ch. 13 Flashcards
Nature of Developmental Psychopathology: An Overview
Normal vs. abnormal development
Consider age and environment of child
Developmental psychopathology
Study of how disorders arise and change with time
Disruption of early skills can affect later development
Neurodevelopmental Disorders
Diagnosed first in infancy, childhood, or adolescence
Include the following:
Attention deficit hyperactivity disorder (ADHD)
Specific learning disorder
Autism spectrum disorder
Intellectual Disability
Communication and Motor Disorders
Communication and Motor disorders
Childhood Onset Fluency Disorder
Speech difficulty that may include repeated syllabus (stuttering), pauses or substituting words that are easier to pronounce
Language Disorder
Limited speech in all situations; understanding of speech is normal and problem may self-correct
Social (Pragmatic) Communication Disorder
Difficulty with social aspects of communication (e.g., dominating conversations, switching topics excessively), but lacks other features of autism spectrum disorder (e.g., restrictive behaviors and interests)
Tourette’s Disorder
Involuntary motor movements and/or vocalizations, which may include obscenities
Nature of ADHD
Central features – inattention, overactivity, and impulsivity Associated with numerous impairments Behavioral Cognitive Social and academic problems
DSM-5 symptom types
ADHD
Predominantly inattentive presentation
Predominantly hyperactive/impulsive presentation
Combined presentation
ADHD: Facts and Statistics
Prevalence
Occurs in approximately 5% of school-aged children
Symptoms are usually present around age three or four
Children with ADHD have similar problems as adults
Gender differences: Boys outnumber girls 3:1
Cultural factors
ADHD most commonly diagnosed in the United States, although prevalence appears fairly constant worldwide
The Causes of ADHD: Biological Contributions
Genetic contributions
ADHD seems to run in families
DAT1 – dopamine transporter gene has been implicated
Some ADHD drugs work by inhibiting DAT1
Neurobiological correlates of ADHD
Smaller brain volume
Inactivity of the frontal cortex and basal ganglia
Abnormal frontal lobe development and functioning
The role of toxins
Food additives (e.g., dyes, pesticides) may play very small role in hyperactive/impulsive behavior among children
Maternal smoking increases risk
The Causes of ADHD: Psychosocial Contributions
Psychosocial factors
ADHD children are often viewed negatively by others > Frequent 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 and to improve attention
Stimulant medications
Currently prescribed for approximately 4 million American children
Low doses of stimulants improve focusing abilities
Examples include Ritalin, Dexedrine, Adderall
Problem: May increase risk for later substance abuse
Other medications with more limited efficacy
Imipramine and clonidine (antihypertensive)
Genes affect individuals’ response to meds
Some trial and error is necessary
Effects of medications
Improve compliance, decrease negative behaviors
Do not affect learning/academics directly
Benefits are not lasting following discontinuation
Behavioral and Combined Treatment of ADHD
Behavioral treatment Reinforcement programs To increase appropriate behaviors Decrease inappropriate behaviors May also involve parent training Combined bio-psycho-social treatments Often recommended May be superior to medication or behavioral treatments alone, but more research is needed
Specific Learning Disorders: An Overview
Scope of learning disorders
Academic problems in reading, mathematics, and/or writing
Performance substantially below expected levels based on age and/or demonstrated capacity
Problems persist for 6+ months despite targeted intervention
Specific Learning Disorder: Types
With impairment in reading, may include:
Word reading accuracy
Reading rate or fluency
Reading comprehension
With impairment in written expression, may include:
Spelling accuracy
Grammar punctuation and accuracy
Clarity/organization of written expression
With impairment in mathematics, may include: Number sense Memorization of arithmetic facts Accurate or fluent calculation Accurate math reasoning
Specific Learning Disorder: Statistics
Prevalence of learning disorders
Six million children have been diagnosed in the United States
Highest rate of diagnosis in wealthier regions, but children with low SES more likely to have difficulties
Reading difficulties most common, affect 4-10% of the general population
School experience tends to be generally negative
Biological and Psychosocial Causes of Specific Learning Disorder
Genetic and neurobiological contributions
Learning disorders run in families, but specific difficulties are not inherited
Evidence for subtle neurological difficulties is mounting (e.g., decreased functioning of areas responsible for word recognition)
Overall, contributions are unclear
Psychosocial contributions are likely important
Treatment of Specific Learning Disorder
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
Autism Spectrum Disorder
Problems occur in language, socialization, and cognition
Pervasive – problems span many life areas
Two main areas of impairment:
Communication and social interaction
25% don’t acquire effective speech
Restricted, repetitive patterns of behavior, interests, or activities
Need to maintain “sameness” - high level of consistency in activities or experience
Label is new to DSM-5
Encompasses several disorders previously classified as “pervasive developmental disorders”,
Including:
Autistic disorder
Asperger’s disorder
Childhood disintegrative disorder
Rett syndrome
Autism Spectrum Disorder: Prevalence
1 in 50 school-aged children meet criteria More commonly diagnosed in males IQ interaction 38% show intellectual disabilities Occurs worldwide
