Neurodevelopmental Dx Flashcards

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1

Neurodevelopmental Dx- list

  1. Intellectual Developmental Disorders (category)
  2. Communication Disorders (category)
  3. Autism Spectrum Disorder (category)
  4. ADHD (category)
  5. Specific Learning Dx (category)
  6. Motor Disorders (category)
  7. Tic Disorders (category)
  8. Other neurodevelopmental Disorders

2

Other Neurodevelopmental Dx- list

  1. other specified neurodevelopmental dx
  2. unspecified neurodevelopmental dx

3

Intellectual Developmental Disorder- list

  • category of neurodevelopmental dx
    1. Intellectual developmental dx
    2. global developmental delay
    3. unspecified intellectual developmental dx

4

Intellectual Developmental Disorder

  • AKA intellectual disability
  • A. Deficits in intellectual functions (reasoning, problem solving, planning, abstract thinking, academic learning) confirmed by both clinical assessment and individualized/ standardized IQ testing
  • B. deficits in adaptive functioning that result in failure to met developmental standards of personal independence. Without ongoing support, deficits limits functioning in 1 or more activities of daily life (communication, social participation, independent living)
  • C. Onset of the intellectual and adaptive deficits during the developmental period
  • ****severity is based on deficits in conceptual, social, and practical domains

5

Intellectual Disability Specifiers

  • Mild
    • conceptual=difficulties with abstract thinking, short term mem, etc
    • social= concrete communication, immature in social situations
    • practical=some support needed for complex daily tasks, help with family rearing, can still be employed
  • Moderate
    • conceptual= lag behind peers in academics
    • social=language is tool for communication, limited decision making judgement
    • practical= can care for personal needs, can obtain a job, may need support for daily activities
  • Severe
    • conceptual=limited; little understanding of numbers and language
    • social= spoken language is limited
    • practical=requires support for all daily activities
  • Profound
    • conceptual= very concrete
    • social= very limited; nonverbal, nonsymbolic communication
    • practical=dependent on others for all aspects of life

6

Global Developmental Delay

  • neurodevelopmental dx
  • reserved for those under the age of 5 when clinical severity level cannot be reliably assessed during early childhood
  • child fails to meet expected developmental milestones in several areas of functioning but are unable to go through assessment of intellectual functioning (like too young to take standardized tests)
  • requires reassessment after a period of time

7

Unspecified Intellectual Developmental Dx

  • neurodevelopmental dx
  • AKA unspecified intellectual disability
  • reserved for children under 5 when assessment of the degree of intellectual developmental disorder cannot be assessed because of sensory impairments (blindness), disability, etc.
  • should only be used in exceptional cases and must be reassessed after a period of time

8

Communication Disorders- list

  • category of neurodevelopmental dx
    1. language dx
    2. speech sounds dx
    3. child onset fluency dx
    4. social communication dx
    5. unspecified communication dx

9

Language Disorder

  • neurodevelopmental dx
  • A. Persistent difficulties in acquisition/ use of language across modalities (e.g. spoken, written, etc) due to deficits in comprehension or production that include the following:
    1. reduced vocab
    2. limited sentence structure
    3. impairments in discourse
  • B. Language abilities are substantially and quantifiably below those expected for age, resulting in functioning limitations in communication, social participation, achievement,
  • C. Difficulties are not attributed to hearing or other sensory impairment, motor dysfunction, or other medical/ neurological condition, or global developmental delay

10

Speech Sound Disorder

  • neurodevelopmental dx
  • A. Persistent difficulty with speech production that interferes with speech intelligibility or prevents verbal communication of messages
  • B. disturbance causes limitations in effective communication that interferes with social participation, academic achievement, etc
  • C. onset of symptoms is in early developmental period
  • D. Difficulties not attributable to congenital or acquired conditions, such as a cleft palate, deafness or hearing loss, etc

11

Childhood Onset Fluency Disorder

  • neurodevelopmental dx; aka stuttering
  • A. disturbances in normal fluency/ time patterning of speech that are inappropriate for age and language skills, persist over time, and characterized by one or more of the following:
    1. sound and syllable repetitions, 2. Sound prolongations of consonants and vowels, 3. broken words, 4. audible or silent blocking (pauses in speech), 5. circumlocutions (using other words to avoid a difficult word), 6. word produced with a lot of tension, 7. monosyllabic whole word repetitions (I-I-I-I etc)
  • B. Disturbance causes anxiety or limits effective communication, social participation, etc
  • C. onset of symptoms is in early developmental period (later onset cases are diagnoses as adult onset fluency disorder)
  • D. disturbance not attributable to a speech motor or sensory deficits, neurological issue (like tumor)

