developmental disabilities and pervasive developmental disorders
DESCRIPTION
Developmental Disabilities and Pervasive Developmental disorders. Dr. Sophia Hrycko April 15, 2010. Objectives. To review Developmental Disabilities To review Pervasive Developmental Disorders To discuss comorbidity and treatment options. Developmental Disability. - PowerPoint PPT PresentationTRANSCRIPT
Developmental Disabilities and Pervasive Developmental disorders
Dr. Sophia HryckoApril 15, 2010
Objectives
To review Developmental Disabilities
To review Pervasive Developmental Disorders
To discuss comorbidity and treatment options
Developmental Disability
Often diagnosed in infancy Mental retardation is the result of a
pathological process in the brain characterized by limitations in intellectual and adaptive function.
Areas of function affected: communication, self-care, independence, functional/academic skills, work, health, leisure, safety
DSM-IV-TR
Mental retardation requires intellectual deficits (IQ measured by standardized test) and deficit in adaptive function (use of measure with deficits in at least two areas of deficits, Vineland Adaptive Behavior Scale: communications, daily living skills, socialization and motor skills)
Manifested before age of 18
TABLE 21–3. Clinical features of mental retardation
Source. Reprinted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000. Used with permission.
#1
DSM-IV-TR lists the prevalence of mental retardation in the US as A. 1 % B. 3% C. 5% D. 6% E. None of the above
#1A
DSM-IV-TR lists the prevalence of mental retardation in the US as A. 1 % B. 3% C. 5% D. 6% E. None of the above
#2
When IQ is used as the sole criterion for mental retardation, the prevalence rate is estimated to be: A. 0.5 % B. 1% C. 2 % D. 3% E. 10%
#2A
When IQ is used as the sole criterion for mental retardation, the prevalence rate is estimated to be: A. 0.5 % B. 1% C. 2 % D. 3% E. 10%
Epidemiology
About 1 % of the population. 1.5 time more common in men High mortality rates with severe or
profound MR because of complications associated with physical disorders.
Etiology
Genetic Down syndrome Fragile X Prader-Willi syndrome PKU Neurofibromatosis Tuberous sclerosis
Developmental/Acquired Environmental/social
#3
Moderate Mental retardation A. Reflects an IQ range of 25 to 40 B. Is seen in approximately 3 to 4 % of
persons with mental retardation C. Has an identifiable organic etiology
in the vast majority of cases D. Usually is associated with the ability
to achieve academic skills at the second to 3rd grade level
E. All of the above
#3A
Moderate Mental retardation A. Reflects an IQ range of 25 to 40 B. Is seen in approximately 3 to 4 % of
persons with mental retardation C. Has an identifiable organic etiology
in the vast majority of cases D. Usually is associated with the
ability to achieve academic skills at the second to 3rd grade level
E. All of the above
Acquired/developmental
Prenatal: rubella, CMV, Syphilis, Toxoplasmosis, Herpes, AIDS, fetal alcohol syndrome
Complications of pregnancy Perinatal Infection, head trauma, etc.
#4
A. Adrenoleukodystrophy
B. Rett’s disorder C. Acquired immune
deficiency syndrome AIDS
D. Rubella E. Cytomegalic virus
CMV F. Toxoplasmosis
Mental retardation with periventricular intracerebral calcifications, jaundice, microcephaly and hepatosplenomegaly
Progressive encephalopathy and MR in 50% of children born to mother with this disorder
An X-linked MR syndrome that is degenerative and affects only females
Diffulse demyelination of cerebral cortex leading to visual and intellectual impairment, seizures, and spasticity, and adrenocortical insufficiency
MR, microcephay, microphthalmia, congenital heart disease, deafness, cataracts
#4A
A. Adrenoleukodystrophy
B. Rett’s disorder C. Acquired immune
deficiency syndrome AIDS
D. Rubella E. Cytomegalic virus
CMV F. Toxoplasmosis (MR,
diffuse intracerebral calcifications, hydrocephalus, seizures and chorioretinitis
Mental retardation with periventricular intracerebral calcifications, jaundice, microcephaly and hepatosplenomegaly E
Progressive encephalopathy and MR in 50% of children born to mother with this disorder C
An X-linked MR syndrome that is degenerative and affects only females B
Diffulse demyelination of cerebral cortex leading to visual and intellectual impairment, seizures, and spasticity, and adrenocortical insufficiency A
MR, microcephaly, microphthalmia, congenital heart disease, deafness, cataracts D
Comorbidity
Up to 2/3 of individuals with MR have comorbid mental disorders.
