PSYC 492 UNIT 3 - Childhood Neuropsychiatric Disorders & Guest Lecture -- 3.21.24 Flashcards
(128 cards)
1
Q
Autism Spectrum Disorder is a developmental disability that can cause ———–, ————-, and ——– challenges.
A
social, communication, behavioral
3.21.24-Neuropsychiatric Disorders
2
Q
In order to be diagnosed with Autism Spectrum Disorder, a person must:
- have ————– deficits in social communication and social interaction that present ————–.
- have ———— and ———— patterns of behavior, interests, or activities
A
persistent; multiple contexts
restrictive; repetitive
3
Q
According to the DSM-V, a person with ASD has:
- challenges in social-emotional ————
- deficits in —————— behaviors used for social interaction
- deficits in ————-, ————–, and ————- relationships.
A
- reciprocity
- nonverbal communicative
- developing; maintaining; understanding
4
Q
A person with ASD has restrictive, repetitive patterns of behavior, interests, or activities manifested by at least 2 of 4 things:
A
- stereotyped or repetitive motor movements, use of objects or speech
- insistence on sameness, inflexible adherence to routines, or ritualized patterns of behavior (verbal or nonverbal)
- highly restricted, fixed interests taht are abnormal in intensity or focus
- hyper or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
5
Q
In Autism Spectrum Disorder, symptoms must be present in ————————- (but may not ————).
A
early developmental period; become fully manifested until later
6
Q
T/F
People with ASD must have an intellectual impairment in order to be diagnosed.
A
False; ASD can be with or without accompanying intellectual impariment
7
Q
T/F
A language impairment is not a requirement in order to be diagnosed with ASD.
A
True
8
Q
According to the DSM, how many/what are the severity levels of ASD?
A
3 levels
Level 1: requiring support (speaks but lacks reciprocity; difficulty switching activities)
Level 2: requiring substantial support (simple/limited sentences, distress when changing focus)
Level 3: requiring very substantial support (non-verbal; great distress when changing focus.
9
Q
To be diagnosed with ASD, the individual’s disturbances are not better explained by ————— or —————–.
A
- intellectual disability
- global developmental delay
10
Q
For people with ASD, symptoms cause —————– in social, occupational, or other important areas of current functioning.
A
significant impairment
11
Q
add some flashcards that make you figure out which disorder
A
12
Q
According to the CDC ——- of 1000 (or 1 in ——) 8-year-olds has ASD.
A
18.5; 54
13
Q
Boys are how many times more likely to be diagnosed than girls with ASD.
A
4x
Boys = 1/34
Girls = 1/45
14
Q
Why are girls (potentially) underdiagnosed with ASD?
2 reasons
A
- different symptom presentation (less restrictive/repetitive behaviors)
- better as masking social aspects
15
Q
Which group of children is least likely to be diagnosed with ASD?
- black
- Asian/Pacific Islander
- white
- Hispanic
A
Hispanic (1/60)
16
Q
ASD is strongly ———- and there is evidence supporting it as a ———- disorder.
A
heritable; biological
17
Q
Explain how brain growth in children with ASD seems to differ from children without the disorder.
A
Children with ASD seem to have overgrowth of the brain between ages 2-4.
Overgrowth ends around 5-6 then stops (no significant enlargement after this point)
Later in adolescence/childhood, there seems to be a decline in gray matter volume.
18
Q
————– is not observed in all people with ASD. What are some reasons this might be?
A
Brain overgrowth
- not a common pathological mechanism?
- neurobiological subtype with larger brain?
- pattern of general physical overgrowth?
19
Q
People with ASD seem to have ————- overgrowth, including the ———— of typical growth patterns.
A
unequal; reverse (brain grows front to back instead of back to front)
20
Q
Unequal overgrowth in children with ASD leads to ————- of prematurely developing regions from the rest of the cortex, which causes ———————–.
A
uncoupling; differences in connectivity
21
Q
During which developmental processes does overgrowth in people with ASD occur? What other effect does this have?
3 processes for question 1
A
synaptogenesis, myelination, pruning
effects white matter: high white matter integrity early on, but then lower integrity later
22
Q
In adults with ASD, we see abnormalities in which brain structures?
