Week 5 (Neural and Behavioral Development) Flashcards

Question

Temperament in infancy

Answer 1

Way in which child interacts and responds to his/her environment **Can change** over time with environment **Easy, slow-to-warm-up, difficult** = 40%, 15%, 10%

Answer 2

Infancy: **6 weeks**: controls **head** when held **upright** **4 months**: rolls **front** to **back** **6 months**: rolls back to front and **sits** unattended **9 months**: **pulls** **to** **stand** **12 months**: starts to **walk** unattended Toddlers: 15 months: crawl up stairs, walk backwards **18 months**: walk stairs with help and **run** 24 months: ball skills and walk on tip-toes 30 months: jump **36 months**: alternate feet up **stairs** Preschool: 3 years: use of utensils, broad jump, gallop (most show hand preference by age 3) **4 years**: alternate feet **down** **stairs**, hop and skip 5 years: balance 10 seconds on one foot and print letters School age: refined coordination for sports/fine arts

Answer 3

Infancy: 6 weeks: reaches for objects **4 months**: **grasps** objects **6 months**: transfers objects across **midline** and puts objects in **mouth** 9 months: plays pat-a-cake and uses refined pincer grasp **12 months**: tower of **3 blocks** Toddlers: **18 months**: **scribble** **24 months**: put on **garments** **36 months**: **9 blocks**; **bridge** of blocks; **R/L preference** School age: cursive, typing

Answer 4

Infancy: 1 month: responds to directed call **3 month: coos** **6 months**: **babbles** (mama, dada) **inappropriately** **9 months**: mama and dada **appropriately** 12 months: follows simple commands, at least 1 word Toddlers: **2 years: 2 words**; 50% intelligible; follow 2-step commands **3 years: 3 words** (phrases); 75% intelligible; follow multi-step commands **4 years: 4 words** (sentences); 100% intelligible Preschool: conversation, feelings, talk about past **School** age: inferences, jokes, **sarcasm**, reading **Adolescence**: comprehend **double meanings**, make inferences

Answer 5

Infancy: 3 months: responsive smile 6 months: sense of self and attachment with caregiver **9 months**: **separation and stranger anxiety** **12 months**: beginning of **empathy** **Toddler**: increasing **anxiety** over separation and seek extra support when returning, but as comfort level with separation increases, length of separation increases Preschool: **3 years**: **toilet trained**, know own age and gender, play imaginative, take turns, share 4 years: interactive play in small groups, pretend social scenarios and role playing **4-5 years**: simple board games, follow **rules** School age: accomplishment, best friend, segregate by gender, sportsmanship Adolescence: peer group sets standard, individuality from parents, romantic relationships, hobbies, etc

Answer 6

Infancy: 0-4 months: modify/regulate primitive reflexes **4-8 months**: **manipulate** objects meaningfully 7 months: attention span is 5 minutes **9 months**: **object permanence** 8-12 months: goal-directed behavior Toddlers: **12-18 months**: **cause** and **effect** 15 months: functional play (push the car) and early representational play (toy phone) **18-24 months**: symbolic representation and **body parts** 24 months: start of simple concepts (size, color, number) Preschool: **3-4 years: identify colors** 4-5 years: identify complex body parts **5-6 years**: understand **abstract** **symbols** (letters, numbers) **School** age: conservation, **reasoning**, organization (HW), **active working memory**, attn span 1 hour **Adolescence**: abstract thinking, **hypotheses**, deductive reasoning, speculate and consider alternative possibilities (can lead to idealism)

Answer 7

**Parent questionnaires** and **examiner based assessments** Early development: Denver Developmental Assessment and Mullen scales of Early Learning (ages 0-5) Cognitive assessments: WPPSI (ages 3-7), WISC-IV (ages 6-16)

Answer 8

Incorporates mechanisms that are able to deal with targeting errors and with influences that derive from **interactions with** **the** **environment**

Answer 9

Prominent features of neural development Naturally occurring **cell death** **Pruning** exuberant connections and synapses (reduction in grey matter during childhood and adolescence) Combinations of **synaptic** **plasticity** and **regressive** **events** during juvenile development allow interactions with the **environment** to **"sculpt" neural systems** in permanent or long lasting ways: **"critical periods,"** language, ocular dominance, colonization of "unused" cortex

Answer 10

Plays central role in the formation of neural circuits More neurons are born than are needed Only those neurons survive that make connections to appropriate target neurons Survival is determined by **retrograde** **transport** of **trophic** **factor** produced by target cells!

Answer 11

Neuronal survival is supported by neurotrophic growth factors (**NTF**) that are produced by **target** neurons and are **retrogradely** **transported** by input neurons **Afferent** (signaler) neuron must be **active** in order to cause target neuron to secrete NTF though! **External (environmental) factors** that influence target neural activity can alter trophic factor production and **influence circuit development!**

Answer 12

Pruning of connections plays a central role in the formation of neural circuits More connections are made than are needed Only appropriate connections are maintained **Maintenance** of connections is determined by **neural** **activity** and by **trophic** **factors** produced by target cells Axons can overshoot their normal targets by long distances and send out many exuberant branches that are either pruned or in some cases persist on the basis of activity dependent interactions.

