Neurodevelopmental Disorders- O'Grady Flashcards
What are the 9 hyperactivity symptoms of ADHD?
Fidgeting
Leaves seat when expected to stay
Runs around/feels restless
Unable to play quietly
‘On the go’
Talks excessively
Blurts out answer/conversation
Difficultly waiting
Interrupting/Intruding
*Notice a lot of these are very similar symptoms*
What are the 9 inattentive symptoms of ADHD?
Poor attention to details
Difficulty in sustained attention
Not listening when spoken to directly
Poor follow-through on instructions
Difficulty organizing tasks
Avoids tasks requiring sustained effort
Loses materials for tasks
Easily distracted
Forgetful in daily activities
What are the criteria for a diagnosis of ADHD?
6 out of 9 hyperactivity symptoms for at least 6 months
6 out of 9 inattention symptoms for at least 6 months
Not explained by other disorders
Before 12, must occur in multiple settings, with functional impact
What 5 qualifiers can be used to describe ADHD?
- Combined
- Primarily Inattentive
- Primarily Hyperactive
- Partial Remission
- Mild/Moderate/Severe
What are 6 potential symptoms of learning disorders?
What criteria is need for diagnosing a learning disorder?
- Inaccurate or slow/effortful word reading
- Difficulty understanding what is read
- Difficulty spelling
- Difficulty in written expression
- Difficulties in mastering number sense, facts calculation
- I think this is basically trouble adding/subtracting/multiplying/dividing
- Difficulties in math reasoning
1 of the 6 symptoms must be present for at least 6 months
Can not be explained by any other problem (EG poor eyesight)
Skills measurably below expected norms
How are learning disorders specifically classified?
Reading Impairment
Written Expression
Math Impairment
Mild/moderate/severe
Readin’, Ritin’, and ‘Rithmatic (also how bad it is)
What criteria is needed for diagnosis of Motor-Developmental Coordination disorder?
When is it typically diagnosed?
Persistant difficulty in acquisition and execution of coordinated motor skills (EG clumsiness, inaccuracy, slowness) affecting productivity
Usually diagnosed during developmental period (young childhood, or toddlerhood for severe cases)
What criteria are needed to diagnose a motor stereotypic movement disorder?
When is it’s typical onset?
repetitive, driven, purposeless movement not explained by OCD or other disorder
Onset during developmental period
What type of disorder is Tourette’s syndrome?
What differentiates it from from other similar disorders?
What does it share with similar disorders?
Tic disorder
Tourette’s has multiple motor and vocal tics, but symptoms may wax and wane
Onset before 18, and persists for at least 1 year
Assume the patient is 12 and has no other symptoms or medications
What is the diagnosis if the patient has 1 tic (motor or vocal) that has been present for more than 1 year?
What is the diagnosis if the patient has tics (motor or vocal) that has been present for less than 1 year?
Persistant Motor or Vocal Tic Disorder
Provisional Tic Disorder
What should be kept in mind for patients with developmental disorders?
Look for the presence of other disorders or syndromes that could explain multiple, concurrent disorders
2x as likely to have a medical problem
3x as likely to have a psychiatric problem
4x as likely to have a preventable mortality
What should the interview of a pediatric patient with a developmental disorder cover?
When should disorders ideally be diagnosed?
Review of all previous developmental stages (preschool, school age, adolescent, young adulthood)
Interview the patients’ parents about their experiences
Preschool age, but most are diagnosed during school aged
What motor milestones should be seen at 1 month?
6 months?
12 months?
18 months?
24 months?
1 month
- support head
6 months
- Thumb/finger grasp
- sits on their own
12 months
- walking
18 months
- build/scribble
- run/jump
24 months
- grasp small things
- draw a circle
- stairs
At what age should infants start to associate sounds with communication?
At what age should infants begin using words to communicate?
8-12 months old
12-24 months old
During months 6-24, infants develop expressive language.
What are the five stages of expressive language development?
