MEDI7301 Study Guide - Final Guide: Attention Deficit Hyperactivity Disorder Predominantly Inattentive, Pharyngitis, Somnolence
Neurodevelopmental Disorders
Introduction
Overview Neurodevelopmental disorders are a group of conditions with onset in the
developmental period that manifest as developmental deficits impairing personal, social,
academic or occupational functioning
Developmental deficits range from very specific limitation of learning or control of
executive functions -----> global impairments of social skills or intelligence
Difficulties may persist into adulthood
Classification Intellectual disabilities
Communication disorders
Autism spectrum disorder
ADHD
Specific learning disorder
Motor disorder (includes tic disorders)
Autism spectrum disorder
Epidemiology Onset in preschool years, most commonly between 12-24mths
First sx frequently involve delayed language development +/- lack of social
interest or unusual social interactions, odd play patterns (eg carry around toys but never
play with them) and unusual communication patterns (eg know alphabet but not name)
3 severity levels of ASD (level 1 mild, level 2 moderate, level 3 severe)
Most children improve throughout adolescence
Commonly comorbid diagnosis of intellectual disability + autism spectrum
disorder
Autism spectrum disorder that is associated with a known medical or genetic
condition, environmental factor or another neurodevelopmental/ mental/ behavioural disorder
= record autism spectrum disorder associated with "name of condition/ disorder/factor"
Example - ASD associated with Rett syndrome
DSM-5 criteria Persistent deficits
in social
communication/
interaction across
multiple context
Failure of social-emotional reciprocity
Mild
oAbnormal social approach
oFailure of normal back-and-forth conversation
(child dominates with singular theme/ interest)
Severe
oReduced sharing of interests, emotions and
affect
oFailure to initiate or respond to social
interactions
Failure of nonverbal communication
Mild
oPoorly integrated verbal and nonverbal
communication
Moderate
oNo eye contact nor appropriate body
language
oDeficits in understanding and use of gestures
Severe
oTotal lack of facial expressions
oNonverbal communication
Poor skills in developing, maintaining and understanding of
relationships
Mild
oDifficulties adjusting behaviour to suit various
social contexts
Moderate
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oDifficulties in sharing imaginative play or
making friends
Severe
oAbsence of interest in peers
Example - question peoples relationships on TV
Restrictive
repetitive
behaviour (2 of
the following sx)
Stereotyped or repetitive motor movements, use of objects or
speech
Lining up toys or flipping objects, echolalia etc
Insistence on sameness, inflexible adherence to routines or
ritualized patterns of verbal or nonverbal behaviour
Extreme stress over small changes, difficulties with
transitions, rigid thinking patterns, need to take same route or eat
same food every day
Highly restricted, fixated interests that are abnormal in
intensity or focus
Strong attachment/ preoccupation to unusual objects
Excessively circumscribed or perseverative interests
Hyper- or hypo-reactivity to sensory input or unusual interest
in sensory aspects of the environment
Indifference to pain/ temp
Adverse response to specific sounds or textures
Excessive smelling or touching of objects
Visual fascination with lights or movement
Other criteria Symptoms are present in early developmental period (it may
not fully manifest until later or be masked by learned strategies in later
life)
Symptoms cause clinically significant impairment in social,
occupation or other important areas of current functioning
Disturbances aren't better explained by intellectual disability
or global developmental delay
Diagnosis is most valid and reliable when based on multiple
sources of information (clinician observation, caregiver history and
possibly self report)
Clinical workup Do they interact with others or by their self?
Do they seem to be 'in his own world' unaware of others?
Do they have difficulty making eye contact?
Are they unresponsive to their name being called, or commands?
Are they aware of personal space/ boundaries (with strangers, family, friends)?
Do they have any obsessive interests (eg trains, string etc)?
Do they get upset with change (eg particular with toy setup, certain driving route)?
Do they have any particular rituals or patterns to follow (eg food on the plate)?
Do they walk on their toes, flap their hands, clench fists etc?
Do they excessively crave movement (eg swinging, running)?
Management Non-
pharmacological
Special education and programs to modify behaviour
Family education
Applied behavioural analysis (ABA) - intensive behavioural
modification program, 20-40hr per week
Child and youth mental health clients - level 1 ASD suitable,
treat comorbidities & manage suicidal thought
Pharmacological No medication cure for ASH
Psychotropic drugs
Reduce severity of sx (hyperactivity, aggressiveness,
distractibility, temper tantrums, stereotypies)
Periodic review every 3-6mth to assess efficacy and
assess continuation; long-term use requires supervision of specialist
Must take in conjunction with appropriate non-
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