Answer 13

**Environmental** **factors** that influence target cell activity and **trophic** **factor** **production** can sculpt circuit development by influencing afferent neuronal survival and the maintenance of connections Environmental factors that influence target cell activity by the afferent neuron can regulate trophic factor production by the target neuron, which in turn can sculpt circuit development by influencing afferent neuronal survival and synaptic connections If **no** activity, whole connection **pruned** If **weak** activity, synapses **may** **be** pruned If **highly** active, synapse **strengthened**

Answer 14

Founding member of the **neurotrophin** family Can activate multiple signaling pathways that influence different cellular processes (PI3 kinase for **cell** **survival** and ras and PLC pathways for **neurite** **outgrowth** and **neuronal differentiation**)

Answer 15

BDNF, NT3, NT4/5 These are structurally related to NGF but also have other functions in mature animals (other than developmental growth factors)

Answer 16

NGF, BDNF, NT3, NT4/5, CNTF, FGFs, IGF, EGF, thrombospondin (produced by astrocytes) Capable of complex signalling interactions that can influence many different cellular activities during development and after maturity (cell survival, neurite outgrowth and neuronal differentiation, activity-dependent plasticity, cell cycle arrest, cell death) Different neurotrophins, alone or in combination, help to determine final pattern of connectivity of sensory neurons in the peripheral nervous system by mediating target effects on regressive effects that determine which neurons and terminals survive pruning

Answer 17

**Steroids** (sex and adrenal) **Thyroxin** **Transmitters** Etc

Answer 18

New growth in the form of **terminal** **sprouting**, dendritic **branching** and **synapse** **formation** are important aspects of juvenile neural development that add substantially to tissue volume Synapse formation also "sculpted" by environmental interactions or influenced by exposure to hormones, toxins and other molecules Note: **neuropil** fills space between neurons with **dendritic** **branches** and **synapses**, which is **a lot of space**, so changes in neuropil **volume** (which correlates with synapse density) can be measured in **MRI** scans

Answer 19

Adolescents with schizophrenia have **decreased** **grey** **matter** in cortex This loss may correlate with i**ncreased synaptic pruning** and decreased synaptic density

Answer 20

**Developmental** **windows** in which **anatomical** **connections** and **functional** **properties** of neural cells and circuits can be **modified** **by** **experience** (AKA environmental interactions during juvenile development can have permanent effects on CNS structure) Changes (increases or decreases) in activity during the brief developmental "critical periods" can cause **permanent changes** in CNS structure Critical periods are windows of opportunity--activity that occurs after a critical period has passed will not be able to establish the normal adult pattern of structure Loss of activity in adults does not alter the established structural pattern in adults in the same way as loss of activity during the critical period The time of critical period varies with systems Examples at the **behavioral** level: parent **imprinting** in birds, **language** in humans (learn language with no accent if 3-7yo) Example at the cellular level: **visual** system

Answer 21

Evidence for environmental regulation (pruning) of afferent axon terminals in ocular dominance columns in the **primary visual cortex** During development, projections from both eyes initially overlap, followed by progressive segregation of projections into **separated** **domains** for each eye by **pruning** of exuberant collateral branches (this segregation requires stimulation in the form of light activation of the retina) If **light** **activation** of retina and pathways is **blocked** in one eye during critical period of development (2-3 months), then the pathways of the activated eye survive, while those of the **un-activated eye are pruned**

Answer 22

**Amblyopia** is abnormal development of visual cortex due to **deprivation of vision in one or both eyes** during childhood due to **strabismus**, congenital **cataract** or other causes Untreated strabismus can lead to **domination** of visual cortex development by **one** **eye**, with consequent **failure** of development of **binocular vision** Treatment consists of achieving binocular stimulation of the visual cortices by use of eye **patches** (over dominant eye) or **glasses** (or surgery to adjust extra-ocular muscles) Treatment is most effective when initiated **before 5 years of age**, and is somewhat effective in teenagers and less so in adults

Answer 23

In sighted people, V1 is the primary visual cortex In the blind (from birth), **V1** can be used for **verbal** **memory**

Answer 24

Autism Spectrum Disorders (**ASD**) Attention deficit hyperactivity disorder (**ADHD**) **Schizophrenia** Fetal alcohol syndrome (**FAS**) (Drugs of abuse) Potential causes include **genetic** associations and exposure to **toxins**, the timing during development of which determines symptoms

Answer 25

Neuropathological evidence for multiregional dysregulation of neurogenesis (increased brain mass, increased regional cell densities, reduced neuronal size), neuronal migration (heterotopia (abnormal neuronal groups), dysplasia of cortical architecture (dyslamination)), synapse development (abnormal signaling in post-synaptic spines and dysregulation of glutamate signaling in Fragile X) Imaging evidence for increased brain mass, abnormal myelination Etiologies are not certain: evidence for complex genetic influences, but also ASD symptoms from single gene mutations (Fragile X syndrome with FMR1 and Rett syndrome with MECP2)

