Ch 13 Nurodevelopmental and neurocognitive disorders
Agnosia
the inability to recognize familiar objects. May be a symptom of dementia or other brain disorders
Other medical conditions that cause neurocognitive disorder
Aphasia Frontotemporal neurocognitive disorder Pick's disease Traumatic brain injury Lewy body disease Parkinson's disease HIV Substance use Huntington's disease Prion Disease Creuzfeldt-Jakob Disease
Assign a label to each of the following cases: In school, six year old :-) appears extremely awkward. She doesn't understand when other children are being sarcastic and Mrs. many social communication cues. A) ADHD B) social (pragmatic) communication C) Tourette's disorder D) Specific learning disorder
B
Treatment of ADHD
Psychosocial treatments - Goalsetting and reinforcement Biological treatments (medication) - Improved compliance - Decrease negative behaviors - Effects not long term Combined approach to treatment
delirium
Rapid-onset reduced clarity of consciousness and cognition, with confusion, disorientation, and deficits in memory and language. - People with delirium appear confused, disoriented, and out of touch with their surroundings. They cannot focus and sustain their attention on even the simplest tasks. There are marked impairments in memory and language - Symptoms develop over hours or a few days, and they can vary over the course of a day - Most prevalent among older adults, people undergoing medical procedures, cancer patients, and people with AIDS A temporary state of confusion and disorientation that can be caused by brain trauma, intoxication buy drugs or poisons, surgery and a variety of other stressful conditions, especially among older adults
Pick's Disease
Rare neurological disorder that results in pre-senile dementia (has a genetic component and usually occurs during a persons 40s or 50s)
Communication and motor disorders
(Closely related to specific learning disorder) - Childhood speech fluency disorder - Language disorder - Social (pragmatic) communication disorder - Tourette's disorder
Overview of Neurodevelopmental Disorders
- ADHD - Specific Learning Disorder - Autism Spectrum Disorder - Rett Disorder - Intellectual Disability (Intellectual development disorder (ID))
pervasive developmental disorders
- Autism spectrum disorder ASD - Intellectual disability ID
Combined approach to treatment for ADHD
- Behavioral interventions have the added benefit of improving aspects of the child and family that are not directly affected by medication - (Current thinking in this area points to using parent and\or teacher delivered behavioral interventions for young children before attempting medication) More research likely will be needed to clarify the combined and separate affects of these two approaches to treatment.
Psychosocial treatments for ADHD
- Generally, focuses on broader issues such as improving academic performance, decreasing disruptive behavior, and improving social skills. - Program set such goals as increasing the amount of time the child remain seated or the number of math problems completed, or inappropriate play with peers. - Reinforcement programs reward for improvement and punishments misbehavior with loss of rewards - Other parent education programs teach families how to respond constructively to their child's behaviors and how to structure the child's day to help prevent difficulties. - Social skills training for these children also seems to be an important treatment component - For adults with ADHD, cognitive behavior interventions help reduce distractibility and improve organizational skills - *Most clinicians recommend a combination of approaches, targeting both short term management issues (decreasing hyperactivity and impulsivity) and long-term concerns (preventing and reversing academic decline and improving social skills).
Statistics for specific learning disorder
- The frequency of this diagnosis appears to increase in wealthier regions of the country, suggesting that with better access to diagnostic services, more children are identified - It appears that societal views of disability, racism, and inequitable assessment are among the factors that contribute to disproportionality - Difficulties with reading are the most common - Childhood onset speech fluency disorder (stuttering) - Language disorder
Neurocognitive disorders have many causes:
- Variety of brain traumas (i.e. stroke, syphilis, HIV, severe head injury, the introduction of toxic or poisonous substances, diseases such as Parkinson's, Huntington's, Alzheimer's)
According to the DSM-5, the symptoms that are characteristic of ADHD are: A) And attention and hyperactivity/impulsivity B) Echolalia and hyperactivity/impulsivity C) Hallucinations and delusions D) Obsessions and compulsions
A
Assign a label to each of the following cases: 10-year-old Cole has trouble waiting his turn during games and does things seemingly without thinking. He often calls out answers in school, sometimes before the complete question is asked. A) ADHD B) social (pragmatic) communication C) Tourette's disorder D) Specific learning disorder
A
Behavioral techniques are often used to address communication problems that occur with autism. __________ involves rewarding the child for progressive approximations of speech, and blank involves rewarding the child for making sounds that the teacher request. A) Shaping; discrimination training B) Modeling; syntax training C) Imitating; expression training D) Processing; academic training
A
Determine how well you are able to diagnose the disorder in each of the following situations by labeling them: Six-year-old Sally has a low IQ and enjoy sitting in the corner by herself, or she arranges or toys or spins around in circles. She is unable to communicate verbally. She throws tantrums when her routine is changed or when her parents try to get her to do something she doesn't want to do. A) ASD requiring very substantial support B) ASD requiring support C) Rett Disorder D) Social (pragmatic) communication disorder
A
Identify the following symptoms of dementia from the description: Timmy's elderly grandmother no longer recognizes Timmy when he visits, even though he is her only grandchild. A) facial agnosia B) agnosia C) aphasia
A
___________ is a form of intellectual disability caused by the presence of an extra 21st chromosome. A) Down syndrome B) Fragile X syndrome C) PKU syndrome D) Fetal alcohol syndrome
A
Intellectual disability (intellectual developmental disorder ID)
A diagnosis received when one achieves a significantly below average score on a test of intelligence and by limitations and the ability to function in areas of daily life. Significantly sub average intellectual functioning paired with deficits in adaptive functioning such as self-care or occupational activities, appearing before age 18. (Previously mental retardation) DSM five identifies difficulties in three domains: - Conceptual (i.e. skill deficits in areas such as language, reasoning, knowledge, and memory) - Social (i.e. problems with social judgment and the ability to make and retain friendships) - Practical (i.e. difficulties managing personal care or job responsibilities) Down syndrome Fragile X syndrome Cultural familial intellectual disability
Chorionic villus sampling CVS
A genetic test conducted during early pregnancy that sample cells found in the placenta (chorionic villi) and assesses possible genetic or chromosome all problems in the villus.