The more severe the MR, the higher the risk for other mental disorders.
Disruptive and conduct-disorder behaviors are more frequent in Mild MR
Autistic disorder more common with severely retarded individuals.
#5
Common manifestations of anxiety in persons with mental retardation include A. Aggression B. Agitation C. Repetitive behaviors D. Self-injury E. All of the above
#5A
Common manifestations of anxiety in persons with mental retardation include A. Aggression B. Agitation C. Repetitive behaviors D. Self-injury E. All of the above
Evaluation
Complete history and physical exam Will need to evaluate Intellectual
function (WISC or WPPSI) and Adaptive function (Vineland Adaptive Behavior Scale)
Sensory screening ( speech, hearing) Laboratory studies:
Genetic testing, metabolic testing, thyroid/lead screening, imaging
Practice Parameters: Evaluation of child with Global Develop. Delay
Metabolic screening NOT indicated in initial evaluation (yield 1%)
Routine cytogenetic studies and molecular testing for FRA X mutation recommended (yield 3.5-10%)
Consider Rett syndrome in girls with unexplained moderate to severe delay
Serum lead when identifiable risk EEG NOT recommended initially unless features of
epilepsy Imaging with MRI > CT if physical findings Shevell et al Neurology 2003 60: 367-380
Down Syndrome
Trisomy 21, 95% nondisjunction 1 in 1000 live births 1 in 80 at 40 yrs Hypotonia, upward slanted
palpebral fissures, midface depression, flat wide nasal bridge, simian crease, short stature, increased incidence of thyroid anomaly and congenital heart disease.
Passive, affable 25% ADHD Verbal processing > auditory
processing Increased risk of depression
and dementia as adult
Down syndrome. Note depressed nasal bridge, epicanthal folds, mongoloid slant of eyes, low-set ears, and large tongue.
Fragile X Mutation of the FMRI
gene at Xq27.3. Full mutation: CGG trinucleotide repeat > 200 to 230 repeats
Prevalence 1/1000 male births and 1/3000 female birth
Second most known cause of MR of genetic origin (10-12% MR in men)
long face, large ears, midface hypoplasia, arched palate
Fragile X
Macroorchidism Short stature, strabismus, joint
laxity ADHD, anxiety, speech/language
delays, shyness, irritability, stereotypies. LD in some female.
Male: moderate to severe MR Female: mild MR
#6
Fragile X syndrome A. Has a phenotype that includes
postpubertal microorchidism B. Affects only males C. Usually causes severe to profound
MR D. Has a phenotype that includes large
head and large ears. E. All of the above.
#6A
Fragile X syndrome A. Has a phenotype that includes
postpubertal microorchidism B. Affects only males C. Usually causes severe to profound
MR D. Has a phenotype that includes
large head and large ears. E. All of the above.
#7
Which of the following disorders is least often associated with Fragile X syndrome: A. Autistic disorder B. Schizotypal personality disorder C. Attention deficit/hyperactivity
disorder D. Bipolar disorder E. Social anxiety disorder
#7A
Which of the following disorders is least often associated with Fragile X syndrome: A. Autistic disorder B. Schizotypal personality disorder C. Attention deficit/hyperactivity
disorder D. Bipolar disorder E. Social anxiety disorder
Praeder-Willi Syndrome Deletion on long arm of
chr. 15q11-15q13 (70% paternal, rest maternal uniparental disomy)
1 in 15 000 birth Hyperphagia Obesity Small hands/feet Short stature Microorchidism Fair hair/light skin Almond shaped eyes
Praeder-Willi Syndrome
Obsessions and compulsions
High rates of behavior problems: aggression, temper tantrums, emotional lability, daytime sleepiness
Increased risk for OCD, affective and impulse control disorders.
