Neurodevelopmental Disrders 2 Flashcards
Give the epidemiology 9f Autism Spectrum Disorder
- About 1.5% of the population
- Increasing the rates leads to increase in research and awareness
- more prevalent in makes than females
- Chronic condition
Give the etiology of Autism Spectrum Disorder
- Genetics —> multiple genes
- Biology
- Disruption in normal brain development both early in embryological developmental and after birth (e.g. overgrowth)
- Environment
- lead, insecticides, valproic acid
- material infections
- Advanced paternal age
Not due to MMR vaccines(the lancet)
What is the Diagnostic criteria Autism Spectrum Disorder?
- Persistent deficits in social communication and social interaction across multiple contexts
AND
- Restricted, repetitive patterns of behavior (RBBs), interests, or activities
“Persistent deficits in social communication and social interactions across multiple contexts”, is a diagnostic criteria of Autism a Spectrum Disirder. Explain this
Persistent deficits in social communication and social interactions across multiple contexts, as manifested by:
A. Deficits in social-emotional reciprocity
-limited back-and-forth conversation
-failure to initiate or respond to social interactions
- Does not share experiences/emotions
B. Deficits in nonverbal communication behaviors
- limited eye contact, use of gestures, facial expressions
- limited understanding of body language and facial expressions
C. Deficits in developing, maintaining, and understanding relationships (problems with sharing, imaginative play, making friends)
“Restricted, repetitive patterns of behavior (RBBs), interests, or activities” is a diagnostic criteria of Autism Spectrum Disorder. Explain this
Restricted, repetitive patterns of behavior (RBBs), interests, or activities, manifested be behavior such as:
A. Stereotyped or repetitive motif movements, use of objects, or speech
B. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
C. Highly restricted, fixated interests that are abnormal in intensity or focus
D. Hyper- or hypo- reactivity to sensory input or unusual interest in sensory aspects of the environment
Diagnosis usually made by by age 2
What are the specifiers of Autism Spectrum Disorder?
- With or without accompanying intellectual impairment
- With or without accompanying language impairment
- In the old DSM 4, there was a classification -“Asperger’s disorder”
- However, in the new DSM-5, persons would be diagnosed as Autism Spectrum Disorder without language impairment and without intellectual impairment
How early must Autism Spectrum Disorder symptoms must be present?
Symptoms must be present I; the early development period
- often recognized between 1-2 years - May develop after 3-4 years of normal development
What are the Behavioral features of Autism Spectrum Disorders ?
Behavioral features:
- often hyperactive, impulsive, self-injurious
- often pica (eating of non-nutritive substances)
What are the cognitive features of Autism Spectrum Disorder?
If intellectual/language deficits exist, the problems tend to be uneven:
- Comprehension better than spoken language
- Non-verbal reasoning better than verbal reasoning
- Some show savant is (“Savant syndrome”)
What is Savant syndrome?
Having a notable skill (e.g. music) despite significant cognitive deficiencies
What are the types of Savant syndrome?
- Talented: a regular talent despite
Deficiency (about 10% of persons with autism have this) - Prodigious: a talent would be considered amazing, even in those without a disability. Prodigious savants are very rare
Explain the Hemispheric Asymmetries of Autism Spectrum D8sirder
- For those “with” cognitive impairment, left hemisphere verbal language functions are more affected
- For those “without” cognitive impairment p, right hemisphere nonverbal language functions are more affected (e.g. understanding prosody)
- In savantism: with left hemisphere injury, right hemisphere skills are facilitated (e.g. music, art)
What is the treatment for Autism Spectrum Disorder?
Depending on the severity and associated cognitive deficits
-Early, rigorous, 1:1 specialized treatment
- Involving behavioral modification principles (“Applied Behavioral Analysis”) -ABA) - Socialization skills and communication training - course: independent living is difficult for those it’s language +/- intellectual deficits
What is ADHD?
- affects preschoolers, children, adolescent, adults
- about 3% children
- More prevalent in males than females (nearly 2:1)
What are the diagnostic criteria of ADHD?
