15 Flashcards
Perspectives
Normal development is important for understanding the nature of childhood psychological disorders.
Disorders first diagnosed in infancy, childhood, or adolescence:
Attention-deficit/hyperactivity disorder (ADHD)
Specific learning disorder
Autism spectrum disorder
Intellectual disability
Developmental psychopathology is the study of how disorders arise and change with time. These changes usually follow a pattern, with the child mastering one skill before acquiring the next. This aspect of development is important, because it implies that any disruption in the acquisition of early skills will, by the very nature of the developmental process, also disrupt the development of later skills.
Attention-deficit/hyperactivity disorder (ADHD) involves characteristics of inattention or hyperactivity and impulsivity.
Specific learning disorder is characterized by one or more difficulties in areas such as reading and writing.
Autism spectrum disorder is a more severe disability, in which a child shows significant impairment in social communication and restricted patterns of behaviour, interest, and activities.
Intellectual disability involves significant deficits in cognitive abilities.
Attention-Deficit/Hyperactivity Disorder
Clinical Description
Unable to sustain attention on tasks, activities
Inattentive, motor hyperactivity, impulsive behaviour
Disrupted schooling and relationships
DSM-5 differentiates two categories of symptoms:
- Inattention
- Hyperactivity and impulsivity
Statistics
ADHD: 3.4% children and adolescents worldwide
Boys outnumber girls 4:1
ADD: 2.6% Canadians overall; more men than women
Problem of overdiagnosis of ADHD in North America
Comorbid with disruptive behaviour disorders
Causes:
Hereditary factor
Multiple genes responsible
- Copy number variants: extra copies or deletion of genes
Inhibition of dopamine gene
Prenatal smoking, stress, alcohol use
Subtle brain differences; reduced with medication
Volume (size) of brain is slightly smaller
Small impact of artificial food colours
Sleep problems
Negative responses by others create low self-esteem
Treatment
1. Biological (medication)
Improves motor planning, response inhibition, compliance
Decreases negative behaviours
Effects not long term
2. Psychological (behavioural)
Goal setting and reinforcement
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common reasons children are referred for mental health services (Popper et al., 2003; Taylor, 2012).
The primary characteristics of people with attention-deficit/ hyperactivity disorder are a pattern of inattention (such as not paying attention to school- or work-related tasks), impulsivity, and/or hyperactivity. These deficits can significantly disrupt academic efforts and social relationships.
Although the manifestations of ADHD change as people grow older, many of the problems persist.
The causes of ADHD have centred on genetics, brain damage, toxins and food additives, and maternal smoking. Negative responses by parents, teachers, and peers to the affected child’s impulsivity and hyperactivity may foster a low-self image in ADHD children.
Page 461: A child with ADHD is likely to behave inappropriately regardless of the setting.
Page 461: ADHD is often comorbid with other disruptive behaviour disorders, such as conduct disorder, the childhood precursor to antisocial personality disorder.
The causes of ADHD have centred on genetics, brain damage, toxins and food additives, and maternal smoking. Negative responses by parents, teachers, and peers to the affected child’s impulsivity and hyperactivity may foster a low-self image in ADHD children.
Treatment of ADHD has proceeded on two fronts: biological and psychosocial interventions.
The goal of biological treatments is to reduce impulsivity and hyperactivity and to improve attention.
Behavioural interventions for ADHD involve reinforcement programs to increase appropriate sitting, work, and play.
Specific Learning Disorder
Specific learning disorder is characterized by performance that is substantially below what would be expected given the person’s age, IQ, and education (Pierce, 2016).
Deficits in reading, math, and written expression
- Dyslexia
Statistics
Between 5% and 15% youth of various ages and cultures
18% disabled Canadians over age 15 have a learning disability (Statistics Canada, 2017c)
Boys and girls equally affected
Related to later development of other mental health problems
- Less education, underemployment, unemployment
Causes
Genetic: found in identical twins, relatives
Neurobiological: subtle brain damage
- Phonological processing problems and reading disabilities linked in both children and adults
Environmental factors: SES, cultural expectations, parental interactions and expectations, child management practices, support (lack of) provided in school
Treatment
1. Education intervention
Remediate directly the underlying basic process of problems
Improve cognitive skills
Improve behavioural skills
2. Combination of programs effective
Learning disorders cover problems related to academic performance in reading, mathematics, and writing that is substantially below what would be expected given the person’s age, IQ, and education.
A study of more than 1600 German elementary schoolers found that approximately 7 percent showed significant deficits in reading, 9 percent in spelling (i.e., written expression), and
5 percent in arithmetic (Moll et al., 2014).
In the United States, approximately 6.5 million students between the ages of 3 and 21 were receiving services for specific learning disorder between 2009 and 2010 (U.S. Department of Education, 2012).
Etiological theories of learning disorders include genetic, neurobiological, and environmental factors.
