Clinical Approach to Neurodevelopmental and Attention Disorders

Question 1

children with intellectual disabilities have deficits in 3 domains:

Answer 1

conceptual
social
practical

Question 2

conceptual domain

Answer 2

reasoning
problem-solving
planning
abstract thinking
judgment
academic learning
learning from experience

Question 3

social domain

Answer 3

immature in social interactions
difficulty with social cues
less mature conversation
difficulty with emotion and behavior
immature social judgment - at risk for being manipulated

Question 4

practical domain

Answer 4

difficulty with age-appropriate personal care
cannot perform daily tasks without assistance
difficulty making good decisions about well-being
employment restrictions
need help with health care and legal decisions

Question 5

preschoolers with ID demonstrate:

Answer 5

slowly develop language and pre-academic skills

Question 6

school-age children with ID demonstrate:

Answer 6

progress in reading, writing, math, concepts of money and time lag behind compared to peers

Question 7

adults with ID demonstrate:

Answer 7

academic skills at elementary level
support required for use of academic skills in work
assistance needed for conceptual tasks

Question 8

diagnostic tools for Intellectual Disability

Answer 8

Denver developmental screening test (DDST)
Wechsler intelligence scale for children (WISC-V)

*severity based on adaptive functioning - not IQ!

Question 9

global developmental delay

Answer 9

unable to undergo systematic assessments of intellectual functioning

meet dx criteria for ID

likely secondary to acquired insult or head injury during developmental period

Question 10

language disorders

Answer 10

difficulty with spoken, written, and sign language

language abilities are below those expected for age and negatively impact functioning

difficulties are not due to hearing or sensory impairment, motor dysfunction, neuro condition or being a foreign language speaker

Question 11

speech sound disorders

Answer 11

difficulty making speech sounds that are intelligible and limits verbal communication

interferes with social participation, academic achievement, and occupational performance

not due to congenital or acquired conditions such as CP, cleft palate, deafness, or TBI

no attributed to limited opportunity for language acquisition

Question 12

Childhood-onset fluency disorder (stuttering)

Answer 12

difficulty with fluency and patterns of speech sound

limits effective communication, social participation and academics due to anxiety

not due to speech-motor or sensory deficit, neuro insult, or another mental disorder

Question 13

social (pragmatic) communication disorder

Answer 13

difficulty with social use of verbal and nonverbal communication (ex: greetings, sharing info, social cues)

deficits may not become obvious until social communication demands exceed limited capacities

not due to other medical or neuro conditions.

not due to autism, ID, global delay or other language DO

Question 14

autism spectrum disorder

Answer 14

problems with social communication and social interaction

problems with nonverbal behaviors used for social interaction

problems with developing, maintaining, and understanding relationships

restricted, repetitive patterns of behavior, interests or activities

insistence on sameness, inflexible adherence to routines, or ritualized patterns

obsessive and intense fixation with objects or subjects of interest

abnormal reaction to sensory input

Question 15

how do you differentiate between ASD and ID?

Answer 15

presence of restricted interests or repetitive behaviors

Question 16

behavioral interventions for ASD

Answer 16

education and support for parents, siblings, and teachers
learning about “parallel processing” for behavior
controlling the environment to limit sensory overload
allow for difficulty with transitions

Question 17

FDA approved medications for irritability and agitation in ASD

Answer 17

risperidone

arirpiprazole

Question 18

pediatric prevalence of ADD/ADHD

Answer 18

8.7% of children in the US between ages 8-15

boys > girls

girls with ADHD present with inattentive subtype, therefore, less likely to receive treatment

Question 19

ADHD comorbidities

Answer 19

mood disorders
anxiety disorders
substance abuse
intermittent explosive disorder
tic disorders
suicidality

Question 20

Tourette’s syndrome triad

Answer 20

motor/vocal tics lasting > 1 yr (Tourette’s)
ADHD
OCD

Question 21

executive functioning deficits in ADHD

Answer 21

ability to assess a situation
prioritizing relevant vs irrelevant
filtering extraneous information
developing and organizing a plan of action
execute the plan to completion
assess the effect of action in a fluid manner

Question 22

what part of the brain is linked to executive functioning deficits in ADHD?

Answer 22

dorsal anterior midcingulate cortex

*primarily due to deficiency in DA and NE

Question 23

which parts of the brain are linked to inhibition tasks in ADHD?

Answer 23

right inferior prefrontal cortex
supplemental motor area
anterior cingulate cortex
left caudate

Question 24

which parts of the brain are linked to attention tasks in ADHD?

Answer 24

right dorsolateral prefrontal cortex
left putamen and globus pallidus 
right posterior thalamus and caudate
right inferior parietal lobe
superior temporal lobe

Question 25

inattentive type ADHD (6+ symptoms for dx)

Answer 25

failures to give close attention to details/makes careless mistakes difficulty sustaining attention does not appear to listen struggles to follow through on instruction difficulty with organization avoids or dislikes tasks requiring a lot of thinking loses things easily distracted forgetful in daily activities

Question 26

hyperactive type ADHD (6+ sx for dx)

Answer 26

fidgets with hands or feet/squirms in chair difficulty remaining seated runs or climbs excessively difficulty engaging in activities quietly acts as if driven by a motor talks excessively blurts out answers before questions are completed difficulty waiting or taking turns

Question 27

ADHD diagnostic tools

Answer 27

Computerized: TOVA Conners continuous performance test Checklist: Vanderbilt Conners

Question 28

ADHD treatment for preschool-aged children (4-5 y/o)

Answer 28

1. behavioral therapy | 2. methylphenidate if behavioral therapy does not provide significant improvement

Question 29

ADHD treatment for elementary school-aged children and older (6-18 y/o)

Answer 29

behavioral + pharmacological therapy

Question 30

developmental coordination disorder

Answer 30

problems with coordinated motor skills interferes with self-care and self-maintenance interferes with school, vocational, leisure and play activities not attributed to neuro condition such as CP, MD or degenerative DO

Question 31

stereotypic movement disorder

Answer 31

repetitive, compulsive and purposeless motor behavior not attributed to effects of a substance or neuro condition not attributed to mental disorder - trichotillomania or OCD

Question 32

criteria for Tourette's disorder

Answer 32

multiple motor and phonic tics present tics occur many times a day, every day for > 1 yr location, frequency, type, and severity of tics changes onset before age 18 movements/noises not explained by other medical condition tics must be witnessed or recorded

Question 33

Tourette's comorbidities

Answer 33

``` ADHD OCD anxiety DOs mood DOs suicidality disruptive behaviors learning disabilities sleep DOs ```

Question 34

Tourette's medications

Answer 34

``` antidopaminergics dopamine depleters antipsychotics a adrenergic agonists botox anticonvulsants ```

Question 35

Persistent motor or vocal tic disorder

Answer 35

single or multiple motor or vocal tics - do not occur together persisted for > 1 yr onset before age 18 not attributed to substance or other medical condition have not met criteria for Tourette's