CHAPTER 15 PERVASIVE DEVELOPMENTAL DISORDERS AND MENTAL RETARDATION

PERVASIVE DEVELOPMENTAL DISORDERS Conditions that become apparent early in a child's development and affect all major developmental systems (social, cognitive, and language) Autistic disorder Asperser's disorder Childhood disintegrative disorder Rett’s disorder

AUTISTIC DISORDER Characteristics Usually noticed by age of 3 years Marked difficulty in social interaction and communication Restricted range of interests Strong desire for routine 75% are mentally retarded

AUTISTIC DISORDER Deficits Theory of mind – Inability to infer the mental states of others and to think abstractly Executive functions – Cognitive operations involved in planning and flexibility of response Language – Many never speak and those who do have stereotypical, repetitive, idiosyncratic speech patterns Joint attention behaviors – Inability to maintain eye contact and social interaction

AUTISTIC DISORDER CAUSES Brain abnormalities Genetic factors Stress or injury may interact with genetic vulnerability TREATMENT Behavioral – Increase skills, reduce problem behaviors Learning techniques to take into account cognitive strengths and weaknesses Medications to treat some symptoms

HEREDITARY FACTORS IN AUTISTIC DISORDER

ASPERGER’S DISORDER May be a mild form of autism Impaired social interaction Restricted and repetitive patterns of behavior and interests Does not include language delays and absence of autism Does not include impaired cognitive development of autism Usually not diagnosed until school age

CHILDHOOD DISINTEGRATIVE DISORDER Normal development until age 3 or 4, followed by loss of previously acquired Language, social, and motor skills and bowel and bladder control Changes thought to be associated with deterioration in the nervous system Very rare – One in one million births More common in boys than girls Causes unknown

RETT’S DISORDER Progressive disorder appearing after normal development at about 5 months of age Head stops increasing in size, so becomes smaller than normal (microcephaly) Loss of previously acquired developmental skills (language, social, and motor) Typically affects only girls Most become severely retarded No specific treatment

MENTAL RETARDATION Characteristics Subaverage intellectual function with significant limitations in adaptive functioning that begins before age 18 Levels Mild – IQ to 70 Moderate – IQ to Severe – IQ to Profound – IQ below 20 or 25 Incidence One in every 100 individuals in the US

MENTAL RETARDATION

CAUSES OF MENTAL RETARDATION Genetically based Dominant genes Tuberous sclerosis Recessive genes Genetic mutation Phenylketonuria (PKU) Chromosomal abnormalities Fragile X syndrome Down syndrome Polygenetic

FRAGILE X CHROMOSOME

DOWN SYNDROME

CAUSES OF MENTAL RETARDATION The fetal environment Maternal infections Chronic conditions Blood incompatibilities between mother and child Chemicals in fetal environment Alcohol- Fetal alcohol syndrome Radiation Malnutrition Factors associated with age and stress of mother

CAUSES OF MENTAL RETARDATION Problems during birth Prematurity Low birth weight Lack of oxygen during birth process Too-rapid progress through the birth canal Damage to the nervous system after birth Infections (encephalitis) Extreme malnutrition Blows to the head Tumors Oxygen deprivation due to accidents (such as near drowning) Environmental poisons (lead paint)

CAUSES OF MENTAL RETARDATION Psychosocial disadvantage Impoverished environment 30-50% of variation in intelligence test scores can be attributed to environmental influences

PREVENTION OF MENTAL RETARDATION Primary prevention Public education about need for prenatal care, dangers of pregnant women drinking, and dangers of exposure of children to lead Amniocentesis and ultrasound scanning that may lead to termination of pregnancy Secondary prevention Treatment, as in special diet for PKU children Tertiary prevention Maximizing child’s skills and potential School- and community-based educational, vocational, and skills training programs

EARLY INTERVENTION FOR MENTAL RETARDATION Children at psychosocial risk Home-based interventions Special centers with trained staffs, supplemented by home visits School-based programs Individuals with Disabilities Education Act (IDEA) guarantees free public education for all disabled children, including the mentally retarded Least-restrictive placement Mainstreaming versus special placement

VOCATIONAL AND SOCIAL SKILLS TRAINING FOR MENTALLY RETARDED ADULTS Job preparation – Sheltered workshops Learning how to deal with personal, financial, and sexual exploitation Teach social skills and how to say “no” Training in appropriate sexual behavior

RECOGNITION AND TREATMENTE OF PSYCHOLOGICAL PROBLEMS Forty percent of mentally retarded meet criteria for some other disorder Severely and profoundly retarded often have autism or pervasive developmental disorder One-fourth have a personality disorder Many adolescents have temper tantrums, aggressive and destructive behavior, and alcohol and drug abuse Children with fragile-X syndrome often have ADHD Children and adults with Down syndrome often suffer from depression