Neurodevelopmental Disorders in Children

Dyslexia Brain Studies

1917: asserted the primary disability was in visual memory for words and letters and described symptoms including letter reversals and difficulties with spelling and reading comprehension 1970s: histological studies found neural ectopias - concentrated in left temporal lobe

ID Origins

40-50% unknown

Learning Disability

5% of the population a significant learning difficulty - unexplained - not caused by low IQ, health, psych issues generalized reading probs: caused by vision issues, language processing issues, poor vocab, poor attention dyslexia: specific reading disability that is characterized by poor phonetic decoding and spelling skills - a basic reading mechanics issue math: dyscalculia (NVLD) dysgraphia: difficulty organizing and communicating ideas in writing

Language Processing Disorders

5-7% 1st graders poor articulation: slurring receptive: difficulty understanding verbal directions, poor listening/reading comprehension; what?? kids expressive: word finding problems, difficulty expressing ideas, needs can become frustrated bc of problems central auditory processing disorder: CAP evaluation difficulty with sound discrimination, weak auditory figure ground (dx by audiologist)

DSM-V Dx Criteria for ADHD

6 or more symptoms of inattention: rush through tasks, difficulty sustaining attention on tasks, easily distracted, loses things, forgetful of daily activities 6 or more symptoms of hyperactivity (impulsivity): fidgets, talks excessively, always moving - on the go - ants in pants, runs excessively in situations where it is not appropriate - store, church, library

Psychostimulant Tx for ADHD

73-77% show improved behavior

Mental Health Disorders in Children: Others

ADHD

ADHD Imposters

anxiety disorders childhood depression academic failure receptive-expressive language processing disorders MR, autism psychological trauma (PTSD)

Mental Health Disorders in Children: Pervasive Developmental Disorders

autism (Asperger's, PDD)

Psychoeducational Eval/Neuropsych Eval

battery of standardized tests admin to discern why a child is having problems based upon standardized data and behavioral data, the psychologist can make the appropriate mental health dx once the dx is made the psychologist can make recs admin by: school psychologist, clinical psychologist, educational psychologist, neuropsychologist

Dyelxia Signs

bizarre reading and spelling guess at words, spell bizarrely (words bear little if any relation to the sounds in the words) tend to be very intelligent, have well developed language skills and strong math skills difficulties processing the phonetic structure of language: rhyming, sound blending, pseudoword decoding, sound substitution, word decoding, reading fluency and comprehension over time if not addressed negatively affects orthographic reading skills and causes reading avoidance over time

Developmental Disability

born with or originates in early childhood - manifests before age 22 expected to be life-long restricts individuals functioning in major life activities (vision, mobility, hearing, learning, social) results in functional limitations in 3 or more of: self-care, learning, social functioning, capacity for independent living, receptive/expressive language, mobility, motor capability, economic self-sufficiency

Causes of ASD?

brains of ASD babies are larger at 2 yrs of age regression of skills pruning? swelling? genetic causes - most NDD - highly genetic (100 genes - 50 chromosomal abnormalities - autism) there are many autism genes!! associated w very broad spectrum of relative risk many gene to gene relationships appear to be true for many autism genes and neurodevelopmental disorders

Writing Disability

can be caused by many diff problems dyslexia, expressive language deficits, NVLD, cognitive limitations

Prevalence of Developmental Disorders

children 3-17 years of age 1997-2008: 13.87% US 1 in 6 children, boys 2 times rate vs girls, income below US poverty line - higher prevalence peds study: 7.66% significant learning disabilities, 6.69% children have ADHD, 5-15% kids NYC have learning disabilities 2 million students in NYC - 10% have learning difficulties - disabilities, 200k students in NYC have learning disabilites 2.9 mil kids in US have learning disabilities

Mental Health Disorders in Children: Behavioral

conduct disorder oppositional defiant disorder

Interventions for DD

do not cure! goal is to improve functioning of the child, thereby enhancing his/her ability to function/learn research has clearly shown that kids with DD lives/functioning can be significantly improved w services

Mental Health Disorders in Children: Mood

dysthymic disorder, depression

Mental Health Disorders in Children: Communication

expressive language disorder mixed receptive - expressive

Neurology of ADHD

fMRI studies - less active in prefrontal lobes chatecholamine therapy - misbalance DOPA and NE in prefrontal lobes responsible for "executive processing skills" - sustained attention, planning, metacognition, inhibition of actions,, switching attention, working memory

Tx of ID

for many years did not survive, then switched to institutionalize, now integrate into society - have homes where they can live/work in the community

Referral Criteria for SLP

if the child has a hx of language problems or if you hear articulation/language problems in your exam and: the child has never undergone speech and language testing or therapy the parent is not satisfied with previous testing/therapy services

Referral and Tx for LD

if the child has not been eval or is not getting services - refer for psychoeducational eval (NYBOE, clinical psychologists) tx: edu based; phonetic reading instruction may also need writing and math instruction, also may require other therapy services - VT, OT, SLP, counseling

