Transcript Developmental Disorders

Chapter 13
Developmental Disorders
Nature of Developmental Psychopathology: An Overview
 Normal vs. Abnormal Development
 Developmental Psychopathology
 Study of how disorders arise and change with time
 Childhood is associated with significant developmental
changes
 Disruption of early skills will likely disrupt development of
later skills
 Developmental Disorders
 Diagnosed first in infancy, childhood, or adolescence
 Attention deficit hyperactivity disorder (ADHD)
 Learning disorders
 Autism
 Mental retardation
Attention Deficit Hyperactivity
Disorder (ADHD): An Overview
 Nature of ADHD
 Central features – Inattention, overactivity, and impulsivity
 Associated with behavioral, cognitive, social, and
academic problems
 DSM-IV and DSM-IV-TR Symptom Clusters
 Cluster 1 – Symptoms of inattention
 Cluster 2 – Symptoms of hyperactivity and impulsivity
cluster
 Either cluster 1 or 2 must be present for a diagnosis
ADHD: Facts and Statistics
 Prevalence
 Occurs in 4%-12% of children who are 6 to 12 years
of age
 Symptoms are usually present around age 3 or 4
 68% of children with ADHD have problems as adults
 Gender Differences
 Boys outnumber girls 4 to 1
 Cultural Factors
 Probability of ADHD diagnosis is greatest in the United
States
The Causes of ADHD: Biological Contributions
 Genetic Contributions
 ADHD runs in families
 Familial ADHD may involve deficits on chromosome 20
 Gene for the D4 receptor is more common in ADHD
children
 Neurobiological Contributions: Brain Dysfunction and
Damage
 Inactivity of the frontal cortex and basal ganglia
 Right hemisphere malfunction
 Abnormal frontal lobe development and functioning
 Yet to identify a precise neurobiological mechanism for
ADHD
The Causes of ADHD: Biological Contributions (cont.)
 The Role of Toxins
 Allergens and food additives do not appear to cause
ADHD
 Maternal smoking increases risk of having a child with
ADHD
The Causes of ADHD: Psychosocial Contributions
 Psychosocial Factors Can Influence the Disorder Itself
 Constant negative feedback from teachers, parents, and
peers
 Peer rejection and resulting social isolation
 Such factors foster low self-image
Biological Treatment of ADHD
 Goal of Biological Treatments
 To reduce impulsivity/hyperactivity and to improve
attention
 Stimulant Medications
 Reduce the core symptoms of ADHD in 70% of cases
 Examples include Ritalin, Dexedrine
 Other Medications
 Imipramine and Clonidine (antihypertensive) have some
efficacy
Biological Treatment of ADHD (cont.)
 Effects of Medications
 Improve compliance and decrease negative behaviors in
many children
 Medications do not affect learning and academic
performance
 Beneficial effects are not lasting following drug
discontinuation
Behavioral and Combined Treatment of ADHD
 Behavioral Treatment
 Involve reinforcement programs
 Aim to increase appropriate behaviors and decrease
inappropriate behaviors
 May also involve parent training
 Combined Bio-Psycho-Social Treatments
 Are highly recommended
Learning Disorders: An Overview
 Scope of Learning Disorders
 Problems related to academic performance in reading,
mathematics, and writing
 Performance is substantially below what would be
expected
 DSM-IV and DSM-IV-TR Reading Disorder
 Discrepancy between actual and expected reading
achievement
 Reading is at a level significantly below that of a typical
person of the same age
 Problem cannot be caused by sensory deficits
(e.g., poor vision)
Learning Disorders: An Overview (cont.)
 DSM-IV and DSM-IV-TR Mathematics Disorder
 Achievement below expected performance in
mathematics
 DSM-IV and DSM-IV-TR Disorder of Written Expression
 Achievement below expected performance in writing
Learning Disorders: Some Facts and Statistics
 Incidence and Prevalence of Learning Disorders
 1% to 3% incidence of learning disorders in the United
States
 Prevalence is highest in wealthier regions of the United
States
 Prevalence rate is 10% to 15% among school age
children
 Reading difficulties are the most common of the learning
disorders
 About 32% of students with learning disabilities drop out
of school
 School experience for such persons tends to be quite
negative
Learning Disorders: Some Facts and Statistics (cont.)
