Chapter 16: Childhood and Adolescence Disorders

Question 1

What are neurodevelopmental disorders?

Answer 1

Involve impaired development of the brain and central nervous system
Symptoms become increasingly evident as child grows and develops

Question 2

What are the types of neurodevelopmental disorders?

Answer 2

Tic disorders
Attention-deficit hyperactivity disorder
Autism spectrum disorders
Intellectual and learning disorders

Question 3

What are tics?

Answer 3

Recurrent, sudden, involuntary, nonrhythmic motor movements (motor tics) or vocalizations (vocal tics)

Question 4

What is provisional tic disorder?

Answer 4

Tics present for less than a year

Question 5

What is chronic tic disorder?

Answer 5

Lasting more than a year
Motor or vocal

Question 6

What is Tourette’s disorder?

Answer 6

Characterized by multiple motor tics and one or more vocal tic
Present for at least one year

Question 7

What is coprolalia?

Answer 7

Involuntary uttering of obscenities or inappropriate remarks
10% of Tourette’s cases

Question 8

What are the causes of tics and Tourette’s?

Answer 8

Genetic basis
Highly comorbid with obsessive-compulsive disorder:
Similar neurochemical abnormalities and brain structures are likely involved
Stress, negative social interactions, anxiety, excitement, or exhaustion can increase the frequency and intensity of tics

Question 9

How are tics and Tourette’s treated?

Answer 9

Psychotherapy can help with the distress caused by tic symptoms
Behavioral techniques such as habit reversal can be effective (teaching a behavior that is incompatible with the tic)
Antipsychotic medications are sometimes used to treat severe tics

Question 10

What is Attention-Deficit Hyperactivity Disorder?

Answer 10

Characterized by inattention and/or hyperactivity and impulsivity atypical for the child’s age and developmental level

Question 11

What is required to diagnose ADHD?

Answer 11

Symptoms begin before age 12 and persist for at least six months
Symptoms interfere with social, academic, or occupational activities
Must display symptoms in at least two settings

Question 12

What are the biological causes of ADHD?

Answer 12

Highly heritable (up to 80% of symptoms explainable by genetic factors)
Exact nature is unclear
Epigenetic biomarkers involving several risk genes linked to ADHD
Neurological mechanisms:
Abnormalities in prefrontal cortex
Brain structure and circuitry irregularities in frontal cortex, cerebellum, and parietal lobes
Reduction in neurotransmitters
Environmental factors account for between 10 and 40 percent of the variance

Question 13

What are the psychological, social, and sociocultural dimensions of ADHD?

Answer 13

Social adversity: family stress, severe marital discord, poverty, family conflicts, paternal criminality, maternal mental disorder, and foster care placement
Negative reactions from parents and rejection from peers
Cultural and regional expectations
Exercise and outdoor activity reduces risk of ADHD symptoms

Question 14

How is ADHD treated with medication?

Answer 14

Stimulants such as Ritalin have been used for decades
Normalize neurotransmitter functioning
30 percent do not respond or experience significant side effects
SPN-812, which increases serotonin, norepinephrine, and dopamine, is in the final phases of the FDA approval process

Question 15

How is ADHD treated with therapy?

Answer 15

Behavioral and psychosocial treatment shown effective
Many experts argue that parent behavior training should be used before considering medication
Modifying the environment or social context can enhance feelings of competence, motivation, and self-efficacy
Providing opportunities for moderate exercise can improve attention and reduce impulsivity and hyperactivity

Question 16

What are autism spectrum disorders?

Answer 16

Characterized by significant impairment in social communication skills
Stereotyped interests and behaviors
Symptoms range from mild to severe

Question 17

What are the symptoms of ASD?

Answer 17

Deficits in social communication and social interaction: atypical social-emotional reciprocity, atypical nonverbal communication, difficulties developing and maintaining relationships
Repetitive behavior or restricted interests or activities involving at least two of following: repetitive speech, movement, or use of objects, intense focus on rituals or routines and strong resistance to change, intense fixations or restricted interests, atypical sensory reactivity

Question 18

What physical and intellectual conditions often co-occur with ASD?

Answer 18

Immune system dysregulation and higher rates of food, respiratory, and skin allergies
42%: average or above-average cognitive skills and are considered “high-functioning”
1/3: have significant cognitive impairment
Some with below average intellectual functioning exhibit splinter skills - autistic savants

Question 19

How is ASD diagnosed?