Psychological and social causes of neurocognitive disorders
A persons life style may involve contact with factors that cause neurocognitive disorder - In the case of vascular neurocognitive disorder, a person's biological vulnerability to vascular disease will influence the chance of strokes that can lead to this form of disorder. - Lifestyle issues such as diet, exercise, and stress influence cardiovascular disease Cultural factors may also affect this process (ie - hypertension and strokes are more prevalent among African-Americans and sub groups of Asian Americans than non-Hispanic whites) Not getting enough vitamin B9 and B 12
Delirium (DSM 5)
A. A disturbance in attention (i.e. reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment) B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day C. An additional disturbance in cognition (i.e. memory deficit, disorientation, language, Visuospatial ability or perception) D. The disturbance in criterion A and C are not better explained by another pre-existing, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as a coma E. Evidence due to another medical condition, substance intoxication or withdraw, exposure to a tocsin, or due to multiple etiologies
ADHD DSM-5
A. A persistent pattern of inattention and/or hyperactivity-impulsivity shown by 6 or more for at least 6 months: 1. Six or more inattentive symptoms, and/or - Often fails to give close attention to details or makes careless mistakes - Often has difficulty sustaining attention in tasks or play activities - Often does not seem to listen when spoken directly to - Often does not follow through on instructions and fails to finish school work, chores, or work - Often has difficulty organizing tasks and activities - Often avoid, dislikes, or is reluctant to engage in tasks that require sustain mental effort - Often loses things necessary for tasks or activities - Is often easily distracted by extraneous stimuli (for adults unrelated thoughts) - Is often forgetful and daily activities 2. Six or more hyperactive-impulsive symptoms (Six or more for at least six months) - Often fidgets with or tabs hands or feet or squirms and seat - Often leaves see in situation when remaining seated is expected - Often runs about or climbs in situations where it is inappropriate (adults- feeling restless) - Often unable to play or engage in leisure activities quietly - Often quote on the go," acting as if "driven by a motor" - Often talks excessively - Often blurts out an answer before a question has been completed - Often has difficulty waiting his turn - Often in a Rupps or intrudes on others B. Several symptoms present before age 12 years C. Several symptoms present in two or more settings D. Symptoms interfere with functioning E. Symptoms are not better explained by another disorder Note: Symptoms not solely a manifestation of oppositional behavior, defiance, hostility or failure to understand instructions
Specific learning disorder DSM-5
A. Difficulty learning and using academic skills - at least one symptom for 6+ months, despite the provision of interventions that target those difficulties: 1. In accurate or slow and effortful word reading 2. Difficulty understanding the meaning of what is read 3. Difficulty with spelling 4. Difficulty with written expression 5. Difficulty mastering number sense, number facts, or calculation 6. Difficulty with mathematical reasoning B. Affected skills are substantially and quantifiably below those expected for that age and cause significant interference with academic or occupational performance, or with activities of daily living (standardized assessment) C. Learning difficulties began during school age years but may not become fully manifest until the demands for those affected academic skills exceed the individual's limited capacity D. Not better accounted for by intellectual disabilities, uncorrected visual or auditory acuity, or other mental or neurological disorders, psychosocial adversity, lack of the language proficiency of institution, or in adequate educational instruction
Mild neurocognitive disorder DSM-5
A. Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual motor, or social cognition based on): 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and 2. A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in it's absence, another quantified clinical assessment B. The cognitive deficits do not interfere with capacity for independence in every day activities C. The cognitive deficits do not occur exclusively in the context of delirium D. Not better explained by another mental disorder Specify whether due to: - Alzheimer's disease, frontotemperal lobe degeneration, Lewy body disease, vascular disease, Trumatic brain injury, substance/medication use, HIV infection, prion disease, Parkinson's disease, Huntington's disease, another medical condition, multiple ideologies, unspecified
Major neurocognitive disorder DSM-5
A. Evidence of significant cognitive decline from a previous level of performance in one or more (cognitive domain complex attention, executive function, learning and memory, language, perceptual motor, or social cognition based on): 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and 2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in it's absence, another quantified clinical assessment B. The cognitive deficits interfere with independence in every day activities C. The cognitive deficits do not occur exclusively in the context of another mental disorder Specify whether due to: - Alzheimer's disease, frontotemperal lobe degeneration, Lewy body disease, vascular disease, Trumatic brain injury, substance/medication use, HIV infection, prion disease, Parkinson's disease, Huntington's disease, another medical condition, multiple ideologies, unspecified
Autism spectrum disorder DSM-5
