10/17 Neurodevpt Disorders - Petti Flashcards Preview

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Flashcards in 10/17 Neurodevpt Disorders - Petti Deck (47):
1

differences in assessing child/adolescent (as compared to assessing adult)

  • neurodevpt changes
    • cognitive
    • emotional
  • relative importance of the environment
  • need to consider motivation for seeking help (often due to parent/teacher request)
  • need to differentiate normally expected behaviors from psychopathology
    • ex. we expect to see oppositional/defiant behavior in the "terrible twos" and adolescence → separation/individuation phases in which this is normal
  • need for indirect methods of assessment in young children

2

pearls for neurodevpt disorder classification criteria

 

intellectual disability

ASD

language disorder

social (pragmatic) communication disorder

specific learning disorder

devpt coordination disorder

stereotyped movement disorder

intellectual disability

  • low intelligence
  • need for special help to cope with life in conceptual, social, practical domains

autism spectrum disorder

  • impaired social interactions and communication
  • stereotyped interest and behavior from early life

language disorder

  • delay using spoken and written language
  • notable for small vocabulary, sents grammatically incorrect, trouble understanding sents/words

social (pragmatic) communication disorder

  • have adequare vocabulary, ability to create sentences BUT unable to use language practically
  • conversations/writing tend to be inapprop

specific learning disorder

  • problems with reading, written expression, mathematics beyond expected for age

developmental coordination disorder

  • motor coordination slowly developed

stereotyped movement disorder

  • repeated rocking, head banging, skin or body orifice picking, or biting that is STEREOTYPED

3

pearls for neurodevpt disorder classification criteria

 

intellectual disability

ASD

language disorder

social (pragmatic) communication disorder

specific learning disorder

devpt coordination disorder

stereotyped movement disorder

intellectual disability

  • low intelligence
  • need for special help to cope with life in conceptual, social, practical domains

4

pearls for neurodevpt disorder classification criteria

 

intellectual disability

ASD

language disorder

social (pragmatic) communication disorder

specific learning disorder

devpt coordination disorder

stereotyped movement disorder

autism spectrum disorder

  • impaired social interactions and communication
  • stereotyped interest and behavior from early life

5

pearls for neurodevpt disorder classification criteria

 

intellectual disability

ASD

language disorder

social (pragmatic) communication disorder

specific learning disorder

devpt coordination disorder

stereotyped movement disorder

language disorder

  • delay using spoken and written language
  • notable for small vocabulary, sents grammatically incorrect, trouble understanding sents/words

6

pearls for neurodevpt disorder classification criteria

 

intellectual disability

ASD

language disorder

social (pragmatic) communication disorder

specific learning disorder

devpt coordination disorder

stereotyped movement disorder

social (pragmatic) communication disorder

  • have adequare vocabulary, ability to create sentences BUT unable to use language practically
  • conversations/writing tend to be inapprop

7

pearls for neurodevpt disorder classification criteria

 

intellectual disability

ASD

language disorder

social (pragmatic) communication disorder

specific learning disorder

devpt coordination disorder

stereotyped movement disorder

specific learning disorder

  • problems with reading, written expression, mathematics beyond expected for age

8

pearls for neurodevpt disorder classification criteria

 

intellectual disability

ASD

language disorder

social (pragmatic) communication disorder

specific learning disorder

devpt coordination disorder

stereotyped movement disorder

developmental coordination disorder

  • motor coordination slowly developed

9

pearls for neurodevpt disorder classification criteria

 

intellectual disability

ASD

language disorder

social (pragmatic) communication disorder

specific learning disorder

devpt coordination disorder

stereotyped movement disorder

stereotyped movement disorder

  • repeated rocking, head banging, skin or body orifice picking, or biting that is STEREOTYPED

10

pearls for neurodevpt disorder classification criteria

 

Tourette's disorder

persistent/chronic motor or vical tic disorder

Tourette's disorder

  • multiple vocal and motor tics throughout day
  • duration from onset > 1yr

persistent (chronic) motor or vocal tic disorder

  • vocal OR motor tics → not both
  • duration from onset > 1yr

provisional tic disorder

  • tics lasting < 1yr

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pearls for neurodevpt disorder classification criteria

 

ADHD

attention-deficit/hyperactivity disorder

  • inattentive, hyperactive, or impulsive (3 presentations)

12

pearls for neurodevpt disorder classification criteria

 

ODD

oppositional defiant disorder

  • various forms of persistent negative behaviors
  • duration from onset is important

13

pearls for neurodevpt disorder classification criteria

 

CD

conduct disorder

  • persistent violation of rules/rights of others
  • duration from onset is important

