Chapter 14 Developmental Disorders

Nature of Developmental Psychopathology: An Overview Normal vs. Abnormal Development Developmental Psychopathology Study of how disorders arise and change with time Disruption of early skills can affect later development 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 numerous impairments Behavioral Cognitive Social and academic problems DSM-IV and DSM-IV-TR Symptom Types Inattentive type Hyperactive type Impulsive type

Edward

ADHD: Facts and Statistics Prevalence Occurs in 6% of school-aged children 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 Greatest in the United States

ADHD: Sean

The Causes of ADHD: Biological Contributions Genetic Contributions ADHD seems to run in families DRD4, DAT1, and DRD5 genes have been implicated Neurobiological Contributions Smaller brain volume Inactivity of the frontal cortex and basal ganglia Abnormal frontal lobe development and functioning Precise neurobiological mechanisms remain unclear The Role of Toxins No evidence that allergens and food additives are causes Maternal smoking increases risk

The Causes of ADHD: Psychosocial Contributions Psychosocial Factors Can influence the nature of ADHD ADHD children are often viewed negatively by others Constant negative feedback from peers and adults Peer rejection and resulting social isolation Such factors foster low self-esteem

Biological Treatment of ADHD Goal of Biological Treatments To reduce impulsivity and hyperactivity To improve attention Stimulant Medications Reduce core symptoms in 70% of cases Examples include Ritalin, Dexedrine Other Medications With More Limited Efficacy Imipramine and Clonidine (antihypertensive) Effects of Medications Improve compliance in many children Decrease negative behaviors in many children Do not affect learning and academic performance Benefits are not lasting following discontinuation

Behavioral and Combined Treatment of ADHD Behavioral Treatment Involve reinforcement programs To increase appropriate behaviors Decrease inappropriate behaviors May also involve parent training Combined Bio-Psycho-Social Treatments Are highly recommended Superior to medication or behavioral treatments alone

Learning Disorders: An Overview Scope of Learning Disorders Academic problems in reading, mathematics, and writing Performance substantially below expected levels DSM-IV and DSM-IV-TR Reading Disorder Discrepancy between actual and expected achievement Performance significantly below age or grade level Cannot be caused by sensory deficits DSM-IV and DSM-IV-TR Mathematics Disorder Achievement below expected performance DSM-IV and DSM-IV-TR Disorder of Written Expression Achievement below expected performance in writing

Learning Disorders: Some Facts and Statistics Prevalence of Learning Disorders 5-10% prevalence in the United States Highest in wealthier regions of the United States About 32% of these students drop out of school 5-15% prevalence for reading difficulties School experience tends to be generally negative

Growth Area Figure 14.1 Growth area. More than half of all schoolchildren classified as disabled have learning disabilities. Twenty-one years ago, the proportion was around 25%.

Uneven Distribution Figure 14.2 Uneven distribution. The highest percentages of schoolchildren diagnosed with learning disabilities are in the wealthiest states.

Biological and Psychosocial Causes of Learning Disorders Genetic and Neurobiological Contributions Reading disorder runs in families 100% concordance rate for identical twins Evidence for subtle forms of brain damage is inconclusive Overall, contributions are unclear Psychosocial Contributions are Largely Unknown

Treatment of Learning Disorders Requires Intense Educational Interventions Remediation of basic processing problems Improvement of cognitive skills Targeting skills to compensate for problem areas Data Support Behavioral Educational Interventions

Pervasive Developmental Disorders: An Overview Nature of Pervasive Developmental Disorders Problems occur in Language, Socialization, and Cognition Pervasive – Problems span many life areas Examples of Pervasive Developmental Disorders Autistic disorder Asperger’s syndrome

The Nature of Autistic Disorder: An Overview Autism – Significant Impairments Social interactions and communication Restricted patterns of behavior, interest, and activities Three Central DSM-IV and DSM-IV-TR Features of Autism Qualitative impairment of social interaction Problems in communication 50% never acquire useful speech Restricted patterns of behavior, interests, and activities

