Bns 3 Exam - Pervasive Developmental Disorders

Front 1

PERvasive developmental disorders (PDD) definition:

Back 1

o A group of disorders in understanding and expressing language and social reciprocity
o Affects multiple areas of development
o Manifest early in life
o Cause persistent dysfunction

Front 2

List 5 PDDs in DSM-IV TR:

Back 2

. Autistic Disorder***
o 2. Asperger’s Disorder ***
o 3. Rett’s Disorder
o 4. Childhood Disintegrative Disorder
o 5. PDD, Not Otherwise Specified

Front 3

What does it mean to be “on the spectrum”?

Back 3

o Severity of symptoms can be wide ranging.
o Trait vs. state.
o On the spectrum usually refers to:
o PDD, NOS
o Undiagnosed Autistic Disorder
o Undiagnosed Asperger’s Disorder.

Front 4

Average age of diagnosis of spectrum disorder is _____

Back 4

4.5 years

Front 5

____ on the spectrum are Autistic

Back 5

47%

Front 6

Autistic Disorder Diagnosis
general

Back 6

Social/communication symptoms prior to age 3 yo with AT LEAST:
 2 or more social criteria
 1 or more communication criteria
 1 or more behavior patterns criteria
 Requires minimum of 6 symptoms in these 3 categories

Front 7

Autistic Disorder Diagnosis
Social Criteria:

Back 7

Social Criteria:
 Impaired nonverbal behaviors.
 Impaired development of peer relationships.
 Lack of seeking to share pleasure, joy with others.
 Lack of social or emotional reciprocity.

Front 8

Autistic Disorder Diagnosis
Communication Criteria:

Back 8

Communication Criteria: Delay or total lack of spoken language.
 If have speech, fail to initiate or maintain conversations with others.
 Stereotyped, repetitive, idiosyncratic language.
 Lack of make believe or social imitative play appropriate to developmental level.

Front 9

Autistic Disorder Diagnosis
Behavior Patterns Criteria:

Back 9

Behavior Patterns Criteria:
- restricted interest
-interest with parts of objects
-Inflexible changes to routines, rituals
-Motor stereotypies (hand flapping, finger flapping, twisting, complex whole body movements.
-Delays/abnormalities present in one of three areas prior to age 3: social interaction, language use for social communication, or symbolic or imaginative play.
 Rule out: Rett’s, Childhood Disintegrative Disorder

Front 10

Autism Work up includes:

Back 10

o History and Physical/Audiology and Vision assessment
o EEG
o Labs: DNA for Fragile X in all males; other genetic tests based on dysmorphisms, lead level to rule out pica, lead poisoning.

Front 11

Assessment of Nonverbal IQ

Back 11

Leiter International Performance Scale

Front 12

What is
Austism Diagnostic Interview-Revised (ADI-R) ?

Back 12

that reviews development of child age 3-4 and covers all areas to make dx.

Front 13

What is
Autism Diagnostic Observation Scale (ADOS) ?

Back 13

Child interviewed, 4 versions to choose from based on child’s language ability.

Front 14

Vineland Adaptive Behavior Scale asses what areas?

Back 14

 Communication
 Daily Living Skills
 Socialization
 Motor Skills

Front 15

Primary cause of Autism:

Back 15

Unknown – 90-95% of cases.
 We think it is 90-95% genetic but…
 combined effect at multiple loci
 In most cases can’t id a single defect
 Also multifactorial = environment counts!

Front 16

Secondary cause of Autism

Back 16

: 5-10% cases
 Recognized Teratogens:
 Lead, Mercury, Thalidomide, Misoprostol, Valproic Acid (Depakote) confers 11% autism risk!
 Infections: TORCH (Toxo, rubella, CMV)
 Genetic Disorders: Fragile X (33% with AD), Tuberous Sclerosis

Front 17

NO ASSOCIATION BETWEEN AUTISM AND ;

Back 17

 VACCINES
 MERCURY IN VACCINES
 Specific psychosocial risk factors
 Dietary factors: Gluten, casein, others.

Front 18

Complex vs Essential Autism:

Back 18

 Complex: Autism W. Physical abnormality
 Essential: Autism W/O any physical findings – by far the majority of autism!

Front 19

Neurological Features of Autism

Back 19

 50-70% have comorbid MR (must do NVIQ like LIPS to determine IQ in child with autism)
 25% have seizure disorder by adolescence
 Self imposed restricted diet – probably due to food texture and on certain clothes probably due to sensory integration deficit
 Hyperacusis
 High pain threshold
 Posture/gait abnormalities
 Prominent insomnia, early am awakening
 Vestibular Dysmodulation – need to spin, twirl, general clumsiness.

Front 20

What decreases in the The Autistic brain?

Back 20

Decreased cerebellum, brain stem, amygdala, corpus callosum, cingulate gyrus, and hippocampus

Front 21

What increases in the Autistic brain?

Back 21

 Increased ventricle size and caudate

Front 22

Early signs of impairment at _______

Back 22

12 mo

Front 23

Social implication for Autism

Back 23

Decreased eye contact, dec. interest in other children, not responding to name, dec. warm affect, stereotypies.

Front 24

Language implication for Autism

Back 24

no babbling by 12mo, no first word by 16mo, no 2 word phrase by 24 mo

Front 25

Treat Core Sx for Autism include

Back 25

o Aimed at social/language problems. No meds shown effective in RPCTs.
-Applied Behavioral Analysis or “ABA”
 Operant Conditioning via + and – reinforcers to reduce unwanted symptoms and promote social interaction and self care. Looks at antecedants, behaviors, and consequences and modifies behavior via manipulation of antecedents and consequences.
 Improves communication, academics, social skills, self care, play, and motor skills (CASS-PM).
 Treat Problem Symptoms: Targets problem behavior with medication.
 SSRIs, Atypical Antipsychotics (Risperidone is FDA indicated for irritability assoc. with autism age 5-16), Stimulants, Alpha 2 Agonists, Anticonvulsants
 Behaviors treated: Self Injury, Aggression/Irritability, Anxiety, Obsessions, Compulsions, Preoccupations, Sleep issues.
 Golden Rule in Child Psychopharm: Start LOW and go SLOW.

Front 26

Asperger’s Disorder

Back 26

 Same as autism except NO language deficit, cognitive (normal IQ), or adaptive/self care delays.
 Have social interaction and behavioral pattern criteria met same as autism.

Front 27

Asperger’s Disorder Treatment:

Back 27

o Target social and behavioral delay via:
 training in vivo
 step by step social learning
 problem solving.

Front 28

 Common to see Asperger’s teens:

Back 28

o develop on-line community of friends
o cyber role play gaming
o gravitate towards jobs with low or no social interaction (i.e., higher functioning:computer programmer, lower functioning:night watchman)