12

Social (Pragmatic) Communication Disorder

  • neurodevelopmental dx
  • A. Persistent difficulties in social use of verbal and nonverbal communication as manifested by ALL:
    1. deficits in social communication (greeting, sharing info)
    2. impairments in ability to change communication to match context (inside vs outside voice)
    3. difficulties following rules of conversation (taking turns talking)
    4. difficulties understanding what is not explicitly said
  • B. deficits result in functional limitations in effective communication, social participation, etc
  • C. onset of symptoms in early developmental period
  • D. not attributable to another medical or neurological condition and not better explained by ASD, intellectual disability, or other mental dx

13

Autism Spectrum Disorder- list

  • category of neurodevelopmental dx
    1. ASD

14

ASD vs. intellectual developmental disorder

  • frequently co-occur
  • to make a comorbid diagnosis, social communication should be below that expected for general developmental level

15

Autism Spectrum Disorder

  • A. persistent deficits in social communication and social interaction across multiple contexts, manifested by ALL of the following:
    1. deficits in social-emotional reciprocity
    2. deficits in nonverbal communication bx
    3. deficits in developing, maintaining, understanding relationships
  • B. Restrictive, repetitive patterns of bx, interests, activities, manifested by TWO of the following:
    1. stereotyped or repetitive movements, use of objects, or speech
    2. insistence on sameness, inflexible adherence to routines, ritualized patterns
    3. high restricted, fixated interests that are abnormal in intensity or focus
    4. hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
  • C. symptoms must be present in early developmental period
  • D. symptoms cause clinical significant impairment in social, occupational, other areas of functioning
  • E. not better explained by intellectual devel. dx, global dev delay

16

Specifiers for ASD

  • Specify if
    • requiring very substantial support=severe deficits in verbal and nonverbal social communication; very limited; extremely difficulty coping with change
    • requiring substantial support=deficits in verbal communication, even with supports impairments are noticed; casual observed can see inflexibility in response to change, etc
    • requiring support=difficulty initiating social interaction; inflexibility in behavior causes difficulty in functioning
  • Specify if
    • with or w/out accompanying intellectual impairment
    • with or w/out accompanying language impairment
  • Specify if
    • associated with known genetic or other medical condition or environmental factor (must also ID the genetic/med condition)
    • associated with a neurodevelopmental, mental, or bx problem
  • Specify if
    • with catatonia

17

ADHD- list

  • category of neurodevelopmental dx
    1. ADHD
    2. other specified ADHD
    3. Unspecified ADHD

18

Attention- Deficit/ Hyperactivity Disorder (ADHD)

  • neurodevelopmental Dx
  • A. Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
  • B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years
  • C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings
  • D. Clear evidence that the symptoms interfere with, or reduce the quality of, social academic, or occupational functioning
  • E. Symptoms do not occur exclusively during the course of schizophrenia, other psychotic dx, not better explained by another mental dx.

19

Inattention Diagnostic Criteria

  • 6 or more of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
    1. often fails to give close attn to details or makes careless mistakes
    2. often has difficulty sustaining attention in tasks or play activities
    3. often does not seem to listen when spoken to directly
    4. often does not follow through on instructions and fails to finish schoolwork, chores, duties
    5. often has difficulty organizing tasks and activities
    6. often avoid, dislikes, or is reluctant to engage in tasks that require sustained mental effort
    7. often loses things necessary for tasks and activities
    8. often easily distracted by extraneous stimuli (for adolescents and adults, may include unrelated thoughts)
    9. often forgetful in daily activities
  • NOTE for older adolescents and adults, only 5 symptoms are needed

20

Hyperactivity and Impulsivity Criteria

  • 6 or more of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
    1. often fidgets with or taps hands or feet/ squirms in seat
    2. often leaves seat in situations when remaining in seat is required
    3. often runs or climbs where its inappropriate (for adults, feeling restless)
    4. often unable to play or engage in leisure activities quietly
    5. often "on the go" or acting as if "driven by a motor"
    6. often talks excessively
    7. often blurts out an answer before a question has been completed
    8. often has difficulty waiting his or her turn
    9. often interrupts or intrudes on others
  • NOTE for older adolescents and adults, only 5 symptoms are needed

21

ADHD specifiers

  • specify if:
    • in partial remission (when full criteria has previously been met, but fewer than the full criteria have been met for 6 months)
  • specify if:
    • mild=only (minimum) 6 or 7 criteria met
    • moderate= between mild and severe
    • severe=excess of symptoms present (way more than what's needed for the diagnosis)

