Neurodevelopmental Disoders

What are the two neurodevelopmental disorders we talked about?

- Autism Spectrum Disorder

- Attention Deficit Hyperactivity Disorder

What is autism spectrum disorder?

neurodevelopmental disorder in which patients suffer from difficulties with language/communication, social interaction, and have repetitive, restricted interests and behaviors

When do parents start noticing autism in their children?

17 months

What are the dysfunctional behaviors of autism?

repetitive, non goal-directed, stereotypic behaviors: hand flapping, rocking, self-interest behavior, sleep difficulties, eating problems, and sensitivity to pain, insistence on "sameness" perseveration, and varying difficulties with changes to routines

What are early warning signs for autism spectrum disorder?

- no babbling, no gesturing, pointing, or waving goodbye by 12 months

- no single words spoken by 16 months

- no 2 words spoken together spontaneously by 24 months

- loss of previously acquired language or social skills at any time

What are the screening tools for autism spectrum disorder?

- M-CHAT

- ADOS

What is the gold standard screening tool for autism spectrum disorder?

ADOS

What is the most common medication prescribed for autism spectrum disorder?

SSRI (like zoloft etc)

What is FDA-approved for irritability caused by autism spectrum disorder?

Risperdal

What is required before starting risperdal in children with autism spectrum disorder?

labwork: prolactin levels

What is ADHD, inattentive subtype?

Six (or more) of the following symptoms have persisted for at least six months to a degree that is inconsistent with developmental level and that

negatively impacts directly on social and academic/occupational activities

What is ADHD, inattentive subtype criteria?

1. inattention

2. lack of listening when spoken to directly

3. fails to finish schoolwork

4. difficulty organizing tasks and activities

5. often avoids or dislikes tasks that require sustained mental effort

6. often loses things necessary for tasks or activities

7. often easily distracted by extra stimuli

8. often is forgetful in daily activites

What is ADHD, hyperactive/impulsive subtype?

Six (or more) of the following symptoms have persisted for at least six months to a degree that is inconsistent with developmental level and that

negatively impacts directly on social and academic/occupational activities:

What is ADHD, hyperactive/impulsive subtype criteria?

1. often fidgets with, taps hands, or squirms in seat

2. often leaves seat in situations when remaining in seat is expected

3. runs or climbs in situations that are inappropriate

4. often unable to play or engage in leisure activities quietly

5. often on the go, driven like a motor

6. often talks excessivley

7. often blurts out an answer before a question has been complete

8. often has difficulty waiting his or her turn

9. often interrupts or intrudes on others

What also has to be present for ALL types of ADHD?

- Several inattentive or hyperactive-impulsive symptoms were present prior to age 12

- Several inattentive or hyperactive-impulsive symptoms are present in TWO or more settings (home, school, or work; with relatives or friends; in other activities)

What is the FREE assessment tool for ADHD?

Vanderbilt Assessment Rating Scales

What is the caveat for the vanderbilt assessment rating scales?

cannot be used BEFORE the age of 6

What is the Adult ADHD Self-Report Scale Symptom Checklist?

require 4 or more responses in the criterion boxes of Part A (the first 6 questions) of the ASRS

What treatment is recommended for preschool and school-age children for ADHD?

evidence-based behavioral therapy alone: behavioral parent training, classroom management, and/or peer interventions

What is the most common stimulant prescribed for ADHD?

Methylphenidate

What are the side effects of stimulants?

- Appetite Suppression

- Headache

- Dizziness

- Stomach Discomfort/Nausea

- Difficulty with sleep

- Zombie State (overmedication)

What is the non-stimulant prescribed for ADHD?

Strattera (SNRI)

What is dissociative identity disorder (DID)?

disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession

What is done to manage DID?

- Integrative psychotherapy

- phasic trauma treatment

- supportive psychotherapy

What is dissociative amnesia?

inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting

What is the treatment for dissociative amnesia?

- safe environment removed from the source of stress

- a trusting therapeutic relationship

What is a dissociative fugue?

- purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information

- can last from minutes to months

What is depersonalization?

experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions

What is derealization?

experiences of unreality or detachment with respect to surroundings

A 7 yo male presents with his parents who are complaining that for the last 9 months the child has been having increasing difficulty in school. He has consistently been inattentive in school, has difficulty following directions, cannot stay on task, is easily distracted, and is often forgetful about what he is assigned to do. At home he does not listen to his parents. What is the most likely diagnosis for this patient?

Attention Deficit Hyperactivity Disorder

3 multiple choice options

A 11 yo male presents with his parents who are complaining that for the last 12 months the child has been having increasing difficulty in school. He has consistently been hyperactive in school, has difficulty following directions, cannot stay on task, is easily distracted, and is often forgetful about what he is assigned to do. At home he displays many of the same behaviors and he has been in therapy for 6 months with no improvements. What is the best medication to start?

Methylphenidate Extended Release

3 multiple choice options

A 4 yo male presents with his parents who are complaining that for the last 6 months the child has been having increasing difficulty in daycare. He has been asked to leave one daycare setting already. He has very destructive play, difficulty initiating sleep, is always on the go, is dangerously daring and multiple accidental injuries. What is the best assessment tool for this patient?

Conner's Scales

3 multiple choice options

A 16 yo female presents and is a bright young women with no learning disabilities. She did well until the 6th grade when her academics began to decline steadily. She appears demoralized about her poor grades but not clinically depressed. No substance abuse. Often has challenges with organization and seems to daydream. What factor(s) have delayed her diagnosis?

All of the above

3 multiple choice options