Figure 14.1
Half of school children classified as disabled have learning disabilities. Twenty years ago
the proportion was 25%
Learning Disorders: Some Facts and Statistics (cont.)
Figure 14.2
Uneven distribution of learning disabilities in the United States in the wealthiest states
Biological and Psychosocial Causes of Learning Disorders
 Genetic and Neurobiological Contributions
 Reading disorder runs in families, with 100%
concordance rate for identical twins
 Evidence for subtle forms of brain damage is inconclusive
 Overall, genetic and neurobiological contributions are
unclear
 Psychosocial Contributions are Largely Unknown
Treatment of Learning Disorders
 Requires Intense Educational Interventions
 Remediation of basic processing problems (e.g., teaching
visual skills)
 Improvement of cognitive skills (e.g., instruction in
listening)
 Targeting behavioral skills to compensate for problem
areas
 Data Support Behavioral Educational Interventions for
Learning Disorders
Pervasive Developmental Disorders: An Overview
 Nature of Pervasive Developmental Disorders
 Problems occur in language, socialization, and cognition
 Pervasive – Means the problems span the person’s entire
life
 Examples of Pervasive Developmental Disorders
 Autistic disorder
 Asperger’s syndrome
The Nature of Autistic Disorder: An Overview
 Autism
 Significant impairment in social interactions and
communication
 Restricted patterns of behavior, interest, and activities
 Three Central DSM-IV and DSM-IV-TR Features of Autism
 Problems in socialization and social function
 Problems in communication – 50% never acquire useful
speech
 Restricted patterns of behavior, interests, and activities –
Most striking feature!
Autistic Disorder: Facts and Statistics
 Prevalence and Features of Autism
 Rare condition – Affecting 2 to 20 persons for every
10,000 people
 More prevalent in females with IQs below 35, and in
males with higher IQs
 Autism occurs worldwide
 Symptoms usually develop before 36 months of age
 Autism and Intellectual Functioning
 50% have IQs in the severe-to-profound range of mental
retardation
 25% test in the mild-to-moderate IQ range (i.e., IQ of 50
to 70)
 Remaining people display abilities in the borderline-toaverage IQ range
 Better language skills and IQ test performance predicts
better lifetime prognosis
Causes of Autism: Early and More Recent Contributions
 Historical Views
 Bad parenting
 Unusual speech patterns
 Lack of self-awareness
 Ecolalia
 Current Understanding of Autism
 Medical conditions – Not always associated with autism
 Autism has a genetic component that is largely unclear
 Neurobiological evidence for brain damage – Link with
mental retardation
 Cerebellum size – Substantially reduced in persons with
autism
 Psychosocial Contributions Are Unclear
Asperger’s Disorder: Part of the Autistic Spectrum
 The Nature of Asperger’s Disorder
 Such persons show significant social impairments
 Restricted and repetitive stereotyped behaviors
 May be clumsy, and are often quite verbal (i.e., pedantic
speech)
 Do not show severe delays in language and other
cognitive skills
 Prevalence of Asperger’s Disorder
 Often under diagnosed
 Affects about 1 to 36 persons per 10,000 people
 Causes of Asperger’s Disorder Are Somewhat Unclear
Treatment of Pervasive Developmental
Disorders: Example of Autism
 Psychosocial “Behavioral” Treatments
 Skill building and treatment of problem behaviors
 Communication and language problems
 Address socialization deficits
 Early intervention is critical
 Biological and Medical Treatments Are Unavailable
 Integrated Treatments: The Preferred Model
 Focus on children, their families, parents, schools, and
the home
 Build in appropriate community and social support
Mental Retardation (MR): An Overview
 Nature of Mental Retardation
 Disorder of childhood
 Below-average intellectual and adaptive functioning
 Range of impairment varies greatly across persons
 Mental Retardation and the DSM-IV and DSM-IV-TR