Page 468: These functional MRI scans of composite data from six adults with dyslexia and eight adults without dyslexia show a horizontal slice through the brain, with the face at the top. Imaging shows atypical brain activity associated with dyslexia. The scans were performed while participants tracked a pattern of moving dots on a computer screen. A brain area (V5/MT) normally active during such motion tasks did not switch on in adults with dyslexia (right). Their brain activity was more similar to that of adults without dyslexia during a pattern recognition task (left).
Treatment for learning disorders requires intense educational intervention and biological treatment and is typically restricted to those individuals who may also have ADHD.
Autism Spectrum Disorder
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that, at its core, affects how one perceives and socializes with others (Durand, 2014).
The DSM-5 combined most of the disorders previously included under the umbrella term “pervasive developmental disorders” (e.g., autistic disorder, Asperger’s disorder, and childhood disintegrative disorder) and included them into this one category (American Psychiatric Association, 2013).
Clinical Description
Autism spectrum disorder (ASD)
ASD described by DSM-5:
Severely impaired socialization and communication
Restricted, repetitive patterns of behaviour
Impairments present in early childhood: limit daily functioning
DSM-5 introduces three levels of severity:
Level 1: requiring support
Level 2: requiring substantial support
Level 3: requiring very substantial support
–Levels are described qualitatively
–Do not have any quantitative equivalents
Impairment in Social Communication and Social Interaction
Failure to develop age-appropriate social relationships, communication, social reciprocity
Inability to engage in joint attention
Uninterested in social situations
Deficits in nonverbal communication
Lack prosody
Restricted, Repetitive Patterns of Behaviour, Interests, or Activities
Stereotyped and ritualistic behaviours
- Maintenance of sameness
Rituals often complex
If rituals are interrupted or prevented, person has a severe tantrum
Statistics
One in 68 eight-year-old children in the U.S.
One in 66 Canadian children:
- 1 in 42 boys, 1 in 165 girls (ratio of 4.5 to 1)
Increased awareness among professionals
Universal phenomenon
31% have intellectual disabilities (IQ less than 70)
Better language skills mean better prognosis
Causes
Neurobiological Influences:
Fewer neurons in amygdala
- With continued stress cortisol damages the amygdala, causing relative absence of neurons
Organic (brain) damage
Lower levels of oxytocin in blood
Causes: Psychological and Social Dimensions
Parents of individuals with ASD may not differ substantially from parents of children without disabilities
Self-concept may be lacking due to cognitive disabilities
Savant skills: exceptional mental abilities found in one-third of ASD individuals
Echolalia: repeating a word or phrase spoken by another person
Treatment
1. Psychosocial Treatments
Behavioural focus to improve communication, socialization, living skills
- Naturalistic teaching strategies
- Inclusive schooling
- Early intervention
- Biological Treatments
Medical intervention has little success
One drug does not work for all with ASD - Integrating Treatments
School education, supports for problems with communication and socialization, parental support
Community integration
Autism spectrum disorder, or autism, is a childhood disorder characterized by significant impairment in social interactions and communication and by restricted patterns of behaviour, interest, and activities.
Specially designed computer games may help children with learning disorders improve their language skills.
Difficulties with social communication and interaction are further defined by the inclusion of three aspects—problems with social reciprocity (a failure to engage in back-and-forth
social interactions), nonverbal communication, and initiating and maintaining social relationships—all three of which must be present to be diagnosed with ASD (see DSM Table 15.3).
Neurobiological evidence of brain damage is derived from the observation that three of four people with autism have some level of intellectual disability, and 30% to 75% display neurological abnormalities such as clumsiness or abnormal posture or gait.
In the past, autism was viewed as the result of bad parenting. Such parents were thought to be perfectionistic, cold, and aloof. Later research has contradicted this view.
Page 475: The communication deficits typical of ASD often lead to social isolation.
Psychosocial treatments for autism include behavioural approaches that focus on skill building and treatment of problem behaviours.
Targets for treatment include communication problems, problems with language, and socialization deficits.
Naturalistic teaching strategies (Durand, 2014): These teaching strategies include arranging the environment so that the child initiates an interest (e.g., placing a favourite toy just out of reach), and this is used as a teaching opportunity (e.g., Say, “I want truck.”).
Psychosocial treatments for autism include behavioural approaches that focus on skill building and treatment of problem behaviours.
Targets for treatment include communication problems, problems with language, and socialization deficits.
Naturalistic teaching strategies (Durand, 2014): These teaching strategies include arranging the environment so that the child initiates an interest (e.g., placing a favourite toy just out of reach), and this is used as a teaching opportunity (e.g., Say, “I want truck.”).