A. Persistent deficits in social communication and social interaction across multiple context as manifested by the following (currently or by history): 1. Deficits in social emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversations; to reduce sharing of interests, emotions, and affect; to failure to initiate or respond to social interactions 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits and understanding and use of gestures; to a total lack of facial expressions and nonverbal communication 3. Deficits in developing, maintaining, and understanding relationship, ranging from difficulties adjusting behavior to suit various social contacts; two difficulties in sharing imaginative play and in making friends; to absence of interest in peers B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least 2: 1. Stereotyped or repetitive motor movements, use of objects, or speech 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns a verbal or nonverbal behavior 3. Highly restricted, fixated interests that are abnormal in intensity or focus C. Symptoms must be present in the early developmental period (but may not become fully manifest until later) D. Symptoms causes clinically significant impairment in social, occupational, or other important areas of current functioning E. Not better explained by intellectual disability or global developmental delay. Intellectual disability and ASD frequently cooccur - To make comorbid diagnosis of ASD and intellectual disability - social communication should be below that expected for general developmental level
Biological, Psychological and social causes of ASD
ASD does not appear to have a single cause. A number of biological contributions may combine with psycho social influences - 1/3 of ASD have savant skills (exceptional mental ability) Biological dimensions: deficits in such skills as social communication and the characteristic restricted and repetitive behaviors and interests appear to be biological in origin: - Numerous genes on a number of our chromosomes have already been implicated in someway in the presentation of ASD. Many genes are involved, but each one has only a relatively small effect. - Evidence of brain damage (cognitive deficits) combined with psychosocial influences Neurobiological influences - Theory: amygdala in children with ASD is enlarged early in life causing excessive anxiety and fear. With continued stress, the release of the stress hormone cortisol damages the amygdala, causing the relative absence of these neurons in adulthood. - Some research on children with ASD found lower levels of oxytocin in their blood - One highly controversial theory - that mercury from vaccines is responsible for the increases seen in ASD
Determine how well you are able to diagnose the disorder in each of the following situations by labeling them: At an early age, Dwight became preoccupied with geography and could name all of the state capitals. His speech development was not delayed, but he does not like to play with other children are being touched her health. A) ASD requiring very substantial support B) ASD requiring support C) Rett Disorder D) Social (pragmatic) communication disorder
B
Echolalia is characterized by which of the following behaviors: A) Continuously reading the same sentence or word B) Repeating the speech of others C) Mimicking the movements of others D) Staring ahead without blinking for long periods
B
Identify the following symptoms of dementia from the description: Timmy is elderly grandmother does not recognize her own home anymore. A) facial agnosia B) agnosia C) aphasia
B
Match the term with the following descriptions of delirium: Treatment of delirium depends on the __________ of the episode and can include medications, psychosocial intervention, or both. A) Memory B) Cause C) Counseling D) Confused E) Elderly F) Trauma
B
Which disorder can be diagnosed definitively on an autopsy by the presence of large numbers of amyloid plaques and neurofibrillary tangles? A) Vascular neurocognitive disorder B) Neurocognitive disorder due to Alzheimer's disease C) Delirium D) Neurocognitive disorder due to Parkinson's disease
B
Which of the following is NOT a recommended treatment for persons with specific learning disorder's? A) Instruction on vocabulary B) Finding facts in reading C) Efforts to improve cognitive skills through decision making and critical thinking D) Medical intervention
B
Treatment for intellectual disability
Biological treatment of ID is currently not a viable option Generally, the treatment parallels that of people with more severe forms of ASD, attempting to teach them the skills that they need to become more productive and independent. For individuals with mild ID, intervention is similar to that for people with learning disorders. The expectation for all people with ID is that they will in someway participate in community life, attending school in later hold a job, and have the opportunity for meaningful social relationships. - Task analysis: wear those with ID can acquire skills through the mini behavioral innovations to teach people how to function in daily life - Communication training is also important for those with ID (Augmentative communication strategies) - Supported employment: involves helping an individual find and participate satisfactorily in a competitive job Increasingly, teaching strategies to help the students learn are being used and regular classrooms and in preparing them to work at jobs in the community
statistics for ADHD
Boys are 2 to 3 times more likely to be diagnosed (Girls with ADHD tend to display more behavior is referred to as "internalizing" (specifically anxiety and depression) People with ADHD are first identified as different from their peers around three or four. The symptoms of inattention, impulsivity, and hyper activity become increasingly obvious during the school year's. - Half of the children with ADHD have ongoing difficulties through adulthood Diagnosing children with ADHD is complicated. Several other DSM-5 disorders, also found in children, appear to overlap significantly with this disorder - specifically oppositional defiant disorder ODD, conduct disorder, and bipolar disorder.
