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Neurodevelopmental Disorders

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Lauren Wojdyla

on 16 October 2015

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Transcript of Neurodevelopmental Disorders

Neurodevelopmental Disorders
ADHD and Autism

Etiology
Etiology is the known as the cause of something.
- The causation of a mental disorder
In ADHD and Autism, Etiology is often complex and in most cases unknown. Most studies cannot provide predictions just correlations.

Life Experience
Neurodevelopmental Disorders
Intellectual Development Disorders
Communication Disorders
Autism Spectrum Disorders
ADHD
Specific Learning Disorders
Motor Disorders
DSM Criteria for Attention-Deficit/Hyperactivity Disorder
ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
Autism
Autism Spectrum is mostly genetic.

•Families studies show 3 markers of the c-Harvey-ros oncogene and the homeobox gene EN2.


•have a low level of serum dopamine β-hydroxylase (DβH), (2 sources) - autistic children have a low level of serum dopamine β-hydroxylase (DβH), which catalyzes the conversion of dopamine to norepinephrine,


•Autism may arise from abnormal central nervous system functioning.

•. Genetic polymorphisms of cytochrome P450 enzymes have also been linked to autism - because Vitamin D is important for neuronal growth and neurodevelopment, and defects in metabolism or deficiency have been implicated in autistic individuals


ADHD


No single risk factor explains ADHD.


DSM Criteria for Autism Spectrum Disorder

ASD is characterized by persistent deficits in social communication and social interaction across multiple contexts, currently or by history.
Severe ASD is characterized by social communication impairments and restricted, repetitive patterns of behavior.
Neurodevelopmental disorders can affect every aspect of a person and their families life. One quote from "Early Support for children, young people and familis: Information About Neurological Disorders, really describes some of the troubles families have. "Having a child with a neurodevelopmental diorder means you have to completely readjust your expectations of what being a parent will mean, and accept that you will not have the same experiences most parents take for granted. You have to learn a new way of communicating with your child."
Every day life can be extremely hard for some of these kids. Every child has their strengths and it is important, especially with children with these disorders, to make the most of these strengths. Children with certain neurodevelopmental disorders like autism and ADHD have provlems tolerating or processing sensory information like, limited body awareness, avoiding a lot of foods, dislike of social settings, dislike to clothing or certain fabrics, poor attention and concentrarion, and high or low activity levels or pain thresholds. A lot of these children also have problems sleeping either becayse they have problems settling down or feel anxious when left alone when in bed. It is important for these children to have a routine because it gives them a sense of security. Many children with neurodevelopmental disorders begin their life with eating problems abd have to be fed through a tube.
School can be very difficult for these children. Many children dont even have a diagnosis until they are in school. The Center for Autism and Neurodevelopment Disorders have come up with two different programs for schools. First, they have F.A.S.T, families and schools together. This offers support to families and schools using a cohesive multi disciplinary approach. It encourages increased communication between all team members, strong relationships, and sharing resouces. The second program is C.A.P, Chapman Ability Project. This focuses on high level education. THis includes workshops, lectures, and certificate programs. CAP helps increase the knowledge of those helping these children. This is used in schools and in clinical settings. It also works closely with schools and parents to make an IEP plan for the student. CAP comes to schools when they are in need of faculty training.

ADHD
For a child with ADHD a class room environment can be very difficult especially having to sit, concentrate, and listen quietly. Most of these children get frustrated because they want to be able to learn and act like others but they just can't. One way to help the child succeed is to create a behavioral plan. This helps give the child structure and clear expectations. Children with ADHD work best when they have goals and daily positive reinforcement. Children with ADHD are easily distracted. Some ways to help them is to seat them away from windows and doors, allow them to move throughout the day, write important information where they can see it, divide big assignments up into smaller ones, and give breaks frequently.
Adults with ADHD also have troubles and concentrating but they also have other difficulties like, coping with stress, keeping stable relationships, low frustration tolerance, disorganizion and mood swings.

