Neuro

Delopmental Disorders
BY:
Psychiatry team- faculty of medicine for
girls
Al-Azhar University

2023-2024
Attention Deficit Hyperactivity
Disorder

2023-2024
Intended Learning Outcomes (ILOs)
 Definition
 Epidemiology
 Etiology and psychopathology
 Diagnosis
 Management

2023-2024
 Definition

A neuropsychiatric condition characterized by

a pattern of diminished sustained attention,
and increased impulsivity or hyperactivity.

2023-2024
 Epidemiology
 Prevalence: 5-12% of school-aged children.
 M:F = 4:1
 Girls tend to have inattentive/distractible
symptoms
 boys have impulsive/hyperactive symptoms.

2023-2024
 Etiology

 Genetic: dopamine candidate genes.

 Catecholamine/neuroanatomical hypothesis.
 Cognitive: developmental disability,
inhibitory control and other errors of
executive function.
 Arousal: alterations in the sensory system
filters.

2023-2024
 Diagnosis

Inattention
 Careless mistakes.
 Cannot sustain attention in tasks or play.
 Does not listen when spoken to directly.
 Fails to complete tasks.
 Disorganized.
 Avoids, dislikes tasks that require sustained
mental effort.
 Loses things necessary for tasks or activities.

2023-2024
 MAJOR DEPRESSIVE DISORDER
(MDD)
 Lifetime prevalence: 12% worldwide
 Onset at any age, but the age of onset peaks in the
20s
 1.5–2 times as prevalent in women than men during
reproductive years
 Depression can ↑mortality for patients with other
comorbidities such as diabetes, stroke, and
cardiovascular disease.

2019-2020
 Hyperactivity / Impulsivity
 Fidgets, squirms in seat.
 Leaves seat when expected to remain seated.
 Runs and climbs excessively.
 Cannot play quietly .
 “On the go”, driven by a motor.
 Talks excessively.
 Blurts out answers before questions completed.
 Difficulty awaiting turn.
 Interrupts/intrude.

2023-2024
 Subtypes
 Combined Type: 6 or more symptoms of
inattention and 6 or more symptoms of
hyperactivity-impulsivity.

 Predominantly Inattentive Type: 6 or more

symptoms of inattention.

 Predominantly Hyperactive-Impulsive Type: 6

or more symptoms of hyperactivity-
impulsivity.

2023-2024
 For older adolescents (>17 yr) or
adults, 5 symptoms required,
symptoms persist for > 6 months.
 Onset before age 12.
 Symptoms present in at least two
settings (i.e. Home, school, work).
 Interferes with academic, family, and
social functioning.

2023-2024
 Treatment

Non-pharmacological:

 Parent management.
 Anger control strategies.
 Positive reinforcement.
 Social skills training.
 Individual/family therapy.
 Classroom intervention.
 Exercise routines, extracurricular activities.
2023-2024
 Pharmacological trearment:
Standard treatment
 Stimulants: methylphenidates,
Amphetamines (dextroamphetamine, mixed
amphetamine salts, lisdexamfetamine.
 Non stimulant medications: atomoxetine.

For comorbid symptoms

Antidepressants, antipsychotics.

2023-2024
 Prognosis
 65% continue into adulthood; secondary
personality disorders and compensatory
anxiety disorders are identifiable.

 70-80% continue into adolescence, but

hyperactive symptoms usually abate.

2023-2024
2023-2024
 ILOS

 Definition
 Etiology
 Clinical picture
 DSM 5 Criteria
 Diagnosis
 Comorbidity
 Differential diagnosis
 Treatment

2023-2024
 Definition

Heterogeneous group of neurodevelopmental

syndromes, with polygenic heritability,
characterized by a wide range of impairments
in social communication and restricted and
repetitive behaviors.

2019-2020
 Epidemiology
 Prevalence: approximately 1%.
 M: F = 3-4:1.

2023-2024
 Etiology
 No definite cause is identified:
 May be genetic in origin.
 Changes in 5-HT regulation.
 Immunological incompatibility (i.e., maternal
antibodies directed at the fetus).
 Advanced maternal and paternal age at
birth, maternal gestational bleeding, and
gestational diabetes.
 Obstetric complications.

2023-2024
 Diagnosis
Persistent deficits in social communication and
interaction manifested in three areas

 Social-emotional reciprocity.
 Nonverbal communicative behaviors.
 Developing, maintaining and understanding
relationships.

2023-2024
Restricted, repetitive patterns of behavior,
interests, or activities. Two or more of:

 Stereotyped, Repetitive motor movements.

