Focus, Spectrum, and Smarts: Navigating the Big Three for Licensure

In this episode of Licensure Lifeline, we go into the second show in the mini-series on the DSM-5—your essential roadmap for differential diagnosis on the licensure exams. Today, we zoom in on Neurodevelopmental Disorders, including ADHD, Autism Spectrum Disorder, and Intellectual Disability. You’ll learn how these disorders are defined, how they commonly show up on test vignettes, and how to avoid the traps that exam writers love to set.

We’ll start with a fascinating historical vignette about the early days of diagnosing childhood disorders, unpack the key criteria in plain language, and then walk through real exam-style questions—both multiple-choice and case vignette formats. Plus, in the Study Stack segment, you’ll get practical AI prompts you can plug into ChatGPT or other tools to boost your studying efficiency.

Take a look at the app here!

The LicensureLink App: Where Licensure Meets Peace of Mind.

Email the show: licensurelifeline@gmail.com

Transcript

SPEAKER_00: 0:00

In 1943, Austrian-American psychiatrist Leo Kanner published a groundbreaking paper where he described a group of children who seemed profoundly different from their peers. They struggled with language, had repetitive behaviors, and seemed detached from social interactions. Kanner called this condition early infantile autism, a term that would later become central in shaping our understanding of neurodevelopment disorders. Just a year later, in 1944, Hans Asperger, working independently in Vienna, described another group of children, bright, articulate, and often highly skilled in specific areas, yet profoundly challenged in social reciprocity and communication. His work, largely unknown outside of Europe at the time, would decades later inspire the term Asperger's syndrome. These early descriptions were pivotal in shaping how we understand autism spectrum disorder today. What's fascinating is that despite their shared insights, Kanner and Asperger were working in the shadow of World War II at the time, with very different contexts and cultural perceptions of children's development. This history shows how the seeds of our modern DSM-5 categories were planted by clinicians observing patterns in children's behavior, patterns that are still central to the licensure exam today. Welcome to the Leicester Lifeline podcast. This is your host, Matt Lawson. And today we're going to be talking neurodevelopment disorders. The next. part of the miniseries I'm doing around the DSM-5. So like I said, I'm hoping to cover like five or six areas out of the DSM-5 over these next couple of episodes. I'm calling this kind of like a miniseries. Also, this is season three, in case you didn't realize that we're in a completely new season now. It's kind of arbitrary where I'm creating seasons, but just to let you know. But the areas we're gonna cover today are gonna be things like ADHD, autism spectrum disorder, intellectual disabilities, and then like specific learning disorders. So I'll get into a lot more detail around those areas. But first, let's get into a little good news. Pretty exciting times here at the licensure lifeline. I finished my app and this is called licensure link. I will have a link for this in the show notes. You can go check it out. Please go check it out. It does have the option to purchase, but what this is, is an app that helps you manage your license and certifications. So what this will allow you to do is to create an account and you can upload your license. It does have a feature that I hope works that will take your license and tell you the different requirements based on the state that you're in. And then you put in the other information of the license, like you put in your license number and all that other stuff. and it'll allow you to upload CEUs and keep up with your CEUs as you go into your licensure. And it really is a way to just manage things. It's only happened to me one time, but I just wasn't paying attention. I think it was right after COVID and I just, I don't know what I was thinking, but I didn't think they were still following the same rules in Illinois around licensure, and I missed my renewal day. They were very cool about it and they worked with me and I had all my CEUs done and was able to kind of get everything in and it was fine. But the moment of panic that I felt was just, it was enough for me to create an entire app. So that was a while ago. I'm not a tech savvy individual. I actually used some AI to create this app, a lot of AI to create this app, but it's really cool. Like I said, I'll have the link to it in the show notes You know, at minimum, just go check it out. And I know a lot of people listening to the show don't even have their license yet. But it's never too early to start thinking about how you're going to manage things, how you're going to just keep things straight. Like I said, you know, you'll be able to upload your CEUs. There's going to be like a progress bar. I think I even put a little gamification in there that acknowledges when you hit certain numbers. And there are notification systems. So, you know, it'll tell you when there's like, oh, there's, you know, you have six months left before you have to renew or you have a year left before you need to renew. You just don't want to be stuck in a position where you're trying to get all your CEUs in at the last