Phenylketonuria
Autosomal Recessive defect in phenylalanine hydroxylase 12q.24.1 or cofactor 11q22.3-q23.3
Cause accumulation of phenylalanine if untreated and will result in MR (mild to profound), microcephaly, delayed speech, seizures and behavior problems (self-injury, hyperactivity)
Prevalence 1/12 000 Fair skin, blue eyes, blond hair
Tuberous Sclerosis
Autosomal Dominant Mutation in TSC1 gene (hamartin)
9q34 or the TSC2 tumor suppressor gene (tuberin) 16p13
Prevalence 1/6 000 Spectrum of MR, none (30%) to
profound Epilepsy, autism, hyperactivity,
impulsivity, aggression, self-injurious behaviors, sleep problems
Tuberous Sclerosis
Figure 589-2 Tuberous sclerosis. A, CT scan with subependymal calcifications characteristic of tuberous sclerosis. B, The MRI demonstrates multiple subependymal nodules in the same patient (black arrow). Parenchymal tubers are also visible on both the CT and the MRI scan as low-density areas in the brain parenchyma.
Neurofibromatosis type 1
Autosomal dominant 17q11.2 Prevalence 1/3 000 (NF2 1/33 000, 22q) Café au lait spots Neurofibromas Short stature and
macrocephaly in 30- 45%
10 % with moderate to profound MR
ADHD, anxiety, mood problems
Fetal Alcohol Syndrome
Fetal Alcohol Syndrome
Most common preventable cause of MR
1/3 000 live birth Microcephaly, short
stature, midface hypoplasia, short palpebral fissure
Thin upper lip, micrognatia, hypoplastic long/smooth philtrum
Mild to moderate MR, irritability, memory impairment
#8
A. Prader-Willi syndrome
B. Down’s syndrome
C. Fragile X syndrome
D. Phenylketonuria
Attributed to a deletion in chromosome 15
Most commonly occurs via autosomal recessive transmission
Abnormalities involving chromosome 21
Occurs via a chromosomal mutation at Xq27.3
Example of a genomic imprinting
#8A
A. Prader-Willi syndrome
B. Down’s syndrome
C. Fragile X syndrome
D. Phenylketonuria
Attributed to a deletion in chromosome 15 A
Most commonly occurs via autosomal recessive transmission D
Abnormalities involving chromosome 21 B
Occurs via a chromosomal mutation at Xq27.3 C
Example of a genomic imprinting A
Pervasive Developmental disorders
Autistic Disorder Rett’s Disorder Childhood Disintegrative Disorder Asperger’s Disorder Pervasive Developmental disorder
NOS
Autistic Disorder
Diagnostic Features 3 main sets of behavioral characteristics:’
- Social abnormality - Language abnormality - Stereotyped repetitive pattern of behavior
Age of onset: prior to age 3 Male/Female = 4/1 Prevalence: 9.5 / 10 000 (range 2.3 to
30.8/ 10 000)
Autistic Disorder
Course: variable, strongest predictive factors for adult outcome are IQ (below 70 is strongly indicative of poor social adjustment) and the level of language functioning at age 5
Etiology: unknown, evidence of strong genetic component; abnormal serotonergic activity, hyperdopaminergic activity
Diagnostic Criteria Qualitative impairment in Social Interaction Impairment in the use of multiple nonverbal
behaviors: eye to eye gaze, facial expression, body postures and gestures to regulate social interaction
Failure to develop peer relationships appropriate to developmental level
Lack of spontaneous seeking to share enjoyment, interests or achievements with other people (not showing, bringing or pointing out objects of interests)
Absence of social or emotional reciprocity
Cont. Qualitative impairment in
Communication Delay in or total lack of, development of
spoken language (no attempt to compensate with gestures or mime)
If speech present, marked impairment in the ability to initial or sustain conversation with others
Stereotyped and repetitive use of language or idiosyncratic language
Lack of varied, spontaneous make-believe play or social imitative play appropriate to develop. level
