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Neurodevelopmental Interview


based on lecture by Dr Hapke and powerpoint by Suzanne Lawton

NEURODEVELOPMENTAL CONDITIONS
affect behavior, memory, ability to learn
ADD, ADHD (mostly male)
autistic spectrum incl Aspberger's (4:1 male, 1/150 kids)
epilepsy
Tourette syndrome

GOALS OF TX
support self esteem
ability to get along with othrs
success at school or owkr
ease parent's fear and embarrassment
ease pressure from school

ADHD
3 types: predominance of attention deficit or hyperactivity or mixed
more men have it but more women present for tx

book The Last Child in the Woods
nature deficit disorder-->ADHD

SX:
befuddled
can't track questions, respond to open ended questions
hate school, difficulty with homework, chores
hyperactive: disruptive in office
teens: mb sullen, angry, depressed, may seem ODD, say nothing is wrong with them
adults: low confidence, compensatory systems, desperation, depression, rare mania
multitasking, poor tsting but high intelligence, wired or dull
interrupts in order not to forget what they were going to say
HX:
specific learning disability?
medical hx? operations? anesthesia? abx? leaky gut? allergies? meds? hearing/vision prob?
common: food allergies, sensitivities, HTN, intestinal complaints (IBD, diarrhea, constip)
patterns? timing? palliate/provoke?
family hx? family dynamics? favoritism?
embarrassment? patient? (obstacle to cure) parents?
diet? foods exacerbate? envir?
trauma? prenatal?
what is teacher's concern?
what makes pt feel different?
what parents would like to change?
supps? make sure fish oil is free of mercury.
heavy metals?
TV watching? each hour/day-->10% more chance ADHD dx
on meds? want off? want to avoid?

DX
don't really have to have diagnosis
suggest that child's behavior is "ADHD-like", having a bad day
goal: less bad days
avoid dx: avoid guilt, feeling of being forced to do something
needs dx: if parents won't be proactive without it
if ADD mb nice but spacey
if ADHD expect an attitude, mb misdxd as ODD
DDX: GAD, hypoglycemia, bipolar, depression

TX
set realistic expectations
this will take time and effort on parent and child's part
improvements begin in about a week, takes 2-3 months to reach new equilibrium
eliminate food sensit
incr prot, reduce sug
improve sleep
remove stimulants
30% of pts will be cured by these changes: not true ADHD

* Article reviewing nutritional interventions for ADHD
http://members.cox.net/harold.kraus/gluten/anno_symptoms_files/ADHD.htm
* Resources for Adults with ADHD- some info is members only
http://www.addresources.org/adhd_articles_adults.php
* Meditation and ADHD
http://cie.asu.edu/volume10/number2/

ASPERGER
poor soc interaction
social challenges
IQ must be over 70 but mb very high
at least two:
1) masked impairment of multiple nonverbal hehav ie eye to eye gaze, facial expression, body postures, gestures
2) failure to develop peer relationships appropriate to developmental level
3) lack of spontaneous seeking to share enjoyment, interests, achievements with others
4) lack of social or emotional reciprocity
at least one:
1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus (she gives motors as example)
2) apparently inflexible adherence to specific nonfunctional routines, rituals
3) stereotypes and repeptitive motor mannerisms (hand, finger flapping, whole bod)
4) persistent preoccupation with parts of objects
Clinically significant disruption of social life?
delay in language?
delay in cognitive development or self help, adaptation, social interaction

pts want to avoid psychotropic drugs
parents want specific tx plan, may want a "cure"
answer: "each child is different", if 1 tx worked for everyone, that would be a cure
pt is not defective, this is a neurological pattern
connect with pt via special interest
kids are anxious, if you can get them comfy enough to talk, let them
if they're wandering, they may still be paying attention to you
mb sweet, naive, monomaniac, OCD, poor eye contact, few friends
aversion to change
involuntary motions, tics
sensory challenges, overwhelm from sounds, lights, voice, smells
may have good family life
signs of overload: acting out, phasing out, going to "sleep"
GI or anxiety issues in parents? can lead to Asperger's

ADULT SX
closed, guarded, hypervigiliant
depressed, hopeless, mb sent by therapist
dependent on meds, psych
low vs high functioning
adrenal fatigue, headaches, fungal infx, insomnia, tourette's/epilepsy/tics

TX
small dietary changes implemented over time
negotiate negotiate negotiate
what is my most imp goal?
what is not negotiable for tx to work?
what are possible tradeoffs or concessions
where is the compromise threshhold

AUTISM
components of ADHD plus sevre anxiety, poor soc interaction, debilitating sensory challenge, sig communication difficulties: communication, interaction, imagination
short interviews, minimal eye contact OK: interview the parents, observe the child
clarify expectations of parents
can't say how much nat med will help until 3rd or 4th visit that I'll have a good idea
pts sensitive to doc anxiety

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