Neurodevelopmental Disorders Flashcards
What defines ADHD in terms of DSM categories? P 520
Differentiates two categories of symptoms;
Problems of inattention
Symptoms of hyperactivity and impulsivity
ADHD discuss causes / contributions p 521 to 523
Highly influenced by genetics with environmental factors playing a relatively small role (more about management of ADHD, but does not rule out the importance of gene environment interaction, like smoking when pregnant)
Multiple genes are responsible.
Research is showing mutations occur that either create extra copies of a gene on one chromosome or result in the deletion of genes (called copy number variants)….
Strong evidence ADHD is associated with dopamine D4 receptor gene, dopamine transporter gene DAT1 and dopamine D5 receptor gene.
Little evidence to support idea that food additives a possible cause. Research points to toxins found in pesticides as contributing to increased risk,
Risk increases if family member has the disorder or any psychopathology in general.
Brain volume slightly smaller. A number of brain area’s affected especially those involved in self organised abilities. Stimulant medication seen as responsible for these brain differences being less pronounced for children taking medication (growth enhancing effect)
Treatment of ADHD P 523 to 525
Treatment proceeded on two fronts; psychosocial and biological. Psychosocial focus on broader issues like improving academic performance, decreasing disruptive behaviour and improving social skills. Biological focus on reducing impulsivity and hyperactivity and improving attention skills.
Psychosocial interventions : effective interventions include behavioural parent training, behavioural classroom management, behavioural peer interventions, organisation training programs. In general goals include increasing the amount of time the child remains seated, number of math papers completed, appropriate play with peers. Reinforcement programs for reward and punishing misbehaviour with loss of rewards….
Biological interventions:
Stimulant and several non stimulant medications have shown to be successful in reducing the core symptoms of hyperactivity, impulsiveness.
Although it may seem paradoxical to use a stimulant but on low doses, both children and adults with and without ADHD react in the same way - reinforcing the brain’s ability to focus attention during problem solving. Temporary use is recommended in combination with psychosocial interventions to help improve social and academic skills….
Treatment of ADHA - psychopharmacogenetics the study of how genetic makeup influences your response to certain medications p 525
Example of biology and treatment
This new study holds the promise of potentially eliminating this guesswork by tailoring medication to the individual.
One study found that those who had a specific gene defect - the adrenergic alpha 2A receptor gene, Ritalin had a strong positive effect, but not for those who did not have this particular gene defect.
Autism Spectrum Disorder - what disorders does this include (which some of which use to sit under the umbrella of pervasive developmental disorders ? P 530
Asperger’s
Autistic
Childhood disintegrative
Rett disorder
Social (pragmatic) communication disorder
What is the clinical description for Autism Spectrum Disorder? P 530
Two major characteristics of ASD are expressed in DSM;
1) impairment in social communication and social interaction
2) restricted, repetitive patterns of behaviour, interest or activities
In addition it is recognised that the impairments are present in early childhood and that they limit daily functioning. It is the degree of impairment in each of these characteristics that presumably distinguish individuals previously diagnosed with the seperate disorders of autistic disorder, Asperger’s and pervasive developmental disorder- not otherwise specified.
Autism Spectrum Disorder- to accomodate the range of difficulties in the two symptom clusters (social/communication interaction and restricted, repetitive patterns of behaviour, interests or activities), DSM introduced 3 levels of severity being qualitative descriptions of high are? P 530
Level 1 Requiring support
Level 2 Requiring substantial support
Level 3 Requiring very substantial support
Autism spectrum disorder - discuss impairment in social communication and social interaction p 531
One of the defining characteristics of ASD is that they do not develop age appropriate social relationships. The case example of Amy - she never made friends among her peers and limited her contact with adults to the use of tools, for example taking an adults hand to reach for something she wanted.
Difficulties with social communication and interaction are further defined by the inclusion of three aspects;
Problems with social reciprocity, nonverbal communication, and initiating and maintaining social relationships. All three must be present for diagnosis of ASD
What is joint attention? P 531 Autism Spectrum Disorder
Social reciprocity for individuals with more severe symptoms of ASD involve the inability to engage in joint attention. If a toddler without ASD sees a toy she likes, she might look at her mother, smile, look at the toy and look at the mother again to express interest in the toy. This action is limited in persons with ASD. For people with milder symptoms, previously diagnosed with Asperger’s, lack of social reciprocity might present as appearing self-focused and not showing interest in things others care about.
Autism Spectrum Disorder - research using sophisticated eye tracking technology shows how social deficits evolve as the person develops, explain ? P 531
A classic study showed a man with ASD some scenes from movies and compared how he looked at social scenes with how a man without ASD did so. The man with ASD scanned nonsocial aspects for example, the actors mouth, jacket, while the man without ASD looked at social meaningful sections, looking from eye to eye of people conversing. Suggests people with ASD may not be interested in social situations- for reasons yet unclear.
Autism spectrum disorder statistics p 532 what are reliable predictors of how children with ASD will fare later in life?
Language abilities and IQ scores.
The better the skills and test performance the better the prognosis.
Autism spectrum disorder - Genetic influences / contributions discussed p 533
The genetics of ASD are highly complex with a moderate genetic heritability.
Numerous genes on a number of chromosomes have already been implicated.
And like other psychological disorders such as schizophrenia, many genes are involved but each one has a relatively small effect.
Families with one ASD child have about 20% chance of having another child with ASD. A rate more than 100 times the risk in the general population.
One area receiving attention involves the genes responsible for the brain chemical oxytocin because oxytocin is shown to have a role in how we bond with others and in our social memory.
There appears to be in increased risk of having an ASD child among older parents,..
Autism spectrum disorder: neurobiological influences discussed p 534
As in the area of genetics, many neurobiological influences are being studied to help explain the social communication and behaviour problems. Research on the amygdala- the area of the brain that is involved in emotions such as fear and anxiety is one such area of study. One study showed that the amygdala of deaf adults with and without ASD were the same size, but for those with ASD, that it had fewer neurons. The theory being proposed is that in children with ASD, the amygdala which has been shown to be enlarged causes excessive fear and anxiety (perhaps contributing to social withdrawal). With continued stress, the release of cortisol damages the amygdala, causing the relative absence of these neurons in adulthood. The damaged amygdala may account for the different way people with ASD respond to social situations.
An additional neurobiological influence discussed in genetic causes is the role of neuropeptide oxytocin (remember this is an important social neurochemical that influences bonding and is found to increase trust and reduce fear. Some research on children with ASD found lower levels of oxytocin in their blood and giving oxytocin to people with ASD improved ability to remember and process information with emotion content.
Autism spectrum disorder; an integrative model, discuss p 534
The study of ASD is a relatively young field and still awaits an integrative theory of how biological, psychological and social factors work together.
Treatment of Autism Spectrum Disorder; what can be said in general about treatment! P 534
No completely effective treatment exists. Attempts to eliminate the social communication problems experienced have not been successful to date. Rather, most efforts at treating ASD focus on enhancing communication and daily living skills and on reducing problem behaviours such as tantrums and self injury.
