Transcript Low-Incidence Behavior Disorders

Low-Incidence Behavior
Disorders
Early Perspectives on Severe
Behavior Problems of Childhood
and Youth
Maudsley- Among the first to acknowledge insanity in
children
1890’s textbooks-childhood psychosis as diagnostic
entity
Early to mid 1900’s
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Schizophrenia introduced
Potter (1933) 6 conditions of childhood schizophrenia
Bradley & Bowen (1941) 8 symptoms of schizophrenia
Bender (1942) Schizophrenia attributable to developmental
irregularities in the CNS
– Kanner (1943) early infantile autism, separate category
– Rank (early 1950”s) “atypical child”; symptoms attributed to
maternally induced ego fragmentation
More recently (DSM-IV 2000)- low incidence disorders
viewed as developmental disability
Pervasive Developmental
Disorders
Characterized-impairments in social
interaction skills, communication skills,
and/or the presence of stereotyped
behaviors, interests, and activities
Includes autistic disorder, childhood
disintegrative disorder, Asperger’s
disorder, and pervasive developmental
disorder not otherwise specified
Autistic Disorder
Definition
– Severe developmental disability marked by very early age of
onset, impaired social development, and preservation/rigidity of
behavior; onset before age of 3
Universal/specific characteristics of Autism
– Impairment in the development of verbal and nonverbal social
interactions
– Impairment in the development of communicative language
– Restricted repertoire of activities interests that are characterized
by an abnormal intensity or ritualistic compulsive behavior
– Differential diagnosis determines the three universal and specific
characteristics evidenced before the age of 3, though are more
difficult to observe before age 2; symptoms are individualized;
not noticed till the child is placed with peers
Autistic Impairments in Establishing
Social Relationships
Lack of social smile or warm response
Lack of anticipatory posture to being picked up
Lack of attachment behaviors
Avoid direct eye contact, gaze aversion
Gaze aversion leads to difficulty with interpreting faces and
language
Joint attention, alternating gaze between speaker and object
speaker is referring to
Deficits in orienting, shifting, and sustaining attention and stimulus
overselectivity make responding to social, especially multiple, cues
difficult
Deficits in imitation make reciprocal social play difficult
Limitations in understanding abstract language, making
understanding peer overtures difficult
Developmental benchmarks are not easily reached
Impairments in Communicative
Language
Expressive Language
– 50% do not acquire useful speech; complete
speech loss- girls more than boys; 85% of
children with echolalia go on to develop some
degree of functional language
– Speech not used for social communication
Receptive Language
– Deficiencies in information processing and
semantically based comprehension strategies
– Code visual input spatially vs. temporally
Restricted, Repetitive, and
Stereotypical Behaviors
Behaviors- restricted in scope, repetitive, and
stereotypical
Compulsively adhere to schedules and routines
Intensive attachments to certain objects
Play patterns-abnormally regimented
Repetitive or obessional behavior may not be
sign of executive dysfunction but an attempt to
identify cause-effect relationships
Stereotypical behaviors may serve variety of
functions; operant-conditioning can reduce such
behaviors
Identifying Autism: Major Sources
of Diagnostic Confusion
Sources of confusion from three major factors
– Historical antecedents- “diagnostic muddles”
– Syndrome complexity: Multiple etiologies, variety of
subject-specific treatment approaches
– Misunderstood differences in selection purposesresearch, clinical, or administrative
Resolution of Confusion
– Adoption of Rutter’s (1978a) definition of autism
– Adopting a multiaxial approach to classifying autism
– Grouping to reflect the multiaxial classification system
Behavior Correlates of Autism
Variable Intellectual Functioning
– 38-48% IQ’s above 70
– High Functioning Individuals with Autism- less likely
than low functioning children to exhibit gross deficits
in social interactions and emotional expression
deficits; inappropriate play; self injurious behavior,
and motor and language development delays
Self-injurious Behavior (SIB)
– Self-directed aggression-punching, scratching, biting,
severe head banging, up to 5% of psychiatric
population, 10-20% of persons with autism engage in
SIB
