Childhood Developmental Disorders and Autism Flashcards
(48 cards)
1
Q
Attention-Deficit Hyperactivity Disorder
A
- 3 - 5 % of preschool and school-age children
- Childhood onset; often lasts into adulthood
- Disrupts functioning across settings (at school AND home)
- Exact causes unknown
- Combination of nature and nurture
-
RF: FHx, prenatal risks, environmental toxins, differences in brain structure (*FAS)
- different neuroimaging, ADHD kids’ brains develop slower
-
Boys > Girls (10:1)
- manifest (impulsive) sx more
-
Symptoms:
- Inattention
- Impulsivity
- Hyperactivity
- Lower DA levels
- Tx:
- Stimulants: methylphenidate, dextro-amphetamine
- Non-stimulants: atomoxetine
- if pt has low BMI or its mostly attentive, use NON-stim
2
Q
What are the common s/s of ADHD-ATTENTION (1/3)
A
- trouble paying attention or listening
- inattention to details, careless mistakes
- losing things (e.g., school supplies)
- forgetting to turn in homework
- trouble finishing assignments
- trouble following multiple adult commands
- difficulty playing quietly
3
Q
What are the common s/s of ADHD-HYPERACTIVITY (2/3)
A
- fidgeting
- inability to stay seated
- running or climbing excessively
- always “on the go”
4
Q
What are the common s/s of ADHD-IMPULSIVITY (3/3)
A
- no forethought prior to behavior
- talks too much
- interrupts or intrudes on others
- blurts out answers
- impatience
- difficult to redirect
5
Q
Diagnosis of ADHD
A
- Symptom onset: prior to 12 years
- Symptom duration: > 6 months
- 2 or more settings (school, home, work)
- Use of rating scales (Conners, Vanderbilt)
- have teacher and parents complete eval, will give feedback to help adjust dose accordingly
- 3 presentations:
- Combined-many s/s from both categories; tx is the same
- Predom. inattentive
- Predom. hyperactive/impulsive
- Educating the parents is v. important
- exercise helps fight inner restlessness
- when they are nder stress or have a task they enjoy they are better able to focus
- when untreated see comorbid depression and anxiety
6
Q
ADHD vs. Bipolar Disorder
A
- often co-morbid (~ 40-90% est. prevalence)
- Similarities:
- distractibility
- increased energy
- Characteristic of bipolar d/o:
- elevated mood
- periods of sadness or negative mood
- severe problems regulating emotions
- flight of ideas
- decreased need for sleep
- bursts of energy, exuberant or destructive
- some cyclicity
- elevated mood
- hypersexuality
7
Q
ADHD vs. Oppositional Defiant Disorder (ODD)
A
- often loses temper (disproportionately to the problem)
- argues with adults
- ***hostile, defiant behavior towards authority figures (parents, teachers, clergy)
- ***blames others for own mistakes
- annoys people deliberately
- touchy and easily annoyed by others
- often spiteful and vindictive
- ***pattern of anger-guided disobedience
8
Q
ADHD vs. Conduct Disorder
A
-
Repetitive/persistent pattern of behavior-pattern gets in the way of functioning
- (Think of it as a more severe form of ODD.)
- Violates others’ basic rights or major age-appropriate societal norms/rules
- Childhood-onset (<10-yo) vs. Adolescent-onset
- Often bullies, threatens others
- Cruel to animals
- Destroys property, sets fires
- Often starts fights
- Often lies and lacks remorse
- Skips school, runs away
- Often stays out at night, despite parental rules
- child may develop anti-social personality disorder if it continues
9
Q
What is the definition of a tic?