Answer 19

Many not diagnosed until age 4 or later
Many of early indicators are subtle (e.g., limited eye gaze) - not easily detectible
Recommended to screen all children 18 - 24 months
Parent reports and observations important to diagnosis
Eye-tracking technology successful in detecting decreases in eye contact between 2 and 24 months

Question 20

What are biological causes of ASD?

Answer 20

Strong genetic influence: monozygotic over dizygotic, siblings over general population
Neurological findings:
Abnormal development of the frontal and temporal lobes, amygdala, and cingulate regions of the brain
Reduced gaze toward the eye regions of faces
Atypical responsiveness to the sensory-limbic systems of the brain
Postmortem analyses show patchy development - suggest it begin in womb
Effects of genetic mutation begin in fetal development
Metabolize environmental toxins differently

Question 21

What non-biological factors influence ASD?

Answer 21

Primarily biological
ASD affects the way a child interacts with the world, which in turn affects how others interact with the child
Children with ASD may feel isolated
Behavioral characteristics and caretaking demands associated with ASD can cause family stress

Question 22

How is ASD treated?

Answer 22

Prognosis is mixed - most children retain diagnosis and require support throughout lifetime
Individuals with milder symptoms may be self-sufficient and successfully employed
Comprehensive training and integration into society improve outcome and quality of life
Oxytocin increases social functioning skills in children with ASD
Components of effective programs include improving reciprocal social interaction, developing communication skills through imitation, reinforcing behavioral improvement, and social skills training
Pivotal response treatment (PRT) is now used as an early intervention with infants at high risk of ASD

Question 23

What is intellectual disability?

Answer 23

Characterized by limitations in intellectual functioning and adaptive behaviors

Question 24

What are the categories of intellectual disability?

Answer 24

Mild (IQ 50-55 to 70)
Moderate (IQ 35-40 to 50-55)
Severe (IQ 20-25 to 35-40)
Profound (IQ below 20-25)

Question 25

What are the causes of intellectual disability?

Answer 25

Mild is idiopathic (no known cause)
Pronounced related to genetic factors, brain abnormalities, or brain injury
Genetic factors: Chromosomal variations, inheritance of a single gene, many located on the X chromosome (Fragile X syndrome)

Question 26

What is Fragile X Syndrome?

Answer 26

Developmental delays (not sitting, walking, or talking at the same time as other children the same age)
Learning disabilities (trouble learning new skills)
Social and behavior problems (not making eye contact, anxiety, trouble paying attention, hand flapping, acting and speaking without thinking, and being very active)

Question 27

What are the nongenetic biological factors associated with intellectual disability?

Answer 27

Environmental influences during the prenatal, perinatal, or postnatal period
Prenatal: Viruses and infections, Phenylketonuria (PKU), drugs and alcohol (fetal alcohol syndrome), radiation, and poor nutrition
Perinatal: Premature birth and low birth weight
Postnatal: Head injuries, brain infections, tumors, prolonged malnutrition, and exposure to environmental toxins

Question 28

What is Down Syndrome?

Answer 28

Extra copy of chromosome 21 (trisomy 21) originates during gamete development
Distinctive physical characteristics
Mild to moderate intellectual disability
With support, many adults can have jobs and live semi-independently
Prenatal detection is possible

Question 29

What are the psychological, social, and sociocultural dimensions of intellectual disabilities?

Answer 29

Children with socioeconomically advantaged homes often experience enriching activities, while those living in poverty are at an intellectual disadvantage and poverty can influence whether they reach their full potential
Strong, positive influences: enriching, encouraging home environment, ongoing education intervention
Coping strategies and use of outside resources are often influenced by sociocultural context

Question 30

What are learning disorders?

Answer 30

Academic disability characterized by reading, math, or writing skills deficits

Question 31

What are different learning disorders?

Answer 31

Dyslexia (significant difficulties with accuracy or fluency of reading)
Dyscalculia (significant difficulties in understanding quantities, number symbols, or basic arithmetic calculations)
Disorders of written expression

Question 32

What support is needed for individuals with neurodevelopmental disorders?

Answer 32

Build skills and develop potential to the fullest extent possible
For those with moderate to severe intellectual disability or autism spectrum disorder: support often begins in infancy and extends across the life span
Support in childhood when autism spectrum disorder or intellectual disability is identified early (individualized home based or school-based programs)
Support in Adulthood: number of programs for young adults with moderate neurodevelopmental disabilities to learn vocational skills or to participate in work opportunities in a specialized setting