Answer 26

ADHD and FAS exhibit abnormalities of cerebral cortex development that result in certain cortical regions having either **increased** or **decreased** **cortical** **thickness** relative to controls This suggests it may be possible to identify cortical changes associated with **behavioral** **phenotypes** and eventually may help with **diagnosis** or **therapy**

Answer 27

**Social interactions** **Training** and **learning** Exposure to **toxins** Essential **nutrients** **Hormones**

Answer 28

**Emotional** or **affective** bond between **infant** and **caregiver** Nature of attachment relationship is thought to reflect the quality of **interaction** between infant and caregiver, not to be reflective of attributes of either the infant or caregiver alone Thus, each attachment relationship is **unique** to a particular dyad Caregiver functions (ideally) as a **secure** **base** and as a **safe haven**

Answer 29

Caregiver functions (ideally) as both of these **Secure** **base**: when a child trusts that (s)he has a sensitive, responsive, dependable caregiver, (s)he is able to **venture** **out** and **explore** the world around him/her **Safe** **haven**: when a child trusts that (s)he has a sensitive, responsive, dependable caregiver, (s)he will seek **comfort** or **reassurance** from that caregiver when (s)he feels distressed or threatened

Answer 30

**Organized** **system** of behaviors (not just single behavior) that infant uses to maintain interaction, proximity, connection with caregiver Activated under conditions of **threat** Serves a **protective** function, **evolutionarily** adaptive

Answer 31

Can be **primary** and **secondary** Historically, mothers were considered a priori to be primary attachment figure, but now is increased recognition that other caregivers can be primary attachment figures (fathers, grandparents, child care providers) As childcare duties are dispersed across more caregivers, child may develop more than one primary attachment figure

Answer 32

John Bowlby's assumptions **Early infant-caregiver interactions** are viewed as a foundation for other **social** **relationships** established in **childhood, adolescence, and adulthood** Patterns of dyadic regulation between infant and caregiver give rise to the child's ability to **self-regulate** Quality of attachment relationship (secure vs. insecure) reflects differences in these patterns of dyadic regulation Quality of child's early attachment relationships will have implications for patterns of adaptation throughout the **life** **span**, with regards to **behavioral, social, emotional, cognitive functioning**

Answer 33

Early development is inextricably embedded in the infant-caregiver relationship The human infant relies on caregiver not just for sustenance but for **external** **regulation** of physiological states Over time we learn to regulate ourselves, but this ability to self-regulate originates in large part in the context of earliest relationships with caregivers

Answer 34

Just a few hours after birth, infants will show preference for mother's **face** over a female stranger's and that preference will occur even with relatively little viewing of the mother By 1-2 days of life, infants can recognize mother's **smell** As early as 3rd day, infants can discriminate mother's **voice**

Answer 35

**Mutual** **regulation**: mothers and newborn infants help regulate physiological responses **of one another** Ideally a synchrony develops between infant and caregiver: the "dance" that occurs between parent and child during brief, but emotionally intense, playful interactions Notably, much of infant-caregiver interaction involves **mismatched** **states**: the key is not whether infant and caregiver are always in sync, but whether there are attempts to **repair interactions**

Answer 36

Lab procedure to develop methodology for assessing patterns of infant-caregiver interaction in order to provide empirical **validation** for **attachment theory**

Answer 37

**Secure**: 65%; **actively** **explores** environment, shares experience w/caregiver, visibly **upset** during separation (esp second separation), **actively** **greets** parent upon reunion; if upset, seeks proximity to caregiver and can be **soothed** by caregiver; once comforted, returns to exploration **Avoidant**: 20%; readily explores environment, but **minimal** display of **affect** or using parent as secure base; **minimal** apparent **distress** during separations; little or no proximity seeking upon reunion, possible active avoidance; may stiffen, **lean away**, prefers to interact with toys **Ambivalent/resistant**: 15%; exploration is of **poor** quality, often visibly **distressed** even before separation; extreme distress during separations; mixes **proximity** **seeking** with **resistance** upon reunion, cannot be soothed **Disorganized**: 15%; behavior **lacks** any apparent **goal** or intention; displays of **contradictory** behavior, often simultaneously; incomplete, interrupted movements; odd postures, stereotypes, freezing, stilling, fear grimaces

Answer 38

**Secure**: parent responds **sensitively** and **consistently**; child feels comfortable expressing range of emotions; child can be soothed, and learns to **soothe self** **Avoidant**: parent is **rejecting**, minimizes child's distress, may **mock** or express resentment at child's expression of distress; child learns to **suppress** emotional needs **Ambivalent/resistant**: parent is **inconsistently** available, may alternate between being neglectful and intrusive; may use **threats** **of** **abandonment** as a means of control; child learns to heighten, **exaggerate** **distress** **Disorganized**: parent may be **abusive**, or caregiver has been traumatized themselves: **frightening** or frightened behavior; child has no clear consistent strategy for regulating emotions

