Neurodevelopment + Attention Disorders

Question 1

Females with ADHD present more commonly with which subtype; why is this a problem?

Answer 1

• Inattentive subtype
• Less disruptive behavior in females may contribute to referral bias causing under identification and lack of tx

Question 2

What is the tourette’s syndrome triad?

Answer 2

• Tics
• ADHD
• Obsesseive compuslive sx’s (OCS)

Question 3

Which other disorder needs to be considered in both the initial assessment and ongoing management of children with ADHD?

Answer 3

Chronic Tic Disorder

Question 4

ADHD is an information processing dysfunction where in the brain; primarily due to deficinecy of which 2 NT’s?

Answer 4

• Within prefrontal cortex
• Deficiency of dopamine and norepinephrine

Question 5

According to the DSM-5 how many sx’s should a child vs. patient >17 y/o have for making dx of ADHD?

Answer 5

• Children: should have 6 or more
• Adults: should have at least 5 sx’s

Question 6

According to the DSM-5 what are 9 sx’s of the inattentive type of ADHD?

Answer 6

• Fails to give close attention to details or make careless mistakes
• Difficulty sustaining attention
• Does not appear to listen
• Struggles to follow through on instructions
• Difficult with organization + loses things + easily distracted
• Avoids or dislikes tasks requiring a lot of thinking
• Is forgetful in daily activities

Question 7

According to the DSM-5 what are the sx’s that fit the hyperactive type of of ADHD?

Answer 7

Question 8

What are the clinical practice guidelines for treating preschool-aged children (4-5 years of age) with ADHD?

Answer 8

• Prescribe evidence-based parent- and/or teacher-administered behavior therapy as the 1st line tx
• Prescribe methylphenidate if the behavior therapy does not provide significant improvement and the child continues to have moderate to severe sx’s

Question 9

What are the clinical practice guidelines for treating elementary school-aged children (6-11 years of age) with ADHD?

Answer 9

• Prescribe FDA approved meds for ADHD and/or evidence-based parent and/or teacher-administered behavior therapy as tx for ADHD
• Preferably both medication and behavior therapy should be used together
• Evidnce is particularly strong for stimulant medications

Question 10

What is a potential AE associated with Bupropion?

Answer 10

↑ risk of seizure

Question 11

Which stimulant used for ADHD is a re-uptake inhibitor of catecholamines AND also releases catecholamines?

Answer 11

Amphetamines

Question 12

Intellectual disability leads to…

Answer 12

intellectual deficiets and impairement of adaptive functioning

3 requirements:

1. Deficits in intellectual functions
2. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards
3. Onset during developmental period

Question 13

Speech vs. Language vs. Communication Disorders

Answer 13

1. Speech: difficulty with speech sound production
2. Language: difficulty with acquisition and use of language
3. Communication: disturbances in normal fluency and time patterning of speech (difficulty with sequencing)

onset for all occurs early developmental period

Question 14

How does autism manifest?

Answer 14

1. Deficits in social-emotional reciprocity
2. Deficits in nonverbal communicative behaviors used for social interaction
3. Deficits in developing, maintaining, and understanding relationships
4. Restrictive, repetitive patterns of behavior (at least two):
   
   1. Stereotyped or repetitive motor movements, use of objects, or speech
   2. Insistence on sameness, inflexible routines
   3. Highly fixated interests
   4. Hyper or hypo reactivity to sensory input

Question 15

What is the most important behavioral intervention for cases of autism?

Answer 15

education and support for family members + teachers

teach about parallel processing

Question 16

What medications are approved for ASD?

Answer 16

risperidone and aripiprazole for the irritability and agitation

Question 17

What is Tourette’s Triad

Answer 17

OCS

ADHD

Tics

Question 18

Dx criteria for chronic tic disorder

Answer 18

motor OR vocal tics

wax and wane in frequency, but persist more than one year

onset before age 18

*higher in kids with ADHD

Question 19

The tx for ADHD with stimulants can have what effect on associated tics?

Answer 19

increased

Question 20

The executive functioning is dysfunctioning in ADHD due to…

Answer 20

located in prefrontal cortex

def of DA and NE

Question 21

What tests can be useful in ADHD dx?

Answer 21

1. Test of Variables of Attention (TOVA)
2. Conners Continuous Performance Test (8 y/o+)

Question 22

What are some alternative medications (other than stimulants) for ADHD?

Answer 22

1. Guanfacine, Clonidine: alpha 2 agonists; modulate noradrenergic tone in PFC
2. Bupropion
3. Atomoxetine: inhibits presynaptic NE reuptake; used with caution in CV risk
4. Modafinil: adults only, inhibits DA reuptake

Question 23

What is developmental coordination disorder?

Answer 23

coordinated motor skills below expected

manifests as clumsiness, inaccuracy in motor performance…

significant enough to interfere with academics, daily life…

Question 24

What condition is marked by repetitive, seemingly driven, and apparently purposeless motor behavior?

Answer 24

stereotypic movement disorder

Question 25

Criteria for Tourette's Disorder

Answer 25

multiple motor **_AND_** verbal tics present (though do not have to be at the same time) for _over one year_ onset prior to age 18 comorbidities: **ADHD**, **OCD**, anxiety, mood disorders, risk of **suicide**, disruptive behaviors, **learning disabilities**, sleep disorders