Week 3: Neurodevelopmental Disorders

When do neurodevelopmental disorders typically begin?

Childhood

What are Neurodevelopmental Disorders characterized by?

abnormalities in the brain development that affect - Emotion, Learning, Capabilities, ADL, IADL, Self-control and Memory, The development of the nervous system is disturbed leading to a structurally compromised brain.

What are ADL’s?

Eating, bathing, getting dressed, toileting, transferring, and continence

What are IADL’s?

Cleaning, managing money, moving within a community - ambulation and public transportation, preparing meals, shopping, taking prescribed meds, using the phone/other forms of communication

How do neurodevelopmental disorders impact self-control?

The person may struggle to regulate their emotions

How neurodevelopmental disorders impact memory?

The person might not have an immediate recall. Can they remember things that happened a while ago?

How neurodevelopmental disorders impact the nervous system?

Infections - meningitis, physical trauma to the spinal cord - affect the brain

What do contributing factors include?

Childhood deprivation, Genetic and metabolic diseases, Immune disorders, Infectious diseases, Nutrition, Physical trauma and, Toxic and environmental factors

How does childhood deprivation contribute to neurodevelopmental disorders?

Lack of attention & stimulation - important to sing, talk, and be available so children can feel secure in their environment. People are interested in adoption - children may come from orphanages or places where they were not cared for

How do genetic and metabolic diseases contribute to neurodevelopmental disorders?

Tay Sachs disease, turners, klinefelters can cause brain problems

How do immune disorders contribute to neurodevelopmental disorders?

Premature Lupus can impact brain development

How do infectious diseases contribute to neurodevelopmental disorders?

Children born to moms with HIV - HIV medications can be toxic over a period of time and disturb liver and kidney function. Eventually they will develop dementia

How does nutrition contribute to neurodevelopmental disorders?

Big contributor to ADHD

How does physical trauma contribute to neurodevelopmental disorders?

Shaken baby syndrome and other types of physical trauma impact the brain

How do Toxic and environmental factors contribute to neurodevelopmental disorders?

Lead poisoning, lead-based paint, Flint Michigan and lead in drinking water, passive toxic disorders - cities with a lot of buses, cars, and other transportation that dispel fumes

What do these factors regarding intellectual disability result in the need for?

Special education, psychological, and medical services - neurology, psychology

What are the intellectual disorders?

Intellectual disability (Intellectual developmental disorder) 319 (F70-F73); Global developmental delay 315.8 (F88); Unspecified intellectual disability (Intellectual developmental disorder) 319 (F79)

What are the communication Disorders?

Language Disorder 315.39 (F80.9); Speech sound disorder 315.39 (F80.0); Childhood-onset fluency disorder 315.35 (F80.81); Social (Pragmatic) communication disorder 315.39 (F80.89); Unspecified communication disorder 307.9 (F80.9)

What are the Autism Spectrum/Attention-Deficit/Hyperactivity Disorders?

Autism Spectrum Disorder 299.00 (F84); Attention-Deficit/Hyperactivity disorder 314.01 (F90); Other specified attention-deficit/hyperactivity disorder 314.01 (F90.8); Unspecified attention-deficit/hyperactivity disorder 314.01 (F90.9)

What are the Specific Learning Disorders and Motor Disorders?

Specific learning disorder 315.xx; Developmental coordination disorder 315.4 (F82); Stereotypic movement disorder 307.3 (F98.4)

What are the Tic Disorders?

Tourette’s Disorder 307.23 (F95.2), Persistent (Chronic) Motor or Vocal Tic Disorder 307.22 (F95.1), Provisional Tic Disorder 307.21 (F95.0), Unspecified Tic Disorder

What are other Other Specific and Unspecific Neurodevelopmental Disorders 315.8 (F88)?

When the diagnostician does not have enough information. Frequently, we don’t know if the individual has been living with sxs for long enough to qualify for the diagnosis. The individual has symptoms characteristic of a neurodevelopmental disorder but does not meet the full criteria for any of the disorders in the diagnostic class. Here, the clinical chooses to communicate the specific reason that the presentation does not meet the criteria for instance - Neurodevelopmental disorder associated with prenatal alcohol exposure.

What are intellectual disabilities?

Formerly referred to as mental retardation; Appears before adulthood; Significantly impairs cognitive functioning and deficits in adaptive behaviors (Self-help, Communication, Interpersonal skills - can the person get the burning pot off the stove?)

Children with intellectual disabilities?

It Takes longer to learn to speak, Walk, and take care of personal needs such as dressing or eating. Do they have the capacity to sit at the table and use table utensils?

