LEC 4: INTELLECTUAL DEVELOPMENT DISORDER, AUTISM SPECTRUM DISORDER, ADHD

what are neurodevelopmental disorders?

group of conditions w/ onset in developmental period; typically manifest early (before child enters grade school) and are characterized by developmental deficits that produce impairments of personal, social, academic or occupational development

what is commonly experienced in children of all cultures?

emotional & behavioral problems as they encounter new people & situations (worry, temper tantrums, restlessness, nightmares, and bedwetting)

what are some things adolescents need to deal with?

physical/sexual changes, social/academic pressures, personal doubts/identity questions, many forms of temptation (leads to anxiety, confusion, depression_

how many children & adolescents experience a diagnosable psychological disorder?

at least 1/5

are disorders more common in boys or girls?

boys during childhood/adolescence

are disorders more common in men or women?

by adulthood, psychological disorders are m/c in women

what did intellectual developmental disorder used to be known as?

mental retardation

when is the typical onset of intellectual developmental disability?

during developmental period

what are the 2 categories of symptoms for intellectual developmental disability?

poor intellectual functioning & adaptive functioning

what does poor intellectual functioning consist of?

difficulty w/ problem solving, planning, abstract reasoning, judgement, academic learning, learning from experience

what is adaptive functioning?

significant deficits resulting in developmental and sociocultural standards not being met for: communication, self care, social participation, independent living

what is mild level of intellectual developmental disorder?

IQ 50-70 (most cases)

what are the moderate, severe and profound levels of intellectual developmental disorder?

mod IQ 35-49

severe IQ 20-34

profound IQ <20

what are the possible etiologies of intellectual developmental disorder?

genetic syndromes, perinatal and postnatal

what genetic syndromes potential cause intellectual developmental disorder?

inherited or metabolic (Tay Sachs), chromosomal disorders (down syndrome)

what are possible perinatal causes of intellectual developmental disorder?

labor & delivery related events (fetal malnutrition, prematurity, hypoxia, intracranial hemorrhage)

what are possible postnatal causes of intellectual developmental disorder?

infections, malnutrition, head trauma, lead poisoning, child abuse/neglect

what is the behavioral tx of intellectual developmental disorder?

individualized to reinforce adaptive behaviors

what is the medical tx of intellectual developmental disorder?

anti-seizure med, antipsychotics (reduce agitation), antidepressants (tx comorbid anxiety/depression)

what are some sociocultural programs for intellectual developmental disorder?

focus on integrating into mainstream classes & community activities, group homes, institutionalization

what is asperger's disorder?

average to above average intellectual functioning, socially & emotionally inappropriate behavior & inability to interact successfully w/ peers, peculiarities in speech/language, restricted/repetitive behaviors or rituals

what is autism spectrum disorder characterized by?

persistent deficits in several areas of development including: social interactions, social communications, everyday interests, behaviors and activities

what do we see with children who have ASD?

extremely unresponsive to others, uncommunicative, repetitive, and rigid

what are some characteristics of ASD?

extreme aloofness, lack of interest in others, inappropriate eye contact, few/no facial expressions, echolalia, repeating word/phrases, stimming

what is the prevalence of ASD?

1 in 31 children (8+) in the US

who is ASD m/c in?

4x more common in boys (bc females may go undiagnosed since they do not present as obviously)

when do minorities tend to be dx w/ ASD?

less often, later or w/ alt diagnosis

what are the 3 areas of deficits for the symptoms of ASD?

social interactions, activities & interests, communication

what are social interaction symptoms of ASD?

-little use of nonverbal behaviors (eye contact, gestures, body language)

- little reciprocity

-little expression of pleasure when others are happy, failure to develop peer relationships

what are activities & interests symptoms of ASD?

-hyper/hypo reactivity to sensory input

-stereotyped & repetitive movements (stimming: hand flapping, head banging, lining up toys)

-preoccupation w/: certain activities and compulsive adherence to rules/patterns & parts of objects or unusual uses of objects

what are communication symptoms of ASD?

-delay in/total absence of spoken language

-if speech present: significant trouble initiating/maintaining convo

-unusual language including repetition of certain phrases (echolalia)

- lack of make believe play or imitation of others

when do we typically begin to see symptoms of ASD?

b/w 12-24 mo (mean age 1st eval-48 mo & mean age of 1st dx- 61 mo)

what do pediatricians need to ask about when assessing potential ASD?

social-emotional milestones (comm, interest in others, emotions), any regression in developmental milestones, any symptoms of seizures

what assessment tools can the pediatrician use for ASD?

play/interaction (m/c), non-verbal assessments, parent reports

what are the possible etiologies of ASD?

genetic, chromosomal abn, brain anatomy, prenatal & birth complications, neurotransmitter imbalances

what is the genetic predisposition to ASD?

higher among siblings and highest among identical twins; advanced parental age

what are chromosomal abnormalities associated w/ ASD?

fragile x

what are some brain anatomy issues associated w/ASD?

enlarged brain ventricles

what are some prenatal & birth complications of ASD?

extreme prematurity; exposure to viruses or toxins

what are some neurotransmitter imbalances associated w/ ASD?

