Transcript Psikologi Anak Pertemuan 11 Developmental

Psikologi Anak
Pertemuan 11
Developmental disorders and
Learning disorders
Mental Retardation
DSM-IV Diagnostic criteria
“The essential feature of Mental Retardation is significantly subaverage
general intellectual functioning (criterion A) that is accompanied by
significant limitation in at least two of the following skill areas:
communication , self-care, home living, social/interpersonal skills, work,
leisure, health and safety (criterion B). The onset must occur beforeage 18
years (criterion C).”
American Association on Mental Retardation (AAMR)criteria
• level of environmental support required by the individual
(intermittent, limited, extensive or pervasive)
• 4 different areas: intellectual functioning & adaptive skills,
psychological/emotional functioning, physical/health, and
environment
Continuum of Severity of MR
(from the DSM-IV)
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Mild mental retardation= IQ level 50-55 to 70
Moderate retardation= IQ level 35-40 to 50-55
Severe mental retardation= IQ level 20-25 to 35-40
Profound mental retardation= IQ level < 20-25
Also severity unspecified if individual is untestable
Characteristics of children with MR
• Children with mental retardation a heterogeneous and variable
group
– some children with MR are placid, passive and dependent
whereas others may be aggressive and impulsive.
• however, it is common for people with MR to show deficits in social
skills
• lack of well developed communication skills may predispose
children with MR to disruptive and aggressive behaviours
• no specific physical features associated with MR.
• children with MR are at increased risk of being exploited by others
(e.g., physical &/or sexual abuse)
• the incidence of mental disorders in individuals with MR is 3-4
times greater than it is in the general population.
• common comorbidities: ADHD, mood disorders, pervasive
developmental disorders, stereotypic movement disorder.
Course of MR
• age & mode of onset depend on the aetiology
and severity of the MR
– more severe retardation (esp. when associated
with a specific syndrome e.g., Down’s syndrome)
tends tobe identified early
• where the retardation results from an
acquired cause, onset can be very abrupt
• MR not necessarily a life long disorder (mild
MR)
Aetiology of MR
General points
• Many risk factors for MR have been identified
• For 30-40% of MR cases aetiology is unclear in the past MR has
been seen as being caused by either biological factors or
psychosocial factors
• recent theories view MR as being the result of a combination of
factors, although one factor may contribute more than others.
Genetic Risk Factors for MR
• Chromosomal abnormalities implicated in 10-20% of cases of MR in
which there is a known cause
– Down’s Syndrome
– Fragile X Syndrome
• Genetic disorders
– PKU
Aetiology of MR
Prenatal Risk Factors for MR
• FAS & FAE
• Malnutrition
• Uncontrolled maternal diabetes
• viral & bacterial infections: HIV,
Toxoplasmosis which results in MR
in 85% of offspring affected,
Rubella
Perinatal Risk Factors for MR
• Oxygen deprivation during delivery
• Prematurity
• LBW
Postnatal Risk Factors for MR
• extreme deprivation
• Disease: encephalitis, meningitis
• Lead poisoning
• other mental disorders (eg.
Autism, ADHD)
Psychosocial risk factors for MR
• Maternal age: teenage mothers
and mothers over 35
• Low SES
• Sex
Placement and treatment options
Institutionalisation
• Approx. 4% of children with MR are institutionalized today
• Factors affecting decision to institutionalise: day to day stress,
child’s level of functioning & potential for future learning, child’s
behaviour, family attitude towards placement, medical or physical
problems experienced by MR child, availability of respite care,
professional advice, placement and treatment options
Therapy
• single most important psychological therapy used with MR children
& their families is behaviour therapy or behaviour modification
– aims to eliminate maladaptive behaviours (aggression,selfstimulation) & enhance adaptive skills (language, self-care etc)
Pervasive developmental disorders
• Pervasive developmental disorders such as
Autistic Disorder and Asperger’s Disorder are
characterized by severe and pervasive
impairments in several areas of development
– Reciprocal social interaction skills
– Communication skills
– Stereotyped behaviours, interests or activities
Reciprocal Social Interaction: Autism
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Nonuse or limited use of nonverbals
Gesture, eye contact, nodding
agreement
Failure to develop peer relationships
Lack of spontaneous seeking to share
enjoyment or interests
Lack of social or emotional reciprocity,
give and take, showing interest
Impaired awareness of others
Stereotyped Behaviour: Autism
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Preoccupation with one or more
restricted patterns of interest
Inflexible adherence to nonfunctional
routines or rituals
Stereotyped motor mannerisms
Preoccupation with parts of objects
Abnormal posture or gait
Fascination with movement
Attachment to an inanimate object
Communication: Autism
• Delay or lack of development of
language
• Impaired ability to initiate or sustain
a conversation
• Stereotyped or repetitive use of
language
- Echolalia
- Idiosyncratic language
• Lack of spontaneous make believe
play or social imitative play
• When speech does develop –
abnormal pitch, intonation, rate,
rhythm or stres, impairment in
comprehension of language
Asperger’s Disorder
Social Behavior
• Not motivated to play with others – selffocused
• Tendency to dominate if engaged with others
• At lunch time tend to be alone - often in library or an isolated part of the
playground
• No interest in team activities
• Often excluded by other children and often the victim of bullies
• Codes of conduct not understood
Language
• These children can be delayed in language but most talk fluently by age 5.
