Neurodevelopmental/child disorders

Question 1

What are the main characteristics of intellectual disability (formerly mental retardation)?

Answer 1

Severely impaired cognitive and/or adaptive/social functioning

Question 2

Diagnostic criteria for intellectual disability

Answer 2

Deficits in intellectual functioning (reasoning, problem solving, planning, abstract thinking, judgment, learning)
Deficits in adaptive functioning (communication, social participation, and independent living)
Deficits affect multiple domains: conceptual, practical, social
Onset during developmental period
Intellectual deficits confirmed by clinical assessment and standardized tests (scores <2SD below mean)
Requires ongoing support for ADLs

Question 3

Genetic causes of mental retardation

Answer 3

Down syndrome (1/700 live births)
Fragile X syndrome (second most common cause of ID)

Question 4

Prenatal causes of mental retardation

Answer 4

Infection and toxins
TORCH infections
Toxoplasmosis
Other (syphilis, AIDS)
Rubella
CMV
Herpes simplex

Question 5

Perinatal causes of mental retardation

Answer 5

Anoxia
Prematurity
Birth trauma
Meningitis
Hyperbilirubinemia

Question 6

Postnatal causes of mental retardation

Answer 6

Hypothyroidism
Malnutrition
Toxin exposure
Trauma
Psychosocial causes

Question 7

What is global developmental delay?

Answer 7

Failure to meet expected developmental milestones in several areas of intellectual functioning
Diagnosis reserved for pts <5yo

Question 8

What is specific learning disorder?

Answer 8

Delayed cognitive development in a particular academic domain (reading, writing, ‘rithmetic)

Question 9

Diagnostic criteria for specific learning disorder

Answer 9

• Academic skills significantly impaired/below expected for chronologic age, causing interference in school, occupation, or ADLs
• Begins during school age
• Affected areas: Reading (dyslexia), writing, or arithmetic (dyscalculia)
• Not better accounted for by intellectual disabilities, sensory disabilities, language barriers, or poor education

Question 10

What is speech sound disorder?

Answer 10

Difficulty producing articulate, intelligible speech

Question 11

What is language disorder?

Answer 11

Difficulty acquiring and using language due to expressive or receptive impairment

Question 12

What is childhood-onset fluency disorder?

Answer 12

Stuttering

Question 13

What is social communication disorder?

Answer 13

Challenges with the social use of verbal and nonverbal communication.

*If restricted/repetitive behaviors, activities, or interests also present –> autism spectrum disorder

Question 14

What are the main characteristics of ADHD?

Answer 14

Persistent inattention, hyperactivity, and impulsivity

Question 15

Diagnostic criteria for ADHD

Answer 15

At least 6 inattentive symptoms and/or at least 6 hyperactivity symptoms
>6 months
Symptoms interfere with or reduce quality of social/academic/occupational functioning

Question 16

Inattentive symptoms of ADHD

Answer 16

Fails to give attention to details/makes careless mistakes
Has difficulty paying attention
Does not appear to listen
Struggles to follow through on instructions
Difficulty with organization
Avoids or dislikes tasks requiring a lot of thinking
Loses things
Easily distracted
Forgetful in daily activities

Question 17

Hyperactivity symptoms of ADHD

Answer 17

Fidgets with hands/feet or squirms in chair
Has difficulty remaining seated
Runs about or climbs excessively in childhood; extreme restlessness in adults
Difficulty engaging in activities quietly
Acts as if driven by a motor
Talks excessively
Blurts out answers
Difficulty waiting or taking turns
Interrupts/intrudes

Question 18

Pharmacologic treatments for ADHD

Answer 18

First line: stimulants (methylphenidate, dextroamphetamine, mixed amphetamine salts)
Second-line: atomoxitene (norepi reuptake inhibitor)
Alpha-2 agonists (clonidine, guanfacine) can be used instead or as an adjunctive treatment

Question 19

Nonpharmacologic treatments of ADHD

Answer 19

Behavior modification techniques and social skills training
Educational interventions
Parent education

Question 20

What are the characteristic features of autism spectrum disorder (ASD)?