Cont. Restricted repetitive and
stereotyped patterns of behavior, interest and activities Encompassing preoccupation with one or more
stereotyped and restricted patterns of interest that is abnormal either in intensity or in focus
Inflexible adherence to specific, nonfunctional routines or rituals
Stereotyped and repetitive motor mannerisms: hand or finger flapping or twisting, complex whole-body movements
Persistent preoccupation with parts of objects
Consider Evaluation if by:
12 months: No babbling or gesturing (pointing, waving bye-bye)
16 months: No single words 24 months: No spontaneous 2 word
phrases (i.e. not just echolalia or repeating someone else’s words)
Any age: any loss of any language or social skills
Consider Evaluation if
Especially when combined with language delays: Abnormal eye contact Aloofness Not responding to one’s name Not using gestures to point or show Lack of interactive play Lack of interest in other children
#9
Which of the following features does not distinguish autistic disorder from mixed receptive-expressive language disorder? A. Echolalia B. Stereotypies C. Imaginative play D. Associated deafness E. Family history of speech delay
#9A
Which of the following features does not distinguish autistic disorder from mixed receptive-expressive language disorder? A. Echolalia B. Stereotypies C. Imaginative play D. Associated deafness E. Family history of speech delay
(25% for both autistic and language disorders)
#10
Neurological-biochemical anomalies associated with autistic disorder include A. Grand mal seizures B. Ventricular enlargement on CT scan C. EEG abnormalities D. Increased brain volume E. All of the above
#10A
Neurological-biochemical anomalies associated with autistic disorder include A. Grand mal seizures (4 to 32 %) B. Ventricular enlargement on CT scan
(20 to 25%) C. EEG abnormalities D. Increased brain volume (cerebellum,
frontal lobe and limbic system) E. All of the above
Autistic Disorder Associated Features
IQ below 70 for 75% of autistics Uneven cognitive skills Level of receptive language below
expressive language Behavioral symptoms: hyperactivity,
impulsivity, aggressiveness, self-injurious behavior (head banging, finger/hand/wrist biting), temper tantrums
Abnormal mood (giggling or weeping) Lack of fear
Autistic Disorder Associated Findings
Abnormal Imaging Studies: underactivation of fusiform gyrus, abnormality in the medial temporal lobe, increase in brain size in some
EEG abnormalities: varied, non-specific Non-specific neurological symptoms:
primitive reflexes, delayed hand dominance Medical conditions associated with Autism:
encephalitis, neurofibromatosis, PKU untreated, tuberous sclerosis, fragile X, anoxia, maternal rubella
Epilepsy in 10 – 35%
Temple Grandin
A narrow fixation, with assistance can be broadened into a career (tuning piano, reshelving books, computer programming, etc.)
Recognize the social limitations and protect from situations beyond their capacity
Visual thinking: “all my thinking is in pictures”, abstract concept are represented by pictures.
ex. Word over, video of a dog, boat Sensory problems
#11
True statements about autistic disorder include which of the following? A. Girls outnumber boys in individuals with
autism without mental retardation B. There is an established and conclusive
association between autism and upper socioeconomic status.
C. Prevalence rates amy be as high as 1 in 1000 children.
D. Abnormalities in functioning must be present by age 2 to meet DSM-IV-TR diagnostic criteria.
E. All of the above.
#11A
True statements about autistic disorder include which of the following? A. Girls outnumber boys in individuals with
autism without mental retardation (MR 75%) (boy: girls 4-5:1)
