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OT IN PEDIA
NEURODEVELOPMENTAL, GENETIC, DISRUPTIVE, IMPULSE CONTROL, & CONDUCT DISORDERS
| Term | Definition 1 | Definition 2 |
|---|---|---|
| Global | = Encompasses all functional areas of the child. It includes intellectual & motor capacities and adaptive functioning. They have a deficit in ALL these areas. | |
| GLOBAL DEVELOPMENTAL DELAY | ● This diagnosis is reserved for individuals under the age of 5 years when the clinical severity level cannot be reliably assessed during early childhood. ● This category requires reassessment after a period of time. | ● This category is diagnosed when an individual fails to meet expected developmental milestones in several areas of intellectual functioning, and applies to individuals who are unable to undergo systematic assessments of intellectual functioning |
| categorized in the Global Developmental Delay Sphere. | If the individual doesn’t meet what is needed in the standardized test or minimal requirements to be diagnosed with a condition | |
| DEVELOPMENTAL COORDINATION DISORDER | ● Neurodevelopmental disorder in which a child’s fine and/or gross motor coordination is slower, less accurate, and more variable than in peers of the same age. | ● Affecting about 5 to 6 percent of school-age children, 50 percent of children with developmental coordination disorder also have comorbid attention-deficit/hyperactivity disorder (ADHD) or dyslexia. |
| DEVELOPMENTAL COORDINATION DISORDER EPIDEMIOLOGY | ● The prevalence is about 5 to 6 percent of school-age children. ● Males>Females | |
| DEVELOPMENTAL COORDINATION DISORDER COMORBID | ● Developmental coordination disorder is strongly associated with: ○ ADHD ○ Specific Learning Disorder (reading) /dyslexia ○ Language Disorder | |
| DEVELOPMENTAL COORDINATION DISORDER ETIOLOGY | ● Multifactorial ● Genetic ● Developmental | |
| Multifactorial | – not purely a single thought/reason; not solely responsible for its development | |
| Genetic | – parents; might increase in the risk of the disorder | |
| CLINICAL FEATURES - GROSS MOTOR MANIFESTATIONS ● PRESCHOOL AGE | ● Delays in reaching motor milestones, such as sitting, crawling, and walking ● Balance problems: falling, getting bruised frequently, poor toddling ● Abnormal gait ● Knocking over objects, bumping into things, destructiveness | |
| CLINICAL FEATURES - GROSS MOTOR MANIFESTATIONS ● PRIMARY SCHOOL AGE | ● Difficulty with riding bikes, skipping, hopping, running, jumping, doing somersaults ● Awkward or abnormal gait | |
| CLINICAL FEATURES - GROSS MOTOR MANIFESTATIONS ● OLDER | ● Poor at sports, throwing, catching, kicking, hitting a ball | |
| CLINICAL FEATURES - FINE MOTOR MANIFESTATIONS ● PRESCHOOL AGE | ● Difficulty learning dressing skills (tying, fastening, zipping, buttoning) ● Difficulty learning feeding skills (handling knife, fork, spoon) | |
| CLINICAL FEATURES - FINE MOTOR MANIFESTATIONS ● PRIMARY SCHOOL AGE | ● Difficulty assembling jigsaw pieces, using scissors, building w/ blocks, drawing, tracing | |
| CLINICAL FEATURES - FINE MOTOR MANIFESTATIONS ● OLDER | ● Difficulty with grooming (putting on makeup, blow-drying hair, and doing nails) ● Messy or illegible writing ● Difficulty using hand tools, sewing, and playing piano | |
| In autism spectrum disorder and intellectual disability: | coordination usually does not stand out as a significant deficit compared with other skills. | |
| coordination | it is more pronounced in a developmental coordination disorder than in ASD and ID | |
| Children with neuromuscular disorders (Cerebral Palsy & Muscular Dystrophy) | may exhibit more global muscle impairment rather than clumsiness and delayed motor milestones. Neurological examination and workup usually reveal more extensive deficits in neurological conditions than in developmental coordination disorder. | |
| Extremely hyperactive and impulsive children | may be physically careless because of their high levels of motor activity. Clumsy gross and fine motor behavior and ADHD as well as reading difficulties are highly associated. | |
| Chromosome: 5 | Known as: Cri Du Chat Syndrome | Description: ● Missing genes on chromosome 5 ● High-pitched, cat-like cry ● ID & communication difficulties ● Feeding problems, stereotypical movements and self-injurious behaviors |
| Chromosome: 13 | Known as: Patau Syndrome | Description: ● Three copies of chromosome 13 ● Low birth weight, facial features, microcephaly, holoprosencephaly, microph-o or anophthalmia: deafness, ear malformations; internal organ issues |
| Chromosome: 15 | Known as: Prader-Willi Syndrome | Description: ● Defect on chromosome 15 ● Poor food intake (birth) to hyperphagia ● ID, Behavioral concerns, impulsive, aggressive, disruptive behaviors (secondary to wanting to eat all the time but when stopped or access to food is lessen) |
| Chromosome: 15 | Known as: Angelman Syndrome | Description: ● Loss of gene located in chromosome 15 ● Epilepsy, microcephaly, gait balance issues; sleep problems ● ID |
| Chromosome: 18 | Known as: Edwards Syndrome | Description: ● Three copies of chromosome 18 ● Hypotonia, ID, overlapping fingers, clubfeet, small physical size ● Weak cry and response to sound internal organ issues |
| Microcephaly | – small head size | |
| Holoprosencephaly | – insufficient division of the lobes of cerebral hemisphere | |