Substance induced/medication induced neurocognitive disorder
Brain damage caused by prolonged use of drugs, often in combination with a poor diet - 50 to 70% of chronic heavy alcohol use or show cognitive impairment
Assign a label to each of the following cases: Trans developmental disorder is characterized by uncontrollable yelps, sniffs, and grunting noises. A) ADHD B) social (pragmatic) communication C) Tourette's disorder D) Specific learning disorder
C
Determine how well you are able to diagnose the disorder in each of the following situations by labeling them: Five year old Alicia has increasingly severe intellectual disability and is beginning to have trouble walking on her own. One of the characteristics of her disorder is constant and wringing. A) ASD requiring very substantial support B) ASD requiring support C) Rett Disorder D) Social (pragmatic) communication disorder
C
Identify the following symptoms of dementia from the description: Timmy's elderly grandmother can no longer form complete, coherent sentences. A) facial agnosia B) agnosia C) aphasia
C
Match the term with the following descriptions of delirium: Managed care and patient ___________ have been successful in preventing delirium in older adults. A) Memory B) Cause C) Counseling D) Confused E) Elderly F) Trauma
C
Psychological and social influences are important to consider when studying neurocognitive disorders because they: A) Can accelerate the type of brain damage seen in this disease B) Provide a rationale for psychopharmacological intervention C) May help determine the time of onset and course of dementia D) Can be used to reverse the progression of Alzheimer's disease
C
Research has shown that ADHD in children is associated with: A) Chronic neglect B) Having an alcoholic father C) Maternal smoking during pregnancy D) Death of a parent in early childhood
C
Causes and treatment for Tourette's disorder
Causes: - Likely multiple vulnerability jeans that influence the form and severity of tics Treatment: - Psychological: self monitoring, relaxation training, habit reversal
Causes and treatment of social (pragmatic) communication disorder
Causes: - Limited info Treatment: - Individualized social skills training (i.e. modeling, role-playing) with emphasis on teaching important rules necessary for carrying on conversations with others (i.e. what is too much and too little info)
Causes and treatment of Alzheimer's disease
Causes: - Progressive brain damage, evident in neurofibrillary tangles and neurotic plaque, confirmed by autopsy but assessed by simplified mental status exam - Involves multiple genes Treatment: - No cure so far but hope lies in genetic research and amyloid protein - Management may include lists, maps, and notes to help maintain orientation - New medications that prevent acetylcholine breakdown and vitamin therapy delay but do not stop progression of decline
Causes and treatment for childhood speech fluency disorder
Causes: - Rather than anxiety causing this, this problem makes people socially anxious - Multiple brain pathways appear to be involved and genetic influences may be a factor Treatment: - Parents are counseled about how to talk to their children - Regulated breathing method: (behavioral treatment - to take a deep breath and exhale before proceeding when stuttering episode occurs) - Altered auditory feedback: electronically changing speech feedback to people who stutter
Causes and treatment for language disorder
Causes: - Theory: children's parents may not speak to them enough - Biological theory: middle ear infection is a contributory cause Treatment: - May be self correcting
Creutzfeldt-Jakob disease
Chronic, progressive, fatal disease of the central nervous system caused by a prion. Extremely rare condition that causes dementia
Neurocognitive disorder due to Alzheimer's disease
Condition resulting from a disease that develops most often in people 50 and older, characterized by multiple cognitive defects that develop gradually and steadily. - People with this also display one or more other cognitive disturbances, including aphasia (difficulty with language), apraxia (impaired motor functioning), agnosia (failure to recognize objects), or difficulty with activities such as planning, organizing, sequencing, or abstracting information. - Cognitive deterioration with Alzheimer's disease is slow during the early and later stages but more rapid during the middle stages. the average survival time is estimated to be about 4 to 8 years - Most prevalent among women (maybe due to the hormone estrogen loss as they get older) - Early research seem to suggest that certain population (such as those with Japanese, Nigerian, certain Native American, and Amish background were less likely to be affected)
Frontaltemporal neurocognitive disorder
Condition that damages the frontal or temporal regions of the brain; behavior or language is negatively affected
Prevention of Neurocognitive Disorders
Control blood pressure Don't smoke Lead an active physical and social life
Psychological and social causes of intellectual disability
Cultural influences that may contribute to ID include abuse, neglect, and social deprivation Cultural familial intellectual disability - mild form of intellectual disability that may be caused largely by environment. People with the above characteristics are thought to have cognitive impairments that results from a combination of psychosocial and biological influences.
Assign a label to each of the following cases: Kelly was a good student until the sixth grade. Now, as a high school senior concerned about graduation, Kelly has sought help. She places above average IQ test but shows significant problems with reading and comprehension. A) ADHD B) social (pragmatic) communication C) Tourette's disorder D) Specific learning disorder
D
Determine how well you are able to diagnose the disorder in each of the following situations by labeling them: Six-year-old Megan experiences many problems in communicating and does not seem to understand the "rules" when speaking to other children. A) ASD requiring very substantial support B) ASD requiring support C) Rett Disorder D) Social (pragmatic) communication disorder
D
Joe has mild intellectual disability. His therapist is teaching him a skill by breaking it down into its component parts. Joe's therapist is implementing what technique? A) Skills treatment B) Biofeedback C) Component processing D) Task analysis
D
Match the term with the following descriptions of delirium: People who suffer from delirium appear to be ________ or out of touch with their surroundings. A) Memory B) Cause C) Counseling D) Confused E) Elderly F) Trauma
D
_________ is characterized by acute confusion and disorientation; whereas ________ is marked by deterioration in a broad range of cognitive abilities. A) Delirium; amnesia B) Amnesia; delirium C) Major neurocognitive disorder; delirium D) Delerium; major neurocognitive disorder
D
Fragile X syndrome
Patterns of abnormality caused by a defect in the X chromosome resulting in intellectual disability, learning problems, and unusual physical characteristics
In the following situations, label each of the ID as mild, moderate, or severe, or profound. Also label the corresponding levels of necessary support: intermittent, limited, extensive, or a pervasive: Adam received an IQ score 45. He lives in a fully staffed group home and needs a great deal of help with many tests. He is beginning to receive training for a job in the community.
