1. Chapter 13 Developmental Disorders

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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)

12. 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

13. 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

14. 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%

15. Learning Disorders: Some Facts and Statistics (cont.)
Figure 14.2
Uneven distribution of learning disabilities in the United States in the wealthiest states

16. 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

17. 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

18. 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

19. 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!

20. 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-to-average IQ range
Better language skills and IQ test performance predicts better lifetime prognosis

21. 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

22. 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

23. 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

24. 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

25. 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 to 50-55
Severe MR
Includes people with IQs ranging from up to 35-40
Profound MR
Includes people with IQ scores below 20-25

26. 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

27. 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

28. 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

29. Causes of Mental Retardation (MR): Biological Contributions (cont.)
Figure 14.3
The increasing likelihood of Down syndrome with maternal age

30. 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. Develop-
mental Views
Difference view – Mild MR is a matter of degree and kind
Developmental view – Mild MR reflects a slowing or delay of normal development

31. 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

32. 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

33. Summary of Developmental Disorders (cont.)
Figure 14.x1
Exploring developmental disorders, attention deficit/hyperactivity disorder, learning
disorders, and communication disorders

34. Summary of Developmental Disorders (cont.)
Figure 14.x1 (cont.)
Exploring developmental disorders, attention deficit/hyperactivity disorder, learning
disorders, and communication disorders

35. Summary of Developmental Disorders (cont.)
Figure 14.x2
Exploring developmental disorders, pervasive developmental disorders, mental retardation

36. Summary of Developmental Disorders (cont.)
Figure 14.x2 (cont.)
Exploring developmental disorders, pervasive developmental disorders, mental retardation