Neurodevelopmental dx Flashcards
neurodev dx
includs comm, motor, specific learning, intellectual dev, ASD, ADHD
communication dx
deficit in language skill acquisition
- make impairments in academic achievement, socialization, self-care
Speech disorder
Problems making sounds
language disorder
difficulty undertsanding and using words in appropriate contexts
- evident in inability to follow directions
Expressive lang dx
can’t develop skills to communicate verbally or thru ASL
social communication disorder
interrupt, minimally verbal, probs comm socially
motor disorder
Impaired fine and gross skills
- mild to mod
Developmental coordinate dx
impaired motor skill development
- coor below child’s dev age
- probs interfering with academic achievement and ADLs
Sx of dev coord dx
Delayed sitting and walking, problems jumping or doing tasks like tying shoes
Tx for dev coor dx
phys and occup therapy
stereotypic mvt dx
Repetitive, purposeless mvt for 4w and interferes with ADLs
Sx of stereotypic mvt dx
Nail bite, head bang, flapping, teeth grinding
Tx for stereotypic mvt dx
- safety and injury prevention (mittens, helmet)
- bx therapy w/ habit reversal techniques
Tic dx
sudden, nonrhythmic and rapid motor mvt or vocalizations
sx of tic dx
tongue protrusion, squat, hop, skip, twirl
- usually involves head, torso, limbs
Vocal tic
spontaneous prod of words and sounds
Persistent motor or vocal tic dx
Lasts over 1 y
Provisional tic dx
Lasts under 1 y
Tourette’s
More severe tic dx
- often multiple motor and at least 1 verbal tic
- impaired fxn throughout the day
- lasts over 1y
When do tic dx onset
4-6y
Can ind suppress tics?
Perhaps temporarily sometimes
Lifespan of tics
Often peak in adolescent and dec in adulthood
tx for tic dx
- habit reversal
- relaxation techs (dec anx)
- Meds like antipsychotics, clonidine, klonopin, fluoxetine, sertraline
- DBS: last resort!
Specific learning dx
- dyslexia (reading)
- dyscalculia (math)
- dysgraphia (written)
Specific learning dx and tx
- often dx and tx in school age
- make plans w/ IEP
Intellectual dev dx
Deficit in intellect fxn, social, and daily fxn (work, school, self-care)
Examples of probs with intellect
reasoning, prob solve, abstract, intellect fxn, academic ability
Social impairments with IDD
impaired comm lang, interpret and act on social cues, emo reg
What can inc levels of functioning if begun before age 5y?
Cog and social stim
What determines adult productivity in an ind with IDD?
motivational support!
tx for IDD
- early ID and intervention inc QoL
- psychosocial intx, social skills and ind, fam, cog therapy
ASD
non-prog, pervasive dev dx with sx in comm, soc, bx
ASD characteristics
- w/d and react unusually to others
- stereotypic repetitive speech and/or bx
- unusual attachments to objects (fixed interest)
- overadherence to routine/ritual
- hypo/er reactivity to sensory input
- extreme resistance to chx (love routine)
epidemiology of ASD
- appears in early childhood (often 1st 3y of life)
- more male but fem more severe
Potential causes of ASD
spontaneous genetics muts, LBW, AMA, premature birth, women take valproic acid during preg, Fragile X, prater-willy, rett sx, tuberous sclerosis
Screenings for ASD
CARS and M-CHAT
- lead and hearing
What is key in ASD?