Moderate, limited
Alzheimer's disease
Disease of the cerebral cortex that causes an atypical form of senile dementia, discovered in 1906 by German psychiatrist Alios Alzheimer The leading cause of neurocognitive disorder, affecting approximately 4 million people in the US. No known cause or cure - Increasing memory impairment and other multiple behavioral and cognitive deficit's, affecting language, motor functioning, ability to recognize people or things, and or planning - Subject of most research
Parkinson's disease
Disorder characterized by progressive decline in motor movements, results from damage to dopamine pathways. Dementia may be a result as well. - Because dopamine is involved in complex movement, a reduction in this neurotransmitter makes affected individuals increasingly unable to control their muscle movements, which leads to tremors and muscle weakness - It is estimated that about 75% of people who survive more than 10 years with Parkinson's disease develop neurocognitive disorder
Childhood onset speech fluency disorder (stuttering)
Disturbance in speech fluency and time patterning of speech (for example, sound and syllable repetitions or prolongations) that includes a number of problems with speech, such as repeating syllables or words, prolonging certain sounds, making obvious pauses, or substituting words to replace ones that are difficult to articulate - 2x more among boys
Match the term with the following descriptions of delirium: The _________ population is at the greatest risk of experiencing delirium resulting from improper use of medication. A) Memory B) Cause C) Counseling D) Confused E) Elderly F) Trauma
E
Prevention of Neurodevelopmental Disorders
Early intervention appears to hold promise for some children - It combines educational, medical, and social supports for these children and their families - One project identified a group of children shortly after birth and provided them with an intensive preschool program, along with medical and nutritional support (Not all children benefit from this however) Given recent advances in genetic screening and technology, it may someday be possible to detect and correct genetic and chromosomal abnormalities
Match the term with the following descriptions of delirium: Various types of brain _________, such as head injury or infection, have been linked to delirium. A) Memory B) Cause C) Counseling D) Confused E) Elderly F) Trauma
F
Biological causes of intellectual disability
Genetic influences: multiple genetic influences appear to contribute to ID, including chromosome all disorders and multiple Jean mutations. Only a few dominant genes result in ID and as many as 30% of cases have no identify etiology. - Phenylketonuria (PKU) - Lesch-Nyhan Syndrome Chromosome influences: - Down Syndrome - Chorionic Villus Sampling (CVS) - Fragile X Syndrome
Causes of ADHD
Genetics: - Considered to be highly influenced by genetics (multiple genes are responsible for ADHD) - Copy number variants - Genes that are deleted as a result of mutations; these delusions may play a role in the development of ADHD and other disorders Environmental causes: - Mother smoking during pregnancy - Maternal stress and alcohol use - Parental marital instability and discord - Low birth weight - A variety of tocsin such as allergens in food additives - The overall volume of the brain and those with ADHD is slightly smaller than and children without it Psychological and social dimensions: - Negative responses by parents, teachers, and peers to the affected child's impulsivity and hyperactivity may contribute to feelings of low self-esteem, especially in children who are also depressed. *And integration of the biological and psychological influences on ADHD suggest that both need to be addressed when designing effective treatment
language disorder
Getting one's meaning or message across to others (expressive language disorder), or understanding the message coming from others (receptive language disorder) Limited speech in ALL situations: - Expressive language (what is said) is significantly below receptive language (what is understood - this is usually average) - 5x more in boys
Biological treatment of ADHD
Goal: To reduce impulsivity and hyperactivity and to improve attention skills (trial and error). - Stimulant medications (Ritalin, Adderall) - Other non-stimulant drugs (atomixetine- Strattera) also appear effective for some children with ADHD - Some anti-depressants (imipramine) and a drug use for treating high blood pressure (clonidine) may have similar effects (but stops have been one medication is discontinued) - Unfortunately, some portions of children do not respond to medications. Furthermore, medication causes improvement and attention, but not in academics and social skills.
aphasia
Impairment or loss of language skills resulting from brain damage caused by stroke, Alzheimer's disease, or other illness or trauma.
Clinical description of neurocognitive disorders
In the initial stages, memory impairment is typically seen as an inability to register ongoing events. People may remember events for many years ago but will have trouble remembering what happened in the past hour. - Agnosia - Facial agnosia - Emotional changes often occur as well. Common side effects are delusions (irrational beliefs), depression, agitation, aggression, and apathy - It is not known how much behavioral changes caused by progressive brain deterioration directly and how much is a result of the frustration and discouragement that inevitably accompany the loss of function and the isolation of "losing" loved ones - Ultimately death occurs as a result of inactivity, combined with the onset of other illnesses, such as pneumonia - Major neurocognitive disorder can develop at almost any age, although the disorder is more frequent in adults
Tourette's disorder
In voluntary motor movements takes such as head twitching and vocalizations (ie- grunts) that often occur in rapid succession, come on suddenly, and happen in idiosyncratic or stereotyped ways Vocal tics often include the involuntary repetition of obscenities - Hi comorbidity between tics and ADHD, as well as OCD
Trumatic brain injury
Include symptoms that persist for at least a week following the trauma, including executive dysfunction and problem with learning and memory.
Treatment for ASD
Integrative treatments (No completely effective treatment exists) - Early intervention for very young children holds the most hope for significant changes in the core symptoms - For children, most therapy consists of school education with special psychological supports for problems with communication and socialization. (Inclusive schooling) - Behavioral approaches have been most clearly documented as benefiting children in this area. * Communication * Socialization * Living skills - Pharmacological treatments can help some of them temporarily
Causes of delirium
It is believed that delirium is responsible for many of the falls that caused debilitating hip fractures in the elderly Because possible combinations of illnesses and medications are so numerous, determining the cause is extremely difficult. However, factors other than medical conditions can trigger delirium: - Age (more susceptible to developing delirium as a result of mild infections or medication changes) - Sleep deprivation - Immobility - Excessive stress - General medical conditions - Substances
Treatment for specific learning disorder
Learning disorders primarily require educational intervention: 1. Specific skill instruction, including instruction on vocabulary, finding the main idea, and finding facts and reading. 2. Strategy instruction, which includes efforts to improve cognitive skills through decision-making and critical thinking. 3. Basic processing 4. Cognitive and behavioral skills Direct instruction: appears to significantly improve academic skills and children with specific learning disorder.