Answer 39

Clear set of **expectations** about availability, responsiveness, and sensitivity of their primary caregiver(s) Mechanism that provides for **continuity** in attachment across the life span Are carried forward into other social relationships and used to appraise interactions and **guide** **behavior** in the context of those relationships

Answer 40

**Secure**: better **social** **skills**, more **elaborative** **play**, more **independent** **exploration**, better **cognitive** **skills** and **academic outcomes** **Avoidant**: more **hostile** and less empathetic with peers, more **conflict** in play, more easily **frustrated** **Ambivalent**: more vulnerable to **bully**, show empathy but difficulty with boundaries, elicit nurturance from more competent peers and from teachers, more **inhibited** in play, **restricted** **exploration** during play **Disorganized**: wary and **withdrawn**, views peers as threatening, play characterized by **catastrophic** **themes**, enhanced response to **stress**

Answer 41

**Secure** **attachment** in infancy predictive of greater **social** **competence** during adolescence **Disorganized** **attachment** in infancy predictive of **hostility** in romantic relationships in early adulthood, two decades later and predictive of **conduct** **disorder**, self-injurious behavior, and dissociative symptoms at age 17 **Ambivalent** **attachment** in infancy predictive of **anxiety** disorders at age 17

Answer 42

**Insecure** **attachment** in toddlerhood related to **obesity** at 4 1/2 years old Girls who were **insecure** as infants have shown an **earlier** onset of **puberty** then those who were secure as infants **Insecure** **attachment** in infancy predicted higher rates of **inflammation-based illness** 30 years later

Answer 43

Focus is on **enhancing** the **quality** of the caregiver-child relationship and the child's environment Fostering parental **sensitivity** Teaching parent to **read** and **respond** appropriately to child's emotional cues Teaching parent how to help child develop **emotional** **regulation** skills Increasing **stability** and **support** in the child's environment Tend to be relatively **short term, focused, and with clearly defined goals** Targeted populations: maltreating families, parents with substance abuse problems, depressed mothers, adolescent mothers, preterm infants, children in foster care and adopted children, children with prenatal alcohol exposure

Answer 44

Onset **during** **pregnancy** and up to **one year after delivery** Not to be confused with the "baby blues" **Major depressive disorder** **Anxiety** disorders (OCD, panic disorder, general anxiety disorder) **Bipolar** disorder Postpartum **psychosis**

Answer 45

**MDD: 3-5%** Low-income or **minority** women: 30-40% Incidence **3x higher** in postpartum

Answer 46

Infrequent and **late-entry prenatal care** **Appetite** disruptions **Sleep** disturbances, fatigue Increased risk of **substance** use and **smoking** **Suicidal** **thoughts** and/or actions

Answer 47

**Pre-term delivery** **Low birth weight** **Lower Apgar scores** Elevated **"stress hormones"**

Answer 48

Increased **crying** and **irritability** **Decreased** duration of **breastfeeding** **Increased** risk of child **abuse** and **neglect** **Poor attachment** to mother (emotional disconnection, less face-to-face, less skin-to-skin)

Answer 49

**Cognitive delays** **Poor social/emotional development** **Affect dysregulation** **Behavior disorders** **Anxiety/depression** **Substance abuse** **Poor adult relationships**

Answer 50

Antepartum: high risk OB (particularly **inpatient**), **infertility** hx, **perinatal** **loss** hx, **crisis** pregnancy Postpartum: **traumatic** delivery, **adoption** **NICU** moms **PICU** moms (child abuse/neglect) **Teen** moms/**single** moms **Substance abusers** **Domistic violence survivors**

Answer 51

"You are **not** **alone**" "You are **not** **crazy**" "With the right help, you **will feel better**"

Answer 52

Birth defects? Paxil (**paroxetine**) has possible increased risk of **heart defect** (FDA black box warning); possible uptick in spontaneous abortion (**miscarriage**) Medical risks? Increased risk of **preterm** delivery, **HTN**, poor neonatal adaptation (**PNA**), question of increased risk of persistent pulmonary hypertension of the newborn (**PPHN**) Long-term developmental effects? Little data, but what we have is reassuring; autism data under investigation

Answer 53

Use only when **necessary** and **appropriate** **Do not avoid** if woman truly needs Minimize number of exposures Use **lowest** possible **dose** Consider **breastfeeding** early and often

Answer 54

Consider **early in pregnancy** or even before Safest medications are **sertraline (Zoloft)**, **paroxetine (Paxil)** and **nortriptyline** Use **lowest** possible **EFFECTIVE** dose **Sleep** disturbance heightens risk for relapse It's OK not to breastfeed

Answer 55

**60%** monozygotic twin concordance **20%** chance of having second child with ASD However, 20% of individuals with AS have identifiable **genetic disorders** (Fragile X, tuberous sclerosis, Rett syndrome)

