NRNP 6665 Assignment: Study Guide Forum

 

What is ADHD – ADHD is one of the seven listed neurodevelopmental disorders in the DSM-5 manual that describes ongoing inattentive behavior, hyperactive behavior, or the two combined that affects a person’s ability to function in daily life.

The needs of the pediatric patient differ depending on age, as do the stages of development and the expected assessment findings for each stage. In a 500-750-word paper, examine the needs of a school-aged child between the ages of 5 and 12 years old and discuss the following:

1. Compare the physical assessments among school-aged children. Describe how you would modify assessment techniques to match the age and developmental stage of the child.
2. Choose a child between the ages of 5 and 12 years old. Identify the age of the child and describe the typical developmental stages of children that age.
3. Applying developmental theory based on Erickson, Piaget, or Kohlberg, explain how you would developmentally assess the child. Include how you would offer explanations durin

   

   g the assessment, strategies you would use to gain cooperation, and potential findings from the assessment.

What is the DSM-5 Diagnostic Criteria? – A persistent pattern of inattentive, hyperactive-impulsive behavior lasting

at least six months that is inconsistent with developmental stages which impair the child’s individual, social, educational, and work-related functioning in two or more settings. The diagnosis has to entail at least six symptoms (five if 17 or older and present before the age of 12) from the listed inattentive and hyperactive-impulsive behaviors below (American Psychiatric Association, 2013).

Predominantly Inattentive Presentation – Six or more of the following:

failing to pay attention or makes mistakes problem sustaining attention in tasks or play not seeming to listen when spoken to does not follow instructions and does not finish duties has difficulty organizing tasks/activities avoids, dislikes, or is reluctant to participate in activities that require sustained thinking loses things needed for tasks like books, tools, pencils, keys, etc. easily distracted by other stimuli or thoughts forgetful in daily activities

Predominantly Hyperactive-Impulsive Presentation – Six or more of the following:

fidgety with or taps hands or feet/squirms in seat leaves sit when expected to remain runs about or climbs during times they should not unable to play quietly cannot sit still talks a lot unable to wait their turn interrupts other conversations or activities

American Psychiatric Association (2013)

Mnemonic for Hyperactive Symptoms

You’ll need a MOAT around a classroom that has a hyperactive child- Movement excess Organizational Problems Attention Problems Talks Excessively Kadiyala (2020)

 

Incidence of ADHD

Occurs in 5.9 % of youth and 2.5 % of adults

Affects 3%−4% people worldwide, including millions of children

Occurs more often in males

Increases risk of health problems and lower quality of life

Faraone et al. (2021)

 

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Differential Diagnosis

According to the DSM-5, differential diagnosis for ADHD consists of oppositional defiant disorder, intermittent explosive disorder, other neurodevelopmental disorders, learning disorders, intellectual disability, autism, reactive attachment disorder, anxiety, depression, bipolar disorder, disruptive mood dysregulation disorder, substance use disorder, personality disorder, psychotic disorder, medication-induced symptoms of ADHD, or neurocognitive disorder.

Development, Course, and Prognosis of ADHD

ADHD often develops into further comorbid diagnoses with poor long-term outcomes.

Genetics   Is genetic and runs in families Reduces brain volume Slow maturation of cortical mantle Affects overall brain matter and function

Environmental prenatal maternal distress pre-term birth and/or low birth weight environmental toxicants maternal smoking Nigg et al., 2020

Considerations for Culture, Gender, and Age

• Occurs more often in the Caucasian population than on African American and Latino populations.
• Occurs more frequently in males than female with a ratio of 2:1 in children
• Females are more likely to have inattentive features 
• Most often identified in elementary school

• Before the age of four, symptoms are sometimes noticed but difficult to distinguish between normal behavior for toddlers.

(American Psychiatric Association, 2013)

 

Pharmacological Treatment Options

 

Stimulants such as methylphenidate and amphetamine are highly effective in reducing the symptoms of ADHD Methylphenidate has largest benefit to risk ratio for children and amphetamines for adults Non-stimulants such as atomoxetine, guanfacine, and extended-release clonidine can also treat symptoms of ADHD. Faraone et al., 2021

Side Effects Can increase heart rate and blood pressure, decrease appetite, stunt growth in children, insomnia, and worsen emotional lability. ———————————————– Can cause fatigue, sedation, somnolence, mild lowering of  blood pressure and heart rate, mild QTc  prolongation

 

Nonpharmacological Treatment Options

Consist of behavioral and cognitive behavioral therapy, music therapy, psychoeducation, supplements, physical exercise, and a healthy diet Faraone et al., 2021

 

Diagnostics and Labs

Although some differences have been noted in the brains of those with ADHD, no specific testing diagnoses it. There are assessment tools to assist with recognizing symptom criteria that trained mental health providers utilize to diagnose ADHD.

