Neurodevelopmental disorders (wk 8) Flashcards
what are the criteria for an intellectual disability?
-intellectual disability: reflects impairment in 2 areas:
1. Deficits in intellectual fnx, confirmed by both clinical assessment + individualized, standardized intelligence testing
- significant limitations in adaptive behavior: behaviors necessary to fnx independently, adequately, appropriately in everyday life
-communication (eg expressive, receptive, written language)
-daily living skills (eg eating, dressing, personal hygiene, domestic/community living skills)
-social skills (eg interpersonal relationships, coping, leisure skills)
-motor skills (eg movement coordination, ability to manipulate objects using fingers/hands) - Onset during developmental period
what are causes of ID (genetic, prenatal, birth-related, postnatal)?
-chromosomal abnormalities (eg Down Syndrome) + genetic mutations
-prenatal factors related to maternal health (eg rubella, HIV, drug/alc use)
–birth-related causes: prematurity, lack of oxygen during prolonged/complicated labor
-postnatal environmental factors: psychological + social deprivation due to lack of stimulation + care
compare the chromosomes of a typical human cell w someone with down syndrome
-typical human cell has 23 pairs of chromosomes; in down syndrome there’s an extra chromosome on pair 21
risk of down syndrome increases with ______ AND ______ age
maternal; paternal
what is phenylketonuria (PKU) and how does it cause ID? how can ID be prevented in children w PKU?
-disorder that causes inability to process / metabolize the amino acid phenylalanine. ID occurs when this substance builds up in the brain to toxic lvls
-ID prevented in these children if they follow a v low protein diet
-detected w a blood test
explain the issue of diagnostic overshadowing and comorbidity
-indivs w ID will have comorbidities; perceiving deviant behaviors to be a fnx of the developmental disorder
-indivs w IDs are at ↑ risk of dev’g emotional + behavioral problems
how are IDs prevented (genetic, social, toxic, infectious)?
-genetic: prenatal screening for genetic defects + genetic counselling for families at risk for known heritable disorders
-social:
-govt programs to ensure adequate nutrition to the underprivileged during prenatal months + most critical years of life
-early intervention in situations involving abuse + deprivation
-early testing + proper diet for PKU
-toxic:
-environmental programs to ↓ exposure to lead, mercury, other toxins
- ↑ public awareness of the risks of alc/drugs during pregnancy
-infectious:
-prevention of congenital rubella syndrome
- ↑ public awareness on the risk of HIV, herpes, other infections
-limiting exposure to cat litter that can cause toxoplasmosis
what are the 7 “Essential Daily Ingredients” for Early Intervention (Ramey & Ramey, 1992)?
-encouragement of exploration – physical space where infants/toddlers are free to roam/explore knowing they will be protected
-assistance in basic skills – labeling, sorting, sequencing, comparing, noting means-ends relations
-reinforcements of developmental achievements
-guided rehearsal + extension of new skills
-protection from inappropriate disapproval, teasing, or punishment
-rich + responsive language environment
-supportive + predictable environment in terms of opportunities for learning + patterns of intxn
what are the specifiers of learning disorders?
specifiers for functional impairment, with impairment in:
-reading
-written expression
-mathematics
what is a learning disorder?
-difficulties learning + using academic skills, despite the provision of interventions that target those difficulties
-academic skills substantially + quantifiably below those expected for chronological age
what are complications associated with LDs?
-associated w greater peer victimization, bullying, social rejection
-greater risk of depression + low self esteem
-if unrecognized can lead to academic failure + drop out from high school
what are disorders listed under Pervasive Developmental Disorders (spectrum disorders)?
-autism
-Asperger’s - prev believed to be less impairing than autism, but it was difficult to make that distinction when working w indivs
→ these 2 are now 1 spectrum/category
-Rett’s syndrome: primarily occurs in women; unique pattern of cog/fnxl deterioration incl loss of interest in social contact + hand wringing. Hallmark symptom = Deceleration in head circumference growth
-Child Disintegrative Disorder: marked deterioration in speech + social skills, following several years of normal development
what are the diagnostic criteria for Autism Spectrum Disorder?