Answer 56

Early dysregulation of brain growth: **rapid early growth** (white and gray matter), **plateaus** at age 2-4, likely affects **long range connectivity** Aberrant connectivity (**local** **overconnectivity** and **regional underconnectivity**) 30% have **macrocephaly** Most brain regions implicated

Answer 57

1) Qualitative impairments in **social** **interaction** 2) Qualitative impairments in **communication** 3) **Restricted**, **repetitive** and stereotyped patterns of behavior, interests and activities 4) Delay or abnormal functioning in at least one of the following areas, onset **before age 3**: **social** interaction, **language** as used in social communication, **symbolic** or imaginative play 5) **Not** better accounted for by **Rett's disorder** or **childhood disintegrative disorder**

Answer 58

1) Qualitative impairments in **social interaction** 2) **Restricted**, **repetitive** and stereotyped patterns of behavior, interests and activities 3) Disturbance causes clinically significant impairment in **functioning** 4) **No** clinically significant general **delay** in **language** 5) **No** clinically significant **cognitive** or **adaptive** delay

Answer 59

Severe and pervasive impairment in the development of reciprocal **social** interaction PLUS impairment in either verbal or non-verbal **communication** skills OR presence of **stereotyped** behavior, interests and activities

Answer 60

In DSM-V, will have only **ASD** instead of autistic, asperger's and PDD-NOS

Answer 61

A) Persistent deficits in **social** **communication** and social interaction across contexts B) **Restricted**, **repetitive** patterns of behavior, interests, or activities C) Symptoms present in **early childhood** (doesn't have to be before age 3) D) Symptoms limit/impair everyday functioning E) **Severity** **rating** for each subdomain F) Specifier for **cause** (ie Fragile X) G) Modifier for **other** important factors (ie **seizure** disorder) H) Assessment of **overall impairment**

Answer 62

Impairment of **pragmatics** Diagnosed based on difficulty with **social** **uses** **of verbal and nonverbal communication** which affects functional development of social relationships and discourse comprehension (combined social and communication instead of separating them like DSM-IV) Cannot be explained by low abilities in word structure, grammar or general cognitive ability Symptoms must be present in **early childhood** **ASD** must be **ruled** **out** for SCD diagnosis

Answer 63

**Core**: **social** impairment, **repetitive** behaviors/restricted interests, speech/**communication** deficits (autism only) **Psychiatric** sx: social phobia, ADHD, aggression, OCD **Cognitive**?: expressive/receptive language disorders, intellectual disability Other: **immune** dysfunction, **sleep** disturbance, **motor** problems (apraxia), **macrocephaly**, **GI** disturbance, **epilepsy** (EEG abnormalities)

Answer 64

Very common (80%) Most commonly **insomnia** Delayed sleep onset, night awakening, early morning awakening, reduced need for sleep Longer sleep latency, **increased** duration of **stage 1 sleep**, **decreased** non-REM sleep (**stages 2-4**), **abnormal REM** sleep **"Bad sleepers"** have **worse** cognitive ability, affective problems, hyperactivity, etc

Answer 65

**Abnormal** **EEGs** in up to 50% **Epilepsy** in 30% No primary seizure type Two peaks: early childhood and adolescence ASD + **intellectual** **disability** = more likely to have **epilepsy** than ASD alone More common in ASD **girls**

Answer 66

**Repetitive** **behaviors** part of diagnostic criteria (both because of insistence on sameness and repetitive behaviors) More severe over development More **predominant** in children with severe **language** impairment **Motor** **delay**, **hypotonia** (improves over time), **incoordination**, gait impairment (**toe** **walking** common), **apraxia**, motor planning, postural control No studied treatments for **motor** impairments except **Risperidone** for repetitive behaviors

Answer 67

Gross motor function at age **6 months** significantly **correlated** with visual reception, receptive language and requesting at **12 months**

Answer 68

**ADHD** (cannot formally diagnose in ASD): inattention, hyperactivity **Anxiety** (particularly as children get older) **OCD** Excessive **repetitive** behaviors **Irritability/behavioral problems**

Answer 69

At **18 months**: **M-CHAT**, PDDST-II, Autism Screening Questionnaire Immediate referral if: **fails** screening ("no" to 2 questions), **no babbling/pointing** by 12 mo, **no spontaneous single words** by 16 mo, **no 2-word spontaneous phrases** by 24 mo, any loss of language or social skills at any age, esp before 24 mo

Answer 70

Neuropsychological to test **IQ**, **behavioral** or **emotional** problems, **learning** profile **Genetics**: karyotype, Fragile X, MECP2 mutation, chronosomal microarray analysis **MRI** only if abnormal **neuro** exam or global developmental delay **EEG** only if concern for **seizures** or **language regression**

Answer 71

Treatment intensity more than **25 hrs/wk** High staff:student ratio Teachers with special expertise Individualized programs for each child **Behavioral** **treatment**: ABA, PRT, DIR/floortime, JASPER Pharmacotherapy: FDA approved for 5-16yo with ASD for irritability: **Risperidone**, **Aripripazole** (Abilify) **No medications** shown to change social interaction or communication (**core deficits**)