HIV
Less common type of neurocognitive disorder that affects people who have HIV; may lead to impaired thinking in advanced stages - This impairment seems to be independent of the other infections that accompany HIV - Early symptoms of neurocognitive disorder resulting from HIV our cognitive slowness, impaired attention, and forgetfulness, clumsy, tremors, leg weakness, apathetic and socially withdrawn
The DSM-5 introduced three levels of severity for ASD
Level 1: requiring support Level 2: requiring substantial support Level 3: requiring very substantial support
Causes of Intellectual Disability
Literally hundreds of known causes: - Environmental (i.e. deprivation, abuse, and neglect) - Prenatal (exposure to disease or drugs while in utero or the mothers poor nutrition) - Perinatal (i.e. difficulties during labor and delivery - lack of oxygen during birth) - Postnatal (i.e. infections, head injury, malnutrition) Nearly 75% of cases cannot be attributed to any known cause
Biological treatments for ASD
Medical intervention has had a little positive impact on the core symptoms of social and language difficulties
In the following situations, label each of the ID as mild, moderate, or severe, or profound. Also label the corresponding levels of necessary support: intermittent, limited, extensive, or a pervasive: Logan received an IQ score of 65. He lives at home, goes to school, and is preparing to work when he is through with school.
Mild, intermittent
Identify the neurocognitive disorder described: A decline in cognitive functioning that is gradual and continuous and has been associated with neurofibrillary tangles and amyloid plaque.
Neurocognitive disorder due to Alzheimer's disease
Major and Mild Neurocognitive Disorder
Neurocognitive disorders have a gradual progression as opposed to deliriums acute onset; people with neurocognitive disorder or not disoriented or confused in the early stages, unlike people with delirium.
specific learning disorder
Neurodevelopmental disorder characterized by academic performance that is substantially below what would be expected given the person's age, intelligence quotient (IQ) score, and education. These problems can be seen as difficulties with: - Reading - Math - Written expression ( All are defined by performance that falls far short of expectations based on intelligence and school prep) - Diagnosed by the difference between IQ score and achievement score (if there is a significant difference)
Huntington's disease
Neurological disorder that follows a subcortical pattern and is notable for causing in voluntary limb movements (and progressing to dementia) - This person can live for 20 years after the first signs of the disease appear. Approximately 50% of children will develop the disease when a parent has it.
Social (Pragmatic) Communication Disorder
New to DSM-5 includes the difficulties in social communication seen in ASD, but without restricted, repetitive patterns of behavior - These individuals do not easily learn the social rules when communicating with others. Certain individuals previously diagnosed with pervasive developmental disorder - not otherwise specified (Wide ranging, significant, and long lasting dysfunctions that appear before the age of 18) may fall into this category. - Verbosity - Prosody - Excessive switching of topics - Dominating conversations
Treatment for intellectual disability
No biological intervention Behavioral focus similar to that for autism Prevention - Genetic counseling - Biological screening - Maternal care
Intellectual disability (intellectual development disorder) DSM-5
Onset during the developmental. That includes both and I'll actual and adaptive functioning deficits in conceptual, social, and practical domains. The following three must be met: A. Deficits in intellectual functions, such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualize standardized intelligence testing B. Deficits in adaptive functioning that result in failure to meet developmental and socio-cultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments such as home, school, work and community C. Onset of intellectual and adaptive deficits during the developmental period
Clinical description of intellectual disability (intellectual development disorder ID)
People with ID display a broad range of abilities and personalities. Language and communication skills are often the most obvious. In contrast, people with more severe forms of ID may never learn to use speech as a form of communication. - To be diagnosed with ID, a person must have significantly sub average intellectual functioning, a determination made with one of several IQ tests with a cut off score set by DSM-5 of approximately 70 (but not sufficient for diagnosis) The second criterion calls for concurrent deficits or impairments in adaptive functioning. A person must also have significant difficulty in areas such as communication, self-care, home living, social and interpersonal skills, use of community resources, self direction, functional academic skills, work, leisure, health, and safety The final criterion is the age of onset (must be evident before the person is 18). The age criterion rules out the diagnosis for ID for adults who suffer from brain trauma or forms of dementia that impair their abilities (ID is defined by society)
Childhood Disintegrative Disorder
Pervasive developmental disorder involving severe regression in language, adaptive behavior, and motor skills after a 2- to 4-year period of normal development. - This has now been combined in DSM-5 under autism spectrum disorder (Was under the umbrella term pervasive developmental disorder in DSM-IV
Amniocentesis
Prenatal medical procedure that allows the detection of abnormalities (i.e. Down syndrome) in the developing fetus. It involves removal and analysis of amniotic fluid from the mother.
Psychosocial treatments for ASD
Problems with communication and language are among the defining characteristics of ASD: - Naturalistic teaching strategies: instructional techniques that are used with children having Neurodevelopment disorders and that move away from traditional desk instruction toward more natural social interactions. - Intensive behavioral treatment for communication and social skills problems for 40 hours or more per week. Focusing on the skills in the early years is important for helping the child develop more sophisticated social repertoires. - A number of different programs exist to help school-age children improve skills such as appropriate social interaction, problem-solving, self-control, recognizing emotions and others, expanding their often narrow range of interest, and improving their understanding of non-literal idioms.
In the following situations, label each of the ID as mild, moderate, or severe, or profound. Also label the corresponding levels of necessary support: intermittent, limited, extensive, or a pervasive: Kevin received an IQ score of 20. He needs help with all his basic needs, including dressing, bathing, and eating.
