Neurodevelopmental Disorders and Treatments

What are neurodevelopmental disorders?

Developmental deficits that impair personal, social, academic, and/or occupational functioning, usually beginning early in development.

What is required for a diagnosis of Intellectual Developmental Disorder?

(a) Deficits in intellectual functioning, (b) deficits in adaptive functioning, and (c) onset of deficits during the developmental period.

How is intellectual functioning assessed for Intellectual Developmental Disorder?

Through clinical assessment and individualized, standardized intelligence testing, typically resulting in a score two or more standard deviations below the population mean.

What are the levels of severity for Intellectual Developmental Disorder?

Mild, moderate, severe, or profound, based on adaptive functioning in conceptual, social, and practical domains.

What percentage of cases of intellectual disability have a known cause?

25 to 50%.

What are the most common causes of intellectual disability with known etiology?

80 to 85% are due to prenatal factors, 5 to 10% due to perinatal factors, and 5 to 10% due to postnatal factors.

What is the most common chromosomal cause of intellectual disability?

Down's syndrome, followed by fragile X syndrome.

What is the most common preventable prenatal cause of intellectual disability?

Fetal alcohol syndrome.

What are the diagnostic criteria for Autism Spectrum Disorder (ASD)?

(a) Deficits in social communication and interaction, and (b) restrictive and repetitive patterns of behaviors, interests, and activities.

What are examples of deficits in social communication for ASD?

Impaired social-emotional reciprocity, impaired nonverbal communication, and impaired ability to develop and maintain relationships.

What are some characteristics of restrictive and repetitive behaviors in ASD?

Stereotyped motor movements, insistence on sameness, restricted interests, and hyper- or hyporeactivity to sensory input.

When must the onset of symptoms for ASD occur?

During the early developmental period.

What factors contribute to a better prognosis for individuals with ASD?

An IQ over 70, functional language skills by age five, and absence of comorbid mental health problems.

What associated features may be present in individuals with ASD?

Intellectual and language impairments, self-injurious behaviors, motor abnormalities, and disruptive/challenging behaviors.

What difficulties do individuals with ASD face in social relationships?

Impaired face recognition and emotion recognition.

What was the focus of the study by Dawson et al. (2002) regarding children with autism?

The reactions of children aged 3 to 4 years with and without autism to novel and familiar faces and objects.

How do children with autism react to novel versus familiar faces and objects?

Children with autism react differently to novel and familiar objects but similarly to novel and familiar faces.

What deficits in emotion recognition do children with autism exhibit?

Children with autism have deficits in recognizing basic and complex emotions across all three expression modalities: face, voice, and body.

What is the reported prevalence rate of Autism Spectrum Disorder (ASD) in the population?

The prevalence rates for ASD typically range from 1 to 2% of the population.

How much more frequently is ASD diagnosed in males compared to females?

ASD is diagnosed three to four times more often in males than in females.

What factors are believed to contribute to the etiology of ASD?

The etiology of ASD is believed to be due to multiple genetic and non-genetic factors.

What do family, twin, and adoption studies suggest about the inheritance of ASD?

These studies support the genetic inheritance of ASD, with concordance rates for monozygotic twins ranging from 69 to 95% and for dizygotic twins from 0 to 24%.

What are some non-genetic risk factors for ASD?

Non-genetic risk factors include male gender, birth before 26 weeks of gestation, advanced parental age, and exposure to certain environmental toxins during prenatal development.

Is there a proven link between ASD and childhood vaccinations?

Despite extensive research, a link between ASD and childhood vaccinations has not been established.

What brain abnormalities have been observed in children with ASD?

Accelerated brain growth, larger-than-normal head circumference, and abnormalities in the cerebellum, corpus callosum, and amygdala.

What neurotransmitter abnormalities are associated with ASD?

Individuals with ASD often have lower-than-normal levels of serotonin in the brain but elevated levels of serotonin in the blood.

What is one explanation for the difference in serotonin levels in individuals with ASD?

Blood serotonin may enter the fetal brain during early development before the blood-brain barrier is fully mature, affecting serotonergic neuron development.

Which neurotransmitters are implicated in ASD?

Dopamine, GABA, glutamate, and acetylcholine are also involved in ASD.

What are the primary treatment goals for children with ASD?

To minimize core symptoms, maximize independence through functional skills acquisition, and reduce or eliminate interfering behaviors.