Answer 72

**Behavioral** interventions: bedtime **routines**, **reinforcement** and extinction, parent training **Pharmacologic**: **melatonin** (3-6mg at bedtime), clonidine, trazadone

Answer 73

Because of heterogeneity, there is **no gold standard** treatment **Early** recognition and treatment important Anti-epileptics: **Leviteracitam**: behavioral side effects **Valproid** **acid**: liver toxicity **Benzodiazepines**: drowsiness **Lamotrigine**: SJS

Answer 74

Get **increased** **efficiency** at the **cost** of **decreased plasticity** As we get **older**, less used connections die away (synaptic **pruning**) but **more used** circuits are insulated with **myelin**, which increases conduction speed

Answer 75

Yes! **Thick** cortex = **worse** vocabulary In kids with **superior** **intelligence**, their cortical **thickness** **peaks** **later**, which means they had **more** **time** for synaptic **plasticity** before pruning/making brain more efficient

Answer 76

**Children** have more **diffuse** activation whereas **adults** have more **focal** organized activation This is thought to reflect **decrease** in **plasticity** and **increased** **efficiency**, and maybe the synaptic pruning/increased myelination

Answer 77

Cortex is **thicker** in **FASD** (more is not better!)

Answer 78

In general: **distal** brain regions **don't communicate well**, and there is **excessive** **local information processing** Time course of development is altered Evidence for **early brain overgrowth** followed by **reduced growth trajectory** Autistic children begin life with **larger amygdala**, then **develop at reduced rate** Abnormal growth of white matter: **late-myelinating white matter** compartments **overdeveloped** while **earlier myelinating** deep/bridging zones and **longer** range pathways **less developed** --\> **problems** in **long-range connections** in the brain **Abnormal cortical folding** in inferior frontal gyrus, inferior sensory and motor strips, pars opercularis (containing mirror neuron system for immitating) **Lower** response to **reward**

Answer 79

**Fronto-striatal** network abnormalities **Increased** prefrontal **gray** matter in hyperactivity in **ADHD**

Answer 80

Difficulty with **written** **language** (reading and spelling) Differences in how brain processes written and/or spoken language Many brain regions involved in reading, and dyslexic patients show structural differences from controls in these regions

Answer 81

Testosterone affects with cortex thickness In **boys**, cortex gets **thicker** as testosterone increases In **girls**, cortex gets **thinner** as testosterone increases

Answer 82

6 out of 9 of **innatentive** symptoms and/or 6 out of 9 of **hyperactive/impulsive** symptoms Symptoms present more often than not; chronic course Some sx begun **before age 7**

Answer 83

**No objective test** Several rating **scales** and **questionnaires** (Connors' SNAP, SWAN) that are structured ways of asking about the DSM criteria Must take **developmental context** into account One 30 min encounter with a paient does not rule anything in or out

Answer 84

**30-60%** of people diagnosed with ADHD as children will continue to meet criteria for disorder as **adults** In **short** **term**, **medication** results in significant improvement in academic functioning In **long term**, academic benefits of medication are **modest** and medicated children with ADHD still do not perform as well as neurotypical peers, on average **Hyperactive/impulsive** symptoms tend to **improve** by adulthood, but **inattentive** symptoms **remain**

Answer 85

Oppositional defiant disorder (**ODD**)/conduct disorder (25-33%) **Learning** disorder/language disorder (25%) **Anxiety** disorder (13%) **MDD** (11%) **Substance** **abuse** disorder (20-25%)

Answer 86

Patients less likely to engage in **criminal** **behavior** than unmedicated patients

Answer 87

**Stimulant**: **methylphenidate** (concerta, ritalin) and **mixed** **amphetamine salts** (adderall, vivance) **Non-stimulant:** **atomoxetine**, guanfacine, **clonidine**

Answer 88

Most common is **appetite suppression** **Insomnia**, **mood** changes, increase in **tics**, cardiac **arrhythmias** Long term stimulant use associated with slightly **decreased height** in children

Answer 89

**Classroom** or workplace modification, **behavioral** therapy, **social skills** training, **psychoeducation**

Answer 90

**DSM** definition: discrepancy between **aptitude** and **achievement** in a particular skill **Federal** IDEA standards: if child does not meet **grade-level standards** for the categories listed below and does **not respond** to evidence based intervention

Answer 91

Child must be given an **evidence-based intervention** in that area If child does not respond to that intervention, **evaluation** is done and diagnosis of **LD** can be given

Answer 92

38% with LD have **ADHD** 50% with LD also have **ASD** Other: **anxiety, ODD, conduct disorder**

Answer 93

**Tier 1**: general **classroom** remediation **Tier 2**: **small** **group** instruction **Tier 3**: **individual** instruction, **special education** **No specific pharmacotherapy** for LD, but treating co-morbid conditions always makes things better

