SPRING Developmental Disorders Flashcards
what are developmental disorders
group of conditions with onset in the developmental period
impair social, academic and/or occupational functioning
often co morbid
types of developmental disorders
ASD intellectual disability/developmental disorder communication disorder adhd motor disorders
variants of ASD
autism
asperges
childhood disintegrative disorder
pervasive developmental disorder not otherwise specified
describe ASD/autism
deficit in social communication and interaction
restricted repetitive behaviour, interests and activities
BOTH REQUIRED FOR AUTISM DIAGNOSIS
usually diagnosed around 2years (due to underdeveloped communiction skills before this age) but any age can diagnose
social prgamatic communication disorder / asperges
ASD without the repetitive behaviour
theories of autism
mindblindness (bc 1995) - lack TOM (SAM)
weak central coherence (frith 1989) (detail focus>whole)
empathising systemising theory (bc 2009) (low empathy and high systemising)
extreme male brain theory (bc 2002) autism have exagretated male brian
executive dysfunction
genetics
continuum disorder
describe empathising systemising account of ASD
bc 2009
link with weak central coherence frith 1989
problems in empathy and in systemising
focus on details and fail to take into account the whole
ie less susceptable to illusions
BUT doesnt explain repetitive behaviours
describe executive dysfunction account of ASD
difficulties in planning and organisation
inability to control certain behaviours and plan in the same way as typically developing children
describe genetics account of ASD
MZ inheritence 36-91%
may be genetic susceptability but variable and not certain
genetic cause in 20-15% children ie genome wide assoc link SFARIGENE to disorder + many other assoc mapped
describe continuum disorder of ASD
autism and TD lie on a continuum of social disability
asperges middle - lies as bridge between autism and td
what is the prevalence of ASD in society
increased awarenes and diagnostic classification improvement
increasing 100/10,000
more males than females 4:1
50:50 severe and 10:1 mild
- varies in presence of intellectual disability
what is ASD increasing in society
increased awareness
improvement in measuring and diagnosis
how is ASD diagnosed
interview
observation schedule
rating scale
what is an observation scale diagnosis
lord et al 2000
semi structured standardised assessment of social interaction , communication, play and imagination over 30 minute intervals given 1 module dependent on expressive language ie those who do not use phrase speech, whose who do use but not fluent and dluent chidlren/adults relate to behaviours exhibited ona daily basis but is time consuming method
what is a rating scale diagnosis
schopler, reichler and renner 1986
parent justifies appropriateness of behaviours on a scale and judges appropriateness for use on the scale
may not conisder all aspect
breif and not self adminisered - possibly not accurate representation
what is the autism quotient
BC wheelwright skinner martin and clubley 2001
short self administered scale 50qs assessing 5 areas: social skills attentional switching attention to detail communication imagination
how would an autistic individual rate on the autism quotient?
social skills LOW attentional switching DIFFICULT attention to detail HIGH communication LOW imagination LOW
Hadwin, baron cohen, haulin and hill and teaching TOM
teach to pass TOM improve communication and alleviate social symptoms?
sally anne
- ask why they think they got it wrong and give correct answer - train to develop thier understanding of the situation
LEARN to pass BUT no discriminating improvement in communication or use of mental states in language - did not improve underlying understanding
what is pervasive developmental disorder not otherwise specified
severe and invasive impairment in the development of reciprocal social interaction
assoc with impairment in verbal/non verbal communication skills or in the presence of stereotyped behaviors/interests/activities
not specific or severe enough to be diagnosed with ASD
normal functioning
may exhibit other disorders ie ADHD/motor deficits but not necessarily socially related
what is childhood disintegrative disorder
rare pervasive developmental disorder characterised by 2 years of typical development and them loss of skills across multiple domains ie language, social, cognitive, adaptive, play, motor, self help
onset may be insidious or abrupt
what is intellectual disability
deficit in general mentalising abilities
ie reasoning, problem solving, planning, abstract thinking, judgement, academia, learning from experience and impaired adaptive thinking
prev
what is ‘impaired adaptive thinking’ ?
