Abnormal Exam 3

Why was “diorders of childhood” changed to be called “neurodevelopment disorder”?

They all start in childhood however they can continue into adulthood

What did intellectual disability used to be called?

Mental retardation

What is intellectual disability?

Deficit in intellectual functioning and adaptive functioning

\--IQ must be lower than 75

What kinds of questions do kids struggle with on an IQ test to show a deficit in intellectual functioning?

Math and coding

What kinds of questions do kids struggle with on an IQ test to show a deficit in adaptive functioning?

critical thinking/what would you do questions

\--If you found a wallet in the store, what would you do?

What are the three domains to adaptive functioning?

conceptual, social, practical

What is conceptual adaptive function?

Relates to where they are at in relation to their peers

\--how they are doing in comparison to them in terms of grades, talking, social activities, etc.

What is social adaptive functioning?

ability for child to use language and communicate with those around them

\--someone who gestures at things would have low functioning

What is practical adaptive functioning?

Everyday activities like eating, tying shoes, opening doors, etc.

What causes can lead to the development of intellectual disability?

Prenatal exposure, eating certain foods, genetics, seizures, etc.

What are some treatments to intellectual disability?

1. Teaching training deficit--teaching child proper hygiene such as washing hands


1. Finding a weak area to asses
2. Support- there are many government structures in place for this
3. Prevention when possible-- awareness if very important to reduce this

What is specific learning disorder?

Can include poor performance in reading, written expression, or mathematics

\--diagnosis starts with IQ exam

\--mostly assessed in schools

\--working with children to assess their abilities

What are the three tiers of support?

They are a response to intervention and if they fail to respond to a tier, then they will get pushed into the next tier up


1. Core classroom instruction
2. Targeted Small Group Instruction
3. Intensive Individual Intervention

When treating specific learning disorder, what do treatment options focus on?

Skills and/or strategy; sometimes comorbid conditions (affected from something else like ADHD)

\--treatment may start in groups but then move to more individualization

What is the prevalence rate of specific learning disorder?

5-15% among school age kids

\--seems to be higher in high income states because they have better sources for diagnosing

Is autism dimensional?

Yes, it is a spectrum

What are the two key criteria to autism spectrum disorder?

1. Deficits in social communication and interactions
2. Restricted or repetitive behaviors or interests

What are some examples of deficits in social communication and interactions?

\--exhibit poor “joint attention”

\--deficits in the expression of prosody

\--deficits in non-verbal expression

What is joint attention?

Maing other look/pay attention to the same things they are looking at

\--sharing enjoyment

\*\*Those with ASD look past or through people--like they are looking at the background while TD focus on faces, eyes, mouth

What is prosody?

Progression and intonation as we speak

\--those with ASD do not have this

How many of those with autism do not have verbal ability to communicate?

1/4

What are some examples of restricted or repetitive behavior or interests?

\--Maintenance of sameness (not enjoying change)

\--May engage in stereotyped and ritualistic behaviors and interests

\--hypo or hyper reactive to sensory stimuli

What are examples of stereotyped and ritualistic behaviors someone with ASD might engage in?

\--Movements: flapping hand, head banging, biting

\--Ritualistic behavior: lining up all toys across room

\--can have hyperfixation on interests like dinos and cars

What is an example of hypo or hyper reactivity to sensory stimuli?

Going to a movie can be an overload but to lights and noise

What are potential contributions and causes to ASD?

Genetics, neurological or neurobiological differences

What is the amygdala in charge of?

Emotion and fear responses

What were the results of the post mortem studies looking at the amygdala of those with ASD vs TD?

They are the same size, however those with ASD have fewer neurons present

What were the results of early childhood studies looking at the amygdala of those with ASD vs TD?

Those with ASD actually have a larger amygdala than those TD

What is the prevalence rate for those with ASD?

1 in 50 children are diagnosed

\--some say it is innapropriately diagnosed

\--increasing rate of disorder

What are treatments to ASD?

No cure, so we want to improve life quality through early intervention using teaching an behavioral strategies and applied behavior analysis

What are the 3 subtypes of ADHD?

predominantly inattentive, hyperactive/impulsive, combined

How long do symptoms need to be present to be ADHD?

show symptoms before age 12 for 6 months or more

What is inattentiveness?

Making careless mistakes, being forgetful, losing things needed to complete a task, organizational concerns, tend to start lots of things but not finish it, easily distracted

What is hyperactivity/impulsivity?

Climbing around, running around at innapropriate times, moving around a lot, loudness, struggle to wait for their turn, talking out of turn, tend to make risky decisions/behaviors

What is the prevalence for ADHD?

4-7% in children and 2.5% in adults

\--male to female ratio of 2:1 or higher

What are some causes to ADHD?

genetics, environmental toxins, prenatal factors

What are some ADHD treatments?

MTA studies utilize 3 treatments: medications, behavioral measures, and a combo between the 2

\--meds are best at addressing symptoms

What were some concerns about using medication to treat ADHD?