B. There is an established and conclusive association between autism and upper socioeconomic status.
C. Prevalence rates may be as high as 1 in 1000 children.
D. Abnormalities in functioning must be present by age 2 to meet DSM-IV-TR diagnostic criteria.
E. All of the above.
#12
True statements about the role of genetics in autistic disorder include which of the following:
A. Twin studies indicate only moderate concordance for monozygotes.
B. Family studies show a prevalence of approximately 2 to 3% of autism among siblings of children with autism.
C. Unaffected siblings are not at increased risk for language problems.
D. It is clear that what is inherited is a specific predisposition to autistic disorder.
E. The role of genetic factors in autistic disorder is not well established.
#12A
True statements about the role of genetics in autistic disorder include which of the following:
A. Twin studies indicate only moderate concordance for monozygotes. (high, not moderate)
B. Family studies show a prevalence of approximately 2 to 3% of autism among siblings of children with autism.
C. Unaffected siblings are not at increased risk for language problems. (elevated rates of cognitive disorders in non-autistic twin)
D. It is clear that what is inherited is a specific predisposition to autistic disorder.
E. The role of genetic factors in autistic disorder is not well established.
Rett’s Disorder (Andreas Rett 1966)
All of the following are required: 1. Apparently normal prenatal and
perinatal development 2. Apparently normal psychomotor
development through the first 5 months after birth
3. Normal head circumference at birth
Rett’s Disorder cont.
Onset of all of the following after the period of normal development: 1. Deceleration of head growth between ages 5
and 48 months 2. Loss of previously acquired purposeful hand
skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (e.g. hand-wringing or hand washing)
3. Loss of social engagement early in the course 4. Appearance of poorly coordinated gait or trunk
movements 5. Severely impaired expressive and receptive
language development with severe psychomotor retardation
Rett’s Disorder cont
Prevalence rate: 1/ 15000 – 22 000 females 26% incidence of sudden and unexpected
death X-linked dominant mutation with lethality in
hemizygous males Mutation in the transcription regulatory gene
MECP2 Stages:
Normal prenatal/perinatal development Period of developmental stagnation Gradual, insidious delay in development,
decelerated head and body growth, lack of interest in the environment, loss of previously acquired skills (purposeful hand movements)
Rett’s Disorder cont
Developmental plateau (school age) Severe MR Seizures Motor problems Breathing difficulties (breath-holding spells, air
swallowing) Bruxism Scoliosis
Final phase Nonambulatory secondary to motor problems,
scoliosis
#13
Rett’s disorder A. Is seen only in boys B. Does not involve motor
abnormalities C. Is associated with normal
intelligence D. Shows no loss of social skills. E. None of the above
#13A
Rett’s disorder A. Is seen only in boys B. Does not involve motor
abnormalities C. Is associated with normal
intelligence D. Shows no loss of social skills. E. None of the above
Childhood Disintegrative Disorder (Heller 1908)
Apparently normal development for at least the first 2 years after birth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play and adaptive behavior
Clinically signif. loss of previously acquired skills (before age 10) in > areas: Expressive or receptive language Social skills or adaptive behavior
Childhood Disintegrative Disorder cont.
Bowel or bladder control Play Motor skills
Abnormalities of functioning in at least 2 areas: Qualitative impairment in social interactions Qualitative impairment in communication Restricted, repetitive and stereotyped patterns
of behavior, interests and activities, including motor stereotypies and mannerisms
Childhood Disintegrative Disorder
Prevalence: 1.7 per 100 000 Presence of a period of normal development
before the onset of the deterioration and loss of skills
Typical age of onset 3 to 4 y old Very rare, strong male predominance Deterioration in self-help and motor skills is
often marked Apparently normal fife expectancy Has been associated with metachromatic
leukodystrophy, Schilder’s leukoencephalopathy
Asperger’s Disorder
Impairment in social interactions Marked impairment in the use of multiple
nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
Failure to develop peer relationships appropriate to developmental level
A lack of spontaneous seeking to share enjoyment, interests or achievements with other people
Lack of social or emotional reciprocity
#14
Asperger’s disorder is characterized by delays in A. Self-help skills B. Curiosity about the environment C. Nonverbal communication D. Receptive language E. None of the above.
#14A
Asperger’s disorder is characterized by delays in A. Self-help skills B. Curiosity about the environment C. Nonverbal communication D. Receptive language E. None of the above.
