Modules for next quiz

DSM-5 Neurodevelopmental Disorders: A group of disorders with an onset in the developmental period:

Often before child enters grade school; characterized by developmental deficits that produce impairments in personal, social, academic, and occupational settings; Deficits vary from very specific limitations of learning or control of executive functions to global impairments of social or intellectual capacity; often co-occuring with other disorders; Clinical presentation can include symptoms of excess as well as deficits and delays in achieving milestones

DSM-5 Neurodevelopmental Disorders: Intellectual Developmental Disorder

Deficits in general mental abilities; Can impact reasoning, problem solving, planning, abstract thinking, judgement, academic learning, and experiential learning; The deficits result in impairments of adaptive functioning

DSM-5 Neurodevelopmental Disorders: Intellectual Developmental Disorder: The deficits result in impairments of adaptive functioning

Individuals fail to meet standards of personal independence and social responsibility in one or more aspects of daily life which can include: communication, social participation, academic or occupational functioning, personal independence at home or in the community setting

DSM-5 Neurodevelopmental Disorders: Global development delay

Individual fails to meet expected developmental milestones in several areas of intellectual functioning; Diagnosis used for individuals who are unable to undergo systematic assessments of intellectual functioning; Symptoms are often present more often

DSM-5 Neurodevelopmental Disorders: Intellectual disability may result from acquired injury during developmental period

Such as head injury, oxygen deprivation, etc; a neurocognitive disorder may also be comorbid

DSM-5 Neurodevelopmental Disorders: Communication Disorders: Language disorder

Deficits in the development and use of language

DSM-5 Neurodevelopmental Disorders: Communication Disorders: Speech Sound Disorder (articulation disorder)

Deficits in use of speech

DSM-5 Neurodevelopmental Disorders: Communication Disorders: Social (pragmatic) Communication Disorder

Deficits in the developmental use of sound

DSM-5 Neurodevelopmental Disorders: Communication Disorders: Childhood-onset Fluency Disorder (stuttering)

Characterized by disturbances of normal fluency and motor production of speech; begins early in life and may cause lifelong functional impairments

DSM-5 Neurodevelopmental Disorders: Motor Disorders: Developmental Coordination Disorder

Characterized by deficits in the acquisition and execution of coordinated motor skills; Manifested by clumsiness and slowness or inaccuracy performing motor skills and that interfere with daily living

DSM-5 Neurodevelopmental Disorders: Motor Disorders: Stereotypic Movement Disorder

Repetitive, seemingly driven, and apparently purposeless motor behaviors (hand flapping, body rocking, head banging, self-biting, or hitting); Movements interfere with social, academic, vocational activities; If behaviors cause self-injury, it should be included in diagnosis

DSM-5 Neurodevelopmental Disorders: Motor Disorders: Tic Disorders

Motor or vocal tics (need both, not concurrent, for Tourette); Sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations

DSM-5 Neurodevelopmental Disorders: Motor Disorders: Autism Spectrum Disorder (ASD): Characterized by persistent deficits in social communication and social interaction across multiple contexts (criteria A):

social reciprocity, nonverbal communicative behaviors used for social interaction; skills in developing, maintaining, and understanding relationships

DSM-5 Neurodevelopmental Disorders: Motor Disorders: Autism Spectrum Disorder (ASD): Presence of Restricted, repetitive patterns of behavior, interests, or activities (criteria B)

Symptoms change with development and may be masked by compensatory mechanisms; diagnostic criteria may be met based on historical information; the current presentation must cause significant impairment

DSM-5 Neurodevelopmental Disorders: Motor Disorders: Autism Spectrum Disorder (ASD): Specifiers

with or without accomanying intellectual impairment; with or without accompanying structural language impairment; associated with a known medical or genetic condition or environmental factor; Associated with anther neurodevelopmental, mental, or behavioral disorder; Age at first concern; with or without loss of established skills; Severity; Associated with a known medical or genetic condition or environmental factor

Autism Spectrum Disorders: Screening

Usually, first concerns around 12-18 months; Usually, diagnosis around 4-5 years (significant lag in time = missed opportunities for early interventions, should screening be universal?); Currently, no sceening tool has been validated and shown to have significant specialty and sensitivity; red flags are included in many guideliens and indicate a need to “fast gtrack” referral to assessment (i.e. loss of speech and language in child under 3 years)