Answer 94

Both ADHD and reading disorder seem to have **heritability** of **60%** **Hundreds** of risk genes for ADHD, and **overlap** between risk genes for **ASD**, **schizophrenia** and **ADHD** Candidate genes exist for **reading** disorder, with some overlap for risk with **speech** disorders

Answer 95

ADHD results from dysfunction of **DA** circuits in **PFC**, resulting in **diminished executive function** Imaging studies have shown differences in **L hermisphere occipito-temporal cortex** and **cerebellum** between patients with reading disorder and controls; several candidate genes are involved in neuronal migration

Answer 96

Interplay of **neurochemical** **signaling** in **homeostatic** and **reward** pathways 1) **Direct** regulation by stimulation or suppression of appetite in the **hypothalamus** in response to molecular **signals** from **viscera** 2) **Indirect** regulation by influencing the **reward** value of food in the **mesolimbic** reward pathway 3) **Indirect** modulation by **higher** brain systems

Answer 97

**Cognitive** input (desired **body** **image**, concepts of **health**, **stress**, etc) --\> **contextual** information (cerebral cortex, amygdala, hippocampal formation) --\> **hypothalamus** (compares input to biological set points) \<--\> **mesolimbic** **reward** pathways --\> appetite and feeding behavior **Sensory** inputs (**visceral** and **somatic** sensory pathways, chemosensory and humoral signs) --\> **hypothalamus** (compares input to biological set points) \<--\> **mesolimbic** **reward** pathways --\> appetite and feeding behavior Note: **biological set points** are **plastic** and are established during **development** and can be influenced by **habits** and by **environmental toxins**

Answer 98

**Ventro-medial** areas drive **satiety** (lesions cause hyperphagia and obesity) **Dorso-lateral** areas drive **feeding** (lesions cause hypophagia and starvation)

Answer 99

**Orexigenic** neuromodulators **stimulate** appetite: **orexin**, NPY, AgRP from hypothalamus; **ghrelin** from stomach **Anorectic** neuromodulators **inhibit** appetite: **histamine** and **alphaMSH** from hypothalamus; **leptin** from adipocytes; **insulin** from pancreas Appetite is directly regulated by neurochemical signaling in hypothalamic pathways

Answer 100

They travel via **circulation** to modulate **hypothalamic** circuits Leptin and insulin act on **hypothalamic** **arcuate** **nucleus** to suppress appetite

Answer 101

If **no** **leptin**, nucleus accumbens activation by visual images of food is **higher** (will get **more reward** from looking at food) **Indirect** regulation by influencing reward value of food by controlling **DA release** **Direct** regulation by stimulation or suppression of appetite

Answer 102

Yes, neurochemical inputs of **many** **kinds** and from **many** **sources** (including higher brain centers like cortex, amygdala, etc) modulate **reward** circuits **Histamine, GABA, leptin, insulin** are **inhibitory** **Ghrelin, orexin, glutamate, endocanabinoids** are **excitatory** **Exogenous** neurochemicals (drugs, meds) can also influence these pathways

Answer 103

Defects in **negative** **feedback** predispose to **weight gain** and **insulin resistance** **Fat mass** and **pancreas** (producing **insulin** and **leptin**) feed back into hypothalamus which interacts with **biological set points** and **reward** system and perceived **value** of food and regulates food **intake**, e**nergy expenditure** and **glucose** **production** in the liver **Neurocentric** model linking **obesity, insulin resistance** and **T2DM**: **reduced neuronal insulin/leptin** favors **positive energy balance** and hepatic **insulin resistance**

Answer 104

Same neurochemical signaling in reward and homeostatic pathways, which are influenced by **pro-inflammatory cytokines** Pro-inflammatory cytokines **stimulate** **anorectic** and **inhibit orexigenic** pathways

Answer 105

Eating disorders relatively **rare** among general population **Anorexia nervosa** most common among **young women** All eating disorders associated with increased risk of **mortality** **Binge eating** most common in **men** and **older** people

Answer 106

**Refusal** to maintain body weight at or above a minimally normal weight for age and height (more than 85% of what is expected) **Intense** **fear** of gaining weight or becoming fat, even though underweight Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on **self-evaluation**, or **denial** or seriousness of current low body weight In postmenarcheal females, **amenorrhea** (absence of at least 3 consecutive)

Answer 107

**Restricting** type: during current episode of anorexia nervosa, person has not regularly engaged in binge-eating or purging behavior **Binge-eating/purging** type: during current episode of anorexia nervosa, person has regularly engaged in binge-eating or purging behavior

Answer 108

Bone: Ca2+ loss --\> **osteoporosis** Cardiac abnormalities, **arrhythmia** **Constipation** (gut slows) Orthostatic **blood** **pressure** changes **Amenorrhea** **Electrolyte** **abnormalities** (K+) **Renal compromise** or failure **Body hair** increases **Cognitive impairment** **Cortisol** regulation altered

