Week 6 - Disruptive and Neurodevelopmental Disorders

Question 1

Core symptoms of ADHD

Answer 1

‣ Inattention
‣ hyperactivity
‣ impulsivity occurring at a developmentally inappropriate level
‣ observed in at least two settings (home, school, or work)
‣ clear evidence of clinical impairment in social, academic, or occupational functioning

Question 2

Attention deficit hyperactivity disorder

Answer 2

Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.

Question 4

ADHD

Answer 4

Neurodevelopmental disorder in which children have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.

Question 5

Core symptoms of ADHD

Answer 5

‣ Inattention
‣ hyperactivity
‣ impulsivity occurring at a developmentally inappropriate level
‣ observed in at least two settings (home, school, or work)
‣ clear evidence of clinical impairment in social, academic, or occupational functioning

Question 6

Diagnosis for ADHD

Answer 6

Inattention (at least 6 symptoms)

‣ Careless mistakes
‣ Difficulty sustain attention with activities
‣ Does not seem listen when spoken directly to (distraction)
‣ Does not follow through on instructions (not finishing homework)
‣ Difficulty organizing tasks/activities
‣ Reluctant to engage in things requiring sustained mental effort
‣ Loses things necessary for activities
‣ Easily distracted
‣ Forgetful

Hyperactivity/Impulsivity (at least six )
‣ Figeting
‣ Leaves seat when should remain seated
‣ Runs or climbs when inappropriate
‣ Unable to play quietly
‣ Often “on the go”
‣ Talks excessively
‣ Blurts out answers before question complete
‣ Difficulty waiting their turn
‣ Often interrupts others

Question 7

Cause of ADHD

Answer 7

‣ Primarily genetic
‣ Environmental factors

Question 8

Management of ADHD

Answer 8

focuses on the areas of functional impairment:

‣ academic achievement; relationships—parent, peer, sibling, and adult authority;
‣ social skills—sports and recreational participation; and behavior and emotional regulation.
‣ A key element is having three specific, measurable short-term target goals at a time from the areas that are most impaired, incorporating the child’s strengths and resiliency
‣ Behavioral therapy (only therapy if under 6)
‣ Parent education
‣ Educational and adaptive support

Question 9

Medications for ADHD

Answer 9

Stimulants (first line)
‣ methylphenidate and amphetamine (more potent) compounds

Nonstimulants
‣ Amtomoxetine (norepherine reuptake inhibitor)
‣ 6 weeks before effective

Complementary therapy
‣ Exercise, sleep, good nutrition

Question 10

Autism spectrum disorder

Answer 10

a complex neurodevelopmental disorder that affects communication and behavior beginning in the first two years of life. Causes impairment in social interaction with additional impairment in communication and restrictive, repetitive, stereotyped patterns of behaviors, interests, and activities.

Question 11

Cause of autism

Answer 11

genetic etiology with familial inheritance patterns, difference in brain matter volume, environmental factors

Question 12

Clinical findings for autism

Answer 12

Problems with social interactions, communication, and language skills; unusual ways of relating to people, objects, and events; abnormal responses to sensory stimuli, usually sound; and restricted, repetitive, or stereotypical behaviors and echolalia (meaningless repetition of others’ speech

Question 13

When to screen for autism

Answer 13

18 and 24 months

Question 14

Social Red flags for autism

Answer 14

‣ Lack of social smile and eye contact at 2-3 months of age
‣ Lack of joint attention (shared spontaneous enjoyment) around 9 months
‣ Does not respond to his or her name by 12 months old
‣ Does not follow a point to a picture or object and look back at pointer by 12 months
‣ Does not point at objects to show interest (pointing at an airplane flying over) by 14 months old
‣ Does not pretend (feed a doll) by 18 months old
‣ Avoids eye contact and wants to be alone
‣ Trouble understanding other people’s feelings or talking about their own feelings
‣ Gives unrelated answers to questions
‣ Loss of social abilities at any age

Question 15

Language red flags for autism

Answer 15

‣ Delayed speech and language skills (no babbling or gesturing by 12 months old; no single words by 16 months old; no two-word [not echolalic] phrases by 24 months old)
‣ Repeats words or phrases over and over (echolalia)
‣ Monotone intonation, rhythm, rate, pitch, volume, and quality of sound issues
‣ Speech that sounds scripted
‣ Difficulty with conversation where each person adds information
‣ Parental concern about hearing due to lack of response
‣ Loss of language at any age

Question 16

Behavior red flags for autism

Answer 16

‣ Gets upset by minor changes
‣ Has obsessive interests
‣ Flaps hands, rocks body, or spins in circles
‣ Unusual reactions to the way things sound, smell, taste, look, or feel
‣ Self-injurious behaviors (head-banging, biting, pinching)

Question 17

Assessment for suspected autism

Answer 17

Comprehensive diagnostic assessment should be done by a multidisciplinary team, ideally at a specialty center, and address core symptoms, cognition, language, and adaptive, sensory, and motor skills. Specialty assessment includes developmental, behavioral, and IQ testing; audiologic evaluation; and genetic testing with microarray. Neuroimaging, EEG, and metabolic testing may be done if indicated by examination and history.

Question 18

Autism management

Answer 18

‣ The PCP must assist the parent with ongoing routine care, developmental changes, and day-to-day behavior management as well as the typical problems with sleep, feeding, gastrointestinal issues, and irritability.
‣ Comprehensive school plan
‣ Therapy to include BA therapy supervised by a Board Certified Behavior Analyst (BCBA), speech therapy, occupational therapy with a sensory processing focus (modulation for self-regulating and soothing) and assistance with play and self-help skills, and physical therapy if needed
‣ Well balanced nutrition (may be picky or overeaters)
‣ Good sleep (may be an inssue)

Question 19

Autism medications

Answer 19

Used to treat behaviors

‣ Stimulants - only if they suffer from attention deficit

‣ Alpha agonist (guanfacine or clonidine) or norepinephrine reuptake inhibitors (atomoxetine) may prove more effective

‣ Atypical antipsychotics (risperidone or aripiprazole) for irritability and explosive behaviors but are not routinely recommended

‣ Fluoxetine – anxiety, phobias, compulsion. Requires monitoring for agitation, increased energy, poor sleep.

‣ Anticonvulsants for seizures

Question 20

Complementary therapies for autism

Answer 20

‣ encourage the family to thoroughly research the approach they are considering, know what specific behavior they hope to affect, and attempt only one treatment at a time.
‣ Nutritional strategies – additive or subtractive
‣ Mind body therapies (biofeedback, music therapy, yoga, acupuncture)

Question 21

Executive function

Answer 21

Executive functions are interrelated cognitive processes that let people plan, organize and complete tasks. These skills allow us to:
‣ concentrate
‣ plan and organize a course of action
‣ think before acting
‣ predict consequences
‣ hold several things in our short term (“working”) memory
‣ multitask

Question 22

Sensory processing

Answer 22

Term that refers to the way the brain receives messages from the sensory receptors and turns them into appropriate motor and behavioral responses.

Question 23

Information processing

Answer 23

Information into scripts (similar to those used by computers) that guide behavior and social problem-solving

Question 24

Self-regulation

Answer 24

a person’s capacity to control their impulses and emotional responses. It is inseparably linked with a person’s executive function skills.