Profound, pervasive
Prion diseases
Rare progressive Nuro degenerative disorder caused by prions, proteins that can reproduce themselves and cause damage to brain cells - Unlike other infectious agents such as bacteria or viruses, prions are thought by some to have no DNA or RNA that can be destroyed by chemicals or radiation. As a result, there is no known treatment in the course of the disorder is always fatal. Not contagious in humans.
Phenylketonuria PKU
Recessive gene disorder involving the inability to break down a food chemical who's build up causes intellectual disability, seizures, and behavioral problems. PKU can be detected by infant screening and prevented by a specialized diet
Lewy body disease
Second most common after Alzheimer's Neurological impairment that affects people with Lewy body disease, in which protein deposits damaged brain cells and gradually cause motor impairments and loss of alertness. - The signs of this disorder come on gradually and include impairments and alertness and attention, vivid hallucinations, and motor impairment as seen in Parkinson's
In the following situations, label each of the ID as mild, moderate, or severe, or profound. Also label the corresponding levels of necessary support: intermittent, limited, extensive, or a pervasive: Jessica received an IQ score of 30. She lives in a fully staffed group home where she is trained in basic adaptive skills and communication. She is improving over time and can communicate by pointing or using her eye-gaze board.
Severe, extensive
Identify the neurocognitive disorder described: Julian is a recovering alcoholic. When asked about his wild aventures as a young man, his stories usually end quickly because he can't remember the whole tale. He even has to write down things he hast to do in a notebook; otherwise he's likely to forget:
Substance induced neurocognitive disorder
Clinical description of specific learning disorder
The criteria require that the person perform academically at a level significantly below that of a typical person of the same age. A diagnosis requires that the persons disability not be caused by sensory difficulty, such as trouble with sight or hearing, and should not be the result of poor or absent instruction Clinicians can use the specifiers for disorders of the following to highlight specific problems for remediation and can rate the disorder on level of severity: - Reading - Written expression - Mathematics Response to intervention: is now being used by many clinicians. It involves identifying a child as having a specific learning disorder when the response to a known effective intervention (i.e. an early reading program) is significantly inferior to the performance by peers.
Biological causes of neurocognitive disorders
The most common cause of neurocognitive disorder, Alzheimer's disease, it's also the most mysterious. Multiple genes seem to be involved in the development of it. - Some genes are now identified as deterministic (meaning that if you have one of these jeans you have 100% chance of developing Alzheimer's disease) - Some jeans are susceptibility genes (these genes only slightly increase the risk of developing Alzheimer's disease. These are more common than deterministic genes in the general population). Stressors: - Head trauma - Diabetes - High blood pressure - Herpes
Treatment for delirium
The recommended first line of treatment is psychosocial intervention. The goal of non-medical treatment is to reassure the individual to help him deal with the agitation, anxiety, and hallucinations of delirium. - This can help the person manage during the disruptive. Until the medical causes or identified and addressed - Reassurance - Presence of personal objects - Involvement in treatment decisions
Developmental psychopathology
The study of how disorders arise and change with time. - These changes usually follow a pattern with a child mastering one skill before acquiring the next - This aspect of development is important because it implies that any disruption in the acquisition of early skills will, by the way of nature of the developmental process, also disrupt the development of later skills - Our IQ is stable through life (you can learn new skills but ikioo doesn't change)
Echolalia
The uncontrollable and immediate repetition of words spoken by another person
Causes of Specific Learning Disorder
Theories about the causes of specific learning disorder includes genetic, neurobiological, and environmental factors: - It is clear that learning disorders run in families (They are not different genes responsible for reading disorders and Mathison orders. Instead, there are genes that effect learning, and they may contribute to problems across domains.) - Various forms of subtle brain impairments have also been thought responsible for learning disabilities Psychological and motivational factors that have been reinforced by others seem to play an important role in the eventual outcome of people with learning disorders. - Factors such as Socioeconomic status, cultural expectations, parental interactions and expectations, and child management practices, together with existing neurobiological deficits and the types of support provided in the school, seem to determine outcome
Clinical description of autism spectrum disorder (ASD)
Two major characteristics of ASD: 1. Impairment in social communication and social interactions - Impairments are present in early childhood and limit daily functioning. It is the degree of impairment that presumably distinguishes individuals previously diagnosed with the separate disorders of autistic disorders (Asperger's Disorder and pervasive development disorder) - One of the defining characteristics of people with AST is that they fail to develop age appropriate social relationships. - Difficulties with social communication and interaction or further defined by the inclusion of three aspects (all three must be present) * Problems with social reciprocity (a failure to engage in back-and-forth social interactions) - Can involve the inability to engage in joint attention * Nonverbal communication (Deficits and nonverbal communication also lack appropriate prosody) * Initiating and maintaining social relationships 2. The more striking characteristics of ASD include restrictive repetitive patterns of behavior, interests, or activities (Maintenance of sameness) - This tendency to be much more interested in esoteric facts then and people further helps to interfere with social relationships. People with ASD all experience trouble progressing in language, socialization, and cognition. This is not a relatively minor problem (like specific learning disorder) but is a condition that significantly affects how individuals live and interact with others ASD is a childhood disorder characterized by significant impairment in social and communication skills and restricted, repetitive patterns of behavior, interests or activities
Down syndrome
Type of intellectual disability caused by a chromosomal aberration (chromosome 21) and involving characteristic physical appearance (also known as trisomy 21.) - These people also tend to have congenital heart malformations. Adults with down syndrome have a greatly increased risk of dementia of Alzheimer's type as well. - This is been tied to maternal age
Identify the neurocognitive disorder described: Mr. Brown has suffered from a number of strokes but can still care for himself. His ability to remember important things, however, has been declining steadily for the past few years.