7 regions
A
- fronto-temporal
- fronto-parietal
- amygdala-hippocampal complex
- cerebellum
- basal ganglia
- anterior and posterior cingulate regions
23
Q
T/F
Symptoms of ASD must be persistent and found in multiple domains to warrant a diagnosis.
A
True
24
Q
T/F
ASD is characterized by an overgrowth of the brain in early years.
A
True
25
# T/F
No differences exist between the brains of girls and boys with ASD.
False
26
In boys and girls with ASD, where are functional brain differences found? What do these brain areas affect?
| 3 differences
**Primary motor cortex and supplementary motor area:** correlated with restricted and repetitive behaviors in girls
**Middle and superior temporal gyri**: language network
**Parietal and lateral occipital cortex**: visuospatial attentional system
27
Attention Deficit/Hyperactivity Disorder is a persistent pattern of -------- and/or -------------/---------- that interferes with functioning or development.
inattention; hyperactivity-impulsivity
28
What 3 things are necessary in order to be diagnosed with ADHD?
- 6+ symptoms of inattention and/or 6+ symptops of hyperactivity (5 in people 17 or older)
- symptoms have persisted for 6 or more months
- symptoms are inconsistent with developmental level
29
What are some examples of inattention in people with ADHD?
| 5
- careless mistakes/doesn't pay close attention to detail
- doesn't follow through on instructions
- trouble organizing tasks and activities
- easily distracted
- loses things necessary for tasks and activities
30
What are some examples of hyperactivity/impulsivity in people with ADHD?
| 5
- often fidgets/squirms in seat
- runs about or climbs where it isn't appropriate (restlessness for adults)
- often talks excessively
- difficulty waiting their turn
- often "on the go" or acts as if "driven by motor"
31
According to the DSM, in order to be diagnosed with ADHD:
- several symptoms were present prior to age -----
- several symptoms were present in ------- (#) settings
- clear evidence that ---------------
- not due to -------------
- 12
- 2
- symptoms interfer with function
- other disorder
32
In addition to attentional deficits, people with ADHD have accompanying issues with ------------, including:
- ----------, impulsivity, and poor --------
- problems with regulating/inability to detatch ------------
executive function
- response inhibition; poor planning
- attention
33
A person with ADHD's inability to regulate their attention (detach their attention from something) is consistent with the --------------- hypothesis.
hyperfocus
34
ADHD diagnoses have recently surged (4.4 million in 2003 to 6.4 in 2011). Why might this be?
Social Policy impacts
1. the ADA offers accommodations and reimbursements for people with ADHD; this was not always the case
2. "consequential accountability legislation" -- special education designation; SES disparities --> schools receive more funding if they have higher test scores. They can omit people with ADHD's scores from their aggregate to get more funding.
35
What is the prevalence of ADHD diagnoses in children between ages of 3-17?
9.8% of children between 3-17 (ages 3-5: 2%; ages 6-11: 10%; ages 12-17: 13%)
36
ADHD has high comorbidity with which disorders?
| 6
(highest to lowest)
- mental, emotional, behavioral disorder
- behavior or conduct problem
- anxiety
- depression
- ASD
- Tourette syndrome
37
Women with ADHD tend to present with more ----------- forms, and there are potentially more --------- onset cases.
inattentive; adult-onset
38
A ------------------ might exist with ADHD; meaning women may have lower prevalence but more severe symptoms.
gender
39
According to the BE GIRLS study, girls showed ------------ deficits and onset of ------------------- in mid to teen years.
executive functioning; disordered eating
40
According to the BE GIRLS study, into adulthood, girls were at high risk for --------------------- and -------------- but NOT for -------------. Additionally ---------------- pathology declined.
According to the BE GIRLS study, into adulthood, girls were at high risk for -**antisocial behavior** and **peer rejection** but NOT for **substance use**-. Additionally **eating-related** pathology declined.
41
# According to BE GIRLS study
As adults, women with ADHD were at higher risk for experiencing ------------------ and -------------.
