Childhood Disorders

Question 1

When do neurodevelopmental disorders occur?

Answer 1

Manifest in early childhood

Question 2

What impairments do the developmental deficits produce?

Answer 2

Personal, social, academic

Generally lifelong, but can be subject to maturational changes

Question 3

What are the developmental disorders we study?

Answer 3

Intellectual disability (ID)
Specific Learning Disorder (SLD)
Autism Spectrum Disorder (ASD)
Attention deficit/Hyperactivity Disorder (ADHD)

Question 4

What are the DSM V criteria for intellectual disability?

Answer 4

A- Deficits in intellectual functioning (reasoning, problem solving, planning, learning, judgement)
B - Deficits in adaptive functioning that result in failure to meet developmental & social standards for personal independence and social responsibility (communication, social participation, independent living, across multiple environments)
C - onset of intellectual and adaptive deficits during the developmental period (early childhood)

Question 5

What is the definition of intellectual disability?

Answer 5

Intellectual and adaptive functioning deficits in conceptual, social and practical domains.

Question 6

How do you test for deficits in intellectual functioning for ID?

Answer 6

Use standardized intelligence tests to estimate intelligence (IQ)

Question 7

What is the cutoff for an IQ test?

Answer 7

IQ of 70

Question 8

Who conducts IQ tests?

Answer 8

Psychologist or trained professional

Question 9

How do you test for deficits in adaptive functioning for ID?

Answer 9

Rating scales - what a child can do independently or with assistance (conceptual skills, social skills, practical skills)
Parent, teacher, caregiver, family members complete the form.

Question 10

What are the different types of ID you can get?

Answer 10

Mild, Moderate, Severe, Profound

Question 11

What are the symptoms of ID?

Answer 11

Fails to meet developmental level of independence in daily life
Communication, social, independence
Deficit in intellectual functioning
Usually agrees with everything that is said

Question 12

What is mild ID?

Answer 12

IQ range of 50-55 to 70
Often cannot distinguish from non-ID until they attend school
Learn more slowly, but develop academic skills

Question 13

What is moderate ID?

Answer 13

IQ range 35-40 to 50-55
Progress minimally in academic skills 
Develop good self-care skills 
Perform simple tasks 
Unskilled/semiskilled jobs with supervision

Question 14

What is severe ID?

Answer 14

IQ range from 20-25 to 35-40
Learn to talk & develop basic self-care skills
Often live in group homes/with families

Question 15

What is profound ID?

Answer 15

IQ below 20-25
Require constant care
Understand some language, little ability to talk
Neurological conditions accounting for disability

Question 16

What causes ID? (etiology)

Answer 16

Genetic disorders

Acquired brain injury

Question 17

What is Autism Spectrum Disorder?

Answer 17

Affects communication (verbal/non-verbal), social skills and hevhaviour. 
There is a spectrum --> wide range of differences 
Signs and symptoms vary with age & over time

Question 18

What are the different levels of ASD?

Answer 18

Mild, moderate, severe

Question 19

What are the DSM V criteria for ASD?

Answer 19

A - persistent deficits in social communication & social interaction across multiple contexts, as manifested by the following:
1 - Deficits in social emotional reciprocity e.g. abnormal social approach & failure of normal back-and-forth conversation, reduced sharing of interests, emotions, affect. Failure to initiate or respond to social interactions.
2 - Deficits in non-verbal communicative behaviours used for social interaction e.g. poorly integrated verbal/non-verbal communication, abnormalities in eye contact & body language, deficits in understanding the use of gestures, lack of facial expressions & non-verbal communication.
3 - Deficits in developing, maintaining and understanding relationships. E.g. difficulties adjusting behaviour to suit various social contexts, difficulties sharing imaginative play or making friends, absence of interest in peers.
B - Restricted, repetitive patterns of behaviour, interests or activities; as manifested by at least two of the following, currently or in history:
1 - Stereotyped or repetitive motor movements, use of objects or speech (e.g. simple motor stereotypes, lining up toys, echolalia)
2 - insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal or non-verbal behaviour (e.g. extreme distress at small changes, difficulties with transitions, rigid thinking patterns, need to eat the same food everyday)
3 - highly restricted, fixated interests that are abnormal in intensity or focus (e.g. strong attachment to/preoccupation with unusual objects, excessively circumscribed or preservative interests)
4 - hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling/touching objects, fascination with lights or movement.)
C - symptoms must be present in early developmental period
D - symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning
E - symptoms are not better explained by intellectual disability

Question 20

What disorder frequently occurs with ASD?

Answer 20

ID

Question 21

Describe the cognitive functioning of ASD.

Answer 21

Intellectual is extremely varied
50-70% have ID
Ranges from ID to genius
Non-autistic ID = typically even intellectual profile
Autistic = uneven profile with lower verbal than performance scores
25% = special talents
5% = autistic savants (geniuses)

Question 22

What is the etiology of ASD?

Answer 22

Maternal age, genetic, teratogen, unknown

Question 23

How do you assess ASD?