Faraone et al., 2021

 

Comorbidities

Nigg et al., 2020

Disruptive behavior problems: oppositional defiant, aggressive, tantrums/irritable, conduct, antisocial. ADHD: Attention deficit/hyperactivity disorder; ASD: autism spectrum disorders; LD: learning disorders: ID: Intellectual disability; DCC: Developmental coordination disorder and other problems such as obesity and higher rates of unemployment.

Nigg et al., 2020

 

Legal and Ethical Considerations

Stimulant addiction or misuse, consent for treatment, patient confidentiality, polypharmacy, prescribing medications off label, parents choosing to not treat their children, cultural differences, and mental illness-related biases.

Patient Education

Educate patients and families on treatment approaches, signs and symptoms of ADHD, risk factors, etiology,  prognosis, medication adherence, medication side effects, available therapy, and coping skills

Resources

Diagnostic and Statistical Manual of Mental Disorders. [Electronic Resource]: DSM-5 (5th ed.). (2013). American Psychiatric Association.

Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022

Kadiyala, P. K. (2020). Mnemonics for diagnostic criteria of DSM V mental disorders: A scoping review. General Psychiatry, 33(3), e100109. https://doi.org/10.1136/gpsych-2019-100109

Nigg, J. T., Sibley, M. H., Thapar, A., & Karalunas, S. L. (2020). Development of ADHD: Etiology, Heterogeneity, and Early Life Course. Annual Review of Developmental Psychology, 2(1), 559–583. https://doi.org/10.1146/annurev-devpsych-060320-093413

Language Disorder (LD), previously known as expressive and mixed receptive-expressive language disorders in the DSM IV, is ultimately a neurodevelopmental disorder that is often seen in young children and characterized by significant difficulties that affect the written, spoken, and comprehension of language in all the various communication forms (American Psychiatric Association (APA), 2013). The two primary forms of practical and essential communication involve expressive skills; talking and gesturing, while receptive skills involve the comprehension of language; written, verbal, and non-verbal communications (American Psychiatric Association (APA), 2013). Deficits in either of these essential language skills define a language disorder.

