Flashcards in CM: Child Psych 1 Deck (31):
What is the definition of intellectual disability (ID)?
deficits in intellectual or adaptive functioning
onset during developmental period
severity based on adaptive functioning which determines level of support needed, not IQ score
What are important features of MILD intellectual disability?
preschool age may show no obvious differences
speech grossly similar to peers
personal care intact
needs some support for complex skills/decisions
jobs are possible
What are important features of MODERATE intellectual disability?
conceptual deficits present throughout life
can perform personal care by adulthood but may need reminders and teaching
jobs still possible
What are important features of SEVERE intellectual disability?
speech generally single words or phrases
requires supervision at all times
What are important features of PROFOUND intellectual disability?
little to no speech
requires supervision at all times
What is the epidemiology of ID?
males affected slightly more often than women
mild >>>>>> severe
What is the etiology of ID?
genetic: Downs, fragile X, fetal alcohol, others
prenatal: inf and toxins (TORCH)
perinatal: anoxia, prematurity, birth trauma
Postnatal: hypoT, malnutrition, encephalitis/sepsis, trauma, lead poisoning
What are risk factors for ID of unknown etiology?
low birth weight
lower maternal education, Asian or Hispanic moms - risk for severe ID
lower SES, multiple births, second or later born - risk for mild
What are some important clinical issues in ID?
psychiatric conditions often missed: attributed to ID
careful eval for underlying medical illness or pain must be conducted
common foci of treatment: self-injury, aggression, hyperactivity/impulsivity, stereotypies (rocking, flapping)
higher risk of adverse med rxns
What is the treatment for ID?
educational settings w programs addressing adaptive and social skills training, vocational training, behavioral therapy, etc
pharm to address aggression, self injury, comorbidities, stereotypies (risperidone used a lot)
What is the IDEA?
guarantees right of students w disabilities to free, appropriate, public education - ppl b/w 3-21 years old
anyone can request eval - must happen w/i 60 days
services deemed necessary incorporated into IEP unique for student
What is the definition of global developmental delay?
children under 5 yrs of age who fail to meet expected developmental milestones in several areas of intellectual fxning and are unable to undergo assessment of intellectual fxning (too young)
requires future reassessment
What is unspecified intellectual disability?
individuals over 5 yrs of age w intellectual disabilities but cannot be assessed because of physical or sensory impairments or comorbid disorders
requires future reassessment
What is the diagnostic evaluation of children with ID?
screening by PCP --> specialty eval (H&P, fxnal testing, lead screening) --> genetic testing (CMA is standard for unexplained ID), brain imaging, EEG, metabolic testing
What is specific learning disorder?
difficulties acquiring and using academic skills appropriate for age and grade
specify: w impairment in reading, written expression, or math
symptoms for at least 6 mos, despite interventions
not accounted for by IDs, lack of education, or another disorder
What is the epidemiology of learning disorders?
more common in males than females
What is the etiology of learning disorders?
genetic, perinatal injury (prematurity, low birth weight, maternal exposure), neurological/medical conditions
presentation affected by environmental factors and personal factors
What are some important clinical issues in regards to learning disorders?
can lead to poor self esteem, low morale, poor relationships
more likely to drop out of school (rates of 40%), problems w employment and social adjustment
common comorbids = depression, ADHD, disruptive behavior disorders
How are learning disorders evaluated for diagnosis?
hx of learning problem and performance on standardized or psychometric measures
assessment of outside impairments on learning
info from multiple sources
What is the treatment of learning disorders?
and IEP, management of comorbids
What are the two symptoms domains of autism spectrum disorders?
social communication impairment
restricted interests/repetitive behaviors
must be present in early dev period and affect fxning
How is social communication impairment manifested in children w autism?
must have deficits in all 3 of the following (currently or by hx): social-emotional reciprocity, nonverbal communicative behaviors for social interxn, developing or maintaining and understanding relationships
How is the restricted, repetitive behavior pattern manifested in children with autism?
at least 2 of the following (currently or by hx): stereotyped or repetitive movements, insistence on sameness or ritualized behavior patterns/routines, highly fixated and restricted interests, inc or dec response to sensory input or unusual interest in sensory aspects of environment
What is the epidemiology of autism spectrum disorders?
prevalence increasing: increased awareness, changes in definition, actual increase from unknown etiology
boys 5x more than girls
up to 20% siblings affected
What is the etiology of autism spectrum disorders?
interxns b/w multiple genes, w exposure to environmental modifiers
genetic factors (advanced paternal age), prenatal neurological insults, metabolic or mitochondrial disorders (rare)
What are important clinical issues of autism spectrum disorders?
40-60% have ID
sleep disorders, seizures (in more severe ID), GI issues (restricted diet --> constipation or malnutrition), social isolation, comorbids = anxiety, ADHD, associated w tuberous sclerosis and fragile X, higher risk of behavioral response to meds
common behavioral problems: sensory issues, self-injury, aggression, hyperactivity/impulsivity, sleep disorders
What is the treatment for autism spectrum disorders?
tailored to individual: IEP, physical/occupational/behavrioal/sensory integration/social skills therapy, support groups
meds - only if needed (risperidone or abilify for agression and self harm, stimulants/alpha2 agonists/antipsychotics for hyperactivity, SSRIs for repetitive behaviors (fluoxetine) or anxiety)
What is applied behavioral analysis (ABA)?
behavioral therapy including discrete trial training - based on operant conditioning (parents = co-therapists)
can teach social and adaptive behaviors and decrease problem behaviors
most evidence of efficacy in autism spectrum disorders
What is the prognosis for children with autism spectrum disorders?
if no associated medical disorder - normal lifespan
variable fxnal outcome, but all will have some social difficulty
those w Aspergers or normal IQ can develop expertise in limited area and become successful
most significant predictors of outcome = cognitive level and language abilities
What is social (pragmatic) communication disorder?
difficulties in social use of verbal and nonverbal communication: difficulty using communication for social purposes, following rules for conversation/story telling, understanding things not explicitly stated
onset in early dev period