| Microph-o | – one of your eyes are small | |
| Anophthalmia | – absence of one eye or both eyes | |
| hyperphagia | excessive eating which causes the increase in weight and often leads to obesity | |
| DISRUPTIVE, IMPULSE CONTROL, & CONDUCT DISORDERS | ● Similar to where ADHD is also categorized | |
| OPPOSITIONAL DEFIANT DISORDER (ODD) | ● Oppositional patterns and aggressive behaviors ● At least 4 symptoms (DSM5) within a 6-month pattern ● Negativistic, disobedient and hostile behaviour toward authority figures | ● Inability to take responsibility for mistakes (blaming others) ● Often argues and is easily annoyed (towards rules, correction, processing of situations) ● NO physical aggression or significantly destructive behavior |
| OPPOSITIONAL DEFIANT DISORDER (ODD) 3 types: | (1) Angry/Irritable, (2) Argumentative/Defiant Behavior, (3) Vindictiveness | |
| ODD EPIDEMIOLOGY | ● Can begin as early as 3 years old ● Typically noted of by 8 years old and usually not later than early adolescence ● Boys > Girls (before puberty) ● Boys = Girls (after puberty) | |
| ODD ETIOLOGY | ● Can be multifactorial ● 18-24 months (Terrible Twos) ● Irritability (predictive of later psychiatric disorders) ● Parents as models | |
| ODD DIAGNOSIS & CLINICAL FEATURES | ● Symptoms are most evident in interactions with adults or peers whom the child knows well | |
| ODD PATHOLOGY AND LABORATORY EXAM | ● No specific laboratory tests or pathological findings ● Most likely through interactions, situations, or reports from authorities, parents, or peers. | |
| ODD DIFFERENTIAL DIAGNOSIS | ● Normative negativism ● Disruptive Mood Dysregulation Disorder ● Adjustment Disorder ● Conduct Disorder, Schizophrenia, Mood Disorder | |
| Normative negativism | ○ People who are always ‘normally’ making negative things/remarks | |
| Disruptive Mood Dysregulation Disorder | ○ Psychiatric disorder | |
| Adjustment Disorder | ○ In specific period of time there is a normal adjustment to different situations, but can become pathological later on when exceeding a period of time | |
| Conduct Disorder, Schizophrenia, Mood Disorder | ○ Similarities in the way the changes in mood and manifests in behavior – difference in time frame and age | |
| ODD COURSE | depends on severity of child symptoms and ability of child to develop more adaptive responses to authority | |
| ODD PROGNOSIS | Intact families (+); depends on family functioning and development of comorbid psychopathology | |
| ODD TREATMENT | ● Family intervention ● Cognitive behavioral therapy (CBT) ● Psychotherapy (role-playing) | |
| Cognitive behavioral therapy (CBT) | Look into the thoughts of the child and how the ‘negative,’ intrusive’,’ opposition’ to norms would be corrected and let the child understand how to really respond behaviorally to the different situations | |
| Psychotherapy (role-playing) | ○ Utilized in order to understand the root causes of the behavior and to process the current responses of the child are socially appropriate if they follow social norms, and how much this behavior affects themselves and people around them | ○ Equips the child to respond to situations wherein the child will be taught social interaction, skills, and learning to promote good behavior and responses to authority. |
| CONDUCT DISORDER (CD) | ● Violating the basic rights of others ● 3 persistent specific behaviors of 15 conduct disorder symptoms ● At least one of them present in the past 6 months | ● May be diagnosed with a person older than 18 year old only if the criteria for antisocial personality disorder aren’t met ● “With limited prosocial emotions” ● Harm to self and others ● CD is more severe and expanded than ODD |
| antisocial personality disorder | Aged 18 yrs | |
| CONDUCT DISORDER (CD) 3 subtypes based on age of onset of disorder: | ○ Childhood-onset (1 symptom before 10) ○ Adolescent-onset type (after age 10) ○ Unspecified-onset (age of onset is unknown) | |
| CONDUCT DISORDER (CD) DAFT | ● Destruction of property ● Aggression to people and animals ● Frequency of serious violations of rules ● Theft or deceitfulness | |
| CD EPIDEMIOLOGY | ● Males > Females (4:1; 12:1) ● Greater frequency in children of parents with antisocial PD and alcohol dependence ● Socioeconomic factors ● Parental psychopathology | |
| CD Risk Factors | impulsivity, physical or sexual abuse or neglect, poor parental supervision and harsh and punitive parental discipline, low IQ and poor social achievement | |
| CD ETIOLOGY | ● Parental factors ● Genetic factors ● Sociocultural factors ● Psychological factors ● Neurobiological factors ● Child abuse and maltreatment ● Comorbid factors | |
| CD DIAGNOSIS & CLINICAL FEATURES | ● Time and frequency ● Age of onset younger in boys (10-12 years old) than girls (14-16 years old) ● Violent video games and violent behavior | |
| CD PATHOLOGY AND LABORATORY EXAM | ● No specific laboratory test or neurological pathology to make diagnosis conduct disorder ● Low serotonin levels | |
| CD DIFFERENTIAL DIAGNOSIS | ● Childhood psychiatric disorders (ADHD, ODD, DMDD, MD, major depression, BD, SLD, Psychotic disorders) ● History and chronology of symptoms | |
| CD COURSE AND PROGNOSIS | Guarded (symptoms present at a young age, greatest number of symptoms, most severe, frequent expression) | |
| CD TREATMENT | ● Psychosocial interventions ● Psychopharmacological interventions |
Created by:
avemaria