Historically, intellectual disabilities have been defined by?

an intelligence quotient (IQ) score of under 70. 85-115 was “normal.” But, the definition now includes BOTH intellectual functions and functional skills within the environment.

Prevalence of intellectual disabilities?

Approximately 4.6 million people in the US have this. Roughly 1 percent of the population.

Average lifetime cost of intellectual disabilities amounted to?

slightly over $1,000,000 per person. It may be more now

Intellectual disability differential dx?

Look for problems in: Delayed abilities to sit up, crawl, or walk later than other children (Learn to talk later or have trouble speaking, Find it hard to remember things – executive functioning, Not understand how to pay for things, Have trouble understanding social rules, ADL’s/IADLs); Have trouble seeing the consequences of their actions (Difficulties in executive function - burning your hand on the hot stove); Have trouble solving problems; Have trouble thinking logically - sequence of things.

Intellectual disability: How to diagnose?

Look for the onset of symptoms during the child’s developmental period. Consider both mental abilities and adaptive skills - Intellectual functions confirmed by standardized intelligence testing and by someone with a close relationship with the child who can speak to Adaptive functioning in multiple environments (such as home, work in the community, playground) of symptoms during the developmental period. Finally, look for 2 main things! - Ability to make sense of the world or the ability of the person’s brain to learn, think, solve problems (or IQ/intellectual functioning) AND Whether the person has the skills needed to live independently (or adaptive functioning). Remember!!!!!!!!!!! significantly impaired cognitive functioning and deficits in adaptive behaviors

What is Global Developmental Delay, 315.8 (F88)?

Used for individuals who are 5 years of age or younger (kindergarten) who fail to meet expected developmental milestones. Reserved for the child who is not able to participate in standardized testing. Rely on pediatricians and parents

What is Unspecified Intellectual Disability 319 (F79)?

Used for individuals who are 5 years of age or younger. And who cannot participate in assessment procedures because of sensory or physical impairments (Blindness, Deafness, Severe problem behaviors)

What are Communication Disorders?

This series of disorders affect an individual’s ability to communicate to the extent that school, work, or even relationships are negatively affected. We would see childhood onset noted by: A range from sound repetitions found in stuttering, Occasional misarticulation of words. Remember, think about the developmental stage.

What is a Language Disorder 315.39 (F80.9)?

Key feature: difficulties in learning and using language that involve the processing of linguistic information due to deficits in comprehension or production. The person has problems with vocabulary, grammar, and putting sentences together. There are persistent difficulties acquiring and using language across modalities (spoken, written, sign, or other) due to deficits in comprehension or production (Reduced vocabulary, limited sentence structure, the inability to put words together to form a sentence, or the inability to use vocabulary and connect sentences).

What is a Speech sound disorder 315.39 (F80.0)?

Noted for people who have problems with pronunciation and articulation to the extent that the difficulties interfere with being understood or prevent verbal communication. Look for children older than age 4. Errors can include speech sounds (phonological knowledge) and the ability to coordinate the jaw, tongue, and lips (movements of the articulation). Errors can include substitutions such as saying “wabbit” for “rabbit,” omission of the final consonants such as saying “daw” for “dog” or “ca” for “cat” or deleting parts or blends in words, for instance saying “poon” for “spoon” or “bown” for “brown.” We need to take into account regional variations in word pronunciation. This could happen with parents who have a speech impediment and the child is hearing the parent/caretaker misarticulate.

What is Childhood-onset fluency disorder 315.35 (F80.81)?

Reserved for frequent, persistent, and marked instances of stuttering. Onset is in the child’s early developmental period. Words produced with excess physical tension, or monosyllabic repetitions, such as “I-I-I see him. Most often in male children. It is caused by an auditory processing thing - they have a hard time hearing themselves talk. Preaching/singing can cause it to disappear.

What is Social (Pragmatic) Communication Disorder 315.39 (F80.89)?

Difficulties in social use of verbal (and nonverbal) communication that affects social participation, relationships, academic achievement, or job performance. Social purposes: knowing what to say while greeting others and in sharing information. How to say it: matching communication to the needs of the listener, such as speaking differently in the classroom from on the playground. When to say it: Such as taking turns in a conversation, and Those situations where the child has problems understanding what is not explicitly stated such as humor or something with multiple meanings that depends on the context for interpretation. Potential for autism, onset of schizophrenia

What is an Unspecified Communication Disorder 307.9 (F80)?

Reserved for those who have symptoms of a communication disorder but who do not meet all the criteria and whose symptoms cause distress or impairment. Perhaps the diagnostician does not have enough time to do a thorough diagnostic workup

What is a side note for Autism Spectrum/Attention-Deficit/Hyperactivity Disorder?