 Insistence on sameness.
 Highly restricted fixated interests.
 Hyper/ hypo-reactivity to sensory input.

2023-2024
 With or without accompanying language
impairment

 With or without accompanying intellectual

impairment.

2023-2024
 Management

 Hearing test to rule out impairment.

 Psychological testing to assess intellectual
functioning and learning IQ
 Chromosomal analysis to rule out
abnormalities (e.g. Trisomy 21, Fragile X
syndrome).
 Rule out psychotic disorders, social
problems, depression, anxiety, abuse.

2023-2024
 Team-based: school, psychologist,
occupational therapist, physiotherapist,
speech and language therapy, audiology and
psychiatrist.
 Family education and support.
 Treat concomitant disorders such as tics,
OCD, anxiety, depression, and seizure
disorder.
 Behavior management, school programming.
2023-2024
 pharmacotherapy

 Atypical antipsychotics (for aggression,

agitation, self-mutilation, tics).
 low-dose atypical antipsychotic medications (e.g.,
risperidone, aripiprazole) may help reduce
disruptive behavior, aggression, and irritability.
 SSRIs (for anxiety, depression).
 Stimulants (for associated inattention and
hyperactivity).

2019-2020
 Intellectual disability

Disability characterized by significant limitations in

both
 Intellectual functioning
 Adaptive behavior Disability
characterized by significant limitations in both
Emerges before the age of 18

2019-2020
 RISK FACTORS/ETIOLOG
Genetic
 Down syndrome: Trisomy 21 (1/700 live births) ,
 Fragile X syndrome: Involves mutation of X chromosome, second
most common cause of intellectual disability, M > F
 Others: Phenylketonuria, familial mental retardation, Prader-
Willi syndrome, Williams syndrome, Angelman syndrome,
tuberous sclerosis
Prenatal Infection and toxins (TORCH):Toxoplasmosis , Other
(syphilis, AIDS, alcohol/illicit drugs) Rubella (German measles)
■Cytomegalovirus (CMV) Herpes simplex
Perinatal Anoxia, prematurity, birth trauma, meningitis,
hyperbilirubinemia
Postnatal Hypothyroidism, malnutrition, toxin exposure, trauma,
psychosocial cause 2019-2020
 Epidemiology

 Prevalence : 1% of the population

 Males > Females
 Physical Examination :
Evidence of underlying disorder or injury

2019-2020
 A standardized intellectual test:
 The Stanford-Binet

2019-2020
 Severity levels of intellectual
disability
Mild I.D. (I.Q.= 56- 70
 Attain academic skills to approximately the sixth-
grade level
 Live independently in the community or with
minimal supervision
 Have problems with impulse control and self-
esteem
 Associated with conduct disorders, substance-
related disorders & ADHD

2019-2020
 Moderate I.D. (I.Q.= 46- 55)

 Attain academic skills to a second-grade level

 Manage activities of daily living under supervision
in residential community settings
 Have significant problems conforming to social
norm

2019-2020
 Severe (I.Q.= 35- 45) & Profound I.D.
(I.Q.= <35)

 Limited abilities to manage self-care

 requires highly supervised care setting

2019-2020
 treatment

 Primary prevention
 Special education & Behavioral guidance
 Pharmacological treatment

2019-2020
 Specific learning disorder

DIAGNOSIS AND DSM-5 CRITERIA:

 Characterized by delayed cognitive development in a particular
academic
 Significantly impaired academic skills which are below
expectation for chronological age and interfere with academics,
occupation, or activities of daily living (ADLs).
 Begins during school but may become more impairing as
demands increase.
 Affected areas: Reading (e.g., dyslexia), writing (e.g.,
dysgraphia), or arithmetic (e.g., dyscalculia).
 Not better accounted for by intellectual disabilities,
visual/auditory deficits, language barriers, or subpar education

2019-2020
 Treatment

 Systematic, individualized education tailored to

child’s specific needs.
• Behavioral techniques may be used to improve
learning skills.

2019-2020
 Communication disorder

 Language disorder :Difficulty acquiring and using

language due to expressive and/or receptive
impairment (e.g., reduced vocabulary).
 Speech sound disorder (phonological disorder):
Difficulty producing articulate, intelligible speech.
Childhood-onset fluency disorder (stuttering)
Dysfluency and speech motor production issues.
 Social (pragmatic) communication disorder:
Challenges with the social use of verbal and
nonverbal communication
2019-2020
 Treatment

 Speech and language therapy

 family counseling.
 Tailor educational supports to meet the individual’s
needs

2019-2020
2019-2020