- Canonical (unisyllable utterance can be meaningless)
- Reduplicated babbling (mama, dada, papa, etc)
- First words
- Two word sentences and grammar
- ‘W questions’ (where, why, what, when) and prepositions
How should a newborn react to speech?
How should a 1-6 month old react to speech?
How should a 6-24 month old react to speech?
Newborn
- recognize voices, but no meaning
1-6 months
- turn to voice
- attention, but no comprehension
6-24 months
- single nouns (1st stage)
- increased vocabulary (2nd stage)
- single word commands (3rd stage)
- multi-word commands (4th stage)
How is cognition defined?
How is it measured?
Cognition is the ability to form rules about your environment
IQ tests can test cognition
Define Neurodevelopmental Disorder
A group of conditions with onset in the developmental period that produce impairments in Personal, social, academic, or occupational functioning
Give three defining characteristics of Intellectual Disability / Intellectual Development Disorder (ID/IDD)
- Deficits in general mental abilities
- Impairment of everyday adaptive functioning
- Onset in the developmental period
Give some examples of the deficits in **intellectual functioning **seen in ID/IDD
- reasoning
- problem solving
- planning
- abstract thinking
- judgement
- academic learning
- learning from experience
- practical understanding
What IQ level is associated with ID/IDD?
What are some pitfalls/cautions that a clinician should be aware of?
IQ: 65-75 (two standard deviations below population mean)
Pitfalls/cautions:
- Control for ADHD effects
- cultural appropriateness of test
- psychometric validity of test
- Requires appropriate level of clinical experience and judgement in evaluating these disorder
Deficits in communication, social participation, and independent living are examples of what aspect of ID/IDD?
adaptive functioning
Adaptive functioning in ID/IDD can be further broken down into what three (3) domains? Explain.
- Conceptual (academic) - includes things like problem solving, judgement in novel situations, memory, language, etc
- Social - includes empathy, interpersonal skills, awareness of the thoughts and feelings of others
- Practical - personal care, job responsibilities, self-management, task organization (job, school)
Define **Mild **ID/IDD in terms of the following facets of adaptive functioning:
- Conceptual
- Social
- Practical
- Conceptual: academic difficulty, somewhat concrete problem solving
- Social: immature social interactions
- Practical: some support needed for complex daily living tasks
Define Moderate ID/IDD in terms of the following facets of adaptive functioning:
- Conceptual
- Social
- Practical
- Conceptual - marked lag in conceptual skills
- Social - marked differences in social and communication skills
- Practical - extended teaching of skills needed
Define Severe ID/IDD in terms of the following facets of adaptive functioning:
- Conceptual
- Social
- Practical
- Conceptual - little understanding of language, time, money, quantity
- Social - limited spoken language
- Practical - support for all ADLs
Define Profound ID/IDD in terms of the following facets of adaptive functioning:
- Conceptual
- Social
- Practical
- Conceptual - no symbolic processes
- Social - nonverbal communication
- Practical - dependent on others for all ADLs
Contrast the following:
Global Development Delay
Unspecified Intellectual Disability
Global development delay: cannot test + <5 y.o.
Unspecified: cannot test, >5 y.o., associated mental or physical impairment, severe behavioral disturbace, or co-occurring mental disorder
Define Language Disorder
Persistent difficulties in language acquisition and use of language accross modalities (speech, reading, sign) due to deficits in comprehension or production that include:
- reduced vocabulary
- limited sentence structure
- impairments in discourse
Note: deficits must be substantial and quantifiably below normal development. They also must not be attributable to other etiologies.
**Speech Sound Disorder **is essentially a deficit of what?
Articulation
Must interfere with social, occupational, or academic functioning (also, not attributable to culture i.e. accent?)
Must not be attributable to other etiologies
Childhood Onset Fluency Disorder: define
How is this disruptive to the child?
Disturbances in the normal fluency and patterning of speech (essentially stuttering). May include:
- Syllable repetitions
- Sound prolongations
- Sound pauses within words
- Word substitutions (to avoid problem words)
- Word tension
- Monosyllable whole word repetition (I-I-I-I s-s-seee him)
Disturbances cause anxiety!