What is Early Intensive Behavioral Intervention (EIBI)?

EIBI is an evidence-based treatment using applied behavior analysis principles, providing at least 40 hours per week of behavioral interventions.

What was the focus of Lovaas's method of EIBI?

It involved using shaping and discrimination training to teach nonspeaking children with ASD to communicate verbally.

What outcomes have been found from research evaluating EIBI?

EIBI has the greatest positive impact on intelligence and language acquisition, with smaller and less consistent impacts on adaptive skills and social functioning.

What is the effectiveness of medication for the core symptoms of ASD?

No medication has been found effective for the core symptoms of ASD; medications are usually prescribed for co-occurring psychiatric conditions.

What are the associated behaviors that medications for ASD aim to address?

Medications are prescribed for behaviors causing distress that are not alleviated by nonpharmacological interventions.

What are the primary medications used to alleviate symptoms of ADHD?

Methylphenidate and other psychostimulants.

What types of medications are used to treat depression and anxiety?

SSRIs (Selective Serotonin Reuptake Inhibitors).

Which atypical antipsychotics are commonly used to reduce irritability and aggressive behaviors?

Risperidone and aripiprazole.

What is the minimum duration for symptoms to be considered for an ADHD diagnosis?

At least six months.

Before what age must ADHD symptoms onset for a diagnosis?

Before 12 years of age.

In how many settings must ADHD symptoms be present for a diagnosis?

At least two settings.

What are the consequences of ADHD symptoms on functioning?

They interfere with social, academic, or occupational functioning.

How many symptoms of inattention are required for an ADHD diagnosis?

At least six symptoms.

What are some symptoms of inattention in ADHD?

Doesn't listen when spoken to, fails to pay close attention to details, doesn't follow through on instructions, is easily distracted, and is often forgetful.

What are some symptoms of hyperactivity-impulsivity in ADHD?

Unable to engage in quiet play, often runs or climbs inappropriately, talks excessively, has trouble waiting turns, and interrupts others.

What are the three subtypes of ADHD?

Predominantly inattentive presentation, predominantly hyperactive/impulsive presentation, and combined presentation.

What is the prevalence of ADHD among youth ages 3 to 17 in the United States?

ADHD is the most prevalent diagnosed disorder.

How much more common is ADHD in males compared to females during childhood?

Two times more common.

What is the male-to-female ratio of ADHD in adulthood?

About 1.6:1.

What evidence exists regarding the persistence of ADHD into adulthood?

The majority of children with ADHD continue to experience one or more core symptoms as adults.

How do symptoms of hyperactivity change in adulthood?

Excessive motor activity decreases and is replaced by restlessness and impatience.

What changes occur in impulsivity as individuals with ADHD reach adulthood?

Impulsivity decreases slightly and may manifest as reckless driving, abruptly quitting jobs, and overspending.

What is a common comorbid disorder associated with ADHD?

Oppositional defiant disorder.

What are some other common comorbid disorders with ADHD?

Conduct disorder, anxiety disorder, and depressive disorder.

What brain abnormalities are associated with ADHD?

Impaired response inhibition, working memory, sustained attention, and executive functioning are linked to abnormalities in the prefrontal cortex, striatum, and thalamus.

What is associated with impaired temporal information processing in ADHD?

Abnormalities in the prefrontal cortex and cerebellum.

What brain region is linked to emotion dysregulation in ADHD?

The prefrontal cortex and amygdala.

What brain regions are associated with reduced volume in children with ADHD?

The prefrontal cortex, striatum, corpus callosum, and cerebellum.

What neurotransmitters are found at low levels in individuals with ADHD?

Dopamine and norepinephrine.

How do low levels of neurotransmitters in the prefrontal cortex affect individuals with ADHD?

They are linked to impairments in impulse control, attention, and executive functioning.

What is the heritability estimate of ADHD according to twin studies?

76%.

What are the reported concordance rates for monozygotic and dizygotic twins with ADHD?

About 71% for monozygotic twins and 41% for dizygotic twins.

What prenatal factors have been linked to ADHD?

Low birth weight, premature birth, and maternal smoking or alcohol use during pregnancy.

What is the recommended treatment for preschool children with ADHD?

Parent- and teacher-administered behavioral interventions, with evidence-based parent training in behavioral management as the primary intervention.

