Week 5 - Disorders of Childhood Flashcards
Are ‘diseases’ applied to neurodevelopmental or psychiatric conditions? Why/ why not?
What is the definition for disease?
No, because diseases are defined as a particular distinctive process in the body with a particular cause and characteristic symptoms
What is a disorder in terms of psychiatric conditions?
Patterns of behavioural or psychological symptoms which impact multiple aspects of life
Define disability according to the CDC.
What are the 3 characteristics of disability.
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)
- impairment
- activity limitation
- participation restriction
Explain neurodivergence
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
Distinguish between a mental illness and a neurodevelopmental disorder
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.
What are 3 aetiological factors of neurodevelopmental disorders?
Intrauterine environment (pre-birth factors)
Extrauterine environment (post-birth environmental factors)
Genetics
List the Intrauterine environment (pre-birth factors) of neurodevelopmental disorders
hormone imbalances, e.g. gestational diabetes, poorly managed maternal thyroid function), intrauterine infection, alcohol/ tobacco/ illicit drug use
List the Extrauterine environment (post-birth environmental factors) of neurodevelopmental disorders
Preterm birth, traumatic brain injury, exposure to heavy metals, malnourishment
List the Genetic factors of neurodevelopmental disorders
Chromosomal disorders (e.g. Down’s Syndrome)
Single gene disorders
Multiple genes disorders
List single gene disorders
Fragile X and Williams Syndrome
List polygene disorders
Attention Deficit Hyperactivity Disorder (ADHD) Autism Spectrum Disorder (ASD) Tourrettes Dyslexia Intellectual Disability Specific Language Impairment (SLI)
What is involved in the diagnosis of neurodevelopmental disorders?
- BEHAVIOUR is flagged by child’s care-givers or teachers
- Child sees GP and is referred to a paediatrician
- 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
What are the 3 main reasons for diagnosis?
- determine the cause
- predict disorder prognosis
- formulate recommendations and treatments outcomes
What are some issues in in the diagnosis of psychopathology in children?
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..
What factors are considered for a diagnosis for neurodevelopmental disorders?
- 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)
What are the weaknesses of the medical model for diagnosing neurodevelopmental conditions ?
- 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
For Autism Spectrum Disorder, what are the two essential categories in the diagnostic criteria according to the DSM-5?
- Social communication/ interaction impairments
2. Restrictive and repetitive behaviour
Autism has a strong genetic component, but it can also be “de novo”. What does this mean?
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.
Roughly how long does it take to diagnose ASD?
3.5 years
What are the verbal, non-verbal and social interactions examples for the diagnostic criteria of “Social communication/ interaction impairment” in ASD?
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
What are the mannerisms, restricted interests and complex behaviours/routine examples for the diagnostic criteria of “Restrictive or stereotypical behaviors and interests” in ASD?
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)
What are the ‘other’ NON-diagnostic features of ASD? (and ADHD)
Sensory (ADHD)
Motor (ADHD)
Gastrointestinal
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
What is the DSM-5 criteria for ASD?
Two main criteria:
- Social communication/ interaction impairment
- 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
In ASD, what are the 3 levels of significant impairment to daily functioning?
Level 3 - requiring very substantial support
Level 2 - requiring substantial support
Level 1 - requiring support
(3 being more support, 1 being less)
What is Attention Deficit and Hyperactivity Disorder (ADHD)?
What is the average time of diagnosis?
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)
What are the two main diagnostic criteria in ADHD?
- Hyperactivity
2 Inattention
True or False; on average, quality of life for ADHD is higher than that of ASD?
true
What are the examples of Hyperactivity in ADHD?
- 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)
What are the examples of Inattention in ADHD?
- 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
What are the examples of Social distress in ADHD?
Difficulties recognising the needs of others
- difficulties taking turns
- difficulties attending to social cues (inattention)
- interrupting
- missing social cues (distraction)
–> outbursts
What are the treatments for ADHD?
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
Whilst ADH has a strong genetic component (__ % genes ___ % environment) it is still highly stigmatised. What are some stigmas/ misconceptions associated with ADHD?
80% genes, 20% environment
- over-diagnosis (not true - prevalence is 3-5%)
- you “grow out of ADHD” - 80% have adult ADHD
- Stigma against medication - side effects (zombies), Parents choosing easy way out, over-prescription
- “don’t we all have a bit of neurodiversity
consequences: bullying, schooling interruption, difficulties maintaining friendships
What is the problem with heterogeneity in ADHD/ ASD research?
- 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
What is the problem with heterogeneity in ADHD/ ASD clinical outcomes?
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
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 ?
RDoC (bottom/up)
- starts with genetics and considers environmental aspects to categorise clients
HiTop (top/down)
