Chapter 11 (Lecture - Ch 9 in textbook) Flashcards
Introduction
- for the past 50 years, study of child development (intellectual, social, emotional) has focused on the brain and central nervous system
- impairments centred in these areas are described as neurodevelopment disorders
- there is wide variation in the symptoms and severity associated with these disorders
Neurodevelopmental Disorders
Neurodevelopmental disorders include:
- fetal alcohol spectrum disorders (FASD)
- intellectual disorders
- motor disorders (Tourette syndrome)
- communication disorders
- genetically determined disorders (down and Williams syndrome)
- conditions associated with traumatic and congenital brain injuries (cerebral palsy)
There is a wide variation in the symptoms and severity associated with these disorders
Neurodevelopmental disorders
- group of conditions with onset in the developmental period (early onset)
- characterised by developmental deficits that produce impairments
Autism Spectrum Disorder (ASD)
- characterised by persistent deficits in social communication and social interaction across multiple contexts including deficits in social reciprocity, nonverbal communicative behaviours used for social interaction, and skills in developing, maintaining and understanding relationships
- presence of restricted, repetitive patterns of behaviour, interest, or activities
- many previously diagnosed with Asperger’s disorder would now receive a diagnosis of autism spectrum disorder without language or intellectual impairment
neurodevelopmental disorders share 2 key features
- at the root of the disorders is a neurological dysfunction that affects the capacity of the individual for intellectual, social, and (sometimes) physical development
- individuals diagnosed with these disorders may struggle to fit in and be fully included in society
Focus on being biological in nature and posing challenges to social functioning and educational achievement
Introduction - continued
- the focus on neurology and attempting to “fix” the disorder makes other, perhaps more socially focused approaches and efforts to enhance accessibility in society, less of a priority
- the chapter focuses primarily on ADHD and autism, but hold lessons related to other neurodevelopmental disorders - as well as our understanding of mental health and illness more broadly
- these disorders are explored through discussions of their clinical features (symptoms and diagnostic criteria), their historical emergence, explanations of the disorders, and debates regarding treatment
ADHD
- characterised by inattentive, hyperactive, impulsive behaviours
- stereotypically: a boy who has difficulty sitting well, being organised, concentrating, resisting impulses, and who may be aggressive
- often first noticed at school, where these behaviours are a deemed “problematic”
- once referred for assessment, the DSM-5 checklist is used to see if the child meets criteria for diagnosis (6/18 symptoms, consistently for 6 months)
- many of the listed criterion are normal childhood behaviours - it is the frequency and social impact of them that leads to diagnosis
ADHD symptoms and checklist
clinicians uses the DSM-5 checklist to make the diagnosis, the child must have presented 6 out of 18 symptoms consistently over a period of 6 months
These symptoms include when a child has:
- difficulty waiting their turn
- often talks excessively
- often fails to give close attention to details or make mistakes
- often does not follow through on instructions and fails to finish schoolwork or workplace duties
While these sorts of symptoms may be problematic (leading to impairment or hindering performance), it is easy to see how they can be interpreted subjectively, perhaps leading to over-diagnosis of the disorder
Also:
- these symptoms are evident among adults when they are stressed, anxious, or short of time
- many high functioning and very effective people may display these symptoms
- context specific nature is evident: one view of ADHD is that specific people (children) do not adequately “fit” with expectations in classrooms and behaviour is deemed a “problem”
ADHD criticisms
Key criticism: diagnositc criteria may be explained by immaturity (has not yet reached a particular level of development) - the youngest children in a school cohort are more likely to be diagnosed with ADHD, and even more likely to be prescribed medication (unable to “fit” with expectations and context)
- estimated that approximately 1.1 million children received an inappropriate diagnosis and over 800,000 received stimulant medication due only to relative maturity -illustrating the importance of this “immaturity” or development view
- another critique points out that a regimented classroom setting may lead to misbehaviour for some children who then would be more likely to be diagnosed, compared to children in a more active, flexible, and hands-on environment (contextual influence on diagnosis)
ADHD global prevalence
5% in children
2.5% in adults
Autism
- media portrayals of autism do not reflect the reality of the disorder for many of the people affected by it
- difficulty understanding the need to be social and managing social interactions is an essential feature of autism
- evolutionary perspective: social relations are the core of our success and survival, so autism may have brought some advantages for individuals as well
- this visibility and perceived prevalence of autism may have risen as society became increasingly urban and complex- became an important concept in the 1940s
Autism - clinical perspective
People with autism struggle to manage social life and social expectations
- core symptoms of autism: difficulties with reciprocal social interaction and communication, as well as repetitive, stereotypical routines and behaviours and associated sensory symptoms
There is no biological marker for autism; it can not be observed or diagnosed with a brain scan, it is not clear what causes it
- DSM-5 attempts to describe the condition, outlining criteria for diagnosis - similar to how medicine described TB prior to identifying the bacteria causing the pathology - focus was one symptoms without knowledge of the underlying cause (now we know the biomarker for TB)
what are ADHD and Autism so important as disorders in this point in time?
- most common of the neurological disorders
- complex and controversial with diverse symptoms of varying severity (present in very different ways among different individuals)
- emerged at about the same time historically (somewhat similar “social trajectories”)
- similar characteristics, but distinct
Also: - both described as modern “epidemics” in current conceptualisation, shaped by social changes
- mental health diagnoses and identity
- intense scientific debates, lots of popular interest
- children and youth are most affected: families and caregivers are active stakeholders, highly relevant for education and the school system,
- shifting understanding of the conditions, being redefined in DSM and society
- co-occurring with other conditions and disorders
- both not just characterisation by deficits but also potential sources of strength and capability
Early onset of childhood mental disorders
Early childhood - birth to 6 years
- effects of parental substances
- learning difficulties
- autism spectrum disorder
- ADHD
- Oppositional-defiant disorder
- some anxiety disorders
Middle childhood - 7 to 12 years
- most anxiety disorders
- post-traumatic stress disorders
- conduct disorder
- OCD
Adolescence - 13 to 18 years
- substance use disorders
- major depressive disorder
- bipolar disorder
- eating disorders
- schizophrenia
High prevalence of childhood mental disorders
- Anxiety 5.2 prevalence
- ADHD 3.7 prevalence
- oppositional-defiant disorder 3.3 prevalence
- substance use disorder 2.3 prevalence (12-18 years)
- Major depression 1.3 prevalence
- conduct disorder 1.3 prevalence
- Autism Spectrum disorder 0.4 prevalence
- OCD 0.3 prevalence
- Bipolar disorder 0.3 prevalence (12-18 years)
- Eating disorders 0.2 (12-18 years)
- post-traumatic stress disorder 0.1 prevalence
- schizophrenia 0.1 prevalence (12-18 years)