 Significantly sub-average intellectual functioning (IQ
below 70)
 Concurrent deficits or impairments in two or more areas
of adaptive functioning
 MR must be evident before the person is 18 years of age
DSM-IV and DSM-IV-TR Levels of Mental Retardation (MR)
 Mild MR
 Includes persons with an IQ score between 50 or 55
and 70
 Moderate MR
 Includes persons in the IQ range of 35-40 to 50-55
 Severe MR
 Includes people with IQs ranging from 20-25 up to 35-40
 Profound MR
 Includes people with IQ scores below 20-25
Other Classification Systems for Mental Retardation (MR)
 American Association of Mental Retardation (AAMR)
 Defines MR based on levels of assistance required
 Examples of levels include intermittent, limited, extensive,
or pervasive assistance
 Classification of MR in Educational Systems
 Educable mental retardation (i.e., IQ of 50 to
approximately 70-75)
 Trainable mental retardation (i.e., IQ of 30 to 50)
 Severe mental retardation (i.e., IQ below 30)
 Implications of Different MR Classification Systems
Mental Retardation (MR): Some Facts and Statistics
 Prevalence
 About 1% to 3% of the general population
 90% of MR persons are labeled with mild mental
retardation
 Gender Differences
 MR occurs more often in males, male-to-female ratio of
about 6:1
 Course of MR
 Tends to be chronic, but prognosis varies greatly from
person to person
Causes of Mental Retardation (MR):
Biological Contributions
 Genetic Research
 MR involves multiple genes, and at times single genes
 Chromosomal Abnormalities and Other Forms of MR
 Down syndrome – Trisomy 21
 Fragile X syndrome – Abnormality on X chromosome
 Maternal Age and Risk of Having a Down’s Baby
 Nearly 75% of cases cannot be attributed to any known
biological cause
Causes of Mental Retardation (MR):
Biological Contributions (cont.)
Figure 14.3
The increasing likelihood of Down syndrome with maternal age
Causes of Mental Retardation (MR):
Psychosocial Contributions
 Cultural-Familial Retardation
 Believed to cause about 75% of MR cases and is the
least understood
 Associated with mild levels of retardation on IQ tests and
good adaptive skills
 Cultural-Familial Retardation: Difference vs. Developmental Views
 Difference view – Mild MR is a matter of degree and kind
 Developmental view – Mild MR reflects a slowing or delay
of normal development
Treatment of Mental Retardation (MR)
 Parallels Treatment of Pervasive Developmental Disorders
 Teach needed skills to foster productivity and
independence
 Educational and behavioral management
 Living and self-care skills via task analysis
 Communication training – Often most challenging
treatment target!
 Community and supportive interventions
 Persons with MR Can Benefit from Such Interventions
Summary of Developmental Disorders
 Developmental Psychopathology and Normal and Abnormal
Development
 Attention Deficit Hyperactivity Disorder
 Deficits in attention, hyperactivity, or impulsivity
 Disrupt academic and social functioning
 Learning Disorders
 All share deficits in performance below expectations for
IQ and school preparation
 Pervasive Developmental Disorder
 All share deficits in language, socialization, and cognition
 Mental Retardation
 Sub-average IQ, deficits in adaptive functioning, onset
before age 18
 Prevention and Early Intervention Are Critical for
Developmental Disorders
Summary of Developmental Disorders (cont.)
Figure 14.x1
Exploring developmental disorders, attention deficit/hyperactivity disorder, learning
disorders, and communication disorders
Summary of Developmental Disorders (cont.)
Figure 14.x1 (cont.)
Exploring developmental disorders, attention deficit/hyperactivity disorder, learning
disorders, and communication disorders
Summary of Developmental Disorders (cont.)
Figure 14.x2
Exploring developmental disorders, pervasive developmental disorders, mental retardation
Summary of Developmental Disorders (cont.)
Figure 14.x2 (cont.)
Exploring developmental disorders, pervasive developmental disorders, mental retardation