Autism
There are so many different function levels of autism. A Huffinton Post Article, "Kids with Autism Describe Their Sensory Experiences, talks about some of the different things these children experience. One says, "And I heard the buzzer and I started to have panic, like "Ahhh!" like the panic that my brain is going in, like "what should I do? Ahh" It;s kind of like bouncing off the walls in, um, my head, like "what should I do?"
Many children with Austism have problems communicating and showing their feelings. On carlysvoice.com it talks about a gitl that is high on the spectrum and her journey to find her voice. According to abcnews.com, Carly Fleischmann was two when her parents noticed she wasnt keeping up with her twin sister. They took her to the doctor where she was diagnosed with austism. At first she was unable to sit and stand, but as she grew older they realized she also couldn't talk, and while therapy was helong with the other things it wasn't doing anything to help her communication. One day when she was 11 she started to not feel well during therapy and ran over to a computer and for the very first time typed the words "help" and "hurt". With the help of her therapists she is now able to type all kinds of words. She's even written a book and been on talk shows to raise awareness for austism. One thing Carly says is, "Our brains are wired differently. We take in so many sounds and conversations at once. I take over a thousand pictures of a person's face when I look at them. Thats why we have a hard time looking at people. I have learnt how to filter through some of the mess." When asked why austistic kids cover their ears, hum, or flap their hands she says, "It's a way for us to drown out all sensory input that over loads us all at once. We create output to block input. Carly and her family also made a video to show people what it is like to have austism.

Autism Spectrum has environmental stresses that can relate to genetics.

•oxidative stress and impaired methylation, which may reflect effects of toxic exposure on sulfur metabolism.

Impaired methylation and mutations of mecp2 have been associated with autistic spectrum disorders


Autism is has heredity based explanation.

- previous reports of an association between optimality and autism are a result of failure to adjust for birth order.
- there is undoubtedly heterogeneity within the diagnosis of autism and/or PDD. The observation of excess twins among offspring with autism may indicate that the etiology in a notable proportion of offspring with autism is related to intrauterine or perinatal factors.


Prenatal Effects
Anything that negatively affects the nervous system, neurodevelopment, and environmental responsive genes during pregnancy. Examples : maternally derived antibodies, maternal infection, heavy metal exposure, folic acid supplementation, epigenetics, measles, mumps, rubella vaccination, and even electromagnetic radiation

Attention deficit hyperactivity disorder (ADHD) and its possible causes still attract controversy. Genes, pre and perinatal risks, psychosocial factors and environmental toxins have all been considered as potential risk factors.

Heredity

• Family studies consistently support the assertion that ADHD runs in families.


Genetics

•Heritability data from twin studies of ADHD attribute about 80 percent of the etiology of - Numerous family, twin, and adoption studies have provided compelling evidence that attention-deficit/hyperactivity disorder (ADHD) is highly heritable, with an estimated genetic contribution of approximately 80%.1ADHD to genetic factors. Adoption studies of ADHD also implicate genes in its etiology.


•Molecular genetic data are bolstered by considerations suggesting that DRD4 and DAT genes - 7-repeat variant in exon 3 of the dopamine d4 receptor gene (DRD4)


Brain Function

•ADHD is associated with abnormalities in the frontal lobes


•89.4% of children with abnormal EEG readings had co-existing ADHD compared to only 25% of children with normal EEG readings ( EEG - measures brain waves)







Psychosocial Adversity and Genetics

•psychosocial adversity have also been identified as risk factors for ADHD


•Adolescents homozygous for the 10-repeat allele of the 40-bp VNTR polymorphism who grew up in greater psychosocial adversity exhibited significantly more inattention and hyperactivity-impulsivity than adolescents with other genotypes or who lived in less adverse family conditions


•These findings provide initial evidence that environmental risks as described by the Rutter Family Adversity Index moderate the impact of the DAT1 gene on ADHD symptoms, suggesting a DAT1 effect only in those individuals exposed to psychosocial adversity.



Prenatal

• prenatal exposure to nicotine


•Results indicate that smoking during pregnancy is associated with specific subtypes of ADHD in genetically susceptible children.


•Results of multiple regression analyses showed prenatal exposure to smoking (β = .16, p < .01) and stress (β = .18, p < .01) were independently associated with later symptoms of ADHD - showed larger number in boys.


•Child hyperactivity-impulsivity and oppositional behaviors were associated with a DAT polymorphism but only when the child also had exposure to maternal prenatal smoking.