A
- Sudden
- Rapid
- Recurrent
- Non-rhythmic motor movement or vocalization
- ***involuntary, worsens under stress
10
Q
Tourette’s Disorder-Tic CP
A
-
Multiple motor and vocal tics:
- Tics occur many times every day or intermittently for > 1 year
- Tics can be:
- simple (rapid, repetitive contractions)
- complex (appear as more ritualistic and purposeful)
- Simple tics appear first-can develop into complex
- onset before 18 years
- intensity may wax/wane
- stress: sleep deprivation, hormonal changes with puberty
11
Q
Tourette’s Disorder-Characteristics
A
- Prevalence is (0.5-1) per 1,000
- Mean age of onset is 7 (onset must be age < 18)
- MALE to female ratio is 3:1
- Evidence of genetic transmission: ~ 50% concordance in monozygotic twins
- Associated with increased levels of DA
-
Associated with ADHD and OCD
- ADHD tx may have SE of tics
- Tx: haloperidol, pimozide, or clonidine
12
Q
Anxiety Disorders
A
- High prevalence rates: (6-20%)-especially middle school kids
- Include:
- specific phobia
- **selective mutism-sometimes anxiety is so overwhelming
- social phobia-not limited to social speaking
- Developmentally inappropriate or excessive fears
- Sequelae:
- interpret ambivalent situations negatively
- underestimate competencies
- Tx: CBT to restructure negative automatic thoughts, 12-16/18 wks-helps with self-esteem
13
Q
Anxiety Disorders-Nml Things to Afraid of (ITSA)
A
-
Infants
- large noises
- being startled
- strangers
-
Toddlers:
- imaginary creatures
- darkness
- normative separation anxiety
-
School-age
- bodily injury
- natural events
-
Adolescents
- school performance
- social competence
- health issues
14
Q
***Separation Anxiety Disorder***-General
A
- Affects 4%-5% of U.S. kids ages 7-11 yo
- Fear, anxiety, avoidance is persistent (> 1 month)
- Develops after significant stressful or traumatic event
- parent deployed, borth of sibling, loss of pet, friend moving away
- Children with over-protective parents
- child can detect and absorb parents emotions
- May be a manifestation of parental separation anxiety
- Vulnerability to the disorder may be inherited
15
Q
***Separation Anxiety Disorder***-Symptoms
A
- Constant thoughts, intense fears about safety of parents
- School refusal-afraid something bad will happen to their parents if they go
- Frequent somatic complaints
- Extreme worries about sleeping away from home
- Being over clingy
- Panic, tantrums when separating from parents
- Trouble sleeping or nightmares (some dying or being left alone)
16
Q
Therapy Modification Based on Classical Conditioning-Systemic Desensitization
A
- Begins with imagining oneself in a progression of fearful situations and using relaxation
-
Often used to tx anxiety and phobias
- start with least frightening things and work way up to most frightening
- When the person is relaxed in the presence of the feared stimulus, objectively, there is no more phobia
- Works by replacing anxiety with relaxation (visual, breathing, muscle relaxation)
17
Q
Therapy Modification Based on Operant Conditioning-Biofeedback (neurofeedback)
A
- use external feedback to modify internal physiologic states
- pts see that they have control over these things and improve in time
- use trial and error learning and repeated practice to make it effective
18
Q
General Patterns in Human Development-Milestones
A
- Milestones are simply normative markers at median ages
- Some children develop slower and some faster
- The ages of the milestones are an approximate-progression is important!!!
19
Q
Developmental Trajectory
A
- Family problems experienced in childhood and adolescence affect brain development and can lead to mental health issues in later life.
- Brain imaging technology used to scan teenagers aged (17-19)
- Those who experienced (mild to mod) family difficulties from birth-11 yo had developed a smaller cerebellum (associated with skill learning, stress regulation, sensory-motor control)
- smaller cerebellum may be a risk indicator of psychiatric disease later in life, as it is consistently found to be smaller in virtually all psychiatric illnesses.
20
Q
Infants Trajectory-Smiling
A
- smile develops from an innate reflex present at birth
- An infant shows exogenous smiling in response to a face at 8 wks
- A preferential social smile (to the mother’s rather than another’s face) appears about 12-16 wks
21
Q
Infants Trajectory-Physical Development
A
- Hands and feet are the first parts of the body to reach adult size
- Motor development follows set patterns:
- Grasp precedes release
- Palm up maneuvers occur before palm down maneuvers
- Proximal to distal progression. Ulnar to radial progression
- first words-10 mo; first steps-13 mo
22
Q
Infants-Key Developmental Issues
A
- Brain-growth spurt: “critical period” of great vulnerability to environmental influence
- Size of cortical cells and complexity of cell interconnections undergo their most rapid increase
- Earliest memories, roughly ages 2-4
-
**Stranger anxiety - distress in the presence of unfamiliar people:
- Appears at 6 mo, peak at 8 mo, disappears after 1yr
- Can occur even when child is held by parent
-
**Separation anxiety - distress of infant following separation from a caretaker:
- At 8-12 mo (1). Begins to disappear at 20-24 mo (2)
- Continued separation (especially prior to 12 months) leads to withdrawal and risk of anaclitic depression
-
***School phobia (Separation Anxiety Disorder) is failure to resolve separation anxiety.
- Tx: focuses on child’s interaction with parents, not on activities in school
23
Q
Management/Tx of Developmental Disorders
A
- Acute Phase vs. Maintenance Phase
- Psychoeducation
-
Medical work-up
- rule-out thyroid disease
- hearing/vision screening
- Supportive management (restore realistic hope)
- Psychotherapy (individual, family)
- Family involvement
- Cultural competence
- Liaison with school
- Medication management
24
Q
Consequences if Untreated (1/2)
A
-
SUICIDE-3rd leading cause of death in youth 15 to 24.
