Neurodevelopmental, conduct, and impulse control disorders ppt

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Questions and Answers

What is the main reason why non-stimulant medications like atomoxetine and clonidine are prescribed in ADHD treatment?

They provide a quicker onset of effects than stimulants

They are more effective than stimulant medications

They are completely free from side effects

They are preferred when stimulant side effects or abuse concerns arise (correct)

Among the following, which condition is NOT typically associated with risk factors for autism spectrum disorder?

Complications at birth

Being born to older parents

Having a family history of asthma (correct)

Having a sibling with ASD

What is a distinguishing characteristic of Asperger's syndrome compared to other types of autism spectrum disorder?

It is associated with severe cognitive impairment

Symptoms can only be diagnosed after age 5

It does not include repetitive behaviors

Individuals typically have high intelligence and functional communication skills (correct)

Which treatment modality is considered beneficial as an adjunct to medication for ADHD in adolescents and adults?

Cognitive-Behavioral Therapy (CBT) Signup and view all the answers

Which of the following is true about the diagnosis of autism spectrum disorder?

Diagnosis is typically based on behavioral assessments Signup and view all the answers

What advantage do 2nd generation long-acting stimulants provide in ADHD treatment?

They allow for once-a-day dosing with continuous release Signup and view all the answers

Which external treatment device has been FDA approved to assist in the treatment of ADHD?

External Trigeminal Nerve Stimulation system (eTNS) Signup and view all the answers

What is a common presentation among individuals with autism spectrum disorder at diagnosis?

Problems with social communication and interaction Signup and view all the answers

Which statement best describes the side effects of stimulant medications used for ADHD?

They can lead to insomnia, appetite suppression, and weight loss Signup and view all the answers

Which of the following is NOT a common symptom of Attention-Deficit Hyperactivity Disorder (ADHD)?

Overly enthusiastic participation in group activities Signup and view all the answers

What is the average age of diagnosis for ADHD?

7 years old Signup and view all the answers

Which of the following potential risk factors is least associated with the development of ADHD?

Excessive video game play Signup and view all the answers

Which disorder is most likely to co-occur with ADHD?

Oppositional Defiant Disorder Signup and view all the answers

Children diagnosed with ADHD must exhibit symptoms from which two broad categories?

Inattention and hyperactivity/impulsivity Signup and view all the answers

What percentage of children diagnosed with ADHD continue to exhibit symptoms into adulthood?

60 - 70% Signup and view all the answers

Which among the following is a common misconception about ADHD?

It solely arises from a lack of discipline in children. Signup and view all the answers

What is the typical first-line treatment for ADHD in pediatric cases?

Stimulant medications Signup and view all the answers

Which ADHD rating scale is specifically designed to assess the severity and improvement of symptoms in adults?

Adult ADHD Investigator Symptom Rating Scale Signup and view all the answers

Which of the following factors does NOT contribute to the etiology of Neurodevelopmental disorders?

Increased screen time Signup and view all the answers

What aspect of ADHD is often misattributed to laziness or poor motivation?

Difficulty adhering to multi-step directions Signup and view all the answers

What is the typical prevalence rate of ADHD among children according to CDC figures?

9 - 10% Signup and view all the answers

Which age range typically shows the first appearance of ADHD symptoms?

3 - 6 years old Signup and view all the answers

Which of the following should be checked in a laboratory work-up for potential ADHD?

Lead levels Signup and view all the answers

Which of the following types of impulse-control disorder is characterized by an urge to steal?

Kleptomania Signup and view all the answers

What is the most common type of impulse-control disorder according to DSM-5 classifications?

Intermittent Explosive Disorder Signup and view all the answers

Which type of treatment is most prominently used for managing impulse-control disorders?

Cognitive Behavioral Therapy (CBT) Signup and view all the answers

Which medication type has shown effectiveness in managing aggression and irritability associated with impulse-control disorders?

Selective Serotonin Reuptake Inhibitors (SSRIs) Signup and view all the answers

What behavior might indicate the presence of an impulse-control disorder over a duration of 6-12 months?

Extreme defiance Signup and view all the answers

What characteristic defines the aggressive outbursts in intermittent explosive disorder?

They are impulsive and grossly out of proportion to any precipitating event. Signup and view all the answers

In the context of conduct disorder, which behavior would indicate a more severe degree of impairment?

Destruction of property and aggression towards animals. Signup and view all the answers

Which statement about the treatment options for intermittent explosive disorder is accurate?

Buspirone is effective for some individuals. Signup and view all the answers

What is a typical demographic characteristic of individuals diagnosed with conduct disorder?

More frequent conflict with school and judicial systems. Signup and view all the answers

What common emotion do patients with intermittent explosive disorder experience after aggressive outbursts?