They were worried it can affect the development of the brain

What are symptoms of sluggish cognitive tempo?

\--sluggish

\--tired/fatigue

\--slow thinking

\--losing train of thought

Why is sluggish cognitive tempo not in the DSM?

It looks like inattentive ADHD but it is not; the symptoms are very similar to depression symptoms

What is Oppositional Defiant Disorder? (ODD)

1. angry/irritable mood


1. lose temper and easily annoyed; consistent tantrums
2. Argumentative/Defiant Behavior


1. Not doing what is asked; going against rules blaming others for their behavior
3. Vindictiveness


1. Must show this 2x within 6 mo period; out for revenge

\*\*Cannot just be siblings they are having issues with but must also be parents, teachers, peers, etc.

When is ODD typically diagnosed?

Under 13 years of age

What is Conduct Disorder (CD)?

1. Aggression toward people and animals


1. Frustration with people typically have a reason but no reason behind harming animals
2. Destruction of property


1. Fires, breaking things, throwing
3. Deceitfulness or Theft


1. Breaking in/lying to obtain what is wanted
4. Serious Violation of Rules


1. Breaking curfew, running away at least twice, skipping school before the age of 13

When is CD typically diagnosed?

After age 13 but showing some signs and symptoms before then

What is Callous Unemotional Disorder?

Showing no remorse; not caring that they are harming

What are positive symptoms of psychotic disorders?

Things added onto usual experiences

\--distortions from reality

What are negative symptoms of psychotic disorders?

Impairment in typical behaviors that take away from typical experience

What are disorganized symptoms of psychotic disorders?

Inappropriate reactions to cues in environment

What are positive symptom examples

1. Delusions


1. persecutory
2. referential
3. grandiose
4. erotomanic
5. nihilistic
6. somatic
2. Bizarre delusions
3. Hallucinations

What are delusions?

Type of positive symptom where you are holding a belief even when given evidence to the contrary

\--ex: not accepting and sticking with belief that Santa is real

What are persecutory delusions?

Subcategory of delusion where person feels you are out to get them but you are not

\-most common type of delusion

\--almost like paranoia

What ae referential delusions?

People think everyone is having a conversation about them even if no evidence permits

\--ex: may think a billboard ad is talking about them

What are grandiose delusions?

Person thinks they are popular, celebrity, important when really not

\--ex: thinks everyone wants their signature bc they believe they are a celebrity when not

What are erotomanic delusions?

Belief that someone is in love with you even if evidence does not permit

What are nihilistic delusions?

Hold belief that major catastrophe is going to occur when no evidence to support

\--ex: anxiety of tornado is coming when they hear “bad weather” in January

What are somatic delusions?

dependent of physical experience; thinks something is physically wrong with them even when no evidence permits

What are bizarre delusions?

1. thought withdrawal
2. thought insertion
3. Delusions of control

a. feels like someone is in control of their body
4. Capras syndrome
5. Cotard’s syndrome

\*\*Cannot occur in anyway

What is Copras syndrome?

Belief there is a double of someone evil (evil twin)

What is Cotard’s syndrome?

Person believes that they are dead themselves

What are hallucinations?

Any clear perceptual experience that does not meet stimuli in the environment

\--most commonly auditory or visual for the mental health standpoint

\--ex: thinking there are bugs crawling on you in the summertime

What are some negative symptom examples?

1. Diminished Emotional Expression/Affective Flattening
2. Avolition
3. Alogia
4. Anhedonia
5. Asociality

What is diminished emotional expression/affective flattening?

Diminished emotional expression refers to voice/tone change, eyes, movement being reduced and below common baseline; reduced gestures

Flat refers to no change in expression

What is avolition?

lack of interest in activity; apathetic; not wanting to do anything at all

\--ex: may be starring out window or sitting in a singular spot for a long period of time

What is alogia?

Lack of speech production; may have trouble finding the right word or struggle in producing speech as a whole; may be slow paced

What is anhedonia?

Lack of pleasure and interest in things they used to enjoy doing

What is asociality?

lack of wanting social interaction; withdraw

What are some disorganized symptoms?

1. Disorganized speech (or thinking)
2. Disorganized behavior (including inappropriate affect)
3. Catatonia--silly response to environment that do not match

What is schizophrenia?

Two or more symptoms must be present most of the time for at least 1 month; significant impairment/disturbance over 6 months


1. delusions
2. hallucinations
3. disorganized speech
4. disorganized behavior
5. negative symptoms

In schizophrenia, how come when affective symptoms/disorders are present, positive symptoms must be present when affective symptoms are not?

If it is only affective symptoms that are present, then they would be classified as mood disorder symptoms

What causes schizophrenia?

There is not one particular manifestation of the disorder which leaves lots of room for variability in symptoms

Is a prodromal phase possible in schizophrenia?

Yes

What is prodromal?