ASD Screening: Core Components

ASD specific developmental history using DSM-5 or ICD 10 criteria; Medical history (prenatal, perinatal, family, genetics, physical, psychiatric); Physical exam (congenital anomalies, skin conditions, growth, head circumference; Observational assessment (may include ASD specific screen tool: childhood autism rating scale or autism diagnostic observation schedule 2); Other individual assessments (depending on clinical presentation): Vision, hearing, sensory, cognition, perceptual, motor coordination, complete a skill profile

Autism Spectrum: Screening: Current EBP recommendations

All children are screened for autism spectrum disorder at age 18 and 24 months; along with regular developmental surveillance

Autism Spectrum: Screening: Barriers include

time and resources (often the largest barrier); resultant long waitlists that plague the profession and the community at large; accessibility and efficiency of diagnostic services; burnout incurred from the time required and document complex concerns; patients lost-to-follow-up due to multiple diagnostic appointments; threats to diagnostic accuracy in autism assessment-under identification of racial minorities; negative caregiver experiences-high frustration and parental stress during diagnostic odyssey

Autism Spectrum Disorders: Racial/Gender

Black children are diagnosed an average 1.4 years later than white children (and are much more likely to have received a previous diagnosis of conduct or adjustment disorder); Hispanic children are diagnosed almost one year later than white children; Girls with autism are more likely to be missed or misdiagnosed

Autism Spectrum: Goal of Treatment

Reduce core symptoms of ASD behaviors; Enable individual to achieve their own potential; Treat any occurring symptoms; Support the caregivers through education and EBP strategies

Autism Spectrum: Types of Treatment

Early intensive behavioral intervention (preschool aged children, principles of applied behavioral analysis and social communication focus); Social skills training (older children and adolescents, peer mediated communication interventions)

ASD Treatment: Lack of quality evidence to support

Auditory Integration Therapy; Sensory integration therapy; Gluten free casein free diet; omega 3 fatty acid supplements; Visual therapies; Music therapies

ASD Treatment: Pharmacology

Symptom focused; guanfacine and clonidine for ADHD/anxiety/agitation/sleep; Especially social anxiety; Risperidone or aripiprazole to address repetitive behaviors, aggression, irritability; SSRIs to address depressive and anxious symptoms

ASD Treatment: Aripiprazole and Risperidone

Positive results: decrease in social withdrawal, irritability, innapropriate speech, stereotypy; Drug holidays

ADHD: differential diagnosis

Developmental trauma, depression, anxiety, bipolar disorder

What percent of children with ADHD have another disorder?

60+%

Pediatric Perceptual Disorders: Schizophrenia : incidence

Very rare under age 10 and in early adolescence (~0.04%);

Pediatric Perceptual Disorders: Schizophrenia : Early or Childhood onset

More severe; More frequent and severe developmental abnormalities; higher risk of poor treatment response

Pediatric Perceptual Disorders: Schizophrenia : Premorbid impairment

~20% have language and motor delays; >30% have social developmental delays

Pediatric Perceptual Disorders: Schizophrenia : Prodromal symptoms

Non-specific and often gradual but with marked social and educational disruptions; Social withdrawal; Odd ideas and behaviors and bizarre/unusual perceptual experiences; Poor academic performance; change in affect

Pediatric Perceptual Disorders: Schizophrenia : Adult vs child

More insidious onset, more negative symptoms, more disorganization, more and higher levels of social disruption, broader hallucination types, less persecutory delusions, often worse long term functional capacity, increased risk of mortality

Pediatric Perceptual Disorders: Significant Cognitive Deficits:

Lower IQ (processing speed deficits, verbal memory deficits, worse attention symptoms); Affective psychoses- differentiate psychoses from COS (timing of onset, negative symptom severity);

Pediatric Perceptual Disorders: Treatment should be multi-modal

Pharmacotherapy; Individual therapy and family therapy; Functional support

Pediatric Perceptual Disorders: Psychopharmacology

Young patients are often more sensitive to side effects; Monitor weight gain and hyperprolactinemia in risperidone-based medications; 1st line should be 2nd gen atypical D2 medications such as aripiprazole and paliperidone; LAIs are rare but can be used

Perceptual disorders are common in pediatric populations

10-20% of children at some time have perceptual symptoms but most are not clinically significant (more common on falling asleep or waking; short in duration; overall low impairment); Caution should be taken to assure AVH is not a trauma response (fear based shadows and noises when alone, not present wiht other unless distressed; does not meet criteria but expresses AVH and often significant trauma history); Multidimensionally impaired (comorbid disorders can increase difficulty in diagnosing perceptual disorders); Strong genetic risk profile