A. Persistent deficits in social communication + social intxn across multiple contexts, as manifested by:
-Deficits in social-emotional reciprocity – eg failure to meet people in terms of their interests/feelings; failure to initiate/respond to social intxns
-Deficits in nonverbal communicative behaviors used for social intxn – eg gesturing, facial expression
-Deficits in dev’g, maintaining, understanding relationships
B. Restricted, repetitive patterns of behavior, interests, activities – eg rocking, spinning; intense interests in one area
in autistic children (first 2yrs of life), what behaviors are exhibited in social interactions?
-lack of attachment + comfort seeking behaviors
-rigid when held/resist being held
-absent / delayed smiling, pointing, joint-attn
in autistic children, what general behaviors are exhibited in social interactions?
-behaviors lack reciprocity
-changes in environment upsetting
-limited nonverbal behaviors that typically guide social intxn (eg eye contact)
-limited imitation - symbolic play
how many autistic individuals are nonverbal?
-1/3 to 1/2
what are some characteristics often displayed in autistic people’s speech?
-Does not communicate meaning
-is abnormal in tone/content
what are 2 speech patterns commonly found in autistic people?
-echolalia: repetition of other’s words/phrases using similar intonation; not done at the function of communication
-pronoun reversal: referring to oneself as “he” or “she” rather than “I” – thought to be related to difficulty understanding perspectives of others / distinction between self/others
describe the behavior and interests of autistic people
-restricted, repetitive, unusual behaviors + interests
-eg hand flapping, rocking, unusual repetitive movements
-[ ] on particular aspects of their environment
-eg the wheels on toy cars
-may be preoccupied w objects or patterns
describe etiology of autism
-genetic factors now considered to play a dominant role in the development of autism spectrum disorders
-there are genetic contributions, but it’s not straightforward
-there’s no one gene for autism
-there’s an interplay between genes + environment
what are genetic/epigenetic/environmental risk factors of autism?
-↑ parental age (paternal and maternal)
-some prenatal infections (eg rubella)
-some medications (eg valproic acid)
-premature birth
what are some non-replicated environmental risk factors of autism?
-agricultural pesticides
-pet pesticides
-hazardous air pollutants
-endocrine disruptors
what is a predictor of a better prognosis in autistic children?
-fluent speech (ie 3-wd phrases produced spontaneously + regularly in an effort to communicate) before age 5
describe ‘savants’ in autism
-small minority of indivs w autism; exceptional abilities in a spec area (eg math, music, art, unusual feats of memory)
what are the components of an autism assessment?
-multidisciplinary team: psychologist, psychiatrist, speech + language specialist, occupational + phys therapist, teacher
-Autism Diagnostic Observation Schedule (ADOS): series of activities pulling from typical social intxns, seeing how child/toddler reacts
-Autism Diagnostic Interview - Revised: give p/cg of child; ask them to describe child’s fnxing + symptoms etc
what are intervention options for autism?
- no meds used to treat autism, but meds often used to manage abnormal behaviors + comorbidity (anxiety, depression, mood regulation difficulties)
- social skills training – helping indivs dev the skills necessary to connect w others in a social world (eg introducing oneself, joining/exiting a conversation, giving apologies/compliments)
- language interventions - class activity
- behavioral interventions effective: used to teach children appropriate behavior (eg in classroom, playground)
-fnxl analysis of antecedents + consequences of behaviors (what leads up to spec behaviors, what is the behavior, what rewards/negative consequences from behavior)
-positive reinforcement of appropriate behavior
how often/when should intervention for autistic children begin? what are characteristics of these interventions?
-Intensive intervention effective (~40h/wk)
-Most successful when intervention initiate early (eg child <3/4yrs)
-Carefully ctrled structure in the learning environment
-Effective patterns consider autistic children’s attentional patterns + carefully plan presentation of stimuli
-Important to emphasize generalization + maintenance of treatment effects
-Parent training
-Individual responses vary considerably
take home message for developmental disorders: _____ ________ and ___________ are related to a better outcome
early diagnosis; intervention