Vascular neurocognitive disorder
Overview of Neurocognitive Disorders
Where as intellectual disability and specific learning disorders are believed to be present from birth, most neurocognitive disorders develop much later in life. Two classes: - Delirium - Mild or major neurocognitive disorder (When the brain is damaged, the effects are irreversible, accumulating until learning, memory, or consciousness are obviously impaired)
task analysis
Where those with ID can acquire skills through the many behavioral innovations to teach people how to function in daily life
Treatment of neurocognitive disorders
With extensive brain damage, no known treatment can restore lost abilities. The goals of treatment therefore become: 1. Trying to prevent certain conditions, such as substance abuse or strokes, that may bring on neurocognitive disorder 2. Trying to delay the onset of symptoms to provide better quality of life 3. Attempting to help these individuals and their caregivers cope with the advancing deterioration Biological treatments: - Neurocognitive disorder resulting from known infectious disease, nutritional deficiencies, and depression can be treated if caught early. Unfortunately, however, no known treatment exist for the type of neurocognitive disorder that accounts for the vast majority of cases. Psychosocial treatments: - People with neurocognitive disorder can be taught skills to compensate for their lost abilities.
Lesch-Nyhan Syndrome
X linked genes disorder characterized by intellectual disability, signs of cerebral palsy, and self injurious behavior
joint attention
attention shared by two persons toward an object after one person has indicated interest in the object to the other person; this social interaction is limited or absent in people with autism spectrum disorder
attention-deficit/hyperactivity disorder (ADHD)
developmental disorder featuring maladaptive levels of inattention, excessive activity, and impulsiveness. - One of the most common reasons children are referred for mental health services in the United States. - The primary characteristic includes a pattern of inattention, such as being disorganized or forgetful about school or work related tasks, or of hyperactivity and impulsivity. - Symptoms may change with maturity, but problems persist - More prevalent in boys
major neurocognitive disorder (dementia)
gradual deterioration of brain functioning that affects memory, judgment, language, and other advanced cognitive processes - Caused by medical condition or drug abuse - Some forms are irreversible; some are resolved by treatment of primary condition A progressive and degenerative condition marked by gradual deterioration of a range of cognitive abilities including memory, language, and planning, organizing, sequencing and abstracting information
Clinical description of ADHD
inattentive, hyperactive, impulsive In addition to this serious disruption and attention, some people with ADHD display motor hyperactivity. For ADHD, DSM-5 differentiates two categories of symptoms (either in attention or hyper activity and impulsivity set of symptoms must be present for someone to be diagnosed with ADHD. If they have all of them, it is a combined subtype): - Problems of inattention: (inattentive subtype ADD - although ADD is not an official diagnostic label) - Hyperactivity and impulsivity (hyperactive/impulsive subtype) Some research shows that having a specific genotype and psychosocial distress can predict ADHD in children.
mild neurocognitive disorder
modest impairment in cognitive abilities that can be overcome with accommodations such as extensive lists or elaborate schedules A condition in which there are early signs of cognitive decline such that it begins to interfere with activities of daily living
maintenance of sameness
necessity among people with autism that their familiar environment remain unchanged. they become upset when new things are introduced.
Autism Spectrum Disorder (ASD)
neurodevelopmental disorder characterized by significant impairment in social interactions and communication and restricted patterns of behavior, interest, and activity. DSM5 combined most of the disorders previously included under the umbrella term "pervasive development disorder's" E autistic disorder, Asperger's disorder, and childhood disintegrative disorder. - Rett Disorder - Social (pragmatic) communication disorder
neurodevelopmental disorders
neurologically based disorders that are revealed in a clinically significant way during a child's developing years and are of concern to families and educators. - Childhood is considered particularly important, because the brain changes significantly for several years after birth; this is also one critical developments occur and social, emotional, cognitive, and other important competency areas. - Interrupting or preventing the development of one skill and pedes mastery of the skill that is normally acquired next - Understanding this type of early developmental relationship is important for several reasons: knowing what processes are disputed will help us understand the disorder better and may lead to more appropriate intervention strategies. -Knowing what skills are disrupted by a particular disorder is essential to developing appropriate intervention strategies * Identifying a disorder such as autism spectrum disorder ASD at an early age is important for these children so that their social deficits can be addressed before they affect other skill domains, such as social communication
Augmentative communication strategies
pictures or computer aids to assist people with communication deficits so that they can communicate
vascular neurocognitive disorder
progressive brain disorder involving loss of cognitive functioning, caused by blockage of blood flow to the brain, that appears concurrently with other neurological signs and symptoms - This is one of the most common causes of neurocognitive disorder - Because multiple sites in the brain can be damaged, the profile of degeneration - the particular skills that are impaired - differs from person to person - In contrast, those with Alzheimer's disease have memory problems as they are initial cognitive disturbance - The risk for men is slightly higher Symptoms include declines in speed of information processing and executive functioning and may also include problems with walking and weakness of limbs Treatment focus is on coping
Rett Disorder
progressive neurodevelopmental disorder featuring constant hand-wringing, intellectual disability, and impaired motor skills. - This is a genetic condition that affects mostly females and is diagnosed as ASD with the qualifier "associated with Rhett syndrome" or associated with MeCP2 mutation.
psychopharmacogenetics
study of how genetic makeup influences your response to certain drugs - This will hopefully take the guesswork out in the future as far as how medications work on people
facial agnosia
type of agnosia characterized by a person's inability to recognize even familiar faces
Prosody
vocal characteristics such as tone and stress; people with autism spectrum disorder often have trouble recognizing and interpreting these vocal cues