• Signs and symptoms according to the DSM-5
  • Reduced vocabulary
  • Limited ability to communicate verbal and written communication
  • Communication abilities are measurably lower compared to developmental level
  • Deficits are not otherwise related to sensory input or other medical issues
  • Speech sound difficulty
  • Prefers to communicate with parents/family only
  • Examples of expressive skill issues: (Schachinger-Lorentzon et al., 2018)
    • Difficulty saying certain words in general and that their parents or strangers understand
      • Includes sounds, single words in sentence structures
    • Word finding issues
    • Quiet or unclear speech, mumbles
    • Various tone issues
    • Conversation issues
      • Staying on point
      • Starting conversation
      • Using gestures
        • Facial expression issues
  • Examples of receptive skill issues: (Schachinger-Lorentzon et al., 2018)
    • Understanding words
    • Understanding concepts
    • Reading non-verbal cues
    • Understanding stories read aloud
    • Understanding one or two-part instructions
• Differential diagnoses (American Psychiatric Association (APA), 2013); (Schachinger-Lorentzon et al., 2018)
  • Autism spectrum disorder (ASD)
  • Intellectual developmental disorder (IDD)
  • Neuropsychiatric disorders, such as schizophrenia or other psychotic disorder
  • Hearing or other sensory deficits
  • Other neurological disorders/diseases, such as brain tumor, hydrocephalus, infection, ischemia, hormone dysregulation, other organic processes
• Incidence
  • 5-6% of the population who are screened for LD screen positive (Schachinger-Lorentzon et al., 2018)
  • May often go undiagnosed or unscreened
• Development and course
  • Early-onset of symptoms, typically by age 2.5-4 years, or late-onset after age 4
    • According to Schachinger-Lorentzon et al. (2018), between 60-72% of children diagnosed with LD also experience comorbid developmental disorders such as ASD, ADHD, and motor, social, reading, and behavioral difficulties
  • Studies show that children with LD have an increased chance of developing social and behavioral issues as they mature compared to children diagnosed with ASD (Yang et al., 2004)
• Prognosis
  • According to the American Psychiatric Association (APA) (2013), children with LD have worse outcomes compared to other receptive or expressive disorders
    • With adequate support and treatment, some studies suggest that clients can achieve quality states closely associated with highly functional ASD, as associated symptoms are similar (Yang et al., 2004)
  • LDs are highly heritable
• Considerations related to culture, gender, age
  • According to Schachinger-Lorentzon et al. (2018), LD is a combination of developmental and environmental influences
  • Early childhood language evaluation should take place at age 2.5-3yrs of age
  • Neurodevelopmental disorders appear to be greater in males at an early age but not enough data exists specifically to LD
• Pharmacological treatments, including any side effects
  • In short, there are no FDA approved drugs for the treatment of language disorders and limited drugs approved to treat the associated symptoms the child may demonstrate that represent behavior changes and other neurodevelopmental comorbidities.
  • Although there are some interesting study’s out there regarding drug studies and their relative improvement on expressive language disorders, they are in the context of ASD and are not yet FDA approved beyond the symptoms associated with behaviors described below
  • Pharmacological treatments include:
    •  SSRI’s such as Prozac to manage mood lability, such as depression or OCD symptoms in children (ages 7+),
      • Potential side effects: HA, GI-N/D, increased SI (rare), anxiety, drowsiness, tremor, insomnia, nervousness, sweating
    • Antipsychotics such as Risperidone to manage irritability and behavior issues in children (ages 5+) with ASD
      • Potential side effects: dizziness, HA, EPS (rare), cough, dreams, GI-constipation/N/D, weight gain, agranulocytosis, rash
    • ADHD medications, such as methylphenidate for children (ages 6+) for comorbid neurodevelopmental diagnosis and associated symptomatology that may be seen in children with LD
      • Potential side effects: growth suppression, anorexia, wt. loss, insomnia, restlessness, anxiety, tremor, irritability, tachycardia, hypertension, dry mouth
• Nonpharmacological treatments
  • Referral to speech-language pathologists (SLP) for developmentally appropriate work to increase comprehension and articulate expression
  • Refer to school-based 504 or similar evaluation and programming for IEP
  • Refer to a behavioral therapist for social, emotional, and behavior modification as needed for both child and parents
• Diagnostics and labs
  • Observations
  • History
  • Screening with standardized assessment tools, such as
  • Children who are suspected of having a neurodevelopmental disorder should be referred for psychological testing
    • Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE) is a concept that highlights and increases screening awareness for comorbid risk factors of children who are suspected or diagnosed with a developmental disorder and the likelihood of other developmental disorders they may have (Schachinger-Lorentzon et al., 2018)
  • Rule out other biological etiologies/biomedical pathologies as suspected with a physical exam and symptom presentation, including brain tumor, sensory deficits, infection, hormone dysregulation, ischemia
    • Brain imaging-MRI/CT
    • Audiometry
    • CBC, CMP, CRP, TSH, EKG, UA
• Comorbidities
  • ASD
  • ADHD
  • IDD
  • Motor
  • Reading
  • Behavioral
  • Social difficulties
• Legal and ethical considerations
  • According to Yang et al. (2004), children with LD do not typically get the same attention and treatment compared to children diagnosed with ASD, yet are just as behaviorally, socially, and cognitively compromised and at risk for developing psychopathology at similar rates and age of high functioning clients with ASD
  • According to your state, the school systems typically have a legal obligation to provide assessment, educational planning, and counseling. Knowing their responsibilities will help decrease redundant work and help you to educate and support the client and family but will not alleviate your responsibility to refer and treat accordingly
• Pertinent patient education considerations
  • Be aware of signs and symptoms of LD, which may include social, behavioral, motor, reading, and other developmental disorders as previously described
  • Set realistic expectations: Testing and treatment planning may include short and long-term management, such as SLP evaluation and treatment, psychopharmacological treatment for behavior, emotional lability, or other neurodevelopmental symptoms, therapy, school placements, and the assessment and implementation of an IEP, specialized training for job skill and social skill development, and residential and community-based housing programs (Yang et al., 2004)

 

References

 

American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®) (5th ed.). American Psychiatric Publishing, Inc.

Schachinger-Lorentzon, U. K. (2018). Children screening positive for language delay at 2.5 years: language disorder and developmental profiles. Neuropsychiatric Disease and Treatment, 14, 3267–3277.