minute. Something else I have had to do in the past and it is not fun and is expensive. A lot of these CEUs are not cheap. And there's also like certain requirements for depending on what state you're in. So this will help you manage all of that stuff. And I do hope that it's just a really nice tool for professionals to use to just allow their experience being a therapist just to be that much easier but you can create an account for free um and you know you can just kind of like take a look at it um you know and any feedback that you guys can give me based on what you see is absolutely helpful um if something's not working or if you think something could be added that would really um know benefit you even more reach out to me through the fan mail feature through the podcast or on instagram it's probably going to be the best way to let me know thanks all right that is the news let's go into the study stack so for the study stack today i really wanted to explore how people can leverage things like ChatGPT, Gemini, some of the large language models to help them study. So first off, I have what I'm calling an active recall practice. So instead of just like passively reading over notes, you can prompt the AI, like this is a prompt that you can write, quiz me on the DSM-5 neurodevelopment disorders as I'm preparing for the NCE. And the AI will generate multiple choice questions. And the neat thing with this is if you don't know the answer or if you want to expand upon your understanding of the answer or the topic that it was covering in the questions you can have a nice little conversation with ai around that question i highly highly recommend that you leverage this this can be a really nice study partner for you next up teach, the teach back method. So the prompt for this one, you can ask AI, pretend I'm a client and explain ADHD to me in plain language. If you can re-explain the AI response confidently, you know you've got it down, right? But just having AI talk to you in a way that you, you know, to get that language around how you would explain these things to people it can like again like having these conversations with these large language models can get you used to talking about these things um and then finally differential diagnoses drill so the prompt might be give me a vignette that could be either autism spectrum disorder or social communication disorder walk me through how to tell the difference So this would mirror what you'll see both on the NCE and NCMHCE, where you can like really explore subtle differences in these vignettes and kind of parse out with the large language model, like, you know, really how to tell them apart and how to differentiate them when you see them on a test. And again, like having that conversation with AI can really help solidify your understanding understanding and knowledge of the topics. See, robots can be used for good. But I'll post up some more prompts that you can use through the Instagram account. You know, and you can just mess around with the large language models and using it to help you study. Okay, getting into the core content today, we're talking neurodevelopment disorder. So these are disorders that are typically first diagnosed in childhood, but they persist into adulthood. Oftentimes they persist into adulthood. These conditions involve early development deficits that produce impairments in personal, social, academic, and occupational functioning. For the exam purposes, always anchor your thinking in early onset pervasive impact in developmental trajectory. Those are going to be some of the main areas that you're going to be considering if you see them like in a vignette or in a question, like how they're impacting the and early onset pervasiveness and just developmental trajectory. First up, we have ADHD, attention deficit disorder, ADHD, attention deficit hyperactive disorder, and they had a lot of different names. It is very interesting to me how many individuals I get pretty far into adulthood that are just in their 30s 40s even 50s just now exploring if they potentially have adhd add um one of the i really think that modern society the way that we consume social media the way that we consume a lot of things just in these little bites has really impacted our attention spans and a lot of the way we're developing in adulthood, even if you didn't have social media as a kid, mirrors what people traditionally has known as symptoms for ADD. Just kind of a thought here. I know there's tests behind this or studies behind this where kind of the same things have been posited. So for further discussion, but diagnosed diagnostic anchors with adhd inattention and or hyperactive impulsivity for six plus months across two plus settings and inconsistent with developmental the developmental level um so it is important that it is you see this across a couple of different settings so you know, a kid that's hyperactive at home, but not really all that hyperactive in school, you kind of have to wonder if it is ADHD. But this has to persist over multiple settings. Exam traps that you might fall into is you must be able to differentiate this from trauma-related attention problems. Trauma usually comes later in life. ADHD symptoms are early and consist... and persist into adulthood. Also, they overlap with learning disorders and oppositional defiance disorders a lot of the times. A subtype of ADHD is predominantly inattentive, predominantly