14

pearls for neurodevpt disorder classification criteria

 

disruptive mood dysregulation disorder

disruptive mood dysregulation disorder

  • persistently negative, irritable mood between temper outbursts

 

15

pearls for neurodevpt disorder classification criteria

 

MDD

major depressive disorder

  • SIG E CAPS

sleep, interest, guilt/worthless/hopelessness, energy, concentration, appetite, psychomotor, SI/HI

 

16

pearls for neurodevpt disorder classification criteria

 

separation anxiety disorder

  • anxious and fearful when separated from parents or home
  • does not need to begin before 18

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pearls for neurodevpt disorder classification criteria

 

generalized anxiety disorder

  • worry about everything
  • feel tense
  • feel anxious much of the time

kids need 1/3, adults need 3/3

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pearls for neurodevpt disorder classification criteria

 

social anxiety disorder

  • imagine being embarassed when speaking, writing, eating in public

19

pearls for neurodevpt disorder classification criteria

 

PTSD

  • repeated reliving of severely traumatic event

20

pearls for neurodevpt disorder classification criteria

 

pica

  • eating non-food material

21

pearls for neurodevpt disorder classification criteria

 

encopresis

enuresis

encopresis

  • repeated defecation after age 4

enuresis

  • repeated voiding urin into clothing/bed after age 5

22

intellectual disability

aka

intellectual developmental disorder

 

***exam

onset during devptal period

3 of following criteria reqd:

  • deficits in intellectual fx confirmed by BOTH clinical assessment and individualized/standardized intelligence testing
  • inability to meet standards for social responsibility and independent learning
    • communication
    • social participation
    • indep living across environments
  •  

23

clinical features of intellectual disability

 

by severity

more severe:

  • early manifestation of delayed fx and clinical sx
  • dysmorphic features
  • decreased adaptive fx over time

less severe:

  • later manifestation of sx
  • more normal appearance
  • increased ability to adapt

 

psych sx more common in this pop than in general pop

24

mild intellectual disability vs genpop

 

conceptual domain

preschool: no obvious diffs

school-age: difficulties learning academic skills (support needed in 1+ areas)

adults: imparied abstract thinking, executive fx, short term memory, fx use of academic skills

 

more concrete approach to prob solving

25

mild intellectual disability vs genpop

 

social domain

immature social interactions

  • difficulty accurately perceiving social cues
  • communication/conversation/lang more concrete or immature than expected for age
  • difficulty regulating emotion and behavior in age-approp fashion
  • poor understanding of risk in social situations
  • poor social judgment, high gullibility

26

mild intellectual disability vs genpop

 

practical domain

age-approp personal care BUT need some support with complex daily living tasks

  • grocery shopping
  • transport
  • food prep

support typically needed to make health care and legal decisions, to learn to perform a skilled vocation, to raise a family

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intellectual disability

 

IQ and level of fx

(mild vs mod vs severe)

mild: 50-55 → 70

  • usually fine academically to 6th grade level
  • conform socially by late teens
  • can be self-supporting in adulthood with ltd guidance needed (unusual social/economic stressors)

moderate: 35-40 → 50-55

  • ceiling is 2nd grade level
  • may learn to travel alone in familiar places

severe: 20-25 → 35-40

  • relatively non-fx

28

intellectual disability: etiology

approx 50% organic

  • known insults from antenatal period

approx 50% unknown

  • most have mild ID, prob with genetic basis yet to be discovered

 

more than 750 known genetic causes! many have known behavioral pattersn

29

Prader Willi syndrome

vs

Angelmann's Syndrome

absence of active paternal gene (15q11.13)

  • mild-mod intellectual disability
  • hyperphagia → obese

absence of active maternal gene (15q11.13)

  • mod-severe intellectual disability with motor delays

30

Fragile X syndrome

2nd most common intellectual disability due to chromosomal abnormality

  • devpt delays, mild-mod ID
  • connective tissue dysplasia
  • gaze aversion
  • macroorchidism
  • appear to have large ears

31

ddx for intellectual disability

  • major and minor neurocog disorders
  • communication disorders
  • specific language/learning disorders
  • ASD

32

intellectual disability

 

course/independence

course depends on multiple factors

 

mild: 1/4 may function adequately in society

mod: may live semi-indep with partial support

severe/profound: high levels of support/supervision required

33

what are the communication disorders (5)

  • language disorder
  • speed-sound disorder
  • childhood-onset fluency disorder (stuttering)
  • social (pragmatic) communication disorder
  • unspecified communication disorder

 

all begin during early devptal period

34

language disorder

persistent problem using written and spoken language lagging behind expectations for given age

  • compared to peers...
    • reduced vocab
    • probs putting sents together
    • unable to use lang to express ideas adequately
    • abilities quantitatively below expected
  • often chronic disability in school/work, social situations

ddx: ASD, sensory impairment, intellectual disability, learning disorder (lots of overlap)

35

social (pragmatic) communication disorder

persistent difficulties in social use of language

  • umable to use comm for social purposes in a manner to approp fit social context
  • unable to change comm to match context/needs of listener
  • diff following rules for conversation or story telling
  • diff understanding what is not explicitly stated

difficulties limit effective comm, social participation, social relationships, academic/occupational achievement

 

onset is in early devptal period (4-5 yr) but may not be noted until later when demands exceed ability for social comm!