Yang, P. J.-J.-Y.-S. (2004). COMPARATIVE STUDY OF EARLY CHILDHOOD HIGH-FUNCTION AUTISM AND DEVELOPMENTAL MIXED RECEPTIVE-EXPRESSIVE LANGUAGE DISORDER. Kaohsiung Journal of Medical Science, 20(1), 12-16.

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What is a TIC disorder?

The Centers of Disease Control and Prevention define Tic disorders as “twitches, movements, or sounds that people do repeatedly”. People who suffer from tic cannot control themselves from these tics. These repetitive movements or sounds could include excessive blinking or making grunting sounds unwillingly. There are three types of tics that are included in the DSM-5, and they are Tourette’s disorder, persistent motor or vocal tic disorder and provisional tic disorder.

Tourette’s syndrome (TS) is diagnosed by having two or more motor tics and a minimum of one vocal tic. It is possible that they may not happen at the same time. The patient must have had the tics for at least a year, happen several times a day and occur almost everyday on and off. These tics must have occurred before the age of 18 and not have been caused by medications, other drugs or other medical conditions.

Persistent motor or vocal tic disorder are like TS, but this disorder has one or more vocal or motor tics but not both tics. These tics must had happened almost daily or on and off for more than a year and must have had started before the age of 18 and have not been diagnosed with TS.

For a person to be diagnosed with a provisional tic disorder the patient must one or more vocal or motor tics, must have had the tics no longer 12 months, the tics must have had started before the age of 18. The symptoms must have not been caused by medicine, other drugs or diseases like the other two disorders and they must have not been diagnosed with any other tic disorder.

Differential Diagnosis

There are many many symptoms that resemble symptoms of tic disorders. These differential diagnoses include genetic conditions like Huntington’s chorea, metabolic diseases like Wilson’s disease, structural diseases (hemiballismus associated with insult to the subthalamic nucleus) (Swain and Leckman, 2005). Complex motor tics can look like other movements and may be identical to some habitual practices. Vocal tics can assist in ruling out other diagnoses because they are exceptionally rare in other neurological conditions. Huntington’s disease is an exception because of  brief sniffing and vocalizations can occur (Swain and Leckman, 2005).

nce figures do vary between 0.4% and 3.8%. It is more likely for boys to develop chronic tics than girls. The ratio between these groups is around 5:1. TS has an onset usually between the ages of five to ten years old. The average age of the start of symptoms can increase with complexity of symptoms. While simple tics develop in earlier and more complex tics, compulsions and obsessions tend to manifest later (Robertson, 2019).

Around 50% of patients who have developed a tic disorder are free of them by the age of 18 (Robertson, 2019). Tics will peak in mid adolescence and will diminish later. A tic disorder can persist into adulthood but will almost always be diminished (Robertson, 2019).

 

 

 

Development

 

Causes of tics is not totally clear but they are thought to be changes in the brain that control movement. Tics can run in the family so there is likely a genetic component involved. Comorbidities like attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder can exist alongside a tic disorder. A tic can also be triggered by illegal drugs and be caused by health conditions like cerebral palsy or Huntington’s disease (NHS,2019).

 

 

 

 

 

 

 

 

 

 

 

 

People with tic disorders can lead a normal life but mild tics can be distressing such as loud vocalizations and or loud movements can lead to social disabilities by either experiencing substantial criticisms or they withdraw from activities (Robertson, 2019).  Robertson states that facing prejudice in work and school settings are common and that tics can interrupt behavior and thought process. It can hinder time to complete tasks because of interruptions form the tics and some people can lose track of conversations because of tic interruptions (Robertson, 2019).

Sometimes people will injure themselves due to a comorbidity such as depression (suicide attempt). In some complex tics injury can be pseudo intentional. For example, people who have a complex tic that causes them to hit themselves in the head repeatedly can cause unintentional injury. Inadvertent injuries can happen due to complex tics that can trigger impulsivities or inattentiveness.

 

 

 

 

 

 

 

Considerations

Tic disorders do not appear to be different in objective traits, course, or etiology by race, ethnicity, and culture. But, race, ethnicity, and culture may affect how tic disorders are observed and managed by the family and the public, as well as affecting patterns of looking for help, and treatment choices.

Males are usually more affected than females, but there are no gender distinctions in the types of tics, the age which the symptom develop, or course. Women with constant tic disorders may be more susceptible to develop anxiety and depression Lewin et al).