Answer 23

Clinical/developmental interview 
Assessment for comorbid medical conditions/mental health issues 
Standardized cognitive testing 
Behavioural observations 
Rating scales

Question 24

Describe specific learning disorder.

Answer 24

A specific difficulty in an academic skill which is significantly below overall cognitive ability.

Question 25

When is the onset of specific learning disorder?

Answer 25

Onset during formal schooling (may be seen earlier)

Question 26

List the DSM criteria for specific learning disorder.

Answer 26

A - difficulties learning & using academic skills, as indicated by the presence of at least one of the following symptoms have persisted for at least 6 months, despite provision of interventions that target those difficulties: 1 - inaccurate/slow/effortful word reading 2 - difficulty understanding the meaning of what is read 3 - difficulties with spelling 4 - difficulties with written expression 5 - difficulties with mastering number sense, number facts of calculation 6 - difficulties with mathematical reasoning B - the affected academic skills are substantially & quantifiably below those expected for the individual's chronological age, and cause significant interference with academic/occupational performance or activities of daily living (confirmed by individualized standardized achievement measures & clinical assessment) C - The learning difficulties begin during school-age years but may not become full manifest until the demands for those affected academic skills exceed the individual's capacity (e.g. timed tests, complex reports) The learning difficulties are not better accounted for by intellectual difficulties, uncorrected visual or auditory acuity, other mental or neurological disorder, psychosocial adversity, lack of adequate academic instruction.

Question 27

What are the academic domains that are impaired?

Answer 27

Reading - word reading accuracy, reading rate/fluency, reading comprehension Written expression - spelling accuracy, grammar/punctuation accuracy, clarity or organization of written expression Mathematics - number sense, memorizing arithmetic facts, accurate or fluent calculation or math reasoning

Question 28

List the severities of specific learning disorder.

Answer 28

Mild, moderate, severe

Question 29

Name essential features of ADHD

Answer 29

Inattention/hyperactivity - impulsivity that interferes with functioning/development Inattention - wander off task, lack persistence, can't sustain focus, being disorganized Hyperactivity - excessive motor activity (running about, fidgeting, tapping, talkativeness) Impulsivity - social intrusiveness, decision making without considering long term consequences

Question 30

List the DSM criteria for ADHD.

Answer 30

A persistent pattern of inattention and or hyperactivity-impulsivity that interferes with functioning or development, as characterized by 1 or 2. 1 - inattention: six or more of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social/occupational activities - careless or not pay attention to detail - difficulty sustaining attention in tasks/play activities - seems not to listen when spoken to directly - difficulty organizing tasks or activities - often avoids/dislikes or reluctant to engage in tasks that require sustained mental effort - often loses things necessary for task/activities - easily distracted by extraneous stimuli - often forgetful in daily activities

Question 31

List the DSM criteria for ADHD.

Answer 31

A persistent pattern of inattention and or hyperactivity-impulsivity that interferes with functioning or development, as characterized by 1 or 2. 1 - inattention: six or more of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social/occupational activities - careless or not pay attention to detail - difficulty sustaining attention in tasks/play activities - seems not to listen when spoken to directly - difficulty organizing tasks or activities - often avoids/dislikes or reluctant to engage in tasks that require sustained mental effort - often loses things necessary for task/activities - easily distracted by extraneous stimuli - often forgetful in daily activities 2 - hyperactivity or impulsivity: six or more of the following symptoms, persisting for at least 6 months to a degree that is inconsistent with developmental level & negatively impacts on social and academic/occupational activities: - often fidgets, taps hands/feet, squirms in seat - often leaves seated situations when remaining seated is expected - often runs or climbs when inappropriate - often unable to play or engage in leisure activities quietly - often on the go/driven by a motor - often talks excessively - often blurts out answers before question complete - often has difficulty waiting his/her turn - often interrupts/intrudes on others Inattentive or hyperactive impulsive symptoms prior to 12 years Present in two or more settings Clear evidence the symptoms interfere with, or reduce the quality of social, academic or occupational functioning Not better explained by another mental disorder

Question 32

What do you need to specify for ADHD?

Answer 32

Combined presentation Predominantly inattentive presentation Predominantly hyperactive/impulsive presentation

Question 33

List the severity of ADHD types

Answer 33

Mild, moderate, severe

Question 34

List some inattention symptoms of ADHD.

Answer 34

``` Careless Doesn't listen Doesn't follow through Forgetful Can't organize Avoids/dislikes tasks requiring sustained effort Loses important items Difficulty sustaining attention in activity Easily distractible ```

Question 35

List the symptoms of hyperactivity in ADHD.

Answer 35

``` Squirms & fidgets Can't stay seated Runs/climbs excessively Can't play/work quietly On the go Talks excessively ```

Question 36

List the symptoms of impulsivity of ADHD.

Answer 36

Blurts out answers Can't wait turn Intrudes/interrupts others

Question 37

What co-occurs with ADHD?

Answer 37

Autism, ID