Week 5 - Disorders of Childhood

Question 1

Are ‘diseases’ applied to neurodevelopmental or psychiatric conditions? Why/ why not?

What is the definition for disease?

Answer 1

No, because diseases are defined as a particular distinctive process in the body with a particular cause and characteristic symptoms

Question 2

What is a disorder in terms of psychiatric conditions?

Answer 2

Patterns of behavioural or psychological symptoms which impact multiple aspects of life

Question 3

Define disability according to the CDC.

What are the 3 characteristics of disability.

Answer 3

Any condition of the body or mind (impairment) which makes it more difficult for the person with the condition to complete certain activities and interact with the world around them (activity limitation)

1. impairment
2. activity limitation
3. participation restriction

Question 4

Explain neurodivergence

Answer 4

Cognitive or neurological differences are to be treated as any other human variation (e.g. height)

This prevents viewing neuodivergence through the medical model which postulates that these differences need to be treated, avoided or cured

Question 5

Distinguish between a mental illness and a neurodevelopmental disorder

Answer 5

A mental illness is:
a health condition which impacts significantly how individuals think, feel, behave and interact with other people (e.g. depression & anxiety)

Whereas a neurodevelopmental disorder is:
a condition which begins during infancy or early childhood development and is considered to be stable over time (life long).

It is characterised by a set of behaviours that arise as a result of factors that affect typical growth or development of the brain of nervous system.

Question 6

What are 3 aetiological factors of neurodevelopmental disorders?

Answer 6

Intrauterine environment (pre-birth factors)

Extrauterine environment (post-birth environmental factors)

Genetics

Question 7

List the Intrauterine environment (pre-birth factors) of neurodevelopmental disorders

Answer 7

hormone imbalances, e.g. gestational diabetes, poorly managed maternal thyroid function), intrauterine infection, alcohol/ tobacco/ illicit drug use

Question 8

List the Extrauterine environment (post-birth environmental factors) of neurodevelopmental disorders

Answer 8

Preterm birth, traumatic brain injury, exposure to heavy metals, malnourishment

Question 9

List the Genetic factors of neurodevelopmental disorders

Answer 9

Chromosomal disorders (e.g. Down’s Syndrome)
Single gene disorders
Multiple genes disorders

Question 10

List single gene disorders

Answer 10

Fragile X and Williams Syndrome

Question 11

List polygene disorders

Answer 11

Attention Deficit Hyperactivity Disorder (ADHD)
Autism Spectrum Disorder (ASD)
Tourrettes 
Dyslexia 
Intellectual Disability
Specific Language Impairment (SLI)

Question 12

What is involved in the diagnosis of neurodevelopmental disorders?

Answer 12

1. BEHAVIOUR is flagged by child’s care-givers or teachers
2. Child sees GP and is referred to a paediatrician
3. Diagnosis made by SPECIALIST against diagnostic criteria (e.g. paediatrician or psychiatrist). Gathers child’s history and BEHAVIOUR assessment conducted from other allied health professionals e.g. occupational therapist & parents/caregivers

Question 13

What are the 3 main reasons for diagnosis?

Answer 13

• determine the cause
• predict disorder prognosis
• formulate recommendations and treatments outcomes

Question 14

What are some issues in in the diagnosis of psychopathology in children?

Answer 14

USE OF THE MEDICAL MODEL FOR DIAGNOSIS
- particularly for neurodevelopmental conditions, must be framed negatively (e.g. condition is a deficit, delay, problem) to aide funding (e.g. Medicare, NDIS)

SEVERE BEHAVIOURS OR SYMPTOMS
e.g. being non-verbal, gastro symtoms thus needing a medical model for treament

NURODIVERGENCE
- there is contention within the neurodevelopment community about whether or not neurodivergence should be considered a part of human variation just like e.g. height..

Question 15

What factors are considered for a diagnosis for neurodevelopmental disorders?

Answer 15

• the presenting problems/ referral question “why are you here today”
• parents/ caregivers/ teacher’s questionnaires
• speech and language assessment
• cognitive asseessment
• developmental history
• behavioural assessment
• adaptive behaviour questionnaires (level of disability or or impairment)

Question 16

What are the weaknesses of the medical model for diagnosing neurodevelopmental conditions ?

Answer 16

• negativity; the language frames the conditions as a ‘deficit’ thus missing the child’s STRENGTHS
• assumption that symptoms must be treated is not exactly ethical
• doesn’t consider social/ environmental factors which contribute to disability
• –> some behaviours may allow a child to self-soothe thus don’t need to be changed

Question 17

For Autism Spectrum Disorder, what are the two essential categories in the diagnostic criteria according to the DSM-5?

Answer 17

1. Social communication/ interaction impairments

2. Restrictive and repetitive behaviour

Question 18

Autism has a strong genetic component, but it can also be “de novo”. What does this mean?

Answer 18

having a strong genetic component means that a child has a high chance of inheriting the disease from a parent.

De novo means that the condition onset began with that child.

Question 19

Roughly how long does it take to diagnose ASD?

Answer 19

3.5 years

Question 20

What are the verbal, non-verbal and social interactions examples for the diagnostic criteria of “Social communication/ interaction impairment” in ASD?

Answer 20

VERBAL

• Literal use of language, pedantic or formal language
• Odd or flat intonation, mechanical, very slow/labored or too quick

NON-VERBAL

• Atypical use of eye contact (avoid or prolonged)
• Atypical use of gestures, body language
• Difficulties reading facial expressions/ body language/ tone of voice of other,

SOCIAL INTERACTIONS

• Difficulties with understanding when other person is bored of conversation
• Difficulties knowing who’s turn it is to speak/ conversation stop-start difficulties// one-sided conversations
• Difficulties understanding why another person feels the way they do
• Difficulties with shifting rules of games

Question 21

What are the mannerisms, restricted interests and complex behaviours/routine examples for the diagnostic criteria of “Restrictive or stereotypical behaviors and interests” in ASD?