History
Autism:
30 years ago Autism was not as common as it is today
Boys are the ones most affected with autism (1 in 42);
Girls are 1 in 189
The people who contributed to the history of autism were:
Michael Rutter: a child psychologist made a big contribution to the distinction between Autism and other psychiatric orders and clarifying the diagnostic criteria
Leo Kanner: used the word "autism" to describe people with "classical autism";
he was also the person that provided the theory of refrigerator parents, in which the theory states that parents are the ones to blame for their child having autism because they cold to them
Bernard Rimland: a psychologist and an advocate for children with autism
he refuted Kanners' view of refrigerator parents, stating that Leo's points on autism was an error because it was a series of events where one infers a cause from a simple correlation of events
ADHD
Autism
Mid 19th Century - Heinrich Hoffman- a german physician described ADHD as an illness that he characterized as resulting from a defect in moral character
He noticed that "the problem resulted in a child's inability to internalize rules and limits, and in addition manifested itself in patterns of restless, inattentive, and over aroused behaviors"
He suggested that the children may have suffered from brain damage, but it could also rise from hereditary or environmental factors
1917-1918: an epidemic broke out thus bringing symptoms of ADHD
the illness was first called "minimal cerebral/ brain dysfunction/damage"
later on the illness was then changed to address the behavioral side of the illness to "hyper-kinetic reaction of childhood disorder"
While the basic core symptoms of inattention, hyperactivity, and impulsiveness have remained consistent over time, the specific diagnostic criteria has changed to conform to the conceptual changes
Many people have blamed ADHD on bad parenting and bad teaching
Comorbidity
simultaneously living with two or more disorders
Autistic Spectrum Disorder
People with ASD are prone to anxiety, depression, and/or developmental coordination disorder.
About 70% of individuals with ASD are also diagnosed with another disorder and 40% are also diagnosed with two or more disorders.
Attention-Deficit/Hyperactivity Disorder
People with ADHD are more likely to have depression, bipolar disorders, and/or substance abuse.
33% of people diagnosed with ADHD ONLY have ADHD; 33% have one comorbid disorder; 16% have two comorbid disorders; 18% have three or more comorbid disorders.
ADHD occurs in 3%-5% of the U.S. population; depression occurs in 20%-30% of patients diagnosed with ADHD; anxiety occurs in 25%; 20% of adults with bipolar disorder also have ADHD
60%-80% of people with Tourette's also have ADHD
Brittany Fichter described how her tics from tourette's made her anxiety worse, which made her tics worse; "It was like a vicious circle".
Assessing
Autism
ADHD

Symptoms
Diagnostic Assessment
Assessment Form
Makes Call
Culture and Society
Autism
Media
The show Parenthood had a character with Aspergers
Many other shows have characters with Autism symptoms, ex: Sheldon from the Big Bang Theory

Celebrities/Activists
Temple Grandin
Diagnosed with Autism at age 2
Named in Time Magazine's 2010 Top 100 in the Heroes category
"The world needs all kinds of minds"

Many other celebrities have family members/children with Autism, and speak out for the disorder
Visibility and stigma
Autism has physical symptoms only on the more low-functioning end of the spectrum
The most common stigma attached to Autism is that those who have the disorder are disruptive, anti-social and "weird"
Charities
The most well-known Charity/Organization for Autism is Autism Speaks
Currently 52 celebrity supporters
Goal is Science and Advocacy
ADHD
Media
The most common point of discussion about ADHD in the Media is the abuse of ADHD medications
Visibility and stigma
ADHD is a very well-known disorder, but there is still a huge stigma attached
the person doesnt have ADHD, faking it for the medicine
the person is just lazy and doesn't want to focus on work
Celebrities/Activists
Adam Levine, lead singer of Maroon 5 had a TV commercial campaign to help reduce stigma attached to ADHD
Charities and Organizations
ADHD Foundation
ADHD Voices
3 types
Symptoms
Assessment
Approach
Makes Call
Common Identifiers:
Caretakers
Teachers
Family Members
Doctors
Treatment
Autism
Nonmedical:
○ Frequently address one specific issue at a time and can yield results in those specific areas as well as more general improvement in functioning.
○ Texas Autism Resource Guide for Effective Teaching (TARGET) - provides information on interventions for people with ASD.
Related Approaches:
○ Art and music
○ Animal therapy
□ Improve coordination and motor development while creating a sense of well-being and increasing self-confidence.

ADHD
Medications
○ Amphetamine - Stimulants
§ Short-acting (4-6):
□ Adderall
□ Dexedrine
□ Dextostat
§ Long-acting (6-12):
□ Dexedrine spansule
□ Adderall XR
□ Vyvanse
○ Methylphenidate - Stimulants
§ Short-acting (3-6):
□ Focalin
□ Ritalin
§ Long-acting (6-12):
□ Concerta
□ Daytrana (patch)
○ Behavior therapy.
- Uses reward systems and timeout.
○ Psychotherapy.
○ Parenting skills training.
○ Family therapy.
○ Social skills training.
Behavior Therapy and Counseling
Sources
Culture and Society
https://www.autismspeaks.org/
http://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml
http://www.adhdfoundation.org.uk/
http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
Life Experience Sources:
http://www.ncb.org.uk/media/875206/earlysupportneurologicaldisorderspart1final.pdf
http://www.forockids.org/FAST_CAP.html