Early ID is key
What to assess with ASD
- intellect (dev delay)
- comm (pronoun reversal, unusual emphasis on words)
- abuse
- bx skills
- stereotypic bx
Psychosocial tx for ASD
- day care tx programs
- bx management
- parent teach
- OT/PT
- speech
- CBT
- foster appropriate social intx
Psychobio tx for ASD
- 2nd gen antipsychotics
- SSRIs
- stims
ASD effective tx program
- build on kids interests
- predictable schedule
- engage in pos reinforce bx
- teach comm, social skills
- teach tasks as series of steps
- engage child actively
- structured activities with beginning, middle, end
- speech and lang therapy
- social skills
- involve parents for tx success
Social skill training in ASD
- help kids recognize social cues
- teach ways to dec stress
- use role play to help play like peers
ADHD
Persistent pattern of inattn, hyperactivity, and impulsivity that is pervasive and inappropriate for dev test in at least 2 settings for 6M before age 12 (work, social, edu)
epidemiology of ADHD
- more boys
- 1 in 10 kids
- more sub abuse in this pop
Emos of kids with ADHD
neg SE, feel stupid, always mess up
rf for ADHD
genetic, LBW or premature, frontal head injury, moms who smoked/drank in preg, exposure to pesticides and lead, neuro pathways
hyperactivity-impulsivity ADHD
6+ present for 6M
- hyperactivity: fidgets, leaves before excused, run/climb excess, probs playing quietly, often on the go, talks excessively
- impulsivity: speak before think/blurts, interrupts, prob waiting their turn
Inattentive ADHD
6+ sx for 6M
- no attn to detail, trouble keeping attn, does not listen when spoken to directly, does not follow thru on tasks, trouble organizing activities, avoids doing tasks that incl mental effort, lose things, easily bored, disorganized
combined ADHD
hyperactivity-impulsivity and inattentive sx
tx for ADHD
- emphasize self-reg, social fxn, conc, attn, focus
- bx manage and FDA approved meds are best
- parent management training
- inc prob solve and coping
best type of therapy for ADHD
group therapy 8-12x weekly for bx chx
- CBT and play not as effective
Stimulant NC
usually work w/i 1 hour
- inc DP in brain so calms
- low dose and inc
- not wt-dependent
- 3 tries for stims before try non-stim
NC for stimulants n outpatient
- VS, weigh (bc suppresses appetite)
- random drug screen
What to do if UDS is negative ona. kid prescribed stims?
Stop rx bc stims are so abused
Long acting stims
- dextroamphetamine/amphetamine
- lisdexamfetamine
- dexmethylphenidate
- methylphenidate (Daytrana, Metadate CD, Ritalin RA, Concerta)
Intermediate acting stims
- dextroamphetamine
- methylphenidate (Ritalin SR, Methylin ER, Metadate ER)
Short acting stims
- methylphenidate (Ritalin)
- dexmethylphenidate
- dextroamphetamine
- amphetamine sulfate
How long do long acting stims last?
8-12h; daily
Which drug is approved for ages 3-16?
dextroamphetamine (short acting)
What form are short acting stims usually?
Chewable or crushable
NC of Daytrana
- causes permanent skin changes (leukoderma)
- patch for 9h on hip; works for hours once removed
- flexible dose/time
Which intermediate acting stim can be chewable OR liquid?
Methylin
Who can get Concerta?
Only kids over 6
Ritalin LA format
Capsule that can be opened and sprinkled
Who can get dextroamphetamine/amphetamine
Over 6y old
What format does dextroamphetamine/amphetamine come in?
can open and sprinkle in applesauce
SE of stimulants
- dec appetite, HA, stomachache, trouble fall asleep, jittery, social w/d
- nerves, overstim, tachy or brady, HTN, restless, insomnia, dry mouth, diarrhea, unpleasant taste
How to manage ADHD stims
Adjust dose or dose time
Common complaint about kids on stims
The child appears dull or overly restricted
Are drug holidays reccommended?
Yes…?
non-stims given for ADHD
- atomoxetine
- bupropion
- clonidine
- guanfacine
- imipramine
TCA given for ADHD
imipramine
Guanfacine NC
- ER tab
- more hyperactivity
- bedtime
- rest less, prob focusing
When is clonidine given
Alone or with stims; esp if tics present
Clonidine SE
dry mouth, dizzy, mild sedation, constipation
When do SE usually get better with clonidine
After several doses
Bupropion SE
dizzy, dry, N, appetite chx, tinnitus, sore throat, muscle pain
Clonidine class
beta blocker?
bupropion class
NDRI
What type of ADHD does bupropion work weel for
combined
atomoxetine NC
- slow therapeutic response…build up gradually and may take longer to see effects
- watch SI closesly!!!
atomoxetine class
SNRI
Who gets atomoxetine
ADHD kids over 6 with anxiety and ODD
atomoxetine SE
dry, dizzy, N/V, dec appetite, prob sleep
ADHD tips
- schedule
- organize daily items
- homework and notebook organizer
- be clear, specific, consistent
- praise/reward when rules followed
- set and reward small attainable goals
