Week 10 - Neurodevelopmental Disorders

What is person-first language?

putting the person before the disability

What is identity-first language?

putting the disability before the person

What is Attention Deficit Hyperactivity Disorder (ADHD)?

A neurodevelopmental disorder that can impact a patient's cognition, academic behavior, emotional and social functioning

What is the most common emotional/cognitive/behavioral disorder in youth?

ADHD

Risk factors of ADHD

- Prenatal exposure to tobacco smoke

- Prematurity

In ADHD, what is more common in male vs female patients?

Male patients - hyperactivity type is most common

Female pts - inattentive is more common

What are some common comorbidities that can exists with a patient who has ADHD?

- Learning disabilities

- Oppositional Defiant Disorder

- Conduct Disorder

- Tics and Tourette Disorder

Can autism coexist with ADHD?

Yes

What are the two core symptoms/clinical manifestations of ADHD?

1) Hyperactivity/Impulsivity

2) Inattention

What characteristics are present within the Hyperactivity/Impulsivity symptom of ADHD?

- Excessive fidgeting

- Inability to sit still

- Excessive taking

- Lack of patience

What characteristics are present within the Inattention symptom of ADHD?

- Reduced ability to focus

- Reduced cognitive processing speed

- Difficult time organizing thing and activities

- Forgetfulness

- Easily becoming off tasks

What are additional symptoms of ADHD?

- Low frustration tolerance

- Emotional Dysregulation

Diagnostic criteria for ADHD (how long and what setting)

- Symptoms present for at least 6 months

- Symptoms occur in more than one setting and impair functioning in academic, social or occupational activities

Symptoms of ADHD should be present before what age?

12 years old

Diagnostic criteria for ADHD (for children < 17 yrs)

- Requires 6 or more symptoms of:

- hyperactivity/impulsivity OR

- Inattention

Diagnostic criteria for ADHD (for adults > 17 yrs)

- Requires 5 or more symptoms of:

- hyperactivity/impulsivity OR

- Inattention

How should ADHD be evaluated?

- Review report from school or day care

- Review psychosocial history (stress, relationships, academics, etc.)

- PE to monitor height, weight, vitals and head circumference (important baseline for monitoring stimulants

- Neuropsych testing to evaluate executive functioning

Management of ADHD

Pharmacotherapy (Mainstay)

- Stimulants (Methyphenidate or Amphetamine)

- Alpha-Adrenergic Agonists (Clonidine and Guanfacine) - non-stimulant as monotherapy or add on for tics, aggression, sleep disturbances

- SNRIs (non-stimulant) - for patients with abuse potential

CBT can be helpful for executive functioning difficulty

-can get accommdations/ need IEP

What are the drugs options for ADHD patients?

- Methylpenidate (Ritalin) - takes effect w/i 30 min

- Amphetamine (Adderall) - takes effect w/i 20-60 min

What are the ADRs of stimulant drugs such as Methyphenidate or Amphetamine?

- Decreased appetite

- Weight loss

- Potential growth hindrance in children (monitor weight, height, and growth charts)

How does alpha Adrenergic agonists help treat ADHD?

- Helpful for tics, aggression and sleep disturbances

How does SNRIs help treat ADHD?

Helpful in patients with abuse potential and stimulant induced tics

What are some important steps in the management of ADHD patients who have academic issues?

- Provide accommodations (e.g. extended exam time)

- IEP (Individual education plans)

What is the prognosis for ADHD?

Persists into adulthood for a majority of patients

What is Autism Spectrum Disorder (ASD)?

An umbrella term that includes conditions such as pervasive developmental disorder, childhood autism, atypical autism, Asperger Syndrome and child disintegration disorder

What is the prevalence of ASD?

Affects 1 in 40 and is more common in males

When may ASD typically be diagnosed?

When social interactions can be observed (e.g. 2-3 years)

How is ASD described?

Persistent deficit is in social communication and reciprocal social interactions & restricted, respective and inflexible patterns of behavior, interest or activities that impairs day-to-day function

Risk factors of ASD

Family History

Advanced parental age

NO VACCINE ASSOCIATION

What are common comorbidities that can present with ASD? (5)

- ADHD

- Learning disabilities

- Intellectual disabilities

- Epilepsy

- Nutritional Deficiencies

- Macrocephaly

What are the three clinical manifestation groupings of ASD?

1) Social communication and interaction symptoms

2) Restricted, Repetitive behaviors and interests

3) "Other"

What characteristics are present in the symptoms affecting social communication and interactions in ASD?

*EARLIEST SYMPTOM*

- Poor eye contact

- Hard time interpreting social cues

- Difficulty understanding abstract speech

- Does not meet normal verbal developmental milestones

When do characteristics present in the symptoms of restricted, repetitive behaviors and interests occur in ASD?

Age 3

What are other symptoms of ASD?

- Highly developed specialized skills (savant)

- Prefers solitary play

What should be examined on PE for patients who have suspected ASD?

- Head circumference (increased in children w/ ASD)

- Neuro exam may show mild hypotonia in children w/ ASD

What is the DSM-V criteria for ASD?

Abnormal or impaired development evident before age 3

When is autism screening recommended?

18-24 months

What is the Modified Checklist for Autism in Toddlers (M-CHAT)?

preferred screening tool for autism with A 20 item "yes/no" caregiver report used between 16 to 30 months to assess for autism

What should be apart of your evaluation in patients who have suspected ASD? (what other tests to order)

- Vision & hearing test

- Lead Levels

What is the Management of Autism Spectrum Disorder?

- Early identification is key by providers

- Implement state early interventions services <36 mo.

- Implement public school services and programs > 36 mo.

- Behavioral and education programs

- Medications (SSRIs)

- Caregiver support programs for parents managing children with ASD

What medication is most commonly used for agitation/aggression present in patients with ASD?

Risperidone

What prognostic factors influence the outcomes of patients with ASD?

Early identification and early intervention