The DSM-5 combines all these disorders together and differentiates by clinical specifiers (dimensions and severity) and associated features (known genetic disorders, epilepsy, and intellectual disability/intellectual developmental disorder).

What is autism?

Severity differs from person to person. It is thought to follow two possible developmental courses: Normal or near-normal development followed by loss of skills or regression in the first 2 to 3 years of a child’s life. The pediatrician will probably see it. OR A gradual onset in which parents report concerns in the development over the first 2 years of life and the dx is made around ages 3 or 4. Now encompasses Autism, Asperger’s syndrome, Childhood disintegrative disorder - like global developmental delays, and Pervasive developmental disorder NOS.

What is Autism Characterized by?

Social deficits - inability to take in social cues for direction, Communication difficulties, Stereotyped or repetitive behaviors and interests, At times, cognitive delays, Frequently co-occurs with other disorders particularly intellectual disability and language disorder.

Autism Differential Diagnosis regarding severity ?

Be aware that Because the key symptoms of communication impairments and restricted/repetitive behaviors can be elements of several other diagnoses, but this disorder is more severe than Rett syndrome (neurological disorder), Selective mutism, Communication disorders, Stereotypic movement disorder (tic, tourettes), ADHD (inability to attend to a conversation), Schizophrenia (catatonia)

What is the cause of autism?

We don’t know yet. Genetics (neurologic), Environment (exposure toxins), Disruption of the normal brain development in the early development of the fetus

What is the prevalence of autism?

About 1 percent of the general population. But, it is 4 times more common in males. We know little about this disorder in older persons - they can learn how to behave - mask, might want to live a more isolated lifestyle.

Differential Assessment of autism?

Sometimes people can learn strategies in later life that mask symptoms. We see difficulties in social-emotional reciprocity. We see restricted, repetitive behaviors (lining up toys, A need for ‘sameness,’ Specific and inflexible routines, Distress over the smallest change). The social worker needs to rate the severity from “requiring very substantial support” to “requiring support.” - this is our clinical judgement. Need to bring in other health professionals.

Specifiers of autism?

With or without accompanying intellectual impairment. With or without accompanying language impairment. Associated with a known medical or genetic condition or environmental factor - need medical records. Associated with another neurodevelopmental, mental, or behavioral disorder. With catatonia

What is Attention Deficit/Hyperactivity Disorder 314.01 (F90.8) (ADHD)?

Affects the areas of social skills, behavior, and communication. Noted by inattention or a lack of focus, executive functioning difficulties impulsivity, and hyperactivity beyond what would be expected for developmental stage.

What is the prevalence of ADHD?

3% to 5% of children and adults. It is chronic where 30% to 50% of children with ADHD will continue to have symptoms into adulthood. There is adult onset - often have paradoxical rxns to stimuli (drink coffee and then go to bed; valium energizes)

Differential Assessment of ADHD?

Inattention and/or hyperactivity-impulsivity that is present before the age of 12 and gets in the way with functioning or development

Regarding inattention in ADHD differential dx?

the child must have six (or more) of the following nine symptoms: Does not pay close attention to details or makes careless mistakes. Has difficulty remaining focused or paying attention to tasks or lacks persistence. Does not seem to listen and seems “elsewhere.” Does not follow through with instructions and fails to finish schoolwork, or for adults preparing reports or completing forms. Often loses things needed to complete tasks/activities such as books, supplies, keys. Often is easily distracted by extraneous stimuli. Often is forgetful in daily activities such as doing chores, paying bills, keeping appointments. This occurs every day throughout the day - use clinical judgement.

Regarding hyperactivity in ADHD differential dx?

the child must show six (or more) of the following nine symptoms, while older adolescents and adults must demonstrate at least five symptoms: Excessive motor activity – fidgeting, tapping, squirming. Often leaves his/her seat when staying seated is expected. Often runs around and, as an adult, seems restless. Unable to sit still. Often talks excessively. Often blurts out an answer before the question is completed or completes other people’s sentences. Has difficulty waiting his/her turn. Excessively interrupts others.

ADHD Specifiers?

Combined for when symptoms are for both inattention and hyperactivity-impulsivity for the past 6 months. The predominantly inattention is met by signs of hyperactivity-impulsivity have been absent for the past 6 months. They want to be present, but cannot (difference between this and ODD). The predominantly hyperactive/impulsive presentation is reserved for the person who shows symptoms of hyperactivity-impulsivity without inattention for the past 6 months. Specify if in partial remission: The diagnostic criteria have previously been met, but for the past 6 months the person has shown fewer than full criteria. Severity can be assigned ranging from mild to moderate to severe

What does the social worker need to be attentive to in people with ADHD?

