School Difficulties

Question 1

Learning Disability: number of disorders which may affect the acquisition, organization, retention, understanding or use of verbal/non-verbal information. Importantly, they are __ and NOT ___

Answer 1

number of disorders which may affect the acquisition, organization, retention, understanding or use of verbal/non-verbal information. Importantly, they are specific and NOT global

• if there are global deficits– consider mental retardation/cognitive impairment/intellectual handicap

True Definition of LD: average cognitive ability (IQ>85), academic performance in one or more areas are significantly below expectations, must have had at least 2 years of formal academic instruction. There is a mismatch between cognitive potential and academic performance.

Question 2

T/f people wiht learning disabilities have a below average IQ

Answer 2

false. they have average-above average cognitive ability, but may have academic performance in an area that is below expectation (ie/ like in math)

Question 3

learning disability vs intellectual disbaility

Answer 3

learning- deficit in one academic subject (ex/ bad at math),– can have comobid conditions like ADHD which makes acaemic life just a bit harder, but there is normal intelligence

intellectual disability; decrease in intelligence AND adaptive skills (ex, communication, self-care, health management)

Question 4

definition and diagnostic requirements for ADHD

Answer 4

def: developmental disorder of inattention AND/OR hyperactivity-impulsivity, symptoms are developmentally inapprorpiate.

6/9 inattention OR hyper-impulsive symptoms OR both that cause impairment before the age of 12.

AND: symptoms are present in two or more settings,

AND impair social, academic or occupational functioning.

Question 5

common comorbidities for ADHD

Answer 5

Co-Occuring Conditions: sleep disorders, learning disabilities, ODD, CD, anxiety disorders, major depression, simple tic disorders.

Question 6

T/F symptoms of ADHD can show themselves in adulthood

Answer 6

false.

Symptoms are present before 12 years of age and in several settings. Must have clinically significant impairment in social, academic, or occupational functioning.

Symptoms DO NOT occur exclusively during the course of PDD, schizophrenia or other psychotic disorders.

Question 7

ADHD treatments

Environmental Modifications: sensory integrative strategies, small class sizes, extra time, organizational tools

Personal modifications: behavioural strategies, organizational social skills training, education, counselling.

Remission can be achieved with a mix of behavioural, environmental, and medical strategies.

Goals of treatment: remission, mean snap-IC <1 for ADHD symptoms, improve academic functioning, improve psychosocial functioning.

WHAT ARE THE FIRST LINE MEDICAL MANAGEMENT STRATEGIES?

Answer 7

Stimulants: methylphenidate (Ritalin, concerta), amphetamine (Adderall)
§ Mechanism: blocks dopamine reuptake via DAT + blocks norepi via NET +
(amphetamines only) displaced dopamine from synaptic vesicles

§ Side effects: appetite suppression, delayed sleep initiation, growth delay, abdo pain,
unmasking of tics, rebound, addiction/abuse

o Atomoxetine (non-stimulant): SNRI (targets both ADHD and anxiety)

§ Mechanism: blocks reuptake of norepi via NETà ­ norepi and dopamine in prefrontal cortex (not in nucleus accumbens- no abuse potential
§ Side effects: sedation, GI, appetite, irritability, headache, suicidal ideation

o Alpha-2-receptor agonist (non-stimulant): clonidine or guanfacine
§ Mechanism: increases norepi activity in frontal and prefrontal lobe. Clonidine is less
specific (more somnolence)

§ Side effects: somnolence, hypotension, sedation, dizziness

Question 8

two neurotransmitters the adhd meds generally work on

Answer 8

increase dopamine or increase NE in the PFC

Question 9

oppositional defiant disorder and conduct disorder definitions

Answer 9

Oppositional Defiant Disorder (ODD) Definition: age inappropriate stubborn, hostile and defiant behaviours

Epi: usually appears by age 8, second peak at age 14-15yo; prevalence 1-7%. Higher in boys in childhood

Symptoms: Often loses temper; Often angry or resentful; Touchy or easily annoyed; Deliberatively annoys others; Actively defy or refuse to complex; Often argues with authority figures; Often blames others for mistakes; Spiteful or vindictive at least twice within past 6mo

Conduct Disorder Definition: a repetitive and persistent pattern of behaviour in which the basic rights of other and major age appropriate societal norms or rules are violated

Epi: 1-10%; more common in boys (more aggressive behaviour in boys than in girls)

Question 10

etiologies of conduct disorder

Answer 10

Etiology: multi-factorial
• Parental factors: harsh/punitive parenting, chaotic home environment, parental psychopathology
• Psychological: poor emotional modulation, poor modeling of impulse control
• Biological: low levels of 5-HIAA in CSF is associated with aggression and violence
• Social: child abuse, maltreatment, lower SES

Question 11

kids with conduct disorder commonly progress to ___ personality disorder

Answer 11

antisocial personality disorder.

Question 12

invesitgations and management of conduct disorders

Answer 12

Investigations: look for common comorbid conditions- ADHD, mood disorders, substance abuse, or less common (anxiety, tic disorders, learning disabilities)

Management: Psychosocial Interventions + Pharmacologic (you can treat symptoms of aggression but focus on comorbidities)