Asperger’s Disorder
Restricted repetitive and stereotyped patterns of behavior, interests and activities
There is no clinically significant general delay in language
There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interactions) and curiosity about the environment in childhood
Asperger’s Disorder cont.
Prevalence estimated to 1 in 10 000 More prevalent in males than females, ratio
of 9 to 1 Normal language development but their
facial expression, prosody and social gestures are often deficient.
Lack “intuitive knowledge” of how to approach others.
Delayed motor milestones, motor clumsiness Have to learn social skills through their
intellect
Evaluation
History Pregnancy, neonatal and developmental hx,
medical hx, family and psychosocial factors, intervention hx.
Psychiatric examination of the child Medical evaluation
Physical exam, including neurological exam Audiological/visual exam
Psychological evaluation Speech/language/communication assessment OT evaluation
Differential Diagnosis
Various PDDs MR not associated with PDD Specific developmental disorder,
e.g. language Early onset psychosis
Treatment Plan Multimodal Establish goals for educational interventions Establish target symptoms for intervention Prioritize target symptoms and/or co-morbid
conditions Monitor multiple domains of functioning
(behavioral adjustment, adaptive skills, academic skills, social/communicative skills, social interactions)
Monitor pharmacological interventions for efficacy and side-effects.
Potential Targets for Pharmacotherapy
Motor hyperactivity Inattention Repetitive behavior Motor and/or vocal tics Aggression Self-injury
#15
A. Autistic disorder B. Childhood
disintegrative disorder C. Pervasive
developmental disorder NOS
D. Asperger’s Disorder E. Rett’s disorder
- Normal development for the 1st 6mo, followed by a progressive encephalopathy:
A better prognosis than other PDD because of the lack of delay in language and cognitive development
Some but not all the features of autistic disorder
Occurrence at a rate of 2 to 10 per 10 000 and impairment in social interaction, communication (language or symbolic play) before age 3
#15A
A. Autistic disorder B. Childhood
disintegrative disorder C. Pervasive
developmental disorder NOS
D. Asperger’s Disorder E. Rett’s disorder
- Normal development for the 1st 6mo, followed by a progressive encephalopathy: E
A better prognosis than other PDD because of the lack of delay in language and cognitive development: D
Some but not all the features of autistic disorder C
Occurrence at a rate of 2 to 10 per 10 000 and impairment in social interaction, communication (language or symbolic play) before age 3 A
#16
Which of the following chromosomal abnormalities is most likely to cause mental retardation? A. Extra chromosome 21 (trisomy 21) B. Fusion of chromosomes 21 and 15 C. XO Turner’s syndrome D. XXY Kinefelter’s syndrome E. XXYY and XXXY Klinefelter’s
syndrome variants
#16A
Which of the following chromosomal abnormalities is most likely to cause mental retardation? A. Extra chromosome 21 (trisomy
21) B. Fusion of chromosomes 21 and 15 C. XO Turner’s syndrome D. XXY Kinefelter’s syndrome E. XXYY and XXXY Klinefelter’s
syndrome variants
#17
The prognosis of autistic disorder is most accurately described by which of the following statements? A. The prognosis is good if the onset of the illness
is at birth B. The prognosis is good if the child has normal
auditory evoked potentials C. The prognosis is determined by language
development D. The prognosis is bad if either of the child’s
parents has manic-depressive illness E. None of the above
#17A
The prognosis of autistic disorder is most accurately described by which of the following statements? A. The prognosis is good if the onset of the illness
is at birth B. The prognosis is good if the child has normal
auditory evoked potentials C. The prognosis is determined by language
development D. The prognosis is bad if either of the child’s
parents has manic-depressive illness E. None of the above
#18
All of the following statements concerning autistic disorder are true EXCEPT A. Incidence appears to be highest in upper