• Pragmatic difficulties (repairing a conversation,coping with uncertainty, irrelevant
comments, interrupting)
• Semantic difficulties (literal interpretations)
• Problems with prosody (lack of variation, accent, formal language, pedantic,
idiosyncratic words, vocalizing thoughts)
Asperger’s Disorder
Interests and routines, Motor Clumsiness, Cognition
• May begin with collecting objects
• Interest in a special topic
• Romantic interest in a real person
• Need for routine, sameness
• Limited ability to kick and catch ball, tie
• shoelaces, odd gait, poor handwriting
• Theory of mind - difficulty in conceptualizing the fact
that others have thoughts and feelings
• Mind-reading
Course of Disorder
Autism
• Onset prior to age 3
• Developmental gains
during school age
• Some deteriorate at
adolescence others
improve
• language skills and IQ best
predictors of prognosis
• Small percentage live and
workindependently
Asperger’s
• Often not diagnosed until
school age
• Heterogeneous presentation
• Many go on to succeed in
work and to live
independently- best
predictors are ability to learn
social skills, support etc
• Prognosis may be better
than for Autism
• Different presentation in
females
Genetic predisposition
Aetiology
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Concordance rates in identical twins ~50%
Runs in families (siblings of children with ASD 50x
more likely to be diagnosed than baseline)
Sex-linked?
Unfavourable obstetric events
– Some mums report difficult or complicated births
in children later diagnosed ASD
Neuropsychological Abnormalities
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Cerebellar abnormalities (reduction in size)
Left hemisphere abnormalities (unusual MRIs)
High comorbidity with seizures
Autopsy studies show heavy brains
Rate of growth of brain (Courchesne)
Diet
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Some suggestion that diet can affect symptoms
Food additives, wheat (gluten), milk (lactose)
MMR (measles, mumps, rubella)
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Latest study (British Medical Journal, 2001) found no evidence of vaccineautism link
suggestion that MMR vaccine could exacerbate already present autism symptoms
Treatment approaches
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Applied Behaviour Analysis (ABA)
Increase communication (PECS)
Relationship Development Intervention
Floortime
Sensory Integration
Social Skills Training
Pharmacotherapy and diet
TEACCH
Learning Disorders
LD diagnosed when achievement on individually
administered, standardized tests in reading,
mathematics or written expression is
substantially below that expected for age,
schooling and level of intelligence
(discrepancy method)
• significant interference caused
Learning Disorders: Subtypes
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Reading Disorder – Dyslexia
Mathematics Disorder – Dyscalculia
Disorder of Written Expression - Dysgraphia
Learning Disorder Not Otherwise Specified
Characteristic features of
children with LDs
• LD child differs from normal learner by
characteristics of the LD, rather than by its
presence
• IQ score usually in average or above average
range but performance on tests very variable
• at increased risk for psychological problems
• poor self-esteem; high rate of high school
drop out
Non-Verbal Learning Disorder
• Not in DSM-IV
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Motor coordination difficulties
General lack of coordination
Both gross and fine motor problems (pencil grip)
Balance problems
Academic difficulties
Deficits in maths, writing and reading comprehension
Problems with organisation, reasoning and problem-solving (executive
functioning)
– Strong verbal and attentional memory
– Good spelling and reading (errors are phonemically correct)
Non-Verbal Learning Disorder
Characteristics
• Visuo-spatial deficits
– Poor visual organisation and recall (Rey)
– Faulty spatial perception and spatial relations
• Emotional
– Tantrums (difficult to soothe)
– Easily overwhelmed (esp. by change in routine)
– Vulnerable to depression, anxiety and low self esteem
• Social difficulties
– Lack of ability to comprehend non-verbal communication
– Deficits in social judgement and social interaction
• Problems with peer relationships