Chapter 14: Neurodevelopmental disorders Flashcards
when are neurodevelopmental disorders first diagnosed?
in infancy, childhood, or adolescence
Name some neurodevelopmental disorders
- Attention deficit hyperactivity disorder*
- Specific learning disorder*
- Autism spectrum disorder*
- Intellectual disability
- Communication and motor disorders
developmental psychopathology
Study of how disorders arise and change with time
Disruption of early skills can affect later development
Caution: do not excessively
what should you consider in addressing abnormal and normal development?
The age and environment of the child. Be sure to not pathologize childhood behavior that is part of normal development
childhood-onset fluency disorder
Stuttering occurs 2x more often in boys than girls
language disorder
limited speech in all situations occurs in 10 to 15% of children younger than 3 years old
Social (pragmatic) communication disorder
It is a language disorder. Difficulties with the social aspects of verbal and nonverbal communication
tourettes disorder
motor and vocal tics, high comorbidity with ADHD and OCD, not uncommon
Attention Deficit/Hyperactivity Disorder (ADHD)
Central features are inattention, overactivity, and impulsivity
Associated with behavioral, cognitive, social, and academic impairments
Shows in early childhood and can continue into adulthood
what are the 3 subtypes of ADHD
- Predominantly inattentive
presentation - Predominantly hyperactive/
impulsive presentation - Combined presentation
prevalence of ADHD
Occurs in 5% of school aged children throughout the world
ADHD most commonly diagnosed in the US, but prevalence is constant throughout the world
5-9% in the general population meet criteria
ADHD gender differences
boys outnumber girls 3:1
Some suggest girls symptoms are less likely to be disruptive, thus less likely to be diagnosed (underdiagnosed in girls), girls are usually less likely to have the hyperactive presentation
Course of ADHD, when does it start? Is it chronic?
Symptoms usually appear at 3 or 4
Half of the children with ADHD will have it into adulthood
Impulsivity decreases but inattention remains
Brain development progresses in a more typical fashion in children receiving medication
Causes of ADHD
Genetic influence is high; it runs in families
The DAT1-dopamine transporter gene has been implicated, as have norepinephrine, GABA, and serotonin. Multiple genes influence it
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 may play a very small role in hyperactive/impulsive behavior among children (eating cereal or a food dye won’t cause this)
Maternal smoking increases risk
what is off with brain development in ADHD individuals?
ADHD represents a delay, not a deviation, in brain development (the brain develops slower). The brain develops from the back to the front; the prefrontal cortex is still developing into the early 20s; it’s the last step in brain development. They are 2 years behind kids who don’t have ADHD.
psychosocial contributions ADHD
Children with ADHD are often viewed negatively by others, leading to frequent negative feedback from peers and adults
Peer rejection and resulting social isolation may lead to low self-esteem (therefore increased risk for depression)
What is the goal of biological treatments for ADHD?
reduce impulsivity and hyperactivity, improve attention
biological treatment of ADHD
Stimulant medications: currently prescribed for 3.5% of American children, newer non stimulant medications are also available.
Genes affect individuals responses to medications so some trial and error is necessary
Effects of medications:
Improve attention/focus (Doesn’t get you better grades, just allows you to focus better)
Decrease negative behaviors
Benefits are not lasting following discontinuation
Behavioral and combined treatment of ADHD
Children: reinforcement programs increase appropriate behaviors, decrease inappropriate behaviors may also involve parent training
Adults: cognitive behavioral therapy to increase attention and organization
Combine bio-psycho-social treatments: May be superior to medication or behavioral treatments alone, but more research is needed
What medications are used for ADHD?
Ritalin or adderall
Specific Learning disorders
Academic problems in reading, math, or writing
Perform substantially below expected levels based on age or demonstrated capacity
Problems persist for 6 or more months despite targeted intervention
prevalence of specific learning disorders
5-15% of kids. More commonly seen in wealthy areas because they have more resources to get the help they need
what is the most common specific learning disorder?
Reading difficulties most common affects 7% of the population
students with specific learning disabilities are more likely to…
Have negative school experiences
Drop out of school
Be unemployed
Have suicidal thoughts
Causes of specific learning disorders
Genetic and neurobiological contributions:
Learning disorders run in families but specific difficulties are not inherited
Evidence for subtle neurological difficulties is mounting (decreased functioning in areas responsible for word recognition)
Psychosocial contributions: some languages are more difficult to read so have higher rates of reading impairment
Treatments for specific learning disorders
requires intense educational interventions : Remediation of basic processing problems, cognitive skills, and compensatory strategies
Data support behavioral educational interventions
Biological interventions (e.g., Ritalin) usually used only for those
individuals who also have ADHD
what is the prevalence of specific learning disorders throughout the US?