socioeconomic strata B. It occurs more commonly in boys than in
girls C. It appears to be a neurologically based
syndrome D. Mental retardation may or may not occur E. Grand mal seizures frequently occur
#18A
All of the following statements concerning autistic disorder are true EXCEPT A. Incidence appears to be highest in
upper socioeconomic strata B. It occurs more commonly in boys than in
girls C. It appears to be a neurologically based
syndrome D. Mental retardation may or may not occur E. Grand mal seizures frequently occur
#19
The hallmark feature of autistic spectrum disorder is: A. Delayed expressive language B. Echolalia C. Functional intelligence quotient in
the superior range. D. Inability to relate socially. E. Stereotypy
#19A
The hallmark feature of autistic spectrum disorder is: A. Delayed expressive language B. Echolalia C. Functional intelligence quotient in
the superior range. D. Inability to relate socially. E. Stereotypy
References
http://www.mic.ki.se/Diseases/C16.html http://medgen.genetics.utah.edu/thumbnail
s.htm http://ca.dir.yahoo.com/Health/diseases Fra X: http://www.fraxa.org Handbook of Developmental Disabilities SL
Odom, RH Horner, ME Snell, J Blacher eds. 2007 The Guilford Press
References
Child Adol Psych Clin NA 16 (2007) Fragile X syndrome 663-675 VCFS 677-693 Praeder-Willi 695-708
Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis AE Chudley, J Conry, JL Cook, C Loock, T. Rosales, N LeBlanc CMAJ Mar 1, 2005 172 (5 suppl) S1-S21
References
Volkmar F, Cook et al 1999. Practice parameters for the assessment and treatment of adolescents and adults with autism and other PDD. J. Am. Acad. Child & Adol. Psych. 38 (12 suppl): 32S- 54 S (erratum 2000 39 (7): 938 and 38: 12: 1611- 1615
Mental Retardation: A Review of the Past 10 Years. Part 1. B.H. King et al 1997. J. Am. Acad. Child Adole. Psych. 36:12, 1656- 1663 (1664 – 1671 for part II)
#20
The most frequent presenting complaint of parents about their autistic child is: A. Their lack of interest in social
interaction. B. Their lack of usual play skills. C. Their difficulty tolerating change and
variations in their routines. D. Delays in the acquisition of language. E. Stereotyped movements.
#20A
The most frequent presenting complaint of parents about their autistic child is: A. Their lack of interest in social interaction. B. Their lack of usual play skills. C. Their difficulty tolerating change and
variations in their routines. D. Delays in the acquisition of language. E. Stereotyped movements.
#21
What percentage of autistic individuals exhibits special abilities or splinter skills? A. Less than 1% B. 10 % C. 25 % D. 50 % E. 80 %
#21A
What percentage of autistic individuals exhibits special abilities or splinter skills? A. Less than 1% B. 10 % C. 25 % D. 50 % E. 80 %
#22
A decline in IQ begins at appromixately 10 to 15 years in which of the following disorders? A. Down’s syndrome B. Fragile X syndrome C. Cerebral palsy D. Nonspecific mental retardation E. Fetal alcohol syndrome
#22A
A decline in IQ begins at approximately 10 to 15 years in which of the following disorders? A. Down’s syndrome B. Fragile X syndrome C. Cerebral palsy D. Nonspecific mental retardation E. Fetal alcohol syndrome
#23
The most common inherited cause of mental retardation is A. Down’s syndrome B. Fragile X syndrome C. Fetal alcohol syndrome D. Prader-Willi syndrome E. None of the above
#23A
The most common inherited cause of mental retardation is A. Down’s syndrome (most common
chromosomal abnormality leading to MR) B. Fragile X syndrome (most
common inherited cause of MR) C. Fetal alcohol syndrome D. Prader-Willi syndrome E. None of the above
#24
Mild mental retardation has been associated with A. Nonspecific causes B. Prader-Willi syndrome C. Females with fragile X syndrome D. Poor socioeconomic background E. All of the above
#24A
Mild mental retardation has been associated with A. Nonspecific causes B. Prader-Willi syndrome C. Females with fragile X syndrome D. Poor socioeconomic background E. All of the above