Special Needs Flashcards
STUDY DEVELOPMENTAL MILESTONES
Abnormal Patterns of Development
the child acquires skills in the typical sequence but at a
slower rate. It may occur within a single stream or across several
dev’tl milestones
Delay
devt is delayed in one stream and not another
Dissociation
child achieves milestones out of the usual
sequence within a stream of devt; ex: uses words before meaning
is understood
Deviancy/ deviation
child is losing milestones, but can more subtly be
recognized when a child stops acquiring new devt skills or has a
slowing in rate of devt’l progress over time
Regression
What is ASD?
CH 30: AUTISM SPECTRUM DISORDER (ASD)
Etiopatho
- As much as 15% of ASD are associated with a known genetic mutation
- M>F (4:1)
- abN in frontal and temporal lobes and cerebellum, dec cerebral GABA, oxidative stress, reduced glutathione,
N-acetylaspartate. Neurophysiologic dysfunction in serotonin, oxytocin, and vasopressin
- The best established prognostic factors for individual outcome are
o Presence or absence of associated
intellectual disability
o Language impairment
clinical manifestations of ASD
CM
1. Sx are typically recognized and observed during the 2nd YOL
- Deficits in 2 core domains (Triad of impairments):
social communication/social interaction AND restricted
repetitive patterns of behavior, interests, and activities - Deviance – nonsequential unevenness in achievement
of milestones within 1 or more streams of devt (expressive language: knows >200 words but unable to
say “mama/papa”)
Diagnostics
DIAGNOSTIC CRITERIA
A. Persistent deficits in social communication and social interaction
1. Deficits in social-emotional reciprocity
*abnormal social approach
*failure of normal back-and-forth conversation
*reduced sharing of emotions, interests or affect
- Deficits in nonverbal communicative behaviors used for social interaction
*abnormal eye contact and body language
*deficit in understanding and use of gestures
*total lack of facial expressions - Deficits in developing, maintaining and understanding relationships
*absence of interest in peers
*difficulties in making friends
B. Restricted, repetitive patterns of behavior, interests or activities manifested by at least 2 of the ff: (4Rs)
1. stereotyped or repetitive motor movements, use of objects or speech)
2. Insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal or nonverbal behavior
3. highly restricted, fixated interests that are abnormal in intensity or focus
4. hyper- or hypo-reactivity to sensory or unusual interest in sensory aspects of the environment
C. symptoms must be present in the early development period
D. Symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning
E. Disturbances are not better explained by intellectual disability or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur
RED FLAGS for ASD from 1-3yo
—–Social symptoms—–
Abnormal eye contact
Limited social referencing
(poor joint attention)
Limited interest in other
children
Limited functional play/no
pretend play
Limited motor imitation
Limited range of facial
expressions/ social smile
Contented to be left alone
—–Communication symptoms—–
Poor response to name
Failure to share interests
(thru pointing, giving, etc)
Failure to respond to
communicative gestures
Use other’s hands as a tool
Hand and finger mannerisms
Unusual sensory behaviors
Inappropriate use of objects
Screening fro ASD
Mgt
1. Screening
AAP recommendations for screening:
a. 9 mos = vision/hearing, gross and fine motor, receptive language
b. 18 mos = gross and fine motor,
personal/social, receptive and expressive language
c. 24 or 30 mos = receptive and expressive language, personal/social
d. Prior to school entry
As a general pediatrician, the MOST important role is to do the ff:
- Surveillance in every well child check-up/ clinical encounter
o Flexible, longitudinal continuous and cumulative process aimed to may have developmental problems - Screen
o Administration of a brief standardized tool for identification of children at risk
- MCHAT revised: done at 16-30 mos old - Refer for early intervention (OT, parent support, and education) and for formal assessment
- Provide a medical home
- Primary care that is accessible, continuous, comprehensive, family-centered, coordinated,
compassionate, and culturally effective
- Pediatrician works in partnership with family and patient to assure all medical and nonmedical needs of
child are met
- Thru partnership, HCP helps family and coordinate specialty care, educational services, out-of-home care, family support
- Recognize important role of community in supporting
healthy behavior among families - Risperidone (age 5-16yo) and aripiprazole (age 6-17yo)
– tx of irritability of ASD (physical aggression, selfinjury,
severe tantrum behavior)
- To facilitate the child’s adjustment and engagement with behavioral, educational, and communication
interventions
What is ADHD?
CH 33: ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD)
Etiopatho
- Characterized by difficulty paying attention, excessive activity, and acting without regards to consequences, which are otherwise not appropriate for a person’s age
- M>F
Pathophysiology of ADHD
Patho
- Exact cause is unknown in the majority.
- Possible dysfunction in the frontal, prefontal, parietal
lobe, cerebellum. Depressed dopamine activity in
caudate and limbic regions.
DSM-5 Diagnostic criteria for ADHD
A. A persistent pattern of inattention and/or hyperactivity/impulsivity
that interferes with functioning or development, as characterized
by (1) and/or (2):
- Inattention: Six (or more) of the following symptoms of
inattention have persisted for ≥6 mo to a degree that is inconsistent with development level and that negatively impacts directly on social and academic/occupational activities:
a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other
activities (e.g., overlooks or misses details, work is inaccurate).
b. Often has difficulty sustaining attention in tasks or play activities.
c. Often does not seem to listen when spoken to directly.
d. Often does not follow through on instructions and fails to
finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
e. Often has difficulty organizing tasks and activities.
f. Often avoids, dislikes, or is reluctant to engage in tasks
that require sustained mental effort (e.g., schoolwork, homework).
g. Often loses things necessary for tasks or activities (e.g., toys,
school assignments, pencils, books, tools).
h. Is often easily distracted by extraneous stimuli.
i. Is often forgetful in daily activities. - Hyperactivity/impulsivity: Six (or more) of the following
symptoms of inattention have persisted for ≥6 mo to a degree
that is inconsistent with development level and that negatively
impacts directly on social and academic/occupational activities.
a. Often fidgets with hands or feet or squirms in seat.
b. Often leaves seat in classroom or in other situations in which
remaining seated is expected.
c. Often runs about or climbs excessively in situations in which
it is inappropriate (in adolescents or adults, may be limited
to subjective feelings of restlessness).
d. Often has difficulty playing or engaging in leisure activities
quietly.
e. Is often “on the go” or often acts as if “driven by a motor.”
f. Often talks excessively.
Impulsivity.
g. Often blurts out answers before questions have been
completed.
h. Often has difficulty awaiting turn.
i. Often interrupts or intrudes on others (e.g., butts into
conversations or games).
B. Several inattentive or hyperactive/impulsive symptoms were present before 12 yr of age.
C. Several inattentive or hyperactive/impulsive symptoms are
present in 2 or more settings (e.g., at school [or work] or at home)
and is documented independently.
D. There is clear evidence of clinically significant impairment in
social, academic, or occupational functioning.
E. Symptoms do not occur exclusively during the course of
schizophrenia, or another psychotic disorder, and are not better
accounted for by another mental disorder (e.g., mood disorder,
anxiety disorder, dissociative disorder, personality disorder,
substance intoxication or withdrawal).
- Inattention domain – 5/9 behaviors if >17yo
- Hyperactivity domain – behaviors 1-6
- Impulsivity domain – behaviors 7-9