As adults, women with ADHD were at higher risk for experiencing **intimate partner violence** and **self-harm** (both non-suicidal self injury and suicide attempts)
42
# According to BE GIRLS study
For women with ADHD -------------- exist into mid and late 20's, even for those -------------------------------------.
For women with ADHD **impairments** exist into mid and late 20's, even for those **whose ADHD symptoms were no longer detectable.**
43
ADHD is associated with increased re-uptake of -----------, which results in decreased levels of extracellular -----------.
| both blanks are the same
dopamine
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
44
What support is there for the "reduced dopamine hypothesis" in ADHD?
| 2 things
1. Ritalin, concerta (methylphenidate) as successful management tool. This is a psychostimulant that is a dopamine re-uptake inhibitor.
2. Gene coding for the dopamine transporter 1 (DAT1), which regulates the dendsity of transporters.
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
45
Both -------- and --------- factors contribute to ADHD.
genetic; environmental
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
46
What support is there for genetic factors that contribute to ADHD?
twin studies vary from .6 to .9 heritability estimates
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
47
No single gene seems to play a major role in ADHD. The most study genes have been associated with variations in the --------------- ------------ and -------- genes.
dopamine receptor and transporter genes
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
48
What are four environmental factors that are associated with ADHD?
| list 4
- exposure to certain toxins (lead, PCBs) in utero or postnatal (BUT effects on specific to ADHD)
- exposure to prenatal smoking or alcohol
- premature birth, low birth rate
- psychosocial adversity, high levels of family conflict
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
49
ADHD is associated with disturbances in 3 dopaminergic pathways. List them and their associated cognitive symptoms.
- **mesocortical:** cognitive symptoms
- **mesolimbic**: motivational deficits and reward circuitry
- **nigrostriatal:** cognitive symptoms and reward
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
50
# ADHD dopaminergic pathway
The mesocortical pathway extends from the ----------- to ---------. It is likely associated with ------------- symptoms in ADHD.
VTA to PFC; cognitive symptoms
| VTA = ventral tegmental area; PFC = prefrontal cortex
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
51
# ADHD dopaminergic pathway
The mesolimbic pathway extends from the --------- to the --------------, ------------, and ------------. It is associated with ----------------- deficits and --------- circuitry in people with ADHD.
The mesolimbic pathway extends from the **VTA** to the **nucleus accumbens**-, **amygdala**, and **hippocampus**. It is associated with **motivational** deficits and **reward**circuitry in people with ADHD.
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
52
# ADHD dopaminergic pathway
The nigrostratal pathway extends from the -------------- to the --------------- (which includes the ----------- and ----------). It is associated with ------------- symptoms and -----------.
The nigrostratal pathway extends from the **substantia nigra** to the **striatum** (which includes the **caudate** and **putamen**). It is associated with **cognitive** symptoms and **reward**.
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
53
Which pathways are involved in ADHD's cognitive symptoms?
mesocortical (VTA to PFC) and nigrostriatal (substantia nigra to striatum, including caudate and putamen)
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
54
Which pathway is associated with motivational deficits in ADHD?
mesolimbic (VTA to nucleus accumbens, hippocampus, amygdala)
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
55
Which pathways are associated with reward in ADHD?
- mesolimbic (VTA to hippocampus, nucleus accumbens, and amygdala)
- nigrostriatal (substantia nigra to striatum, including caudate and putamen)
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
56
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
57
In which areas of the brain do we see abnormalities in people with ADHD?
- prefrontal cortex
- cerebellum
- striatum (specifically caudate, globus pallidus in children and nucleus accumbens in adults)
- inferior parietal cortex
- anterior cingulate
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
58
# ADHD - list functional/structural abnormalities with structure
anterior cingulate
reduced volume and abnormal activation
| Note: anterior cingulate is associated with error detection
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
59
# ADHD - list functional/structural abnormalities with structure
Inferior Parietal Cortex
- increased size in pediatric populations
- decrease in cortical thickness in adults
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
60
# ADHD - list functional/structural abnormalities with structure
Striatum
- reduced caudate and global pallidus in children
- larger nucleus accumbens in adults
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
61
# ADHD - list functional/structural abnormalities with structure
cerebellum
reduced volume
| 3.28.24 ADHD part 2 and Cerebrovascular
## Footnote
Interesting bc cerebellum thought as fine motor coordination; studies looking at cognitive function linked to cerebellum; some pathways link cerebellum to frontal cortex
62
# ADHD - list functional/structural abnormalities with structure
prefrontal cortex
- reduced volume
- reduced activity
## Footnote
3.28.24 ADHD part 2 and Cerebrovascular
63
According to the APA, pediatric neuropsychology is a professional specialty that studies the --------- and ----------- abilities of children in terms of the -----------------, especially in cases of -------------- or -------------------.