- More teens and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined.
- >90% of children and adolescents who die by suicide have a mental illness.
- States spend nearly $1 billion annually on medical costs associated with completed suicides and suicide attempts by youth up to 20 years of age.
- School Failure: highest dropout rate of any disability group.
- Juvenile and Criminal Justice Involvement: 65% of boys, 75% of girls in juvenile detention have at least 1 mental health disorder.
- Higher Health Care Utilization: incurrence of higher health care costs than other adults.
25
Consequences if Untreated (2/2)
* Childhood adversities and early-onset mental disorders associated with higher rates of
* chronic physical problems in adulthood.
* Children with mental illness become adults with mental illness
* Children with behavioral problems more at risk of inflammation and chronic health problems **(heart disease, obesity, diabetes)**
26
Early Identification and Intervention
* Can minimize long-term disability
* Can prevent a significant proportion of delinquent and violent youth from future violence and crime
* Can enable success in school and social development
* **\*\*\*Can promote resilience**
27
Child Abuse-General
* **WE ARE MANDATED REPORTERS (up to age 18)**
* \>6,000 KIDS killed by parents/caretakers each yr in the US
* \>3 million annually are reported abused
* 50% of these are confirmed by investigation
28
Defining Child Abuse
* Tissue damage
* Neglect (basic needs not taken care of)
* Sexual exploitation
* Mental cruelty
29
Clinical Signs of Child Abuse
* Broken bones in first year of life
* doesnt make sense since child isnt mobile yet!!
* STD in young children
* *92% of injuries are **soft tissue injuries*** (bruises, burns, lacerations)
* 5% have no physical signs
* \*\*\***Non-accidental burns** have a particularly poor prognosis:
* They are associated with death or foster home placement
* arms + hands= accident
* only arms = abuse
* Shaken baby syndrome: look for broken blood vessels in eyes
30
Children at Risk
* \<4 years
* Special needs populations:
* **intellectual disability** (formerly mental retardation)
* learning disabilities
* other mental illness
* chronic physical illness (Ex: cerebral palsy)
31
Children who are abused are more ikely to: (5)
* Be aggressive in the classroom
* Perceive others as hostile
* View aggression as a good way to solve problems
* Have abnormally high rate of withdrawal (girls)
* Be unpopular with school peers and other children; the **friends they do have tend to be younger**
* ****feel safer that they wont get hurt
32
Child Sexual Abuse-General
* 50% of sexual abuse cases are within the family
* 60% of victims are FEMALE
* **Most victims are aged *9-12 yo***
* 25% of victims \<8 yrs
* Most likely source: uncles and older siblings, although stepfathers are also more likely. In general, males more likely to be sources.
* Childhood **physical abuse** is assoc with significantly elevated rates of **fxnl somatic syndromes:**
* ****chronic fatigue syndrome, fibromyalgia and multiple chemical sensitivities
* traumatic childhood experiences are linked to an increased risk of **early death**
33
Child Sexual Abuse-RF
* Single-parent families
* Marital conflict
* History of physical abuse (of the caregiver)
* Social isolation (less community, more stress)
34
Child Abuse Perpetrators
* Limited understanding of normative development
* Hx of child maltreatment in parental family of origin
* SUD and/or untx mental illness
* Low SES
* Non-biological, transient caregivers in home
* Social isolation of family
* Community violence
35
Intellectual Disability-General
* Significant deficits in intellectual functioning (reasoning, problem solving, planning, abstract thinking, judgment)
* frontal lobe qualities
* Diagnosis via clinical assessment and standardized neurocognitive testing (Per DSM-IV, IQ \< 70)
* Significant deficits in **adaptive behavior** (failure to meet standards for personal independence, social responsibility)
* Presents as **developmental delay**
* Not all children with developmental delay have intellectual disability.
