Learning Disorder and Autism

Only abt the learning problem bc development is in another flashcard alr

What are the domains that must be met to diag intellectual disability

All 3 MUST be met: Domain A = deficit in intellectual function confirmed by assessment and IQ test + Domain B = deficit in adaptive function + Domain C = During developmental period

What is adaptive functioning

Domain B, deficit in at least 1 domain → Conceptual (academic competence), social, practical (ability to take care of self)

What are the severity levels of ID

Mild, moderate, severe, profound (non-verbal, cannot care for self, non symbolic)

What should a child be able to do at 2-4, 6, 12, 18, 24 and 36 months old

2-4 m → Should be able to track objects visually; 6 m → Turn to sound/voice; 12m → respond to name; 18m → Walk; 24m → Use 10-25 word; 36m → Speak 3 word sentence

What is the difference between global developmental delay and intellectual disability

GDD = failure to meet expected domain in children UNDER 5 y/o

ID = failure to meet expected domain in children >=5 y/o as confirmed by test

Causes of intellectual disability

Genetic = Down or Fragile X; perinatal = preterm, neonatal meningitis, intrapartum asphyxia; postnatal = FAS and congenital hypothyroid

What causes regression in children

Tay-Sach, seizure disorder, IEM, hypothyroid, Rett syndrome

What is Rett syndrome

X linked dominant MECP2 mutation affecting females that causes regression at 1 yr old

Rett syndrome presentation

Microcephaly, ataxia, repetitive hand wringing

ID/GDD comorbidities

ADHD, anxiety; sleep disorders like apnea, GERD; epilepsy, CP and vision/hearing loss

What are the types of SLD

Difficulty with reading and its comprehension = dyslexia

Difficulty with spelling and writing = dysgraphia

Difficulty with number and math = dyscalculia

For at least 6 mo WITH intervention

DSM5 criteria for SLD

Domain A = difficulty in learning for 6+ month despite intervention

Domain B = academic skill substantially below peers

Domain C = difficulties begin in school age years

Domain D = not caused by other disorder like intellectual disability

SLD subtypes and their corrlates

Dyslexia → Def in phonological awareness

Dysgraphia → Def in working memory, visuo-spatial

Dyscalculia → Def in motor skill and EF

Etiology of SLD

Genetic link and heritability; maternal hypertension/obesity/DM, low BW or preterm, FAS, malnutrition, low SES

How would evaluation for SLD differ from ID

SLD does NOT look for dysmorphic feature or behavioral phenotype, no MRI/CT or cytogenic diagnostic

What are the deficits in ADHD

Inattention, impulsivity, hyperactivity

Epidem of ADHD

5% global; 2 boy:1 girl global, Thai is 3:1

Diagnostic framework for ADHD

Onset before 12; chronic display at 2+ setting (home, school); 6+/9 symptoms in children or 5+/9 in >17 y/o; clinically significant impairment; not from neglect, ID etc

Hyperactive symptoms (RUNS FASTT)

• R = run or restless

• U = unable to wait for their turn

• N = not able to play quietly

• S = slow no on the go

• F = fidget with hand or feet

• A = answers are blurted out

• S = staying seated is difficult

• T = talks excessively

• T = tend to interrupt

Inattentive symptoms (CALL FOR FrED

• C = careless mistake

• A = attention difficulty

• L = listening problem

• L = loses things

• F = fails to finish what they start

• O = organizational skill lacking

• R = reluctant to do task that require effort

• F = forgetful in R = routine activity

• E =easily D = distracted

Causes of ADHD

70-80% from polygenic, neurological, toxins; 20-30% are modulators (make better or worse symptom) = social environment

Evaluation for ADHD

History, physical and mental examination, NEBA system

Developmental trajectory for ADHD

Hyperactivity peaks at preschool and goes down as you age (internalization where hyperactivity becomes dreamy symptoms); inattention stays constant throughout life

Comorbidity of ADHD

30-40% associated with disruptive behavior like ODD or CD; 33% come with LD

What is the criteria for ASD

Domain A: Met 3/3 criteria related to social communication deficit; Domain B: Meet 2/4 criteria for restricted and repetitive behavior

What is ASD Domain A (social communication)

Lack of social-emotional reciprocity, lack understanding of nonverbal, cannot adjust behavior for social context

Normal ability of infant (0-12month)

2-4 month → Social smile; 6-9 → Stranger anxiety; 10-12 → Joint attention

Normal ability for toddler (1-3 y/o)

Imitation, parallel play, No phase, imperative and declarative pointing

Normal ability for preschool age (3-5 years)

Empathy, following rules, cooperative play

Normal ability for school age kid (6-12 y/o)

Stable friendship, social comparison, group dynamic

Warning signs to consult doctor

Child avoids eye contact, lack joint attention by 12-15 month; no interest in peers by age 3, delayed empathy by age 5; loss of previous skill and cannot change activity

What is Domain B for ASD (restrictive repetitive behavior)

Repetitive motor movements, use of object or speech; insistence on sameness and routine; highly restricted fixed interest; hyper/hyporeactivity to sensory

Screening timeline for ASD

ASD screening at 18 month ; Routine is during months 9,18,24 and 36

ASD relation to other disorder

High overlap = Rett; moderate = Fragile X, PWS; low = NF and Down

Prenatal exposure that may cause ASD

Air pollution, heavy metal, antiepileptic drug, pesticide

Obstetric related condition to ASD

SGA, maternal miscarriage history, GWG, hyperemesis gravidarum

Neonatal and childhood vulnerabilities for ASD

Neonatal anemia = high risk; neonatal jaundice = moderate risk; early Abx = inconclusive

What is social communication disorder

People that have deficit in social communicative deficit WITHOUT repetitive behavior