According to the APA, pediatric neuropsychology is a professional specialty that studies the **behavior** and **cognitive abilities** of children in terms of the **neural mechanisms that underlie brain activity** especially in cases of **brain damage** or other **neurological disorders.**
## Footnote
Pediatric Neuropsychology: A Primer
64
How is the practice of pediatric neuropsychology different than adult neuropscyhology?
the differences largely relate to the complexities involved in evaluating an *actively maturing young brain* progressing toward it's adult arrangement of *distributed neural networks or functional neural ciruitry*.
- these differences are so important as to be considered maxims of pediatric neuropsychology practice. They are not after thoughts but should guide all practice.
65
----------- is a paramound force in pediatric neuropsychology.
maturation
66
the ----------------------- is the major influence in pediatric neuropsychology research and practice
development of the brain
67
a goal of pediatric neuropsychology is to know ---------- in order to ---------
- what normal or typical brain development looks like
- identify where development might be advanced, delayed, or atypical
68
Pediatric neuropsychologies must have an understanding of ------------------------- and -------------------.
- the way the brain develops
- what to expect at different time points
69
List 5 "maxims" of pediatric neuropsychology.
1. maturation is a paramount force in pediatric neuropsychology
2. adult brain-behavior relationships don't invariably apply to children
3. a model of normal development provides critical clinical context
4. pediatric neuropsychology methods are distinctive
5. Genetics, socioenvironmental, and family factors have primacy
70
What is meant by the pediatric neuropsychology tenet that "adult brain-behavior relationships do not invariably apply to children"?
- children might respond very differently to injury or treatment
- developing brains are often better able to adjust to a focal brain injury
- younger brains might have more serious reactions than adults having the same issue (hydrocephalus, Cushing's disease)
71
a model of ----------------------- provides critical clinical context in pediatric neuropsychology
normal development
72
# Pediatric neuropsychologists must:
1. have a solid foundation in ------------------------- in order to recognize deviations
2. consider the influences of ----------, -------------------, ------------- ------------, and -------------------
3. develop recommendations that ---------.
1. normative child development
2. family; socio-environmental; medical genetic; child's experience
3. appropriate for child's current and expected developmental level
73
Pediatric neuropsychology methods are -------------.
distinctive
74
How are pediatric neuropsychology methods distinctive?
1. different skills are needed to assess kids compared to adults
2. knowledge and selection of appropriate tests for developmental age and skill
3. integration of history -- need A LOT of family and environment context
4. mechanics of testing might be different
5. recommendations focus on development and growth
75
What do we mean when we say "integration of history" is important in pediatric neuropsychology?
need to include a lot of family environment and context
76
How might the mechanics of testing might be different in pediatric neuropsychology?
- rapport
- breaks
- praise
- rewards
- seating considerations
- separation from parents
77
In pediatric neuropsychology, recommendations should focus on ----- and ------ rather than ------------ or -------------.
development and growth rather than prevention of decline or rehab of lost skills
78
What three factors have primacy in pediatric neuropsychology?
- genetics
- socioenvironmental
- family
79
Why do genetics, socioenvironmental, and family factors have primacy in pediatric neuropsych?
1. they affect the outcome significantly
2. many conditions have high genetic concordance rates
3. parent stress level and mental health can affect info reliability and ability to implement recommendations effectively
80
In infants' and toddlers' brains, more than ----------- neural connections can be made each second during this unequalled period of growth.
a million
81
---------- brain development occurs in the first ------- years of life. We spend the rest of our lives developing the last ------%
85-95%; five; 5-15%
82
When does prefrontal gray matter volume peak? In girls? In boys?
around puberty
girls around 12, boys around 13-14
a lot of synaptic pruning occurs after prefrontal cortex peaks
83
What does a full-term baby's brain weigh at birth?