22

Specific Learning Dx-list

  • category of neurodevelopmental dx
    1. specific learning disorder

23

Specific Learning Dx- specifiers

  • specify if:
    • with impairment in reading
    • with impairment in written expression
    • with impairment in mathematics
  • specify if:
    • mild= some difficulties in 1-2 academic domains but is able to compensate
    • moderate= marked difficulties in 1-2 academic domains and person in unlikely to become proficient without intervention or special teaching
    • severe=severe difficulties learning skills, affecting several academic domains so that the individual is unlikely to learn those skills without ongoing intensive individualized and specialized teaching for most of the school years

24

Specific Learning Disorder

  • A. difficulties learning and using academic skills, as indicated by at least ONE or more of the following, persisting for at least 6months, despite the provision of interventions that target those difficulties:
    1. inaccurate or slow and effortful word reading
    2. difficulty understanding the meaning of what is read
    3. difficulties with spelling
    4. difficulties with written expression
    5. difficulties mastering number sense, number facts, calculation
    6. difficulties with mathematical reasoning
  • B. The affected academic skills are substantially and quantifiably below those expected for chronological age, cause significant interference with academic performance, etc. For individual 17 and older, a documented hx of impairing learning difficulties may be substituted for the standardized assessment
  • C. Learning difficulties begin during school age years but may not become fully manifested until the demands for those affected academic skills exceed the individual's limited capacities
  • D. Learning difficulties are not better accounted for by intellectual disabilities, uncorrected visual or auditory acuity, other mental or neurological dx, psychosocial adversity, lack of proficiency in the language, or adequate edu instruction
  • coding note: must specify all academic domains and subskills that are impaired.

25

Motor Disorders- category

  • category of neurodevelopmental dx
    1. Developmental coordination Dx
    2. Stereotypic Movement Dx

26

Developmental Coordination Disorder

  • neurodevelopmental Dx
  • A. the acquisition and execution of coordinated motor skills is substantially below that expected given the individual's chronological age and opportunity for skill learning and use. Difficulties manifested as clumsiness, slowness, and inaccuracy of performance of motor skills
  • B. the motor skill deficits in A significantly and persistently interferes with activities of daily living appropriate to chronological age
  • C. Onset of skills is in early developmental period
  • motor skills deficits are not better explained by intellectual development dx, visual impairment, not attributed to neurological dx

27

Stereotypic Movement Disorder

  • neurodevelopmental dx
  • A. repetitive, seemingly driven, and apparently purposeless motor behavior
  • B. the repetitive motor behavior interferes with social, academic, or other activities and may result in self injury
  • C. onset is in the early developmental period
  • D. the repetitive motor bx is not attributable to the physiological effects of a substance or neurological condition and is not better explained by another neurodevelopmental or mental dx

28

Stereotypic Movement Dx- specifiers

  • specify if
    • with self injurious bx
    • without self injurious bx
  • specify if
    • associated with a known genetic or other medical condition, neurodevelopmental dx, or environmental factor
  • specify if
    • mild=symptoms are easily suppressed by sensory stimulus or distraction
    • moderate= symptoms require explicit protective measures and bx modification
    • severe=continuous monitoring and protective measures required to prevent serious injury

29

Tic Disorders- list

  • type of neurodevelopmental dx
    1. Tourette's dx
    2. persistent motor or vocal tic dx
    3. provisional tic dx
    4. Other Specified Tic Dx
    5. Unspecified Tic Dx

30

Tourette's Dx

  • neurodevelopmental dx
  • A. both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently
  • B. tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset
  • C. Onset before the age of 18
  • D. Disturbance not attributable to physiological effects of a substance or other medical condition

31

Persistent Motor or Vocal Tic Disorder

  • neurodevelopmental dx
  • A. single or multiple motor or vocal tics have been present during illness, but not both motor and vocal
  • B. tic may wax and wane in frequency but have persisted for more than 1 year since onset
  • C. onset before the age of 18
  • D. disturbance not attributable to the physiological effects of a substances or other medical condition
  • E. criteria for Tourette's never been met
  • Specify if:
    • with motor tics only
    • with vocal tics only

32

Provisional Tic Disorder

  • neurodevelopmental dx
  • A. single or multiple motor and/or vocal tics
  • B. the tics have been present for less than 1 year
  • C. onset is before the age of 18
  • D. disturbance not due to substances use of other medical condition
  • E. criteria for Tourette's or persistent motor tic dx have never been met