  • NOT secondary to poor grammar, ASD, ID, or other medical etiology

 

recall: pragmatic language video

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specific learning disorder

impairment in reading & understanding meaning of what's read

impairment of written expression (spelling, content)

impairment of mathematics (number sense, number facts, calculation, math reasoning)

standardized tests demonstrate fx markedly below those expected for age

  • impairment noted in school records allows diagnosis for over 17yrs old

 

learning difficulties may not become fully manifest until later grades when demands exceed ability

difficulties are not better explained by ID, sensory deficits, lack of proficiency in lang, inadequate ed instruction

37

learning disorder: course

  • poor outcome without recognition and intervention
  • high risk for other psych disorders
  • persist through lifetime
  • needs of child/teen/adult change with developmental stage

38

ADHD as a diagnosis

mulitple medical diseases and psych disorders present with ADHD sx

ADHD is a complex genetic disorder resulting from combined effects of several genes and interactions with environment

 

persistent pattern of INATTENTION (6 or more sx for 6 or more months) and/or HYPERACTIVITY/IMPULSIVENESS (6 or more sx for 6 or more months)

  • sx more severe than normally seen for comparable devpt level
  • 5 sx in either or both for 17+

sx negatively impact social and academic/occupational activity

 

39

ADHD and basal ganglia development

ADHD characterized by

  • progressive, atypical contraction of ventral striatal surfaces (localized in reward-processing regions)
  • non0progressive, fixed contraction of dorsal striatal surfaces (localized in executive fx and motor planning support regions)

40

"outgrowing" ADHD

people who carry the 7-repeat allele of DRD4 show differences in regional cortical thinning over time → "outgrow" their ADHD

41

medical disorders presenting with ADHD sx

sleep apnea (risk factors: obesity and/or snoring)

endocrine (esp thyroid)

  • hyperthyroid
  • resistance to thyroid hormone + ADHD sx

elevated lead levels

neuro diseases

  • seizure disorder
  • tumors and unusual syndromes

42

ADHD course

  • deficts persist into adulthood
  • lower ed achievement
  • problems with social skills
  • lower occupational status

risk for developing antisocial personality disorder

 

comorbidities:

  • increased use of substances of abuse
  • 4x STDs
  • 3x unemployed
  • 2x divorced or arrested
  • incr risk for motor vehicle accidencts when unmedicated

43

disruptive mood dysregulation disorder

severe recurrent verbal (rages) and/or behavioral (phys aggression) temper outbursts

  • excessive and devpt disprop in intensity/duration to situation

persistently irritable/angry mood between outbursts on most days

 

duration: over 1 year (with absence of under 3 consecutive months of some sx) in at least two settings

dx: first made between 6-18

  • onset before age 10 (history or obs)
  • no period of more than 1 day meeting full criteria for mania/hypomania
  • not occuring exclusively during MDD episode

44

depression disorders

 

**sign of depression in children/teens

1. disruptive mood dysregulation disorder

2. major depressive disorder

3. persistent depressive disorder (dysthymia)

 

for children/teens,

irritability = depression

45

persistent depressive disorder

dysthymia

 

depression (or irritability in children) + 2 sx: CHASES

  • concentration loss
  • hopelessness
  • appetite (wt change)
  • sleep affected
  • energy loss/fatigue
  • self-esteem

never sx-free for more than 2mo at a time

46

separation anxiety disorder

 

what is it

etiology

duration

criteria

inapprop or excessive anxiety around separation from parenting figures

etiology: genetic predisposition, often develops after life stress

duration: at least 4 weeks children, > 6mo adults

 

3+ persistent/excessive criteria for dx:

  • worry
  • refusal or reluctance to go
  • repeated nightmares with separation theme
  • physical sx when sep occurs/expected

47

social anxiety disorder

social phobia

marked fear or anxiety about 1+ social situations in which they may be scrutinized or judged

  • concern about being embarassed
  • children? anx must occur in peer settings (not just interaction with adults)