.75 lbs
84
A condition that involves early insult or abnormal neural development in the CNS
neurodevelopmental
85
Neurodevelopmental disorders emerge --------- but -------.
early in development but may not always be detectable
86
neurodevelopmental disorders are ------------ in nature but presentation may vary over the lifetime
chronic
87
An individual with a neurodevelopmental disorder presents with unique ----------- that characterize and identify conditions.
neurobehavioral patterns
88
Neurodevelopmental disorders can vary in severity from ------ and ------- to -------- and ----------.
subtle and focal; profound and generalized
89
How many school aged children have an intellectual disability?
1%
90
A focus for diagnosis of intellectual disabilities is -------------------------- but also lower ------------------ abilities.
Adaptive Functioning Weaknesses; lower intellectual disabilities
91
In intellectual disability, devleopmental delays are often notec in ------- and ------------; however mild cases might not be evident until -------------.
infancy; early childhood; school age
92
Individuals with Down Syndrome are at increased risk for -----, ------, ----, and ------.
dementia, moya moya, leukemia, heart conditions
93
What is a risk factor for having a child with Down Syndrome?
older maternal age
94
# T/F
People with Down Syndrome are living longer than they used to.
True (in 1960 avg lifespan was 10, in 2007 it is 47)
95
Down Syndrome occurs in about how many live births?
1:700 to 1:1100
96
Symptoms typically associated with Down Syndrome include:
| list 4
- low muscle tone
- mild-moderate intellectual disability
- language delays
- memory difficulties
97
# ADHD diagnoses require:
- a ----- pattern of ------- adn/or ----- that interferes with functioning or development
- symptoms before age ----
- symptoms occur in ---- or more settings
- symptoms reduce or interfere with --------, -------, or ------- functioning
- symptoms are not ----------------------
- a **persistent** pattern of **inattention** and/or **hyperactivity** that interferes with functioning or development
- symptoms before age **12**
- symptoms occur in **2** or more settings
- symptoms reduce or interfere with **social, academic, or occupational** functioning
- symptoms are not **better explained by another disorder (e.g., anxiety, mood disorder, ASD, intellectual disability)**
98
# Facts about ASD
- rate is about --------
- ratio of diagnosis in boys to girls is -------
- causes are likely to be ------------
- -------------- is critical
- rate is about **1:44**
- ratio of diagnosis in boys to girls is **4:1**
- causes are likely to be **complex genetics**
- **early intervention** is critical
99
What interventions are useful in treating ASD?
- ABA therapy
- Speech therapy
- PT/OT as needed
100
List medical conditions taht affect neurodevelopment (broad).
| 5 general conditions
- developmental abnormalities in brain (e.g., polymicrogyria, agenesis of corpus callosum, schizencephaly)
- neurotoxic exposure (e.g., lead, chemo, radiation, prenatal substance exposure)
- inborn/genetic conditions that affect brain development (chromosomal abnormalities)
- other diseases affecting brain development (e.g., epilepsy, HIV, MS, heart disease/transplant)
- brain injury (e.g., tumor, stroke, hypoxic injury, concussions, MVAs, GSWs, etc)
101
-------- is a very sensitive part of the brain that can be affected very easily.
Myelin
102
Myelin damage is associated with childhood --------- because ------------------.
leukemia; chemo kills cells that make myelin
103
What are the modern cure rates for childhood leukemia?
90% or more (due to modern chemo protocol)
104
What can happen when implementing lifesaving treatments in cases if childhood leukemia?
"late effects" -- delayed detrimental effects
105
"late effects" of treating childhood leukemia commonly include:
| 8
- slower processing speed
- attention difficulty
- working memory and EF
- fine motor speed/coordination, visual motor integration (e.g., handwriting)
- Math/Reading fluency (math application usually spared)
- reading comprehension (bc need attention and working memory)
- social difficulties (control and initiation in EF; attention, processing speed affect social)
106
Deficits or decline associated with childhood leukemia can be due to ------, --------, or both; they may not be apparent for ---------- years following treatment.
illness, treatment; 2-3 years
107
Late effects of childhood leukemia are ------- but typically ---------.
chronic, but not typically progressive
108
What is involved in pediatric neuropsych assessment?