 

 

 

 

 

 

 

 

 

 

 

 

Treatment

According to the Mayo Clinic, medications to assist in controlling tics include medications that block or lessen dopamine such as fluphenazine, haloperidol, risperidone and pimozide. These meds can help control tics. The side effects could include weight gain and involuntary repetitive movements. Tetrabenazine could be prescribed but, the patient would need to be monitored for severe depression. Botulinum (Botox) injections into the impacted muscle may help alleviate a simple or vocal tic. ADHD medications such as methylphenidate (Metadate, Ritalin) and medications having dextroamphetamine (Adderall XR,) can improve attention and concentration. But, for some patients with TS, ADHD medications can make the tics worse. Central adrenergic inhibitors such as clonidine (Catapres) and guanfacine (Intuniv) usually prescribed for hypertension could help manage behavioral symptoms such as impulsivity and rage attacks. These meds could cause sleepiness. Antidepressants like fluoxetine (Prozac, Sarafem) might improve symptoms of sadness, anxiety and OCD. Antiseizure medications like topiramate (Topamax) could help patients with TS Topamax is prescribed to treat epilepsy (Mayo Clinic, 2018).

 

 

Therapy

Cognitive Behavioral Interventions for Tics, this would include habit-reversal training, can assist in monitoring tics, detect premonitory impulses and learn to freely move in a way that is contradictory with the tic (Mayo Clinic, 2018). Psychotherapy can help with additional challenges, such as ADHD, obsessions, depression or anxiety. Deep brain stimulation (DBS) is used for severe tics that do not react to other treatments. DBS requires placing a battery-operated medical device in the brain to provide an electrical stimulus to targeted areas in the brain that regulate movement. This treatment is still in the early investigative stages and needs additional data to determine if this treatment is a safe and effective treatment for TS. When diagnosing TS and tic disorders it is usually from behaviors. To rule out other causes of the tics blood tests and imaging such as MRI’s may be ordered.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comorbidities

The comorbidities that are more associated with tic disorders includes ADHD, OCD, impulse control disorder, rage attacks, sleep issues, depression and migraines. Rare comorbidities include cervical myelopathy, stroke, and dissection due to violent motor tics. The pathophysiology linking to comorbidities in TS is not certain. Investigation and treatment of comorbid disorders are a crucial part of the care for all patients with TS. Healthcare providers should also be mindful about the uncommon but serious neurological problems in these patients and think about treating tics aggressively (Kumar, Trescher, and Byler, 2019).

 

 

 

 

 

 

 

 

 

Legal Considerations

There has been concerns about complex tic disorders and TS acting out violently and should there be a diminished sense of responsibility. Some rights of patients with TS have protection by US federal legislation (Robertson, 2019). This includes the right to public education with the minimal most restrictive educational setting possible (Individuals with Disabilities Education Act) and the right to sufficient accommodations within public settings or the workplace (Americans with Disabilities Act) (Robertson, 2019). Legal advice and talks with qualified support group members can be beneficial in choosing when and how to engage in legal remedies under these laws (Robertson, 2019).

 

 

 

 

 

 

Pertinent Patient Education Considerations

Education should be available on what to expect from the disorder that the patient is diagnosed with. Medications should be explained in depth which should include side effects and nonpharmacologic treatments should be explained as well. The patient should rank the symptoms and ask about the impact of theses symptoms. Nonmedical and medical treatments should be considered starting with the symptom that is the most concerning. If ADHD is a concern the use of stimulant therapy should be discussed along with the benefits and risks of using these drugs. Do not start medication therapy with more than one drug. If a side effect develops it will not be clear which one is causing it and usually one drug can treat more than symptom. It should be explained that goals should be realistic for treatment and medication alone will not help the patient’s symptoms especially if the patient comorbidities of anxiety, depression, substance abuse or rage issues (Cincinnati Children’s, 2018).