Guilt and embarrassment. Signup and view all the answers

What distinguishes conduct disorder behaviors from those of oppositional defiant disorder?

Children with conduct disorder show aggression towards people or animals. Signup and view all the answers

Which of the following is NOT typically a clinical presentation of conduct disorder?

Showing empathy towards one's peers. Signup and view all the answers

What aspect of the course of intermittent explosive disorder is currently understood to be limited?

The patterns of disorder's onset and course. Signup and view all the answers

Which symptom is characteristic of conduct disorder as opposed to oppositional defiant disorder?

Excessive levels of fighting Signup and view all the answers

What is a key diagnostic criterion for oppositional defiant disorder?

Pervasive across multiple settings Signup and view all the answers

What underlying issue might require medication in managing oppositional defiant disorder?

Impulsivity or attention deficits Signup and view all the answers

Which behavior is considered a major violation of social expectations indicative of conduct disorder?

Frequent lying Signup and view all the answers

In evaluating conduct disorder, which factor is critical for establishing a comprehensive diagnosis?

Length of observation period Signup and view all the answers

What might increase the likelihood of significant improvement in a child diagnosed with conduct disorder?

Early intervention strategies Signup and view all the answers

Which characteristic behavior distinguishes oppositional defiant disorder from conduct disorder?

Chronic disobedience to parents Signup and view all the answers

Which behavior is primarily seen in children with oppositional defiant disorder?

Verbal aggression in response to rules Signup and view all the answers

What is a possible long-term consequence for children diagnosed with oppositional defiant disorder?

Development of conduct disorder in adolescence Signup and view all the answers

Which statement about the treatment of oppositional defiant disorder is accurate?

A combination of psychosocial and pharmacological approaches is typically used Signup and view all the answers

Study Notes

Neurodevelopmental Disorders

Affect brain function
Can range from mild to severe, potentially requiring lifelong care
Cause difficulties with social interaction, cognition, and emotional regulation
Most often present in early childhood, with some symptoms persisting into adulthood
Common examples: Schizophrenia, ADHD, Tourette Syndrome, Autism, Fragile X Syndrome, Speech and Language Disorders, Intellectual Disorders, Cerebral Palsy
Most frequent ND conditions: Autism Spectrum Disorder (ASD) and Attention-Deficit Hyperactivity Disorder (ADHD)
Potential causes include genetic predisposition, low birth weight, environmental toxins (like lead), prenatal exposure to substances, nutritional deficiencies, social deprivation, and premature birth
More prevalent in males than females
Individuals often have comorbidities, meaning they may also experience other NDs or psychiatric conditions

Attention-Deficit Hyperactivity Disorder (ADHD)

Typically apparent in early childhood
Characterized by challenges with attention, concentration, short-term memory, and impulsive behavior
Children exhibit hyperactivity, often described as being "driven by a motor"
Difficulty controlling activity levels, from fidgeting to difficulty remaining seated
Inappropriate behavior in public settings (e.g., running, jumping, yelling) is common
Disruptive in classroom settings, significantly impacting academic performance
Usually emerges during kindergarten or first grade
Affects approximately 9-10% of children according to the CDC
Disproportionately affects boys at a ratio of 3:1 to 9:1
The average age of diagnosis is 7 years old, with symptoms often appearing between 3-6 years old
Lower socioeconomic status is linked to higher rates
Up to 80% of adolescents diagnosed with ADHD in childhood continue to experience symptoms into adulthood, with an adult prevalence of 60-70%

ADHD Diagnostic Criteria

Divided into two symptom clusters: Inattention and Hyperactivity/Impulsivity
For a diagnosis, children must exhibit at least 6 symptoms from either or both clusters
Adolescents and adults must demonstrate 5 criteria, with some symptoms present before age 12

ADHD Inattention Criteria

Difficulty paying attention to detail
Trouble maintaining attention
Appearing not to listen when spoken to
Failing to follow instructions in completing tasks
Challenges with organization
Avoiding activities requiring sustained concentration
Losing important items
Easily distracted
Forgetfulness

ADHD Hyperactivity and Impulsivity Criteria

Fidgeting and inability to remain seated
Inappropriate running and climbing
Difficulty engaging in quiet play
Excessive talking
Blurting out answers before questions are completed
Difficulty taking turns
Intruding on others' activities and conversations

ADHD Presentations

Inability to sit still for extended periods (e.g., more than 5 minutes) at school and/or home
When seated, children may engage in leg swinging, rocking, or picking up nearby objects
By first grade, children may have injuries (e.g., scars on legs, arms, head) due to risky behaviors (e.g., jumping from heights, bicycle accidents)
In older adolescents and adults, unfinished chores and forgotten bills are common
Difficulty sitting through presentations, movies, or other events
Frequent interruption of conversations

