PSY2004 S2 W3 Diagnosis Flashcards
(39 cards)
What type of diagnosis is for neurodevelopmental conditions?
William’s syndrome & Down Syndrome: you either have it or you don’t
ADHD & ASC: spectrum, diagnosis criteria
How to diagnose William’s syndrome?
physical and cognitive features
confirmed with a genetic test (blood test to identify absence of the ELN [elastin] gene)
The laboratory test used to detect the elastin gene is called fluorescent in situ hybridization (FISH): noticing physical characteristics associated with William’s syndrome might lead to doing the FISH test
When and How can you diagnosis down syndrome?
Prenatal, screening test available between 10-14 weeks of pregnancy. Typically carried out at the 12 week scan.
Combined test: two primary parts
Blood test (mother’s blood contains DNA from the foetus)
Nuchal translucency scan (checks the build of fluid at the back of the baby’s neck, the larger it is the greater the change of a chromosomal abnormality)
If this tests shows a high risk then the mother would be offered an amniocentesis to confirm. (take a sample of the amniotic fluid, voluntary)
What is Amniocentesis?
A prenatal diagnostic test in which a small amount fo amniotic fluid is removed to determine any genetic abnormality
What is a Post Natal diagnosis of down syndrome?
Check physical characteristics. If unclear, follow up with a blood test. Check for the presence of an extra chromosome.
What conditions are trickier to diagnoses?
ADHD & Autism
Why is it trickier to diagnosis ADHD and autism?
comorbidity
ADHD and autism frequently co-occur, with comorbidity rates potentially as high as 70% (Antshel & Russa, 2019)
ADHD is one of the most commonly comorbid conditions with autism
The previous edition of the DSM (DSM-4, 2000) prohibited dual diagnosis of autism and ADHD
Listed as two separate conditions in the DSM-5, hence why we discuss as two separate conditions throughout these lectures
Nevertheless, worth bearing in mind that many traits associated with ADHD overlap with traits associated with autism
How to diagnosis ADHD?
Initial referral often made in school (e.g. by SENCO).
Primary Care: GP / Social worker / Educational Psychologist
Secondary Care: Psychiatrist / Psychologist working within CAMHS (child and adolescent mental health service).
Diagnosis based on:
Discussion about behaviour in a range of different settings (e.g. school, home, etc)
Full developmental and psychiatric history and observer reports
Assessment of the person’s mental state.
Screening instruments can be used to supplement diagnosis (but not on their own).
Conner’s rating scales
Strengths and Difficulties Questionnaire
How do we diagnosis ASC?
Initial referral often made by parents / school / GP. Referral made to secondary care (e.g. CAMHS)
Autism assessment:
Detailed questions about parent’s or carer’s concerns and, if appropriate, the child’s or young person’s concerns;
Details of the child’s or young person’s experiences of home life, education and social care a developmental history, focusing on developmental and behavioural features consistent with ICD-10 or DSM-5 criteria (consider using an autism-specific tool to gather this information)
A medical history, including prenatal, perinatal and family history, and past and current health conditions
Physical examination
What are the two main diagnostic manuals?
Diagnostic and Statistical Manual (currently 5th Edition, DSM-V, published in 2013)
International Classification of Diseases (currently 11th Edition, ICD-11)
What is the DSM-5 Criteria for ADHD?
Inattention: 6 or more symptoms of inattention for children up to age 16Y. 5 or more for ado 17Y+ symptoms of inattention have been present for at least 6M.
Hyperactivity and Impulsivity: 6 or more symptoms of hyperactivity-impulsivity for children up to age 16Y, or 5 or more for adolescents age 17Y +: symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level.
What are the criteria for innatation (ADHD)?
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
- Often has trouble organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
- Is often easily distracted
- Is often forgetful in daily activities.
What are the criteria of Hyperactivity and impulsivity?
- Often fidgets with or taps hands or feet, or squirms in seat.
- Often leaves seat in situations when remaining seated is expected.
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
- Often unable to play or take part in leisure activities quietly.
- Is often “on the go” acting as if “driven by a motor”.
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often has trouble waiting their turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
What are the DSM-5 Criteria for Autism?
Persistent deficits in social communication and social interaction across multiple contexts: Deficit in social-emotional reciprocity, Deficits in nonverbal communicative behaviour and deficit in developing, mainting and understanding relatinoship
Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history: Stereotyped or repetitive motor movement, insistence on sameness and highly restricted fixated interests and hypoer or hyperactivity to sensory input
What is meant by hyper or hyperactivity to sensory input?
Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
What is meant by stereotyped or repetitive motor movement?
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
What is meant by insistence on sameness?
Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
What is meant by highly restricted fixated interests?
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
What is meant by deficits in social-emotional reciprocity?
Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
What is meant by deficits in nonverbal communicative behaviour?
Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
What is meant by deficits in developing, maintaining, and understand relationships?
Deficits in developing, maintaining, and understand relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
What are standardised tools used in the diagnosis of ADHD?
Conners scale for assessing ADHD.
Questionanires screening for behaviours associated with ADHD, used as initial evaluation when ADHD is suspected
3 Forms: 1 for parents, 1 for teachers, self-report to be completed by the child.
Can be used during follow-up appointments to help doctors and parents monitor how well certain medications or behaviour-modification techniques are working.
How are T-scores made?
The psychologist will total the scores from each area of the test. They will assign the raw scores to the correct age group column within each scale. The scores are then converted to standardized scores, known as T-scores.
What are Autism diagnosed observational scedule?
Autism diagnostic observational schedule (ado)
Semi- Structured Interview. Code interaction for presence / absence of certain key behaviours, e.g. eye-contact, reciprocal interaction, turn-taking, imaginative play, non-verbal communication.
Five modules
Toddler: 12 – 30 months (no consistent speech)
Module 1: 31 months + (no consistent speech)
Module 2: Children any age (not verbally fluent)
Module 3: Children & young adolescents (verbally fluent)
Module 4: older adolescents & adults (verbally fluent)
Have to be carried out by a trained person, you need to be certified to be able to do this. You would always have a ADOS, but you need other interviews/observations as well