36
Disorders Diagnosed in Childhood
* **FAS**= most common known cause of intellectual disability
* Facial characteristics:
* small eye openings
* smooth philtrum
* thin upper lip
* Most common genetic causes:
* **Down syndrome**
* ****flattened nose and face
* upward slanting eyes
* weird toes and fingers
* **Fragile-X syndrome**
* ****elongated face, MVP, jaw, ears, eyes
37
Intellectual Disability-MMSP
38
PDD (Pervasive Developmental Disorders): (ASD) Autism Spectrum Disorders
* Autistis Disorder
* **Asperger's Disorder-higher fxn autism**
* Childhood Disintegrative Disorder
* **Rett's Disorder**
* Pervasive Developmental Disorder-not otherwise specified
39
Autism Spectrum Disorders (ASD)
* Formerly *Pervasive Development Disorders*
* 1 of every 150 births
* Diagnosis **before age 3**
* **MALES** \> Females (4:1)
* Linked to **chrom 15, chrom 11**
* Concordance: MZ\>DZ
* **80% have IQs \<70**
* **FEMALES tend to have greater intellectual disability**
* EEG and seizure disorder (20-25% individuals with autism); comorbid
* Diverse set of neural systems affected; but, definitive data lacking
40
\*\*ASD-Clinical Signs\*\*
* Deficits in reciprocal **social interaction**
* Decreased repertoire of **activities and interests**
* Abnormal or delayed **language** development, impairment in verbal and **non-verbal communication**
* ***No separation anxiety***
* Oblivious to external world
* Fails to assume anticipatory posture, **shrinks from touch**
* Preference for inanimate objects
* **Stereotyped behavior** and interests
41
ASD-DSM 5
* Diagnosis: early developmental period; disturbance in 2 domains
* **1) social relatedness and communication (across multiple contexts)**
* **2) restricted interests/activites**
* **symptom severity scale-relates to functioning**
42
ASD-Potential Causes
* Association with **prenatal and perinatal injury**
* e.g., Rubella in first trimester
* Increased risk if mother had asthma, allergies, or **psoriasis** while pregnant
43
ASD-Differential Diagnosis (1/3)
* must rule out:
* specific developmental disorders (e.g., language d/o)
* sensory impairments (e.g., deafness)
* reactive attachment disorder
* obsessive-compulsive disorder
* anxiety disorders (selective mutism)
* childhood-onset schizophrenia
44
ASD-Differential Diagnosis: Rett Syndrome (2/3)
* Genetic mutation (rare)
* **GIRLS** \> Boys
* **\*\*initial development *NML, then, REGRESSION***
* Onset **6-18mo**
* **\*\*Hand wringing (stereotyped *hand movements*)**
* ***Small* hands & feet**
* **Microcephaly** (decreased rate of head growth)
* prone to seizures, GI issues, scoliosis
45
ASD-Differential Diagnosis (3/3): Asperger's Syndrome
* **language is nml**
* **IQ is nml**
* **HIGHER level of functioning**
* suffer with social interactions-dont perceive social cues
46
Special Education Needs
* co-existing learning disabilities
* **co-existing intellectual disability (ID)**
* *50% with severe-profound ID*
* *35% with mild-moderate ID*
* speech/communication delays
* **aggression to self or others**
* affective instability
* require individual supervision
* Mandated by federal legislation
* (Individuals for Disabilities Education Act)
* Programs vary by school district
* **IEP (Individualized Educational Plan)**
* Speech therapy
* Occupational therapy
* Communication assistance devices-learning how to express themselves (ex: by pointing to pictures)
* Specific teaching technique for autism
47
ASD Tx
* **Behavioral techniques**
* ***Shaping***
* **ABA (Applied Behavioral Analysis)**
* Medication management
* does not change core symptoms
* adjunctive for behavior management
* *atypical (SGA) antipsychotics* (**RISPERIDONE**)
* mood stabilizers
* stimulants
* SSRIs
* (when going through puberty may have inappropriate sexual side effects-masturbation, our public exposure)
48
Therapy Modification Based on Operant Conditioning-Shaping
* aka successive approximations
* Achieves final target behavior by **reinforcing successive approximations** (reward this) of the desired response
* Reinforcement is gradually modified to move behaviors from the more general to the specific responses desired
* e.g., a boy with autism who won’t speak is first reinforced, perhaps with candy, for any utterance
