Block 3- Neurodevelopmental Disorders part 1

Question 1

What are the 2 categories of brain dysfunction?

Answer 1

1. Neurodevelopmental disorders- onset in the developmental period
2. Neurocognitive disorders- onset in later life

Question 2

Why are patients not a checklist of symptoms ?

Answer 2

• Clinical summary of social, psychosocial, biological factors
• Importance of patient’s distress or impairment in social, occupational, important areas of daily living

Question 3

When are neurodevelopmental disorders onset?

Answer 3

Onset in the developmental period

Present during early childhood, typically before child enters grade school

Question 4

What may result from developmental deficits ?

Answer 4

• Developmental deficits producing impairment of personal, social, academic or occupational functioning
• not due to visual/ audition/ neurological problems, lack of/inadequate academic instruction

Question 5

Describe the range of Neurodevelopmental Disorders

Answer 5

• Range of disorders frommspecifuc limitations to global impairments
• in some disorders, the clinical presentation includes symptoms of excess as well as deficits and delays in achieving expected milestones

Question 6

Give the epidemiology of Intellectual disability

Answer 6

• about 1% in high income countries
• 2 to 4% in low to middle income countries
• More prevalent in males than females

Question 7

What are the diagnostic Criteria of intellectual disability?

Answer 7

1. Deficits in intellectual functioning
2. Deficits in adaptive functioning that lead to limitations in communication, social participation, independent living across multiple environments (home, school, work, community)
3. Begins before 18 years

Question 8

How are deficiencies in intellectual functioning confirmed?

Answer 8

1. Clinical assessment

2. Standardized intelligence testing

Question 9

Give an example of standardized intellectual assessment

Answer 9

Wechsler intelligence test (versions for adult and children)

Question 10

What is the normal range for results from a standardized intelligence assessment?

Answer 10

100 SD= +/- 15

Neurotypical IQ= 85-115

Question 11

At what point of results is standardized intellectual disability diagnosed?

Answer 11

An IQ score at least 2 SD below the mean

-Score 70 or below +/- 5

Question 12

Explain the Deficits in adaptive functioning in intellectual disability

Answer 12

• Failure to achieve developmentally appropriate daily living skills in atleast one of the following domains:
  
  • Conceptual (e.g. academic skills)
  • Social (e.g. relational skills)
  • practical (e.g. self management skills)
• Assessed using a standardized rating scale:
  
  • Vineland Adaptive Behavior Scales

Question 13

What are the classifications of intellectual disability?

Answer 13

Mild

Moderate

Severe

Profound

Question 14

Describe the “Mild” classification of intellectual disability and it’s conceptual

Answer 14

About 85%

IQ=. 50-69

Mental age= 9-12

Conceptual- functional ay 6th grade level

• Detected in middle school
• Difficulty doing abstract and egocentric thinking

Question 15

Describe the socialization and dailies living skills of a “ MILD” intellectual disability

Answer 15

Socialization: immature social interactions and judgement

Daily living skills: appropriate personal care

-Needs support with complex tasks

Question 16

Describe the “Moderate” classification of intellectual disability including the conceptual

Answer 16

Moderate

About 10%

IQ= 35-49

Mental age = 6-9 y/old

Conceptual:

• detected at a younger age
• Developmental delays
• Marked lag in cognitive skills

Question 17

Describe the socialization and Daily living skills of “Moderate” intellectual disability

Answer 17

Socialization:

• Limitation in communication and socialization
• Aware of their limitations —> feel alienated, frustrated

Daily living skills:

• Varying degrees of support to live and work in the community
• maladaptive behavior —> self injury

Question 18

Describe the classification of intellectual disability(based on adaptive function) “Profound” including conceptual

Answer 18

Profound

-about 1-2%

IQ= less than 20

Mental age is less than 3

Conceptual:

-Motor or sensory impairments limit functioning

Question 19

Describe the classification of intellectual disability including socialization and daily living skills in profound

Answer 19

Socialization :
-Nonverbal —> gestures, emotional cues

Daily living skills:

-Severe limitation in self care, continence,communication and mobility

Question 20

Explain the etiology and management of Intellectual Disability

Answer 20

Cause of intellectual disability is usually known

Examples:

1. Genetic disorders (fragile X, Down’s Syndrome)
2. Prenatal complications(fetal alcohol syndrome)
3. Perinatal injury (anoxia)
4. Acquired medical conditions (head injury)

Management:

1. Family education
2. Behavioral therapy

Question 21

What are the diagnostic criteria for Specific learning disorders ?

Answer 21

1. Difficulty learning and using academic skills

AND

2. Academic skills less than expected for age

Question 22

Explain the diagnostic criteria “difficulty learning and using academic criteria” for specific learning disorders

Answer 22

At least one symptom for atleast 6 months

• Slow/inaccurate/effortfulbword reading
• Difficulty understanding meaning of what is read
• difficulty spelling
• Difficulty with written expression
• Difficulty with numbers/calculation
• Difficulty with mathematical reasoning

Question 23

Explain the diagnostic criteria “Academic skills less than expected for age “ for specific learning disorders

Answer 23

Academic skills less than expected for age
-Causes significant interference with academics/ occupation/ daily living

• Confirmed with standardized tests and clinical assessment
• Present during school age when demands > capacity

Question 24

What are the specifier of Specific learning disorders?