What causes neurodevelopmental disabilities?

inherited - high concordance rates for genetic twins can be presumably caused by prenatal problems - alcohol abuse, maternal smoking and stress, prematurity, difficult deliveries - fetal distress environmental - exposure to lead, poor nutrition/stimulation parents not reading and talking to kids often leads to delays in lang and vocab development - which leads to learning disabilities

MR

intellectual disability prevalence 2.3% of pop IQ scores <2 stdv from the mean (full scale IQ = 70) impaired adaptive functioning (everyday living skills) - communication, daily living - self help (dressing), social skills

Problems Assoc with ADHD

learning difficulties - inconsistent academic performance, dont read (can affect language acquisition), poor organization skills, poor writing skills (organization) social issues - impulsive behavior SES issues drug abuse - 4x at risk for developing drug abuse (self medicate) marital issues serious car accidents

Dyscalculia

math disability linked ti poor visual processing skills other skills for math - working memory, reasoning (cognitive skills), language skills (word problems)

Tx for ADHD

medical therapy behavioral therapy cognitive therapy environmental changes

Mental Health Disorders in Children: Intellectual

mild, mod, severe

Down Syndrome

most common genetic anomaly - 1 in 700 babies trisomy 21 - additional chromosome, translocation, chromosome 21 attached to another chromosome

ADHD

neurologically based deficit that has been linked to the prefrontal lobe of the brain basic symptoms: hyperactive (cant slow down, fidget, out of chair, playing, talking, checking what other kids doing) difficulty attending on tasks that require sustained mental effort (and on tasks they are not particularly motivated to work on) easily distracted (external stim or internal thoughts), mind wanders difficulty inhibiting inappropriate (impulsive) behavior in diff environments; lack flexibility in their ability to adapt their behavior to diff social settings

ADHD and LD

often comorbid 8-39% of ADHD kids have reading disability 12-30% have a math disability 12-27% have a spelling disability 38% ADHD have LD 60% LD have ADHD

ASD

onset prior to 3 yrs social interaction disorder: poor eye contact, poor peer relationships, lack of enjoyment or interests in interactions w people, lack of social reciprocity communication disorder: delay or lack of spoken language, impairment in ability to carry on a convo (pragmatic language), stereotyped speech patterns (echolalia), lack of make believe or social imitative play stereotypical behaviors: restricted and abnormal patterns of interest, stereotyped motor patterns (pacing, hand flapping/wringing), persistent preoccupation w parts of objects, line up objects

Tx for MR

placement in proper educational setting edu and therapy training - to maximize skills social skills and adaptive functioning training vocational training and living support services

Prevalence of ADHD in General Pop

prevalence varies per study, depending upon how the authors defined ADHD and the tools used to dx it 3-5% of childhood pop Adult ADHD - total 4.7%, combined .9%, hyperactive 2.5%, inattentive 1.3%

Types of ADHD

primary inattentive primary hyperactive-impulsive combined type some h-i or inattentive symptoms have to be present before 12 years of age present in at least 2 settings - school, social clear evidence of clinically significant impairment symptoms cannot be better accounted for by another mental disorder - anxiety, MR, PDD

Who to refer for ADHD evaluations

professional who will do a careful ddx developmental pediatrician hospital based psychiatric clinics ped psychiatrists/neurologists specialize in attention disorders clinical psychologists

Mental Health Disorders in Children: Learning

reading disorder math disorder disorder of written expression LD NOS

Wernickes Area

receptive language

Referral and Tx: SLP

refer child to a SLP: NYBOE, hospital based language centers, private SLP SLP: articulation, vocab development, language processing

Referrals for MR Testing

referral to a clinical psychologist for psychoedu/IQ testing and dx orgs for low cost testing - YAI, AHRC

Mental Health Disorders in Children: Anxiety

social phobia, panic attacks, PTSD

ADHD Executive Processing

sustaining attention switching attention from one task to another (get stuck) planning ahead on tasks (impulsive) slowing down and paying attention to tasks inhibiting inappropriate behaviors poor organization skills - breaking down assignments, organizing papers, remembering deadlines poor memory skills due to inconsistent attention

Cannot assume..

that child has been evaluated to determine what the problem is or what are its origins the child is receiving services to address the problem if the child is receiving services, that they are appropriate

Why do we need to know about developmental disabilities?

understand the whole child change eye exam to obtain best amount of info enable the OD to make appropriate referrals to help kids in ways other than vision

DD Issues

vision probs not only issues every child different in strengths and weaknesses these kids are typically working with many different professionals who are addressing different processing/skill weaknesses that child may have

Developmental Delay

when a child does not achieve developmental milestones within the normal age range - walking, talking, social development sometimes without intervention, the child will catch up some children require intervention, but they can learn the missing skills, catch up and continue with normal development