GABA & glutamate, serotonin, dopamine

what is the behavioral tx of ASD?

modeling & operant conditioning (applied behavioral analysis)

what is the psychosocial tx of ASD?

behavioral techniques & structures educational services, parent training & community integration

what is the medical tx of ASD?

SSRIs, antipsychotics, stimulants

what speech therapy tx can be useful for ASD?

communication training (using apps or sign language)

what occupational therapy tx can be useful for ASD?

play skills, learning strategies, & selfcare

what is the prevalence of ADHD?

7% worldwide; 2x as common in boys

when is the typical onset of ADHD?

symptoms before age 12 (median onset is 6)

what type of IQ do people w/ ADHD tend to have?

above average IQ but are often underachievers

what are the characteristics of ADHD?

persists through childhood but many show lessening of symptoms as they move into mid-adolescence

what race are the rates of ADHD highest in?

non-latinx white (less common in latinx & AA)

why is ADHD higher in non-latinx whites?

underdetection (mislabeling child as oppositional defiant or conduct disorder) & higher parental demand for dx

how is ADHD assessed?

difficult; child's behavior must be present across multiple settings --> obtain reports for parents & teachers; also diagnostic interviews, rating scales, and psych test

what are the inattention symptoms of adhd?

-difficulty sustaining attention

- poor attention to details/careless mistakes

-easily distracted & forget

-loses things easily

-poor follow through on instructions/finishing tasks

-doesn't seem to be listening when others are talking

-avoids activities that require sustained effort & attention

what are the hyperactivity symptoms of adhd?

-fidgets w/ hands/feet & squirms in seat

-restless, leaving seat when not appropriate

-difficulty engaging in quiet activities

what are the impulsivity symptoms of adhd?

-blurts out when others are talking

-has difficulty waiting his/her turn

what are the potential causes of adhd?

biological: genetic, prenatal/birth complications, abn in frontal-striatal regions, dec dopamine activity, brain injury, exposure to envir toxins, alc/tobacco use during preg, premature delivery, low birth weight

what are the psychosocial factors of adhd?

high levels of stress, family dysfxn (poor parenting, severe family conflict)

what is the medical tx of adhd?

stimulant (or non stimulant) medications; requires careful assessment & ongoing monitoring of mental status/psychosocial functioning

what is the behavioral therapy tx of adhd?

individual, group, family

what is the superior tx of adhd?

combo of meds & behavioral interventions

what is the goal of medication in adhd?

symptom reduction--> improves ability to focus & dec physical hyperactivity

what are the common adverse effects of stimulant tx?

nausea, stomach upset, dec appetite, insomnia, HA

what are the long term risks of stimulant tx?

inc risk of CVD esp HTN & arterial disease, dec in height

what is the 2nd line tx of adhd?

non-stimulants (need to be taken daily)

what is the first line tx of adhd in children 4-11?

behavior therapy (will produce significant improvement)

how should adolescents (12-18) be tx for adhd?

medication & behavior therapy (make sure to adjust if necessary bc of puberty)

what is the criteria for Tourette's Disorder?

multiple motor tics AND one or more vocal tics persisting for >1 year; onset before 18 yo

what is the tx of Tourette's?

edu & demystification of sx, improve tolerance of symptoms & avoid situations that will cause stress or embarassment, neuroleptic medication that block dopamine

what is child maltreatment?

all forms of physical and emotional ill-tx, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child's health, development or dignitiy

what is abuse?

an act of commission leadinf to potential or actual harm

what is neglect?

an act of omission leading to potential or actual harm

how many children will experience some form of abuse or neglect in their lifetimes?

1 in 4

what does neglect include?

inadequate healthcare, education, supervision, protection from hazards in the environment, and unmet basic needs such as clothing and food

what is the most common form of child abuse?

neglect

what does physical abuse include?

beating, shaking, burning and biting

what is the m/c finding associated w/ physical abuse?

rib fractures

what does psychological abuse include?

verbal abuse, humiliation, and acts the scare or terrorize a child which may result in future psychological illness

what is sexual abuse defined as?

involvement of dependent, developmentally immature children and adolescents in sexual activities which they do not fully comprehend, to which they are unable to give consent, or that violate the social taboos of family roles

what are the adverse childhood experiences (ACEs)?

collection of potentially traumatic events, such as violence, abuse, or neglect that occur in childhood (0-17)

what can childhood exposure to prolonged traumatic events result in?

toxic stress response, negatively affecting a child's brain development

what do ACEs inc the risk of?

poor physical health, coping skills, or other long-term cognitive impairments

what are the risk factors for child abuse/neglect?

poor socioeconomic status, domestic violence, drug and alcohol abuse, unwanted or unplanned pregnancy

when must be a child abuse/neglect report be made?

when the reporter suspects or has reason to believe that a child has been abused or neglected

what other situation is there a requirement to report?

in which the reporter has knowledge of, or observes a child being subjected to, conditions that would reasonably result in harm to the child

what are mandatory reporters required to report?

the facts & circumstances that led them to suspect that a child has been abused or neglected (they do not have the burden of providing proof)