http://www.helpguide.org/articles/add-adhd/attention-deficit-disorder-adhd-and-school.htm
http://www.huffingtonpost.com/2015/05/08/kids-autism-sensory-exper_n_7129850.html
http://www.mayoclinic.org/diseases-conditions/adult-adhd/basics/definition/con-20034552
Comorbidity
http://www.medpagetoday.com/Pediatrics/ADHD-ADD/24722
http://www.psychiatrictimes.com/adhd/what-are-common-comorbidities-inadhd
Treatment
Websites:
Autism:
http://www.autism-society.org/
ADHD:
http://www.mayoclinic.org/diseases-conditions/adhd/basics/treatment/con-20023647?utm_source=Google&utm_medium=abstract&utm_content=Attention-deficit-hyperactivity-disorder&utm_campaign=Knowledge-panel
http://www.webmd.com/add-adhd/guide/adhd-medication-chart

Scholarly Articles:
Autism:
Health-related quality of life in children with autism spectrum disorders: Results from the autism treatment network:
https://scholar.google.com/citations?view_op=view_citation&continue=/scholar%3Fhl%3Den%26as_sdt%3D0,26%26scilib%3D1&citilm=1&citation_for_view=v3ZDHnIAAAAJ:u5HHmVD_uO8C&hl=en&oi=p
ADHD:
Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: a meta-analysis:
https://scholar.google.com/citations?view_op=view_citation&continue=/scholar%3Fhl%3Den%26as_sdt%3D0,26%26scilib%3D1&citilm=1&citation_for_view=v3ZDHnIAAAAJ:9yKSN-GCB0IC&hl=en&oi=p

Nonpharmacological interventions for ADHD: systematic review and meta-analysis of randomized controlled trials of dietary and psychological treatments:
https://scholar.google.com/citations?view_op=view_citation&continue=/scholar%3Fhl%3Den%26as_sdt%3D0,26%26scilib%3D1&citilm=1&citation_for_view=v3ZDHnIAAAAJ:d1gkVwhDpl0C&hl=en&oi=p

Cost-effectiveness of ADHD treatments: findings from the multimodal treatment study of children with ADHD:
https://scholar.google.com/citations?view_op=view_citation&continue=/scholar%3Fhl%3Den%26as_sdt%3D0,26%26scilib%3D1&citilm=1&citation_for_view=v3ZDHnIAAAAJ:u-x6o8ySG0sC&hl=en&oi=p


History
https://embryo.asu.edu/pages/early-infantile-autism-and-refrigerator-mother-theory-1943-1970
http://www.english.certec.lth.se/autism/kunskap_e.html
Wolraich, Mark L., "Attention -Deficit/ Hyperactivity Disorder".
Infants & Young Children
19.2 (2006): 86-93. Web
www.ncbi.nim.nih.gov/pms/articles/PMC3000907

childmind.org
Rodriguez, A. and Bohlin, G. (2005), Are maternal smoking and stress during pregnancy related to ADHD symptoms in children?. Journal of Child Psychology and Psychiatry, 46: 246–254. doi: 10.1111/j.1469-7610.2004.00359.x

Thapar, A., Cooper, M., Eyre, O. and Langley, K. (2013), Practitioner Review: What have we learnt about the causes of ADHD?. Journal of Child Psychology and Psychiatry, 54: 3–16. doi: 10.1111/j.1469-7610.2012.02611.x

Robinson, P. D., Schutz, C. K., Macciardi, F., White, B. N. and Holden, J. J. A. (2001), Genetically determined low maternal serum dopamine β-hydroxylase levels and the etiology of autism spectrum disorders. Am. J. Med. Genet., 100: 30–36. doi: 10.1002/ajmg.1187

Laucht M, Skowronek MH, Becker K, et al. Interacting Effects of the Dopamine Transporter Gene and Psychosocial Adversity on Attention-Deficit/Hyperactivity Disorder Symptoms Among 15-Year-Olds From a High-Risk Community Sample. Arch Gen Psychiatry. 2007;64(5):585-590. doi:10.1001/archpsyc.64.5.585.


Etiology
○ Nonstimulants
§ Long-acting (extended release) (24):
□ Strattera
□ Intuniv
○ Antidepressants
§ Short-acting (4-5):
□ Wellbutrin
§ NA (8-24)
□ Tofranil
□ Pamelor
□ Aventyl
□ Norpramin
Assessment
ADHD
www.help4adhd.org
www.chadd.org
Autism
www.autismspectrum.org.au
www.eatingdisorders.org.au
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