10/17 Neurodevpt Disorders - Petti

Question 1

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

Answer 1

• 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

Question 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

Answer 2

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

Question 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

Answer 3

intellectual disability

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

Question 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

Answer 4

autism spectrum disorder

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

Question 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

Answer 5

language disorder

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

Question 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

Answer 6

social (pragmatic) communication disorder

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

Question 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

Answer 7

specific learning disorder

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

Question 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

Answer 8

developmental coordination disorder

• motor coordination slowly developed

Question 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

Answer 9

stereotyped movement disorder

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

Question 10

pearls for neurodevpt disorder classification criteria

Tourette’s disorder

persistent/chronic motor or vical tic disorder

Answer 10

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

Question 11

pearls for neurodevpt disorder classification criteria

ADHD

Answer 11

attention-deficit/hyperactivity disorder

• inattentive, hyperactive, or impulsive (3 presentations)

Question 12

pearls for neurodevpt disorder classification criteria

ODD

Answer 12

oppositional defiant disorder

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

Question 13

pearls for neurodevpt disorder classification criteria

CD

Answer 13

conduct disorder

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

Question 14

pearls for neurodevpt disorder classification criteria

disruptive mood dysregulation disorder

Answer 14

disruptive mood dysregulation disorder

• persistently negative, irritable mood between temper outbursts

Question 15

pearls for neurodevpt disorder classification criteria

MDD

Answer 15

major depressive disorder

• SIG E CAPS

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

Question 16

pearls for neurodevpt disorder classification criteria

separation anxiety disorder

Answer 16

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

Question 17

pearls for neurodevpt disorder classification criteria

generalized anxiety disorder

Answer 17

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

kids need 1/3, adults need 3/3

Question 18

pearls for neurodevpt disorder classification criteria

social anxiety disorder

Answer 18

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

Question 19

pearls for neurodevpt disorder classification criteria

PTSD

Answer 19

• repeated reliving of severely traumatic event

Question 20

pearls for neurodevpt disorder classification criteria

pica

Answer 20

• eating non-food material

Question 21

pearls for neurodevpt disorder classification criteria

encopresis

enuresis

Answer 21

encopresis

• repeated defecation after age 4

enuresis

• repeated voiding urin into clothing/bed after age 5

Question 22

intellectual disability

aka

intellectual developmental disorder

***exam

Answer 22

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
    *

Question 23

clinical features of intellectual disability

by severity

Answer 23

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

Question 24

mild intellectual disability vs genpop

conceptual domain

Answer 24

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

Question 25

mild intellectual disability vs genpop social domain

Answer 25

**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

Question 26

mild intellectual disability vs genpop practical domain

Answer 26

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

Question 27

intellectual disability IQ and level of fx (mild vs mod vs severe)

Answer 27

_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

Question 28

intellectual disability: etiology

Answer 28

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

Question 29

Prader Willi syndrome vs Angelmann's Syndrome

Answer 29

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

Question 30

Fragile X syndrome

Answer 30

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

Question 31

ddx for intellectual disability

Answer 31

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

Question 32

intellectual disability course/independence

Answer 32

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

Question 33

what are the communication disorders (5)

Answer 33

* language disorder * speed-sound disorder * childhood-onset fluency disorder (stuttering) * social (pragmatic) communication disorder * unspecified communication disorder **all begin during early devptal period**

Question 34

language disorder

Answer 34

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)

Question 35

social (pragmatic) communication disorder

Answer 35

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

Question 36

specific learning disorder

Answer 36

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

Question 37

learning disorder: course

Answer 37

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

Question 38

ADHD as a diagnosis

Answer 38

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

Question 39

ADHD and basal ganglia development

Answer 39

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)

Question 40

"outgrowing" ADHD

Answer 40

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

Question 41

medical disorders presenting with ADHD sx

Answer 41

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

Question 42

ADHD course

Answer 42

* 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

Question 43

disruptive mood dysregulation disorder

Answer 43

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

Question 44

depression disorders \*\*sign of depression in children/teens

Answer 44

1. disruptive mood dysregulation disorder 2. major depressive disorder 3. persistent depressive disorder (dysthymia) for children/teens, **irritability = depression**

Question 45

persistent depressive disorder

Answer 45

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

Question 46

separation anxiety disorder what is it etiology duration criteria

Answer 46

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

Question 47

social anxiety disorder

Answer 47

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)