Transcript Psychology 4053X1: Advanced Seminar in Child Psychopathology

Child Psychopathology
Childhood Schizophrenia
Chapter 10
Learning Disability
Chapter 11
Childhood-Onset Schizophrenia
• Compared to autism:
– onset is later, intelligence is less impaired, social deficits are less
severe, language deficits less severe
– hallucinations and delusions are present, there are periods of
remission and relapse
• Compared to adult schizophrenia:
– onset more insidious, child not distressed by symptoms,
outcome poorer
• Diagnosis:
– hallucinations, esp. auditory hallucinations
– delusions, disorganized speech, disorganized or catatonic
Box 10.1, 10.2
behavior
– Comorbid with depression and conduct/oppositional disorder
Associated characteristics
• Extremely rare in children under age 12,
some prevalence in adolescence
• Boy:Girl ration = 2:1, eearlier onset in boys
• Causes:
– Diathesis-Stress model
– Genetic vulnerability and stressful environment
– Low expressed emotion in families, trauma
• Treatment is pharmacological, e.g.,
neuroleptics such as chloropromazine
See
handout
Learning Disability
Imagine having important needs and ideas to communicate, but being
unable to express them. Perhaps feeling bombarded by sights and
sounds, unable to focus your attention. Or trying to read or add but
not being able to make sense of the letters or numbers.
You may not need to imagine. You may be the parent or teacher of a
child experiencing academic problems, or have someone in your
family diagnosed as learning disabled. Or possibly as a child you
were told you had a reading problem called dyslexia or some other
learning handicap.
Definitional Issues
• Broad range of definitions in various regions,
provinces, and settings
• Common issue: Children do not perform up to
their expected level in school
• Issues: What is the expectation? What is the
level? How do we assess performance? What are
the areas we are concerned about?
• Multiple aspects of intelligence: Social, musical,
kinesthetic intelligences not always figure into
consideration: Or are these linked? Music/Math
DSM-IV Diagnostic Criteria:
Learning Disorders
• Ability as measured by tests is substantially
below expected given age, intelligence, and
age-appropriate education
• Achievement or activities of daily living is
affected
• Not due to sensory deficit, medical
condition
• Kinds: Reading Disorder, Mathematics Disorder, Disorder of
Written Expression, Developmental Coordination Disorder,
Expressive Language Disorder, Phonological Disorder
Assessment issues
• Detailed assessment of achievement
– WRAT-III has Reading, Arithmetic, and Spelling
subtests
• Intelligence
Fig. 10.6
– e.g., Average IQ, but inconsistent performance such as
“peaks and valleys” in profile or VIQ>PIQ, PIQ<VIQ,
or FSIQ>Achievement
• Other cognitive processes
– Memory (WMS), perceptual processing (Beery),
sound/letter correspondance (TOPA), grammar/ spelling
What is “reading”? What can go wrong?
Focus attention on the printed marks and
control eye movements across the page
Left to right movement
Recognize the sounds associated with letters
Understand words and grammar
Build ideas and images
Compare new ideas to what you already
know
Store ideas in memory
Reading Disorders
• Common underlying feature is inability to
distinguish or separate the sounds in spoken
words or decode words from text
• Reading speed, accuracy, and/or
comprehension are affected
• Reversals (bab = bad), transpositions (was =
saw; plane = plaen), inversions (M/W; u/n),
omissions (bread = bead; pear = pea).
• Give example of each for “nub”
Mathematics Disorder
• Difficulty in recognizing numbers and
symbols, memorizing facts, aligning
numbers, and abstract concepts (What is
“+”; 3 vs. 8; deleting “0” from 100; $$)
• Core deficits in arithmetic calculation
(2+2=3) and or mathematics reasoning
abilities
• Visual perceptual and visual spatial domains
(Geometry, sets, maps)
Writing Disorder
• Problems with writing, drawing, or other
visual-motor tasks
• Combination of core deficits related to
written output including spelling, grammar,
punctuation, poor organization, poor
handwriting; Specifics similar to reading
• Think of how pervasive writing is to testing
within the school system
• Can computers compensate for everything
Etiology
• Reading disorders 60% heritable, thus genetic
basis highly likely: autosomal dominant
• Difficult to detect neurological problem
– Anoxia at birth leads to elevated risk, even
when IVH or lesion cannot be detected
• Integration of skills and information ==
Metacognitive deficits, strategies
• Auditory processing is important
• Comorbid attentional and behavioral problems
Cycle of failure and motivation
• There is a cycle of failure, internal attributions of
failure (“I am stupid”), external blame (“School is
dumb”), loss of motivation to try, (“What is the point”),
leading to further failure, which becomes self-fulfilling.
• Comorbid depression, anxiety, and self-esteem
problems
• Conflict with parents
• Conflict with teachers
• Peer problems can arise
• Cycle must be stopped
• Build on successes
Treatments and prevention
• Early identification and treatment, e.g., reading
recovery, parental reading; Later, special placements
• Children are usually in regular classrooms with extra
assistance either in or outside of classroom
• Direct instruction is necessary, e.g., sound-letter
correspondence, steps in math problems, monitoring
spelling and grammar
• Whole language vs. Code-empasis model of reading
instruction. The former is good to create initial
interest, but skills must be taught
• Metacognitive training: What are you doing? How
long has it taken? Am you “on task”? External cues
Videotape on Learning
Disabilities