Intellectual Disability (Intellectual Developmental Disorder)
Intellectual disability (ID) is a disorder evidenced in childhood as significantly below-average intellectual and adaptive functioning (Toth et al., 2016). People with ID experience difficulties with day-to-day activities, to an extent that reflects both the severity of their cognitive deficits and the type and amount of assistance they receive.
The DSM-5 identifies difficulties in three domains:
conceptual (e.g., skill deficits in areas such as language, reasoning, knowledge, and memory),
social (e.g., problems with social judgment and the ability to make and retain friendships), and
practical (e.g., difficulties managing personal care or job responsibilities; American Psychiatric Association, 2013).
Clinical Description
Intellectual functioning significantly below average
- Language and communication impairments
Wide range of impairment in daily activities
- Mild to profound
Individuals with ID have difficulty learning
DSM-5 excludes numeric cut-offs for IQ scores
Criteria:
- Person must have significantly subaverage intellectual functioning (IQ 70)
- Concurrent deficits or impairments in adaptive functioning
- Age of onset (deficits evident before age 18)
Degree of disability varies among ID individuals
Statistics
Approximately 90% have mild intellectual disability (IQ of 50–70)
Occurs in 1%–3% of general population
Chronic course: people do not recover
Less severe forms relatively independent and productive with training and support
Male-to-female ratio is 1.6:1 in mild form; no gender differences in severe forms
Causes
1. Fetal alcohol syndrome: heavy alcohol consumption during pregnancy
- Biological Dimensions
Multiple genes contribute to ID
Down syndrome: have extra 21st chromosome
Single-gene disorders
Mitochondrial disorders
Multiple genetic mutations
30% have no identified etiology
Down syndrome: trisomy 21; characteristic facial features
- Adults with Down syndrome past age 40 show signs of dementia of Alzheimer’s type
- 15.8 for every 10 000 births
- Can be detected prenatally through amniocentesis
Fragile X syndrome: ID with chromosomal cause - Psychological and Social Dimensions
Cultural contributors to ID:
- Abuse, neglect, social deprivation
Cultural familial intellectual disability: cognitive impairments resulting from a combination of psychosocial and biological influences
Treatment
Behavioural focus similar to that for ASD
Intervention
Additional support to live in the community
Communication training; supported employment
- Augmentative strategies
Intellectual disability is a disorder of childhood that involves below-average intellectual and adaptive functioning. Manifestations of ID are varied, with some individuals able to function well in society.
Intellectual disability is a disorder of childhood that involves below-average intellectual and adaptive functioning. Manifestations of ID are varied, with some individuals able to function well in society.
Page 478: The colourful tapestries of Canadian artist Jane Cameron, who had Down syndrome, hang in galleries all over the world. She flourished both as an artist and as a swimmer in the Paralympics.
Intellectual disability is a disorder of childhood that involves below-average intellectual and adaptive functioning. Manifestations of ID are varied, with some individuals able to function well in society.
Hundreds of known causes of ID, including
environmental (e.g., abuse, deprivation),
prenatal (e.g., exposure to disease, drugs, poor nutrition),
perinatal (e.g., difficulties during labour and delivery), and
postnatal (e.g., infections, head injury).
Despite the range of known causes, nearly 75% of cases cannot be attributed to any known cause or are thought to be the result of social and environmental influences.
Tuberous sclerosis is relatively rare, occurring in one in approximately every 30 000 births. About 60 percent of the people with this disorder have ID, and most have seizures (uncontrolled electrical discharges in the brain) and characteristic bumps on the skin that during their adolescence resemble acne (Samueli et al., 2015).
A recessive disorder called phenylketonuria, or PKU, affects one of every 10 000 newborns and is characterized by an inability to break down a chemical in our diets called phenylalanine (Schuck et al., 2015; Toth et al., 2016).
Lesch-Nyhan syndrome, an X-linked disorder, is characterized by ID, signs of cerebral palsy (spasticity or tightening of the muscles), and self-injurious behaviour, including finger and lip biting (Nyhan, 1978).
Figure 15.1, Page 481: Proportion of live births and Down syndrome births within each maternal age category in Canada, excluding Québec, 2005–2013.
Treatment for ID parallels treatment of individuals with autism and attempts to teach such individuals skills they need to become more productive and independent.
Augmentative strategies may use picture books, teaching the person to make a request by pointing to a picture—for instance, pointing to a picture of a cup to request a drink (Heath et
al., 2015).
Prevention of Neurodevelopmental Disorders
Eugenics: sterilization
Early intervention
Behavioural intervention for safety training
- “Wellness efforts”
Genetic screening and technological advances are promising
Eugenics was a movement involving applications of genetics knowledge at the time, for which the goal was to improve the human race through better breeding. Eugenics advocates argued for the prevention of ID through sexual sterilization of individuals with ID.
Current efforts to prevent neurodevelopmental disorders are in their early stages. One such effort—early intervention—has been described for ASD and appears to hold considerable promise for some children.
