
    • FBC
    • LFT
    • Prolactin
    • EEG
    • ECG
    • Physical / neurological exams
28
Q

How would you treat tic disorder with comorbid ADHD?

A
  • Psychostimulants (e.g. methylphenidate)
  • Atomoxetine or clonidine for mild to moderate tics
  • Addition of risperidone
29
Q

How would you treat tic disorder and comorbid emotional disorders?

A
  • SSRI
  • SSRI & antipsychotic for moderate to severe tics
30
Q

What are the alternative medicine treatments for tic disorders?

A
  • Substantial anecdotal evidence for:
    • Physical exercise
    • Recreational activities in general
  • No evidence for:
    • Diet
    • Vitamin or mineral supplementation
    • Hypnosis
31
Q

What are the features of foetal alcohol spectrum disorders?

A

Birth and Early Years (31 decks)

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