hyperactive, impulsive, combined presentation. treatments for this. You know, you have your stimulant, stimulant medications, your Adderalls, things like that. Although modern, a lot of the modern medications for ADHD are much easier to take. And what I mean by that is it doesn't have the kind of like jittery stimulating effect that people saw with Adderall back in the day. So something to look for. But then you have behavioral therapies like your CBTs. And then parent training. Because this is something that you've seen in childhood, parents really have to be involved with supporting the child with ADHD and teaching them how to better support them, understand them, and just be present. Exam tip here, look for clues like difficulty sustaining attention in multiple environments since early childhood, not just can't concentrate after a parent's divorce. All right, so that is ADHD. Next, we are gonna look at autism spectrum disorder, ASD. So two key domains here, persistent deficits in social communication and social interaction, You also have restricted repetitive patterns of behavior, interest, or activities. The onset of this symptoms usually recognized in the first two years of life. Severity levels, you have a level one requiring support, level two substantial support, and then level three, very substantial support. So you actually have different levels of autism here. That's one of the reasons why this is known as a spectrum disorder. Exam traps that you have the potential to fall into is being able to distinguish this from social anxiety disorder. It can be pretty pervasive and developmental and include repetitive behaviors in social situations. So you need to really be able to take a look and see, is this just because of this person being anxious in a social situation or is it autism spectrum disorder? Also take note, intellectual disabilities in autism, sometimes it can be a strength in some areas. Um, you know, and, and that's one of the neat things with autism is you can help that individual foster their superpower. Um, you see a lot of individuals with autism that gravitate toward things that people can consider mundane a lot of the times, or just are able to get things, subjects, topics, um, easier. in a way that others cannot. Their neurodivergence actually helps them excel in certain areas of their lives. And part of the work that you can do with individuals that have autism is really help them unlock that space that they have that superpower in. So treatment for ASD, applied behavior analysis, ABA, speech and language therapy oftentimes really helps. Then occupational therapy and family support, okay? Pay attention to phrases like restricted interest or hand flapping or lack of peer relationships. Those are going to be some of the key phrases and words that you might see on a test that can really key you into autism spectrum disorder. Next up we have intellectual disability. So three domains of impairment here, intellectual functioning, so reasoning, problem solving, planning are impacted in a negative way, adaptive functioning, so daily life skills, communication, social participation are impacted, and then onset during development periods. There are severity levels, so you do have mild, moderate, severe, profound, which is oftentimes determined by adaptive functioning, not necessarily by IQ score. You're not going to see IQ score used for really much of anything in any of these areas. Look up IQ scores and just their relevance. I'm not going to get into that just now, but yeah, it's kind of old thinking. Exam traps that you might fall into with intellectual disability, don't confuse this with learning disorder. So learning disorders equal academic skill deficits in one or more areas, but adaptive functioning generally stays intact with learning disorders. Treatment with intellectual disability, educational interventions, community support, skill building, and then just advocacy for these individuals. Exam tip here, keywords like requires ongoing support with daily living versus learning disability, which would say something like difficulty with math or reading. Okay, so don't get the two confused. Learning disability would say difficulty with math or reading. Intellectual disability would say something requires support around daily living. Next, we have specific learning disorder. So areas affected, reading, so this would be like dyslexia, writing, dysgraphia, mathematics, dyscalculia, which I didn't know was a word until just now. So that's D-Y-S-C-A-L-C-U-L-I-A. I swear. I think this field just makes things up sometimes. The onset of this is during school age years, despite normal intelligence and educational opportunity. Exam traps that people could potentially fall into is differentiating this from ADHD, attention problems versus specific skill deficits. differentiating from intellectual disability. So this is what I talked about before, LD versus ID, subject specific versus global daily functioning. Treatment for this is educational interventions. So this is where you're seeing a lot of IOPs and things like that with kids. Individualized education plans, EIPs, that's what I meant, sorry, not IOPs, EIPs. And then tutoring. Exam tips here. If the vignette describes an otherwise capable child who struggles specifically with math or reading, think learning disorders, all right? That's what we're gonna be looking at there. next communication