Etiology of Autism
Nature-based explanations
– Function of neurochemical, neurological, and genetic
influences
Nurture-based explanations
– Psychodynamic view-extreme parental rejection
– Behavioral explanation-unresponsive to parents
Nature/Nurture interaction explanations
– Organic, biochemical, neurological impairment
compounded by environmental factors
Course and Prognosis of ASD
Adjustment
– 1 in 6 develops adequate social adjustment
– 2/3 remain severely impacted and fail to develop independent
living skills
– 74% had problems with social aspects of life, relationships, jobs,
independence
Predictors- Cognitive functioning most predictive
– Severe mental retardation
– Higher IQ’s – ½ become productive workers, become more able
to understand and use language
– Spoken Language: Fails to develop useful speech by age 5;
understanding narrative without visual cues correlates with
adaptive behavior; appropriate, collaborative, and systematic
interventions reduce dependence, increase social skills, improve
ability to comprehend and express, reduce behaviors of concern
Asperger’s Disorder
Characteristics
– Severe, sustained, lifelong impairments in social interactioninability to understand rules for social interaction
Restricted, repetitive patterns of behavior, interests,
activities
Attempt to impose ritualistic patterns on environment
Diagnosis, course, and prognosis
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Difficulty in differentiating Asperger’s from other disorders
More common in boys than girls
Rarely recognized prior to age 3
Difficulty in comprehension of figurative language and emotion,
resulting in stress, anxiety, depression, isolation
– Usually referred due to school related problems; refusal, running
away, temper outbursts, stealing, and mutism
– Usually life long disorder
Childhood Degenerative Disorder
(CDD)
Characteristics
– Significant loss of previously acquired skills in multiple
areas following normal development up to ages 3-4
Abnormalities in at least 2 of 3 areas
– Impairments in social interactions
– Impairments in communication
– Restricted, repetitive, and stereotyped patterns of
behavior, interests, and activities
Differs from Autistic Disorder
– Longer period of normal development
– Regression of skills affects more than social skills and
communication
CDD-Etiology
Unknown-damage to CNS likely
Rare, 100 cases worldwide
Age-requires minimum of 3-4 years normal
development and onset before age 10
Loss of skills is progressive initially but
stabilizes
Life long disorder
Pervasive Developmental Disorder
Not Otherwise Specified (PDDNOS)
Diagnostic Criteria
– Severe and pervasive impairment in the development
of social interaction and communication skills that do
not meet criteria for PDD, early onset schizophrenia,
schizotypal personality disorder, or aviodant
personality disorder
– No Specific diagnostic criteria in DSM-IV
Two forms of PDD-NOS
– Symbiotic infantile psychosis- child displays intense
anxiety/panic when faced with separation from mother
– Blueberry syndrome- characterized by inability to
speak, low frustration tolerance, and violent reaction
to invasion of personal space; mental retardation
Early-Onset Schizophrenia (EOSUmbrella term for childhood
schizophrenia)
Primary Characteristics of EOS
– Speech and language disorders, mutism, private language, and do not
use language for communication, language characterized by short
sentences, single words, no abstractions, does not convey mood or
emotion, high pitch, rising inflection, poor reading skills,
mispronunciation
Disorders of relationship- unresponsive to others in their immediate
environment; clinging response; and little interest in the external
environment
Disorders of emotion-in a state of intense anxiety; outbursts lack
purpose or direction
Delusional beliefs and hallucinations- feelings of persecution;
auditory hallucinations that consists of voices that comment on
child’s thoughts or behavior; can believe they are receiving special
messages, possess special powers, or have delusions involving
ghosts, monsters, or animals
EOS cont.
Secondary Characteristics
– Motility-unusual body movements, problems with
bladder and bowel control not unusual
– Measured Intelligence-IQ’s below 80-1/3 to ½
– Classroom performance- do not use classroom skills
for purpose; similar to children with MR
Etiology and Prevalence of EOS
– Nature-based explanations- inherited or organic
factors
– Nurture-based explanations-abnormal family
interactions; severe early trauma