Prevalence differs across the United States and differs state by state. This is due to not as much attention being drawn to this disorder and variability in the resources available for diagnosis
Autism Spectrum Disorder
Problems occur in language, socialization, and cognition
Pervasive: problems span many areas of life
Two main areas of impairment
1. Communication and social interaction. 10-33% dont acquire effective speech
2. Restricted, repetitive patterns of behavior, interests or activities
Includes what used to be termed autistic disorder, aspbergers disorder, childhood disintegrative disorder (regression in functioning) and Rett disorder (genetic disorder associated with MeCP2 gene)
Three levels of severity based on the amount of support needed
What do people with autism have a deficit in?
joint attention: the ability to communicate interest in an external stimulus and another person at the same time
what do people with autism have trouble with?
Defining characteristic: failure to develop age-appropriate social relationships
Trouble initiating and maintaining relationships
Trouble with nonverbal communication
May lack appropriate expressions, tone
Trouble with social reciprocity (joint attention)
Do people with autism need a routine?
yes they prefer the status quo which is hard on the family because dynamics change
typical autistic behaviors, both severe and less severe
Severe forms: stereotyped or ritualistic behavior
Ex: spinning, waving hands, rocking
Less severe forms: intense, circumscribed interest in very specific subjects. Having restricted areas of interest may compound difficulties relating to others
is autism rare? What is causing this rise in numbers? Which gender is it more commonly seen in? Is there comorbidity?
No 1 in 68 8-year-old children meets criteria
* Majority of recent rise in rates due to changes in diagnostic criteria
- More commonly diagnosed in males. Gender ratio: 4-5 to 1
- 31% also have intellectual disabilities
does bad parenting have a large effect on autism?
genes have more of an effect
economic status and IQ of parents with children who have autism
high socioeconomic status and high IQ
Is autism a lack of self-awareness?
No, some individuals do have self-awareness
if you have one child with autism, what are the chances the second child will have it as well?
20%
is one gene responsible for autism?
no multiple are
does age of parents increase autism risk?
yes older parents increase risk, the amygdala is larger at birth
do vaccines cause autism
no
does medical intervention help autism
Medical intervention has had little positive impact on core dysfunction and there are no biological treatments for autism
treatments for autism
Skill building in communication and socialization
Reduce problem behaviors
Naturalistic teaching strategies: at home in the community in addition to at school with (ex: child-initiated activities)
Early intervention, education, and psychological support are critical
Intellectual disability (Intellectual Development Disorder)
Below-average intellectual and adaptive functioning
First evident in childhood
Range of impairment varies greatly
IQ typically below 70 to 75 (average person is 100)
intellectual disability stats, prevalence? Is it chronic? Prognosis?
Prevalence: 1-3% of general population: 9 in 10 people with ID have mild impairment (IQ 50 to 70)
Chronic course
Highly variable individual prognosis
Independence is possible for many individuals with mild impairment when provided with appropriate resources
Intellectual disability examples
Down syndrome, fragile XLesch-Nyhan syndrome, and Phenylketonuria (PKU)
name the 2 chromosomal disorders
Down syndrome and Fragile X
Lesch-Nyhan syndrome
Intellectual disability, symptoms of cerebral palsy, self-injurious behavior
Phenylketonuria (PKU)
Cannot break down phenylalanine, which is found in some foods
Results in intellectual disability when the individual eats phenylalanine
down syndrome
Most common chromosomal cause of intellectual disability
Extra 21 st chromosome (Trisomy 21)
Distinctive physical symptoms
Fragile X Syndrome
Symptoms include learning disabilities, hyperactivity, short attention span, gaze avoidance, and perseverative speech
Primarily affects males
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
Very rare today because of better child-care systems and early
identification of at-risk families
Treatment of Intellectual Disability
Goals are similar across severity; level of assistance differs
* Behavioral interventions teach:
* Basic self-care skills
* Social skills
* Practical skills
Today intellectual disability is diagnosed based on IQ. T or F
false that was in the past now functioning and need for support are also considered
Most people with intellectual disabilities are severely affected and need residential care. T or F.
False 90% are mildly affected and live normal lives
Prevention of Neurodevelopmental disorders
Early interventions for at-risk children:
Head Start Program: Educational, medical (e.g., nutritional), and social
support
Future directions: Genetic screening
Detection and correction
Prenatal gene therapy