disorders so these are language disorders difficulties with vocabulary grammar and narrative um speech sound disorders difficulty with articulation childhood onset fluency disorders things like stuttering social pragmatic communication disorders difficulty with social use of language without restricted repetitive behaviors like asd exam traps here differentiate differentiating things like pragmatic communication disorder from asd not restricted interest or repetitive behavior treatment speech therapy support intervention parental involvement with this one all right so last step here is are the other neurodevelopment disorders um i love how like at the end of all these categories, you have the others, right? Because like this is, it just speaks to the necessity to have something that umbrellas these things at the end that kind of look like something that might be happening in this area, but nobody's quite sure what. So things like motor disorders, so people that are slow to develop coordination problems, or stereotypic movement disorder. Tick disorder falls under this other neurodevelopment disorders. So exam tip here, Tourette's syndrome equals both motor and vocabulary issues. Provisional tick disorder equals less than one year is less than one year of duration. Eagle Tour, less than one year of duration. So just some tips here. Tourette's, I do remember Tourette's showing up on the NCE. And it is, it's one of those that kind of shows up on tests pretty regularly. So just keep that in mind. Okay, let's go into some questions you might see. A nine-year-old child presents with persistent difficulties in reading accuracy, slow reading rate, and poor comprehension despite average intelligence and adequate instruction. Which DSM-5 diagnosis is most appropriate? Would this be intellectual disability, autism spectrum disorder, specific learning disorder, or attention deficit hyperactive disorder? The answer here is gonna be C. Reason behind this, difficulties are in reading, academic skill area, despite average intelligence, which is a hallmark of specific learning disorder. Intellectual disability, which have shown deficits across intellectual and adaptive domains, not just in academics. Question number two, which of the following is a core diagnostic feature of autism spectrum disorder in the DSM-5? Is it A, restricted, repetitive patterns of behavior, interest, or activities? B, significant delay in expressive language only? C, multiple motor or vocal tics? Or D, deficits in attention and hyperactivity? Answer here is going to be B. A. Restricted repetitive patterns of behavior, interest, or activity. ASD requires one deficit in social communication interaction and two restricted repetitive behaviors. Language delays may occur but are not diagnostic alone. Question number three. An individual with an IQ of 65 and deficits in adaptive functioning, e.g. communication, social participation, and independent living skills would most likely be diagnosed with A, borderline intellectual functioning, B, mild intellectual disability, C, specific learning disorders, or D, developmental coordination disorders. The answer here is going to be B, mild intellectual disability. Rationale, intellectual disabilities require IQ scores below 70. I know before I said, you know, the IQ stuff is kind of like, eh. It kind of is, but they still use it to some extent with this as part of the diagnosis. You know, it's definitely not something that you can just look at and say, oh, this person has an intellectual disability. But deficits in adaptive functioning, Things like borderline intellectual functioning IQ 71 to 84 does not meet requirements for the deficit threshold. Question number four, which of the following best distinguishes ADHD from learning disorders? Is it A, symptoms must occur before age seven, B, symptoms must be present in at least two settings, C, symptoms involve persistent inattention and or hyperactivity, Or D, symptoms involve below average intellectual function. Answer here is gonna be C, symptoms involve persistent inattention and or hyperactivity. The rationale behind this ADHD requires impairment and attention to hyperactivity across settings. Learning disorders involve academic skill deficits. Note that the DSM-5 updated the ADHD age of an onset to or before age 12, not seven. So that is a newer update. Question number five. A 10-year-old child displays frequent motor tics, eye blinking, head jerking, and vocal tics, running, throat clearing for over one year. Which DSM-5 diagnosis is most accurate? Would this be A, persistent chronic motor or vocal tic disorder, B, Tourette's disorder, C, provisional tic disorder, or D, autism spectrum disorder? Answer here is gonna be B, this is gonna be Tourette's. Tourette's requires both motor and vocal tics lasting more than one year. Persistent tic disorder is motor or vocal, not, motor or vocal, not both, and provisionally equal to or less than one year. That is going to do it for the show today. Thank you so much for listening again. Like I said, please take a look at the app that I made. I'd love to get feedback. You know, there is a subscription there and that money goes right back into this show. So, you know, if you are looking for a way to support the show, that would be a great way to do it. You can cancel any time. So there is that as well. But until next time, everybody keep studying.

UNKNOWN: 25:25

Thank you.