ADHD Misconceptions

Symptoms are often misattributed to factors like laziness, poor motivation, or lack of caring, rather than a central nervous system disorder
Parents frequently report having to repeat instructions numerous times before their child seems to understand or comply

ADHD Risk Factors and Etiology

Strong genetic inheritance is a contributing factor
Environmental exposures play a role
Pregnancy and delivery complications can contribute
Structural brain anomalies are linked to the disorder
Alcohol and smoking during pregnancy are risk factors

ADHD Complications

Increased risk of psychiatric disorders
Higher rates of cigarette use and nicotine dependency
Elevated rates of school dropout, car accidents, and legal offenses
Even when adolescents no longer meet formal DSM-5 diagnostic criteria, deficits often persist alongside comorbid conditions (e.g., oppositional defiant disorder, conduct disorder, substance abuse)
Adults with ADHD have higher rates of mood, anxiety, and substance abuse disorders
Studies indicate adults with ADHD have three times the number of sexual partners and a significantly higher risk of unplanned pregnancies and contracting sexually transmitted infections

ADHD Labs and Work-Up

No specific laboratory tests exist for diagnosing ADHD
Lead levels may be checked due to potential correlation
Thyroid function tests may be conducted in adults
Sleep studies are used to evaluate for obstructive sleep apnea in adults
Mental status testing is part of the evaluation
Rating scales, psychological screenings, and checklists can be helpful tools

ADHD Rating Scales

Conners-3: Assesses oppositional and conduct disorder behavior, cognitive difficulties, and hyperactivity
Child Behavior Checklist (CBCL): Questionnaire evaluating emotional and behavioral issues
Conners Adult ADHD Rating Scale (CAARS): Measures the presence and severity of ADHD symptoms
Adult Self-Report Scale-V1.1: Screening tool evaluating ADHD symptoms in adults aged 18 and older
Adult ADHD Investigator Symptom Rating Scale (AISRS): 18-item questionnaire assessing symptom severity and improvement

ADHD Treatment and Management

Stimulant medications are the first-line treatment in pediatrics, including methylphenidate and amphetamine-based medications
Immediate-release methylphenidate (e.g., Ritalin, Concerta) is typically administered 2-3 times per day in doses of 5-20mg
Methylphenidate typically takes effect within 30-60 minutes, with peak effects occurring in 1-2 hours and a duration of 2-5 hours
Longer-acting d- or l-amphetamine salts (Adderall) are equally effective alternatives for those who do not respond to methylphenidate
Both medication types are available in short-acting and long-acting versions
Stimulants can cause side effects such as appetite suppression, insomnia, and weight loss

Second-Generation Medications

Newer long-acting stimulants in a continuous-release (CR) form allow for once-daily dosing:
- Lisdexamfetamine dimesylate (Vyvanse)
- Methylphenidate (Concerta)
- Dexmethylphenidate (Focalin-XR)
- Amphetamine preparations (Adderall XR)
Other forms are also available, including:
- Transdermal patch (Daytrana)
- Extended-release oral suspensions (e.g., amphetamine (Dyanavel), methylphenidate (Quillivant-XR))
- Chewing gum (QuilliChew-ER)

Non-Stimulant Medications

Atomoxetine, clonidine, and guanfacine are less effective than stimulants in reducing ADHD symptoms but may be prescribed when necessary
Second-line therapies are considered in specific situations:
- Difficulty with stimulant side effects
- Comorbid conditions (e.g., anxiety disorders, Tourette syndrome, seizure disorders)
- Concerns about stimulant abuse
- Parental opposition to stimulant use

Additional ADHD Treatment Options

Antidepressants (e.g., bupropion, tricyclic agents) have shown some efficacy in treating ADHD, particularly in adults
External Trigeminal Nerve Stimulation (eTNS) is the first FDA-approved medical device for ADHD treatment
Cognitive Behavioral Therapy (CBT) is recommended as an adjunct to medication in adolescents and adults to enhance outcomes

Autism Spectrum Disorder (ASD)

A developmental disability
Individuals with ASD behave, communicate, interact, and learn differently compared to most people
Symptoms typically onset before age 3 and can persist throughout life
Symptoms may improve over time
Some children exhibit developmental progress (e.g., gaining skills, meeting milestones) until around 18-24 months of age, then stop progressing or even lose previously acquired skills
Individuals may have difficulty developing and maintaining friendships, communicating with peers and adults, or understanding social expectations in settings like school or work
There are 5 main types of ASD:
- Asperger's Syndrome (developmental disorder) - Often referred to as "high-functioning"
- Rett Syndrome (rare genetic neurodevelopmental disorder affecting the brain)
- Childhood Disintegrative Disorder
- Kanner's Syndrome (considered "classic autism")
- Pervasive Developmental Disorder, Not Otherwise Specified (NOS)