- 6 or more specific symptoms of inattention AND/OR
- 6 or more specific symptoms of hyperactivity-impulsivity
- Only 5 symptoms required if person is an adult
Explain the symptoms of inattention as a diagnostic criteria of ADHD
Diagnostic criteria: inattention : 6 or more specific symptoms of inattention have persisted for atleast 6 months to a degree that is inconsistent with developmental level, and that negatively impacts directly on social and academic/occupational activities:
- Lack of attention to details
- Difficulty in remaining focused
- May seem not to be listening
- Lack of follow through
- Difficulty organizing tasks
- Avoids tasks that require sustained effort
- Loses things
- Easily distracted
- Forgetful
Explain the diagnostic criteria of Hyperactivity and impulsivity as symptoms of ADHD
Hyperactivity and impulsivity: 6 or more specific symptoms of hyperactivity-impulsivity have persisted for atleast 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational functioning
Hyperactivity:
- fidgets, squirms in seat
- leaves seat, when being seated is expected
- Runs about, inappropriately (adult may feel restless)
- unable to remain quiet while at play or leisure
- on the go; motor driven
- talks excessively
Impulsivity:
- blurts out
- Cannot wait for turn
- Interrupts, intrudes
What are the subtypes of ADHD?
- ADHD, Combined presentation [inattention and hyperactivity-impulsivity]
- both criteria 1 and 2 are met for the past 6 months
- ADHD, predominantly inattentive
- Criteria 1 are met fir the past 6 months
- ADHD, predominant,y hyperactive- impulsive
- criteria 2 met for the past 6 months
What are the time-related symptoms required for ADHD?
- begin before age 12
- present in atleast 2 setting
- Persist for atleast 6 months
- developmentally inappropriate
- clearly interfere with functioning
What are typical behavioral features of ADHD?
- “difficult” temperament as infant
- temperamental with oppositional behavior/conduct disturbance
- Peer rejection
What are the cognitive features of ADHD
- Associated with specific learning disorders
- Often lower academic achievement without specific learning disorder
Explain the etiology of ADHD
Genetics - about 75%
-Neurochemical factors = decreased dopamine and epinephrine
- Nueroanatomy
- Decreased metabolism of prefrontal lobe
- decreased brain volume
Environment
- Toxins —> alcohol
- perinatal complications
- trauma
Explain the neuropathology of ADHD
ADHD is described as a “biological deficit in motivation”:
-Evidence exists that brain’s dopaminergic reward pathway is under active
As a result:
-typical motivators(rules/consequences) do not engage the neural systems important for attention and impulse control (e.g. prefrontal lobe)
-ADHD children need more frequent reinforcers/punishers to modify behavior
Explain possible avenues of Neuropsychological testing of ADHD
- Tests of frontal lobe functioning
- Wisconsin Card Sorting Test
- Tests of sustained attention
- Continuous performance test (CPT)
- Behavioral rating scales
- Achenbach Child Behavior
- the ADHD rating scale
- Conner’s ADHD rating scale
Completed by parents, teacher and child
How can ADHD be managed?
- Psychosocial interventions
- Pharmacotherapy
Explain psychosocial interventions for ADHD
- Individual psychotherapy
- teach “stop, think and act” strategy for impulse control
-address self-esteem
- Parental support
- use of token economies
- Additional advice for structuring environment
- support groups/respite care
What is the first line of treatment for ADHD?
A combination of medication and behavioral psychotherapy are recommended
If child is under 6 years old, then behavioral interventions are first line
What medications can be used to treat ADHD?
Stimulants
Non-stimulant
- Atomoxetine(strattera)
- antidepressants
How can stimulants be used to treat ADHD? include mechanism
Stimulant- drugs affecting Catecholamines
-Amphetamine(adderall), methylphenidate(Ritalin)
Mechanism:
- Increases dopamine and norepinephrine in prefrontal cortex
- Improves attention (even if not ADHD), hyperactivity, impulsivity
- most cases respond well to stimulants
What are the side effects and Contraindications of using stimulants to treat ADHD?
Side effects:
-Appetite loss, insomnia, headache, edginess, nausea
- Serious cardiovascular events may occur
- Blackbox warning: potential for abuse
Contraindications:
- Tics, generalized anxiety, psychosis
- heart disease
- Risk of abuse by patient or family members
Explain the use of non-stimulants for treating ADHD
Atomoxetine (Strattera)
Mechanism: increases norepinephrine
- slower acting and slightly less effective but fewer side effects than stimulants
- Blackbox warning: increased risk of suicide ideation
- used in stimulant failures or if there are contraindications for using stimulants (e.g. coexisting anxiety, tics, abuse liability)
How can antidepressants be used to treat ADHD?
Non-stimulant: Antidepressants
- second line of defense
- tricyclic antidepressants
- Used alone or with stimulants
- reduce hyperactivity/impulsivity
What are the outcomes of ADHD?
In adults associated with:
- lower education and lower occupational status (fired, lower performance ratings)
- substance abuse (if untreated ADHD)
- More traffic infractions and motor vehicle accidents
- Outcome largely dependent on reactions to and consequences of the symptoms
Course: hyperactivity declines in majority of teens, but inattention/impulsivity tend to persist