1. clinical interview and behavioral observations
2. objective testing of skills and abilities to assess brain function
3. multi-informant questionnaires (parent, child, teacher)
4. case conceptualization
5. verbal feedback meeting with full written report
109
What domains are usually assessed in pediatric neuropsychology?
| 7 domains; 3 other areas
- global cognitive functioning
- visual and auditory memory
- attention and EF
- fine motor skills
- visual perception
- visual motor integration
- academic skills (sometimes)
- adaptive skills (other)
- social-emotional skills (other)
- psychosocial/psychiatric functioning (other)
110
What is assessed during multi-informant questionnaires in a pediatric neuropsychological assessment?
- psychosocial
- adaptive funcitoning
- executive control
111
In a pediatric neuropsychology assessment, the verbal feedback meeting and report should include:
- background
- results
- conclusions
- recommendations
112
What happens with the results of a pediatric neuropsych eval?
- help to develop "profile" of strengths, needs
- help clarify diagnostic picture
- help parents, teachers, drs., patients understand why they may exhibit certain behaviors or other challenges
- help guide recommendations for strategies and interventions to treat or accommodate weaknesses
113
Recommondations after a pediatric neuropsychological assessment usually cover these 5 domains:
- follow-up with medical providers (medical)
- sleep (medical)
- mediation issues (medical)
- psychosocial
- school
114
# Pediatric neuropsychology recommendations
Sleep recommendations include:
- earlier bedtime/more overnight sleep
- reduce screentime (no screen 30min before bed)
- ENT consult/sleep study to rule out sleep apnea
115
# Pediatric neuropsychology recommendations
Recommendations related to medication issues include:
- consider consult to discuss options for mitigation of significant attentional/impulse/hyperactivity
- consider medication side effects as source of neurocognitive performance (drowsy, irritable, cognitive slowing)
- consider if anxiety/mood symptoms are such that meds may be necessary part of treatment plan
116
# Pediatric neuropsychology recommendations
Psychosocial recommendations cover the following 3 domains:
- professional mental/behavioral health services
- social recommendations
- parenting strategies (praise, ignore, structure)
117
Recommendations related to professional mental/behavioral health services might include:
- parent training (for behavior mgmt)
- CBT for patient (for anxiety, mood, EF, social issues)
- further eval for possible ASD diagnosis
118
Social recommendations might include:
- "lunch bunch" or other social skills programs to improve skills/develop friendships
- engage in extracurriculars in area of interest
- plan small group/one-on-one playdates where social skills and conflict mgmt can be practiced in supervised setting
119
Common parenting strategies that are psychosocial recommendations in pediatric neuropsych eval:
praise, ignore, structure
120
School recommendations include:
- services (IEP)
- accommodations (Section 504)
120
121
What are some IEP services that could benefit a child with a neurodevelopmental disorder?
| 3
- special ed services, OT, PT, speech, social-emotional support
- special transportation
- extended school year
122
What are some 504 accommodations that could benefit a child with a neurodevelopmental disorder?
| 6
- small group setting
- extra time and breaks during testing
- reduced volume of homework
- preferential seating
- alternative response formats
- slow rate of presentation of material/repeat
123
What are some limitations of testing in a pediatric neuropsychological assessment?
| 4
1. it's only a snapshot of performance at moment in time
2. always must consider motivation and effort
3. reliability and validity of the measure you are using in the appropriate population
4. tests don't measure: creativity, determination, perseverence, or other talents
124
In a pediatric neuropsychology evaluation, it is important to remember that tests don't measure the following:
- creativity
- determination, perseverance
- talents beyond these domains (e.g., musical, technical, social-emotional)
125
A con of working with kids
working with kids, you are managing a lot more behaviors
126
a pro of working with kids
they really want to do their best, people-please
127