Autism Spectrum Disorder (ASD) Risk Factors

Factors include environmental, biological, and genetic influences:
- Having a sibling with ASD
- Having certain genetic or chromosomal conditions (e.g., Fragile X Syndrome, Tuberous Sclerosis)
- Complications during birth
- Being born to older parents
- ASD is four times more common in boys than girls
- Approximately 1 in 100 children worldwide has autism

Autism Spectrum Disorder (ASD) Clinical Presentation and Diagnosis

Individuals often experience difficulties with social communication and interaction
Typically present with restricted, repetitive behaviors and interests
May have differences in learning, movement, or attention
There is no medical test (e.g., labs) to diagnose ASD
Diagnosis relies on observing a child's behavior and development
ASD can sometimes be detected as early as 18 months of age or younger
By the age of 2, a diagnosis by a qualified professional is considered reliable

Autism Spectrum Disorder (ASD) Treatment and Management

Treatment aims to minimize symptoms interfering with daily functioning and quality of life
A multidisciplinary approach is generally recommended, tailoring treatment to the individual
Early access to psychosocial interventions can improve communication and social interaction skills in autistic children
Cognitive Behavioral Therapy (CBT) plays a role in treatment
Regular monitoring of development and healthcare is important
Following diagnosis, providing relevant information, services, referrals, and practical support is crucial

Impulse-Control Disorders

Characterized by impulsive behavior, difficulty controlling emotions, and behaviors.
Can cause significant impairment in daily life.
Violates societal norms and rights of others.
Symptoms persist for at least 6 to 12 months.

Types of Impulse Control Disorders (DSM-5)

Oppositional Defiant Disorder: Characterized by negative, defiant, and hostile behaviors.
Conduct Disorder: Characterized by repeated violations of rules and the rights of others.
Kleptomania: An uncontrollable urge to steal.
Pyromania: An uncontrollable urge to start fires.
Intermittent Explosive Disorder (IED): The most common type, characterized by recurrent, impulsive episodes of aggressive behavior.

Signs and Symptoms

Risky or promiscuous behaviors.
Starting fires.
Stealing.
Violent outbursts.
Extreme defiance.
Excessive hair pulling (trichotillomania).
Excessive lying.
Running away habits.

Treatment and Management

Cognitive Behavioral Therapy (CBT): The most prominent treatment modality.
Parent Management Training (PMT): Used for psychosocial management.
Selective Serotonin Reuptake Inhibitors (SSRIs): Effective in managing aggression, irritability, and some types of impulse control disorders.
Fluvoxamine and Clomipramine: Shown to be effective in the treatment of pathological gambling.
Clomipramine: Shown to be effective in the treatment of trichotillomania (hair pulling).
Fluoxetine: Shown to be effective in the treatment of pathological skin-picking disorder and Intermittent Explosive Disorder (IED).

Intermittent Explosive Disorder

Characterized by impulsive aggressive outbursts disproportionate to the situation.
Onset usually in childhood or adolescence, more common in males.
Often accompanied by substance use and antisocial personality disorders.
Patients experience remorse and confusion after outbursts.
Treatment involves psychotherapy and pharmacotherapy, but evidence supporting their efficacy is limited.
Thought to resolve by the end of the third decade of life, but research is limited.

Conduct Disorder

More severe than Oppositional Defiant Disorder (ODD), involving aggression towards people or animals, property destruction, theft, or deceit.
Individuals with CD generally experience more impairment and social difficulties than those with only ODD.
Often from disadvantaged families with higher conflict with school and judicial systems.
Characterized by difficulty following rules, respecting others, showing empathy, and behaving acceptably.
Can manifest in various ways, including property destruction, aggression, deceit, lying, stealing, truancy, running away, and excessive temper tantrums.
Early and comprehensive evaluation is crucial, including interviewing parents, teachers, etc.
Often co-occurs with mood, anxiety, ADHD, substance abuse, and learning disabilities.
Treatment includes psychotherapy, behavior therapy, special education, and medications to address underlying conditions.

Oppositional Defiant Disorder

A conduct disorder typically emerging in younger children.
Characterized by defiance, disobedience, and disruptive behavior without the severity or law-breaking seen in Conduct Disorder.
Symptoms often appear before age eight, but can emerge in adolescence.
Children with ODD are argumentative, defiant, irritable, resentful, vindictive, and may blame others for their actions.
Aggression is typically reactive and verbal rather than proactive or physical.
Diagnosed based on a persistent pattern of defiant behavior towards adults and peers, and violation of minor rules and social conventions.
Treatment involves a multimodal approach, including psychosocial and pharmacotherapeutic interventions.
Early identification and intervention improve outcomes.

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