Autism: Christina

Rebecca

Autistic Disorder: Facts and Statistics Prevalence and Features of Autism Affects 1 in every 500 births More prevalent in females with IQs below 35 More prevalent in males with higher IQs Occurs worldwide Symptoms usually develop before 36 months of age Autism and Intellectual Functioning 50% have IQs in the severe-to-profound range 25% test in the mild-to-moderate IQ range Remaining test in the borderline-to-average IQ range Reliable indicators of good prognosis Language ability and IQ

Causes of Autism: Early and More Recent Contributions Historical Views Bad parenting Unusual speech patterns Lack of self-awareness Echolalia Current Understanding of Autism Medical conditions – Not always related with autism Genetic component is largely unclear Neurobiological evidence of brain damage Substantially reduced cerebellum size Psychosocial Contributions Are Unclear

Asperger’s Disorder: Part of the Autistic Spectrum The Nature of Asperger’s Disorder Show significant social impairments Restricted and repetitive stereotyped behaviors May be clumsy Often quite verbal No severe language and/or cognitive delays 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 Reduction of problem behaviors Target 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, schools, and 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 DSM-IV and DSM-IV-TR criteria Significantly sub-average intellectual functioning Deficits or impairments in present adaptive functioning Must be evident before the person is 18 years of age

Lauren

DSM-IV and DSM-IV-TR Levels of Mental Retardation (MR) Mild MR IQ score between 50 or 55 and 70 Moderate MR IQ range of 35-40 to 50-55 Severe MR IQs ranging from 20-25 up to 35-40 Profound MR 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 Levels of assistance Intermittent Limited Extensive Pervasive Classification of MR in Educational Systems Educable (IQ of 50 to 70-75) Trainable (IQ of 30 to 50) Severe (IQ below 30) Implications of Different MR Classification Systems

Mental Retardation (MR): Some Facts and Statistics Prevalence About 1-3% of the general population 90% are labeled with mild mental retardation Gender Differences MR occurs more often in males Male-to-female ratio of about 1.6:1 Course of MR Tends to be chronic Prognosis varies greatly from person to person

Causes of Mental Retardation (MR): Biological Contributions Hundreds of known causes Environmental – Deprivation, abuse Prenatal – Exposure to disease or a drug / toxin Perinatal – Difficulties during labor Postnatal – Head injury Genetic Research Multiple genes, and at times single genes Chromosomal Abnormalities Down syndrome and Fragile X syndrome Maternal Age and Risk of Having a Down’s Baby Nearly 75% of Cases Cannot be attributed to any known cause Are thought caused by social and environmental factors

Rates of Down Syndrome Births Figure14.3 The increasing likelihood of Down Syndrome with maternal age (based on data from Hook, 1982).

Causes of Mental Retardation (MR): Psychosocial Contributions Cultural-Familial Retardation Believed to cause about 75% of MR cases Is the least understood Associated with Mild levels of retardation on IQ tests Good adaptive skills Difference vs. Developmental Views Difference view - Kind and degree of impairment Developmental view – Rate of developmental delay

Treatment of Mental Retardation (MR) Parallels Treatment of Pervasive Developmental Disorders Teach Needed Skills To foster productivity To foster independence Educational and behavioral management Living and self-care skills via task analysis Communication training – Often most challenging Community and Supportive Interventions Persons with MR can benefit from such interventions

Summary of Developmental Disorders Developmental Psychopathology Attention Deficit Hyperactivity Disorder Deficits in attention, hyperactivity, or impulsivity Disrupt academic and social functioning Learning Disorders Deficits in performance below expectations 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

Exploring Developmental Disorders (ADHD)

Exploring Developmental Disorders (Learning Disorders)

Exploring Developmental Disorders (Pervasive Developmental Disorders)

Exploring Developmental Disorders (Mental Retardation)