What treatment is recommended for elementary and middle-school children with ADHD?

A combination of medication and behavioral interventions at home and at school.

What is the recommended treatment approach for adolescents with ADHD?

Prescribe medication with the adolescent's assent and combine it with behavioral and instructional interventions.

What types of interventions may benefit adolescents with ADHD?

Behavioral therapy, motivational interviewing, mindfulness-based training, and classroom training.

What is the first-line treatment for adults with ADHD?

Medication.

What psychosocial intervention has the strongest support for adults with ADHD?

Cognitive behavior therapy.

What did the meta-analysis by Humphreys, Eng, and Lee (2013) conclude about psychostimulant treatment in childhood?

It neither decreases nor increases the risk for later substance use disorders.

How does the DSM-5-TR define a tic?

A sudden, rapid, recurrent, nonrhythmic motor movement or vocalization.

What are some examples of motor tics?

Eye blinking, facial grimacing, shoulder shrugging, and echopraxia.

What are some examples of vocal tics?

Throat clearing, barking, and echolalia.

What is the role of behavioral interventions in treating preschool children with ADHD?

They are the treatment-of-choice and focus on evidence-based parent training.

What is the significance of the findings regarding ADHD treatment and future substance use problems?

Children with ADHD who receive psychostimulant treatment have comparable rates of future substance-related problems to those who do not.

What are the implications of ADHD's heritability for treatment approaches?

Genetic factors may influence the effectiveness of different treatment strategies.

What is the relationship between ADHD and executive functioning?

Impairments in impulse control and attention due to low neurotransmitter levels affect executive functioning.

What does the term 'echopraxia' refer to in the context of tic disorders?

The involuntary imitation of another person's actions.

What are the three types of tic disorders distinguished by the DSM-5-TR?

Tourette's disorder, persistent (chronic) motor or vocal tic disorder, and provisional tic disorder.

What is required for a diagnosis of Tourette's disorder?

At least one vocal tic and multiple motor tics that may occur together or at different times, have persisted for more than one year, and had an onset before 18 years of age.

What characterizes persistent (chronic) motor or vocal tic disorder?

One or more motor or vocal tics that have persisted for more than one year and began before age 18.

What defines provisional tic disorder?

One or more motor and/or vocal tics that have been present for less than one year and began before age 18.

What is the typical age range for the onset of tics?

Between four and six years of age.

When does the severity of tics usually peak?

Between 10 and 12 years of age.

What is the most common comorbid disorder associated with Tourette's disorder?

ADHD (Attention-Deficit/Hyperactivity Disorder).

What biological factors are linked to Tourette's disorder?

Dopamine overactivity, a smaller-than-normal caudate nucleus, and heredity.

What types of treatments are available for Tourette's disorder?

Antipsychotic drugs (e.g., haloperidol), medication for comorbid conditions, and behavioral treatments like comprehensive behavioral intervention for tics (CBIT).

What does comprehensive behavioral intervention for tics (CBIT) include?

Psychoeducation, social support, habit reversal, competing response, and relaxation training.

What is childhood-onset fluency disorder commonly known as?

Stuttering.

What are some symptoms of childhood-onset fluency disorder?

Sound and syllable repetitions, sound prolongations, broken words, audible or silent blocking, circumlocutions, excessive physical tension in speech, and monosyllabic whole-word repetitions.

What is the typical onset age for childhood-onset fluency disorder?

Between two and seven years of age.

What is the treatment-of-choice for childhood-onset fluency disorder?

Habit reversal training, which includes strategies like regulated breathing.

What is required for a diagnosis of Specific Learning Disorder?

Difficulties related to academic skills indicated by at least one of six symptoms lasting at least six months despite interventions.

What are some symptoms of Specific Learning Disorder?

Inaccurate or slow word reading, difficulty understanding reading, spelling difficulties, difficulties with written expression, number sense, calculation, and mathematical reasoning.

What percentage of school-age children have a specific learning disability?

About 5 to 15 percent.

What is the most common type of reading disorder?

Dyslexia.

What type of dyslexia is most common?

Dysphonic dyslexia, also known as dysphonetic, auditory, and phonological dyslexia.

What is the typical IQ range for individuals with a specific learning disorder?

Usually average to above-average IQ.

What is the most common comorbid psychiatric disorder found in individuals with specific learning disorders?

ADHD.