 

 

 

References

Robertson, W. C. (2021, November 24). Tourette syndrome and other TIC disorders treatment & management: Approach considerations, treatments for tics, treatment for obsessive-compulsive symptoms in patients with tics. Tourette Syndrome and Other Tic Disorders Treatment & Management: Approach Considerations, Treatments for Tics, Treatment for Obsessive-Compulsive Symptoms in Patients With Tics. Retrieved April 24, 2022, from https://emedicine.medscape.com/article/1182258-treatment#d13

Bagheri, M. M., Kerbeshian, J., & Burd, L. (1999, April 15). Recognition and management of Tourette’s syndrome and Tic disorders. American Family Physician. Retrieved April 24, 2022, from https://www.aafp.org/afp/1999/0415/p2263.html

Centers for Disease Control and Prevention. (2021, April 15). Diagnosing tic disorders. Centers for Disease Control and Prevention. Retrieved April 24, 2022, from https://www.cdc.gov/ncbddd/tourette/diagnosis.html

Home. Cincinnati Childrens. (2018, July). Retrieved April 24, 2022, from https://www.cincinnatichildrens.org/health/t/tics-ts-meds

Kumar, A., Trescher, W., & Byler, D. (2016). Tourette syndrome and comorbid neuropsychiatric conditions. Current developmental disorders reports. Retrieved April 24, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104764/

Mayo Foundation for Medical Education and Research. (2018, August 8). Tourette syndrome. Mayo Clinic. Retrieved April 24, 2022, from https://www.mayoclinic.org/diseases-conditions/tourette-syndrome/diagnosis-treatment/drc-20350470

NHS. (2019, December 30). NHS choices. Retrieved April 24, 2022, from https://www.nhs.uk/conditions/tics/

Robertson, W. C. (2021, November 24). Tourette syndrome and other tic disorders. Practice Essentials, Background, Pathophysiology. Retrieved April 24, 2022, from https://emedicine.medscape.com/article/1182258-overview#a5

Swain, J. E., & Leckman, J. F. (2005, July). Tourette syndrome and TIC disorders: Overview and practical guide to diagnosis and treatment. Psychiatry (Edgmont (Pa. : Township)). Retrieved April 24, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000195/

Tic disorders – tourette Canada. (2012). Retrieved April 24, 2022, from https://tourette.ca/wp-content/uploads/2016/10/DSM-5_Tic_Disorders.pdf

 

Language Disorder

By Krystal Saum

 

Definition: Persistent difficulty in learning and using language as written, spoken, or sign language due to a deficit in the ability to understand language or produce language (American Psychiatric Association, 2013)

 

 

Signs and Symptoms:

• Does not babble as a baby
• Difficulty reading and writing
• Poor social skills
• Says only a few words
• Trouble putting words together to form a sentence (Marrus & Hall, 2017)

Differential diagnoses:

1. Hearing or sensory impairment: When language deficits come from sensory or hearing impairments consider this as an alternate diagnosis
2. Neurological Disorders: Disorders such as epilepsy can be the cause of language deficits
3. Intellectual Disability: Disabilities such as Down Syndrome must be ruled out a reason for language deficits (Bishop, 2017).

Development and course: Changes can start to be noticed in toddlers and can continue into adulthood

 

Prognosis: Individuals with language disorder have a poorer prognosis than those with expressive impairments, these individuals are also more resistant to treatment, and their main difficulty is reading comprehension (American Psychiatric Association, 2013).

 

Considerations related to culture, gender, age: To meet criteria for language disorder the individual must be below average in areas of comprehension that are compared to the normal range for age and gender. Cultural considerations such as English not being the individuals first language has to be taken into account when assessing for language disorder.

 

Pharmacological treatments: No medications specific to treat language disorders

 

Nonpharmacological treatments: Language therapy and speech therapy are used to help correct developmental deficits (McGregor, 2020)

 

Diagnostics and labs: Diagnostic test is assessment of speech and language along with rule out by exclusion

 

Comorbidities: Language disorder is often associated with neurodevelopmental disorders such as autism and ADHD (American Psychiatric Association, 2013)

Legal and ethical considerations: Patient’s ability to understand treatment and ability to express their needs and wants

 

Pertinent patient education considerations: It is imperative to discuss with patient and patient’s parent the benefits of asking for speech and language assessment and inquiring about an IEP to assist in school.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

Bishop, D. V. (2017). Why is it so hard to reach agreement on terminology? The case of developmental language disorder (DLD). International Journal of Language & Communication Disorders, 52(6), 671-680. doi:10.1111/1460-6984.12335

Marrus, N., & Hall, L. (2017). Intellectual Disability and Language Disorder. Child Adolescent Psychiatry Clinics of North America, 26(3), 539-554. doi:10.1016/j.chc.2017.03.001

McGregor, K. K. (2020). How We Fail Children With Developmental Language Disorder. Language, Speech, and Hearing Services in Schools, 51(4), 981-992. doi:10.1044/2020_LSHSS-20-00003