Define Social (Pragmatic) Communication Disorder
Persistent difficulties in the social use of verbal and non-verbal communication
- Problems with the semantic aspect of language (i.e. the meaning of what is said)
- Problems with the pragmatics of language (i.e. using language appropriately in social situtions)
Closely associated with autism and Asperger’s, but other things can cause it too
Define: Unspecified Communication Disorder
Symptoms characteristic of a communication disorder that cause distress or impairment but do not meet criteria of any specific communication disorder
tl;dr garbage-can diagnosis
Autism Spectrum Disorder
Give (3) specific requirements for diagnosis with respect to persistent deficits in social communication and interaction
- Deficits in social-emotional reciprocity
- Deficits in nonverbal communicative behaviors used for social interaction
- Deficits in developing, maintaining, and understanding relationships
Autism Spectrum Disorder
Give (4) examples of the patterned/stereotyped behaviors observed with this disorder
- Stereotyped or repetitive motor movements
- Insistence on sameness, routines, and ritualized patterns
- Highly restricted, fixated interests
- Hyper- or hypo-reactivity to sensory inputs with possible unusual fixation on certain aspects of sensory input (the spinning train wheel example)
Later presentation of Autism Spectrum Disorder may be correlated with what aspect of the illness?
What must be excluded to make an accurate diagnosis?
Prognosis - later presentation tends to correlate positively with higher-functioning autism
Disturbances must not be better explained by intellectual disability or global developmental delay (though ID/IDD can be a co-morbidity…)
Discuss the social communication and restricted/repetitive behavior patterns of Level 1, Level 2, and Level 3 ASD
- Level 1
- Social: noticeable impairments without support, difficulty engaging in social situations, unsuccessful responses to social overtones, decreased social interest
- Behavior: attempts to interrupt may be redirected, some significant interference with functioning
- Level 2
- Social: Marked deficits, even with support; limited and abnormal responses to social overtones
- Behavior: frequent interference with functioning, distress or opposition when interrupted
- Level 3
- Social: severe deficits with minimal social responses or initiatives
- Behavior: interference with all spheres of functioning, extremely difficult to interrupt or redirect
How does the severity of an intellectual disability affect the diagnosis?
The more severe the intellectual disability, the early it can be diagnosed.
Profound diability- 6-12 months old
Severe disability- before 12 months
Moderate disability- 1-2 years
Mild disability- 2-5 years
What are 10 deficiencies seen in toddlers with autistic spectrum disorders?
What are 4 symptoms that are sensitive, but not specific for autism?
- Eye contact
- Response to name
- Joint attention
- Pointing to express interest
- Interest in other children
- Gesturing
- Imitation
- Shared enjoyment
- Empathic responding
- Range of facial expressions
- Toe walking
- W sitting
- Sensory sensitivities
- Stereotypies (repetitive motor movements)
How does diagnosis of developmental disorders change as children enter school age?
What complications can be seen in school aged children?
Diagnoses are typically clearer because symptoms are more visible. However, more complications arise.
Education (classroom or special ed)
Therapy (school or private)
Treatment (therapy vs medication)
Social issues (opportunities to play, bond with other kids)
What social developments are occuring during adolescence?
Erikson’s Identity vs. Role Confusion
Teens need to develop a sense of self and an identity.
Increased social complexity
Increased mood and anxiety disorders
Differences in peers apparent
Increasing independence
What Erikson’s Stage of Social Development is most prominent during middle adulthood (40-65 years old)?
Generativity vs. Stagnation
Adults need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world.
What Erikson’s Stage of Social Development is most prominent during young adulthood (19-40 years old)?
Intimacy vs. Isolation
Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation.
What are some improved quality of life indicators for persons with neurodevelopmental disorders?
- High school graduation
- Paid employment
- Parent knowledge of adult services
- Parent involvement in transition services
- Family coping
- Extended family or non-family support
What are important quality of life dimensions for adults with neurodevelopmental disorders?
- Satisfaction
- Competence and productivity
- Empowerment and independence
- Social belonging and community integration
- Contribution to the community