Psychological and Social Dimensions Autism
Historical views Failed parenting Perfectionistic, cold, and aloof High socioeconomic status Higher IQs Lack of self-awareness Behavioral correlates Echolalia (immediate, delayed, mitigated) Self-injury
Biological Dimensions Autism
Significant genetic component
Familial component: If have one child with autism, the chance of having a second child with autism is 20% (100x greater risk than general population)
Numerous genes on several chromosomes involved
Oxytocin receptor genes
Bonding and social memory
Older parents associated with increased risk
Neurobiological influences
Amygdala
Larger size at birth = higher anxiety, fear
Elevated cortisol
Neuronal damage in the amygdala results from high stress, which may affect processing of social situations
Oxytocin
Lower levels
Causes of Autism Spectrum Disorder : Biological
Neurobiological influences
Vaccinations do NOT increase the risk of autism
Mercury in some vaccinations was rumored to increase autism risk
Large scale studies do NOT support this
High rates of vaccinations do NOT increase risk for autism in the community at large
Health risk of not vaccinating is substantial
Treatment of Autism Spectrum Disorder
Psychosocial treatments Behavioral approaches Skill building Reduce problem behaviors Communication and language training Increase socialization Naturalistic teaching strategies Early intervention is critical – may “normalize” the functioning of the developing brain
Biological treatments Medical intervention has had little positive impact on core dysfunction Some drugs decrease agitation Tranquilizers SSRIs Indicators of good prognosis High IQ, good language ability
Integrated treatments
Preferred model: Multidimensional, comprehensive focus
Children offered special education at school focusing on communication
Judicious use of medication in some cases
Families given support too
When older, focus on integrating into the community while maximizing independence
Intellectual Disability
Overview Below-average intellectual and adaptive functioning First evident in childhood Range of impairment varies greatly Previously called mental retardation
IQ typically below 70-75
Previously distinguished different levels of severity; IQ may be as low as under 20
Previously diagnosed on DSM-IV Axis II
Reserved for conditions that 1) are chronic and pervasive and 2) are likely to influence the presentation of other mental disorders
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)
Practical (e.g., difficulties managing personal care or job responsibilities)
Devalued by society
Other Classification Systems for Intellectual Disability
American Association of Intellectual and Developmental Disabilities (AAIDD)
Based on assistance required
Intermittent
Limited
Extensive
Pervasive
Keeps the emphasis on what assistance is needed
Intellectual Disability: Statistics
Prevalence = 2% of general population
9 in 10 people with ID have mild impairment (IQ 50-70)
Chronic course
Highly variable individual prognosis
Independence is possible for many individuals with mild impairment when provided with appropriate resources (e.g., skills training)
Causes of Intellectual Disability
Hundreds of known causes Environmental (e.g., neglect) Prenatal Perinatal (e.g., problems with delivery) Postnatal
Examples Fetal alcohol syndrome Exposure to other illness in the womb Lack of oxygen (anoxia) during birth Malnutrition Head injuries Childhood abuse
Genetic influences
Chromosomal disorders (e.g., Down Syndrome)
Multiple genetic mutations
Single genes can be responsible
Dominant genes less often responsible for ID (because people with ID are less likely to have children)
Recessive genes more often responsible
Most cases of ID have no identified etiology
Genetic influences
De novo disorders
Lesch-Nyham syndrome
Intellectual disability, symptoms of cerebral palsy, self-injurious behavior
Recessive allele on the X chromosome > only affects males (females have an additional X chromosome to balance)
Phenylketonuria (PKU)
Cannot break down phenylalanine, which is found in some foods
Results in ID when the individual eats phenylalanine
Now, test at birth can detect PKU > diets without phenylalanine actually prevent development of intellectual disability and other problems
Chromosomal influences
Down syndrome
Most common chromosomal cause of intellectual disability
Extra 21st chromosome (Trisomy 21)
Distinctive physical symptoms
Down syndrome
Higher risk with advanced maternal age
Detectable with some prenatal tests
Amniocentesis
Chorionic villus sampling (CVS)
Mother’s blood tests
Tests do not indicate severity of impairment
1 in 4 mothers elects to terminate the pregnancy
Fragile X syndrome
Symptoms Learning disabilities Hyperactivity Short attention spans Gaze avoidance Perseverative speech Gender differences Primarily affects males Women with Fragile X have mild symptoms
Cultural-familial intellectual disability
Refers to intellectual disability influenced by social environmental factors, such as:
Abuse
Neglect
Social deprivation
These factors likely interact with existing biological factors
Treatment of Intellectual Disability
Severe ID: Treatment similar to that for autism spectrum disorder
Mild ID: Treatment similar to that for learning disorders
Goals are similar across severity; level of assistance differs
Behavioral interventions teach:
Basic skills (e.g., dressing, hygiene)
Social skills
Practical skills (e.g., paying bills)
Common goals
Treatment of Intellectual Disability
Participate in community life
Benefit from education
hold a job or other productive pursuits (e.g., volunteering)
Build meaningful relationships