Answer 24

1. Impairment in reading (dyslexia )
2. Impairment in written expression
3. Impairment in mathematics (dyscalculia )

Question 25

What is the severity of Specific learning disorders based on?

Answer 25

Based on how many academic sub levels (e,g, spelling, reading, comprehension) are affected and how much support is needed

Question 26

What is the epidemiology of Specific learning disorders?

Answer 26

Epidemiology: - 3% to 9% school age population - 4% adults - Males more prevelant than females

Question 27

What are the risk factors of specific learning disorders?

Answer 27

- Genetics (60% heritability) - Very low birthweight weight/prematurity - Prenatal exposure to nicotine

Question 28

How are specific learning disorders managed?

Answer 28

- early intervention to lessen effects | - Learning strategies to compensate

Question 29

What are the requirements of communication disorders before diagnosis? (not diagnostic criteria)

Answer 29

Children must have a mastery of multiple aspects of language: - Understand and express ideas using speech - Express themselves in vernacular language Domains of language competence: Phonology- produce sounds, discriminate various sounds Grammar - organization of words, placing words in sensible order Semantics- organization of concepts, acquisition of words Pragmatic- use of language, rules of conversation

Question 30

What are the domains 9f languange competence?

Answer 30

Domains of language competence: Phonology- produce sounds, discriminate various sounds Grammar - organization of words, placing words in sensible order Semantics- organization of concepts, acquisition of words Pragmatic- use of language, rules of conversation

Question 31

What are communication disorder types?

Answer 31

1. Language disorder 2. Speech disorder - Speech sounds disorder - Childhood-onset fluency disorder 3. Social(pragmatic) communication disorder

Question 32

What are the diagnostic criteria of Language Disorder?

Answer 32

1. Persistent difficulty in acquisition and use of language across modalities(speaking, reading, writing, singing, etc.,) There is: - decreased vocabulary - limited sentence structure - impairments in conversing (limited vocabulary, cannot connect sentences) AND 2. Language ability below expectations for age (typically present before 4 years)

Question 33

What is Speech Sound Disorder?

Answer 33

-Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication Blue —> bu Rabbit —> wabbit - speech should be intelligible by 3-4 years old - Milder cases spontaneously recover by age 8 - With speech therapy, almost all cases completely recover

Question 34

What are the diagnostic criteria for Childhood-onset fluency disorder?

Answer 34

1. Persistent disturbances in the normal fluency and time patterning of speech that are inappropriate for age and level of language skill -Sound and syllable repetitions - Sound prolongation of consonants and vowels - Broken words - Blocking- pauses in speech - Words produced with excessive tension. - Monosyllabic whole -word repetitions (e.g., “I-I-I- see him”) AND 2. The disturbance causes anxiety about speaking or limits effective communication

Question 35

When is Communication disorder-childhood fluency-onset usually diagnosed?

Answer 35

Usually diagnosed by 6 years old -May not be present during oral reading, singing or talking to inanimate objects

Question 36

How many recover from Communication disorder childhood-onset fluency?

Answer 36

80% recover without intervention before 16 ye@rs old

Question 37

What are the diagnostic criteria of Social (pragmatic) communication disorder?

Answer 37

1. Persistent in the social use of verbal and non verbal communication (all 0f the following) - Deficits in using communication for social purposes (greeting, sharing info) - Impairment in ability to change communicati9n to match context - Difficulty following the rules for communication - Difficulty understanding implicit meanings AND 2. The deficits result in functional limitations in effect8ve communication that interferes with soc8al, academic, occupational performance Diagnosis rarely made before 4-5 years old

Question 38

What are Tic Disorders?

Answer 38

Tics are motor movements of vocalizations that are sudden, rapid, recurrent, non-rhythmic and involuntary Examples: Motor A) sample - eye blink B) complex- gestures, sequence of movements Vocal: A). Sample -throat clearing B) complex- linguistically-meaningful utterances

Question 39

What are the diagnostic criteria for Tourette’s disorders?

Answer 39

1. Multiple motor tics AND at least one vocal tic sometime during the illness 2. Symptoms last over a year 3. Onset is before 18 years and not due to another cause

Question 40

What is the etiology of Tourette’s disorder?

Answer 40

A genetic disorder with over-activity of dopamine

Question 41

How can Tourette’s disorder be treated?

Answer 41

Psychotherapy: - stress reduction (to decrease tic frequency) - coping strategies (e.g., “masking”/disgusting tics) Pharmological: if required —> dopamine receptors blockers (antipsychotics)

Question 42

What is “Tourette’s triad”?

Answer 42

Tourette’s disirder can be associated with OCD and ADHD

Question 43

Give 2 other Tic disorders aside from Tourette?

Answer 43

1. Persistent motor or Vocal Tic a Disirder - Mood OR vocal tics present during illness, not both motor and vocal -Tics May wax and wane in frequency but persist for over 1 year since onset 2. Provisional tic disorder - Motor and/or vocal tics - Tics are present for under 1 year since first tic onset