Odd behaviors (early signs and symptoms) that are not yet diagnosable

\--ex: teen was in residential area because they couldn’t maintain behavior anywhere--she had a very realistic fantasy world where she could not tell the difference between the two worlds

What is insight and why is it so common in schizophrenia?

How well they understand what they are experiencing

\--ex: having insight they are having hallucinations

\--those with better insight typically have better prognosis

What is the prevalence rate for schizophrenia?

0\.3-0.7%

\--age of onset in 20s is typical

\--sex difference in manifestation are possible (men earlier)

What is brief psychotic disorder?

\--essentially schizophrenia but must have 1 of 4 symptoms

\--duration is too short to provide “full” diagnosis (1day to 1 mo)

\--impairment not required

What is schizophreniform disorder?

\--Same initial symptoms as schizophrenia but briefer duration

\--2 of symptoms

\--Time between 1 mo and 6 mo

\--good premorbid social and occupational functioning

\--no symptoms of blunted or flat affect

What is schizoaffective disorder?

Mood disorder PLUS schizophrenia criterion A

\--symptoms occur separately and on their own

What is delusional disorder?

Presence of persistent delusion

\--for at least 1 mo without other schizo symptoms

\--do not exhibit other symptoms that would suggest schizophrenia

\--no additional functioning problems

What are some beliefs about personality disorders?

1. Trait like rather than state like


1. imbedded in the person
2. extremely difficult to treat
3. gender typed
4. persistent across a lifespan
5. diagnosed in adulthood

What things are affected by personaility disorder?

1. Cognition
2. Affectivity
3. Interpersonal functioning
4. Impulse control

\

What is Cluster A of personality disorders?

Odd or eccentric disorders


1. Paranoid personality
2. Schizoid personality
3. Schizotypal personality

What is paranoid personality disorder?

exhibits extreme suspicion of others

\--hostile and paranoid

\--ex: wife texting=wife cheating

What is schizoid personality disorder?

Lack of interest in personal relationships; present as socially detached

\--activities not enjoyed

\--sex not of interest

What is schizotypal personality disorder?

Lack relationships although would like them

\--similar presentation to schizophrenia

\--odd behaviors and beliefs

\--odd speech patterns

\--paranoid

What is cluster B of personality disorders?

Dramatic, Emotional, or Erratic


1. Antisocial
2. Borderline
3. Histrionic
4. Narcissistic

What is Antisocial personality disorder?

Breaks laws or rules, lies, irritable/aggressive; lack of concern for others’ safety, lack of guilt

\--seems to be ok with criminal behaviors

\--out for personal gain

\--can only be diagnosed after 18; if before 18 then would be conduct disorder

What s borderline personality disorder?

\--Instability of relationships and self

a. unstable emotions and odd behaviors

b. moves from stable to unstable v quick

\--Engagement in self harming

\--Persistent fear of being abandoned

a. goes to extremes to extinguish abandonment

What is histrionic personality disorder?

\--used appearance and speech to receive attention

\--appear emotionally liable

What is histrionic personality disorder?

Uses appearance and speech to receive attention

\--appears emotionally labile (fluctuating a lot)

\--will talk, look, and engage in ways to force attention

\--2/3 of those with this are also diagnosed with antisociak

\--more common in females

What are some similarities between histrionic and borderline personality disorder?

Fluctuation of emotions

What are some differences between histrionic and borderline personality disorder?

\--Borderline wants relationships while histrionic only wants attention

\--Borderline shows deep emotions while histrionic emotion is superficial

What is narcissistic personality disorder?

Those who seek admiration, lack empathy, and take advantage of other

\--see themselves as important people and want to be treated as such

\--they do what they need to do to get to a position of power

\--fragile self-esteem

\--more common in males

\--looks a lot like mania but the time frame is different

What are similarities between narcissistic and antisocial personality disorder?

Both lack empathy and use others

What are some differences between narcissistic and antisocial personality disorder?

Narcissistic: seek admiration; grandiosity

Antisocial: deceitful; aggressive; impulsive; history of conduct disorder

What is Cluster C of personality disorders?

Anxious or fearful


1. Avoidant
2. Dependent
3. Obsessive-Compulsive

What is avoidant personality disorder?

Strong fear of criticism or rejection and limits relationships due to fear of rejection

\--opposite of narcissism

\--low self esteem

What is the difference between avoidant and schizotypal or schizoid?

Schizoid is unlikely to feel lonliness

What is the difference between avoidant and dependent?

Avoidant has fear of rejection rather than need to be cared for

What is the difference between avoidant and social anxiety?

Little difference

What is dependent personality disorder?

Someone who:

\--needs reassurance--constantly need someone checking in with them

\--over submissive--if someone is dominating then they are perfectly happy

\--unwilling to make own decisions--want someone else to talk on role

\--fears being alone--being alone forces them to make their own decisions so they try to form and keep relationships

\--looks incompetent so someone will help them

\--lacks a lot of confidence/ esteem