Signs of negativity, hostility and defiance: Oppositional Defiant Disorder. Serious aggression: Intermittent explosive disorder.

What is Specific Learning Disorder, 315.xx?

Difficulties learning and using academic skills and affect a child’s ability to acquire and apply reading, writing, and/or math skills. The disorder typically becomes apparent when a child begins preschool. These children have at least average intelligence and yet are still not able to acquire the academic skills expected for their age, intellectual ability, and education. We see difficulties in: (Reading, Understanding what is read, Spelling, Written expression, Mastering number sense, facts, and calculation, Math reasoning). We do need psych testing for this disorder. Xx is reserved for specifiers

Prevalence of Specific Learning Disorders?

5% to 15% among children and 4% among adults. Adults might choose a job where they don’t have to do hard subjects, like math.

What are Specifiers of specific learning disorders?

“With impairment in reading,” 315.00 (F81.0), “With impairment in written expression,” 315.2 (F81.81), “With impairment in mathematics,” 315.1 (F81.2)

What is With impairment in reading 315.00 (F81.0) for specific learning disorder?

With reading accuracy, Reading rate or fluency, Reading comprehension

What is impairment in written expression for specific learning disorder?

Spelling accuracy, Grammar and punctuation accuracy, Clarity or organization of written expression

What is impairment in mathematics for specific learning disorders?

Number sense, Memorization of arithmetic facts, Accurate or fluent calculation, Accurate math reasoning)

What must Social workers consider with specific learning disorders?

The ways in which social systems promote or deter people in maintaining or achieving health and well-being. Consultation with various professionals involved in the student’s care - psychological testing. Encourage the use of various assessment measures (reading labels in stores, reading comic books, counting city blocks between the school and home neighborhood).

What do Motor Disorders result from?

damage to the brain’s motor system and cause abnormal and involuntary movements.

What is Developmental Coordination Disorder?

Noted for impaired skills requiring motor coordination (Children having trouble using scissors, riding a bike, participating in sports, sequencing of events). Not typically diagnosed before age 5. Skills interfere with activities of daily living. Illegible handwriting.

What is Stereotypic movement disorder 307.3 (F98.4)?

Repetitive nonfunctional motor behaviors. (Hand waving & Head banging). Unknown cause. Symptoms typically emerge before the age of 3. Sometimes misdiagnosed as Tics.

What are Tic Disorders?

Organized around the categories of Tourette’s disorder. Occur in childhood and peak in severity early in the second decade of life, followed by remission. Coexisting disorders seem to be the rule, rather than exception (50% also suffer from OCD. 20% also suffer from ADHD). Can range in presentation such as: Simple motor tics and Complex motor tics. Onset is before 18 years of age. Some people are able to suppress it until they are in private. It takes a lot of energy to suppress.

What are Simple motor tics?

short duration and including blinking, shoulder shrugging, and extension of the extremities; throat clearing, sniffing, grunting

What are Complex motor tics?

Combination of simple tics such as head turning and shoulder shrugging; purposeful such as obscene gesture (copropraxia) or imitation of another’s movements (echopraxia), repetitive sounds (palilalia), repeating the last word or phrase heard (echolalia), or uttering socially unacceptable words such as obscenities and racial slurs (coprolalia).

What is Tourette’s Disorder 307.23 (F95.2)?

Both motor and one or more vocal tics present at some time, although not necessarily concurrently. The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset. Onset is before age 18. Not attributable to the effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington’s Disease).

What is Persistent (Chronic) Motor or Vocal Tic Disorder 307.22 (F95.1)?

Single or multiple motor or vocal tics have been present during the illness, but not both motor and vocal. The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset. Onset is before age 18. The disturbance is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition.. Criteria have never been met for Tourette’s disorder. Specify - motor tics only or With vocal tics only

What is Provisional Tic Disorder 307.21 (F95.0)?

Single or multiple motor and/or vocal tics. The tics have been present for less than 1 year since first tic onset. Onset is before the age 18. The disturbance is not attributable to the physiological effects of a substance or another medical condition. The criteria have never been met for Tourette's disorder or persistent (chronic) motor or vocal tic disorder.

What is Unspecified Neurodevelopmental Disorder 315.9 (F89)?

Here, the symptoms characteristic of a neurodevelopmental disorder predominate, but do not meet the full criteria for any of the other disorders. Used in situations in which the clinical chooses not to specify the reason that the criteria are not met, and includes presentations in which there is insufficient information to make the diagnosis. Emergency room settings.