Answer 21

MANNERISMS

• Whole body spinning, rocking, shrugging, tongue clicking
• Finger mannerisms, flapping, jumping
• Facial posturing

RESTRICTED INTERESTS

• football stats, trains, dinosaurs, bus timetables, Harry Potter
• computer games/ fads e.g. My Little Pony, Shopkins

COMPLEX BEHAVIOURS/ ROUTINE
- Insisting on doing these the same way each time (e.g. same foods, same school routine, same clothes)

Question 22

What are the ‘other’ NON-diagnostic features of ASD? (and ADHD)

Sensory (ADHD)
Motor (ADHD)
Gastrointestinal

Answer 22

SENSORY

• hypo/hyper-sensitivity to touch, smells, sound and visual
• difficulties tuning out sensory information/ hyper-focus
• hypo/hyper-sensitivity pain
• needing to wear the same cloths, sensitivity to certain wash detergents, cutting off tags

MOTOR
- Clumsiness: dyspraxia (speech), gross motor coordination, visuomotor problems, fine motor problems (grip strength, handwriting)

GASTROINTESTINAL
- (Common with intellectual disability), severe constipation, stomach pain

Question 23

What is the DSM-5 criteria for ASD?

Answer 23

Two main criteria:

1. Social communication/ interaction impairment
2. Restricted and repetitive behaviours

• must be present during early childhood development
• causes significant impairment in daily functioning
• may also have language disorder or intellectual disability
• differentiate from: global developmental delay, trauma, ADHD

Question 24

In ASD, what are the 3 levels of significant impairment to daily functioning?

Answer 24

Level 3 - requiring very substantial support
Level 2 - requiring substantial support
Level 1 - requiring support

(3 being more support, 1 being less)

Question 25

What is Attention Deficit and Hyperactivity Disorder (ADHD)?

What is the average time of diagnosis?

Answer 25

ADHD is a neurodevelopmental disorder which is characterised by atypical development of the brain; the effects become apparent in childhood.

Includes: attention difficulty, hyperactivity and impulsiveness.

Average time: 5.5 years (during school years)

Question 26

What are the two main diagnostic criteria in ADHD?

Answer 26

1. Hyperactivity

2 Inattention

Question 27

True or False; on average, quality of life for ADHD is higher than that of ASD?

Answer 27

true

Question 28

What are the examples of Hyperactivity in ADHD?

Answer 28

• Interrupting
• trouble taking turns
• outbursts
• fidgeting
• having to get up for walks all the time
• risk-taking/ reduced impulse control
• lots of unfinished tasks
• difficulties sitting still (except for highly interesting tasks)

Question 29

What are the examples of Inattention in ADHD?

Answer 29

• Daydreaming
• forgetfulness (even with tasks done everyday)
• lack of attention/ distractibility
• avoidance of tasks which require a lot of mental effort or that aren’t motivating enough
• disorganisation

Question 30

What are the examples of Social distress in ADHD?

Answer 30

Difficulties recognising the needs of others

• difficulties taking turns
• difficulties attending to social cues (inattention)
• interrupting
• missing social cues (distraction)

–> outbursts

Question 31

What are the treatments for ADHD?

Answer 31

MEDICATION (front-line treatment)
- stimulants (for hyper-activity/inattention), sleep disorders co-morbid (melatonin), anxiety medications, aggression & irritability (risperidone).

BEHAVIOURAL
- parenting strategies, social strategies, skill development, anxiety management

SPEECH THERAPY

OCCUPATIONAL THERAPY
- fine& gross motor skills

Question 32

Whilst ADH has a strong genetic component (__ % genes ___ % environment) it is still highly stigmatised. What are some stigmas/ misconceptions associated with ADHD?

Answer 32

80% genes, 20% environment

1. over-diagnosis (not true - prevalence is 3-5%)
2. you “grow out of ADHD” - 80% have adult ADHD
3. Stigma against medication - side effects (zombies), Parents choosing easy way out, over-prescription
4. “don’t we all have a bit of neurodiversity

consequences: bullying, schooling interruption, difficulties maintaining friendships

Question 33

What is the problem with heterogeneity in ADHD/ ASD research?

Answer 33

• case (Child w/ condition) VS control
• doesn’t take into account co-morbidities in desig e.g. intellectual disability
• excludes children with co-morbidities
• only focusses on one aspect of cognition when aspects are usually interrelated e.g. Theory of Mind, Inattention or Hyperactivity

–> should focus less on symptom severity and more on functional outcomes

Question 34

What is the problem with heterogeneity in ADHD/ ASD clinical outcomes?

Answer 34

DSM-5

• whilst the criteria has great reliability; it is very broad.
• -> difficulties with predicting course, outcomes and response to treatment

BEHAVIOIUR

• e.g. hyperactivity, language delay might look the same across multiple clients however might have DIFFERENT causes
• -> e.g. environmental vs biological causes.
• this makes it treatment difficult

PATHOLOGISING TYPICAL DEVELOPMENT
- how do we define disability/ impairment to daily functioning

Question 35

To resolve the mess of subjectivity, dimensionality and heterogeneity there were two projects conducted.

List and explain what they are , are they top/down or bottom/up ?

Answer 35

RDoC (bottom/up)
- starts with genetics and considers environmental aspects to categorise clients

HiTop (top/down)