Answer 20

Impairments in social communication/interaction

Restrictive, repetitive behaviors/interests

Question 21

Diagnostic criteria for ASD

Answer 21

Problems with social interaction and communication
–Impaired social/emotional reciprocity
–Deficits in nonverbal communication
–Interpersonal challenges
Restricted, repetitive behaviors/interests/activities
–Intense, peculiar interests
–Inflexible adherence to rituals
–Stereotyped, repetitive motor mannerisms
–Hyper/hyporeactivity to sensory input
Begin in early development period
Not better accounted for by ID or GDD
Significant social or occupational impairment

Question 22

Etiology of ASD

Answer 22

Prenatal neurologic insults, advanced paternal age, LBW
Genetic
Fragile X –> single gene cause of ASD

Question 23

Management of ASD

Answer 23

Early intervention
Remedial education
Behavioral therapy
Psychoeducation
Low dose atypical antipsychotic meds for disruptive behavior, agitation, aggression, irritability

Question 24

Characteristic features of operational defiant disorder

Answer 24

Irritability/anger, defiance, vindictiveness

Question 25

Diagnostic criteria for ODD

Answer 25

At least 4 symptoms present for at least 6mos (with at least 1 person not a sibling) --Anger/irritable mood: loses temper, touchy/easily annoyed, often angry/resentful --Argumentative/defiant behavior: breaks rules, argues with authority figures, deliberately annoys others --Vindictiveness: spiteful at least 2x in past 6mos Distress or impairment in functioning

Question 26

Treatment for ODD

Answer 26

Behavior modification, conflict management training, problem-solving skills Parent management training (setting limits, enforcing consistent rules) Meds for comorbid conditions (e.g. ADHD)

Question 27

Diagnostic criteria for conduct disorder

Answer 27

Pattern of recurrently violating the basic rights of others or societal norms, with at least 3 behaviors over 6 months: - -Aggression to people and animals - -Destruction of property - -Deceitfulness or theft - -Serious violations of rules (stays out late before age 13, runs away at least 2x, skips school before 13)

Question 28

Diagnostic criteria for Tourette's disorder

Answer 28

Multiple motor and at least 1 vocal tic present for >1 year Onset prior to age 18 Not cause by a substance or medical disease (e.g. Huntington's)

Question 29

Epidemiology of tic disorders and Tourette's

Answer 29

Transient tic behaviors common in kids Tourette's in 3/1000 school-aged children Boys>girls

Question 30

Etiology of Tourette's

Answer 30

Genetic | Prenatal/perinatal factors: older paternal age, obstetric complications, maternal smoking, LBW

Question 31

Course/prognosis of Tourette's

Answer 31

Onset between 4-6yo, with peak severity 10-12yo Tics wax and wane, change in type Symptoms tend to diminish in adulthood High comorbidity with OCD and ADHD

Question 32

Management of Tourette's

Answer 32

``` Psychoeducation Behavioral interventions - habit reversal Meds only if tics are impairing Alpha-2 agonists: guanfacine, clonidine Anti-psychotics if severe ```

Question 33

What are elimination disorders?

Answer 33

Developmentally inappropriate elimination of urine or feces

Question 34

Diagnostic criteria for enuresis

Answer 34

Recurrent urination into clothes or bed-wetting 2x/wk for at least 3 consecutive months, or clinical distress or marked impairment At least 5 years old (developmentally) Not due to a substance or medical condition

Question 35

Diagnostic criteria for encopresis

Answer 35

Recurrent defecation into inappropriate places Occurs at least 1x/month for at least 3 months At least 4 years old (developmentally) Not due to a substance or another medical condition (except via constipation-related mechanism)

Question 36

Treatment for enuresis

Answer 36

Limit fluid and caffeine intake at night Behavioral monitoring and reward system, bladder training exercises, or urine alarm Drugs: DDAVP first-line, imipramine second-line

Question 37

Treatment for encopresis without constipation

Answer 37

Comprehensive behavioral program (bowel retraining) for appropriate elimination

Question 38

Treatment for encopresis with constipation

Answer 38

Initial bowel cleaning followed by stool softeners, high-fiber diet, and toileting routine