Answer 109

These appetite modulators affect non-homeostatic cognitive, **emotional** and **rewarding** component of **food intake** as well as **non food-related reward** AN/BN pathophysiologically linked to dysfunctions of reward mechanisms Development and/or maintenance of aberrant non-homeostatic behaviors such as self-starvation and binge eating may be **due to changes in appetite modulators**

Answer 110

Incidence highest in **females 15-19** Not clear if incidence is rising, although it might be in that age group 5 year recovery rate is 67% **Highest** mortality rate of any mental disorder: 5% per decade 20% of those deaths are **suicide**

Answer 111

Recurrent episodes of **binge** **eating**, characterized by: 1) Eating, in a discrete period of time (within 2 hour period) an amount of food that is definitely **larger** than most people would eat during a similar period of time and under similar circumstances 2) A sense of **lack of control** over eating during the episode Recurrent **inappropriate** **compensatory** behavior in order to **prevent weight gain**, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise The binge eating and inappropriate compensatory behaviors both occur, on average, **at least twice a week** for **3 months** **Self-evaluation** is unduly influenced by body shape and weight The disturbance does not occur exclusively during episodes of AN

Answer 112

**Purging** type: during current episode of BN, the person has regularly engaged in **self-induced vomiting** or the misuse of **laxatives, diuretics,** or **enemas** **Nonpurging** type: during the current episode of BN, the person has used **other** inappropriate compensatory behaviors, such as **fasting** or **excessive** **exercise**, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Answer 113

Median onset at **12.4 years** Lifetime prevalence in US is 0.6% **88%** report at least one **other Axis I disorder** **53%** report **suicidal** thoughts More prevalent in **girls** than boys

Answer 114

**New** diagnosis in DSM-V Common in US **adolescents** Diagnosis requires **binging** at least **once** **a week** for **3 months** **No compensatory behavior**, so may be **overweight**

Answer 115

Very common diagnosis now using DSM-IV, but after DSM-V broadens AN and BN and adds binge eating disorder, won't be used as much

Answer 116

Not about eating per se but appears related in terms of **distortion of body image** **Focus** on some aspect of appearance which is seen as ugly **Fixed delusion** Has fMRI similar to those of AN Can lead to **plastic surgery**, with chronically dissatisfied result

Answer 117

Way of **coping** with **emotions** and **feelings** of failure **Anorexia** uses **control of food**, **exercise** and the body to combat a sense of **losing control** and to succeed **Binging** uses food to try to **soothe** or get **pleasure** and then lose control Both anorexia and bulimia have **disordered** **focus** on weight Cultural expectations contribute to this, but certain temperaments will be more susceptible Heredity is also a factor, as is learning in a family

Answer 118

**Anorexia**: **hard-working, perfectionist, demanding of self**; when confronted with challenges of adolescence feels a bit **overwhelmed** and works even harder; usually has lost weight on **purpose** or with an **illness**, and discovers the **power** of control over the body **Bulimia**: **emotional, somewhat impulsive**, may have a history of **loss** or **trauma**; may have binged or purged with others who were doing it casually (very common at college)

Answer 119

**Re-feeding** is first, as this can be a medical emergency, but must be done gradually, even if by tube **Structured** eating (learn to eat, but also tolerate feeling of fullness) and limited activity at first **Tolerative** changes in body (which are not cosmetic at first) **Family** **therapy** to change interactions about food and to change how family is controlled **Gradually** add in appropriate **activity** Work on **self image** about body, but only after patient is able to think clearly

Answer 120

**Prevent purging** by observing after meals Teach **emotional** **regulation** techniques Treat co-morbid disorders **Family therapy** similar to that for AN **Fluoxetine** has been found to be useful in decreasing binging by over 50% in an open trial **CBT** has been found to be helpful, and may be the treatment of choice for adults

Answer 121

**Sensitization**: recognition of same-sex attraction (childhood - teens) **Identity** **confusion** and **experimentation** **Identity** **assumption**: self-ID as LGB and disclosure to friends, parents, family (late teens) **Identity** **commitment**: LGB lifestyle and engagement in LGB community

Answer 122

**Girls:** First aware 10-11 First L sex 15-17 ID 14-17 Disclosure 16-19 **Boys:** First aware 9-13 First L sex 13-17 ID 12-17 Disclosure 16-20

Answer 123

**Sex-centered pattern**: may be associated with more **internalized homophobia** and **risky sex**, more heterosexual early experiences, M\>F **Identity-centered pattern**: **childhood** **recognition**, socio-historical change, F\>M (80% L)

Answer 124

**Females** have **later** first awareness, same-sex experience, self-identification than males **Females** have more **heterosexual** **experience** and **bisexual** identity Females more **identity-centered development** Recently more females with **bisexual ID**

Answer 125

**Parental physical abuse** **Parents discourage gender-atypicality** **Parents LGB insults** **Gay verbal abuse** **Gender atypicality in childhood** **Family h/o SA** **Being open with family (!)**

Answer 126

Family support (PFLAG) Friends' support Internet support Project 10 and GSA at school Supportive school administration