lack personal independence, lack social responsibility
need help in everyday activities
testing for intellectual disability
abstract reasoning tasks
logic tasks (ie what is heavier, 100g flower or 100g coal)
IQ - not specific criteria anymore but recommended to be included in assessment as typically below 70/average
severity and prevailance of ID
1% population
6/1000 severe ID
more males than females
rare in severest form and often not notice
development of ID
delaye mtoor social and language milestones under 2 years
can be mild and unidentifiable until school age - challenged by academic learning
possible underlying causes of ID
generics ie genetic syndrome, downs syndrome
inborn error ie brain malformation, maternal disease
environmental influence ie alcohol, smoking
TOM and ID
TOM deficit in higher order tasks
may be due to linguistic demands of lang over actual TOM deficit
but language may contribute to TOM
correlational
what are communication disorders
language disorder
speech sound disorder
social pragmatic communication disorder
childhood onset fluency disorder
describe language disorder
persistent difficulty in acquisition and use of language across modality due to deficit in production and/or comprehension
lead to reduced vocab, limited sentence structure and impaired discourse
not attributable to hearing or alternative sensory impairment, motor dysfunction etc
expressive or mixed receptive and expressive problems in language
4y/o+ and life long
describe speech sound disorder
difficulty in speech sound production - impairs speech intelligibility and prevents verbal communication - limits social participation
speech sound requires phonological knowledge and the ability to co ordinate relaxed articulatory movements with breathing and vocalisaiton - difficult to understand and produce
lack of GPC - use immature phoneme simplification processess past norm
3+ years but normal around 7
describe social pragmatic communication disorder
difficulty in use of verbal and NV communication in both those used socially and in the ability to adapt based on context or the needs of the listener
misunderstand rules of conversation and inexplicit meanings
early to develop but rarely diagnosed under 4y.o
deficit not fully manifest until social communication demans exceed limitations
difficulties can be into adulthood but may improve with time
describe childhood onset fluency disorder
disturbance in fluency and time pattern of speech inappropriate for age and language skills
persistant over time
exhibit repetitive perseverance on sounds ie sylable/sound repetition, prolongation of constanants and vowels, pause within words
lead to anxiety and limited social participation
onset 2-7y/o, norm 6 - insidious or sudden as become aware and may develop mechanisms to avoid presenting dysfluency
what is ADHD
attention deficit hyperactivity disorder
innattention and hyperactivity
a lot of symptomatic behaviours so usually diagnosed 6y/o or older
inattention diagnosis of ADHD
no attention to detail cant maintain attention disorganised distractable forgetful lose materials
hyperactivity diagnosis of ADHD
squirm/figit inappropriate running/climbing cant pay quietly driven excessive talking shouts answers
ADHD prevalence
1-19% population but DSM 4 suggest 3-5% and some not always diagnosed
4:1 m:f
can persist into adulthood but less severe (40%)
Conduct disorder
conduct disorder = pattern of behaviour in which the rights of others and age related norms are violated
NOT ADHD
not adhere to social norms
but may be comorbid
baker 2008 bio psycho social model of ADHD
individual influences: genetics, neuropscyhological and cognitive deficit in behaviour inhibition
socio-educational: socioeconomic disadvantage, educational difficulties, peer relationship problems
familiy: coercive parent-child relationship, parental depresion or alcohol abuse
what are specific learning disorders (SLD)
difficulties in learning and application of academic skill - exceedingly below age group but may not manifest until demands exceed capabilities
reading disorder
math disorder
disorder of written expression
learning disorder not otherwise specified
what kinds of motor disorders are there
developmental co ordination disorder
stereotypic movement disorder
tic disorders
what kinds of tic disorders (motor) are there
tourettes persistent motor or vocal tic disorder provisional tic disorder otherwise specified tic disorder unspecified tic disorder
describe developmental coordination disorder
acquisition and execution of co ordinated mtoor skills are substantially below expected given childs age and opportunity to develop skill learning
seem slow, clumsy and inaccurate
undiagnosed
developmental coord disorder and comorbidity
link with ID, visual impairment or another neurological condition?
subype of dyspraxia?
desribe stereotypic motor disorder
perform repetitive, driven but purposeless behaviours
intereferes with social/academic etc
can cause injury
early onset in development
not substance misuse, neurological condition or attributable to other neurodevelopmental disorders
types of developmental disorders
ASD intellectual disability/developmental disorder communication disorder adhd motor disorders
variants of ASD
autism
asperges
childhood disintegrative disorder
pervasive developmental disorder not otherwise specified
describe ASD/autism
deficit in social communication and interaction
restricted repetitive behaviour, interests and activities
BOTH REQUIRED FOR AUTISM DIAGNOSIS
usually diagnosed around 2years
social prgamatic communication disorder / asperges
ASD without the repetitive behaviour
theories of autism
empathising systemising theory (bc)
executive dysfunction
genetics
continuum disorder
describe empathising systemising account of ASD
weak central coherence problems in empathy and in systemising focus on details and fail to take into account the whole ie less susceptable to illusions BUT doesnt explain repetitive behaviours
describe executive dysfunction account of ASD
difficulties in planning and organisation
inability to control certain behaviours and plan in the same way as typically developing children
describe genetics account of ASD
MZ inheritence 36-91%
may be genetic susceptability but variable and not certain
describe continuum disorder of ASD
autism and TD lie on a continuum of social disability
asperges middle - lies as bridge between autism and td
what is the prevalence of ASD in society
increasing 100/10,000
more males than females 4:1
50:50 severe and 10:1 mild
- varies in presence of intellectual disability
what is ASD increasing in society
increased awareness
improvement in measuring and diagnosis
how is ASD diagnosed
interview
observation schedule
rating scale
what is an observation scale diagnosis
observe behaviours exhibited on a daily basis
time consuming
what is a rating scale diagnosis
parent justifies appropriateness of behaviours on a scale
may not conisder all aspect
breif and not self adminisered
what is the autism quotient
short self administered scale 50qs assessing 5 areas: social skills attentional switching attention to detail communication imagination
how would an autistic individual rate on the autism quotient?
social skills LOW attentional switching DIFFICULT attention to detail HIGH communication LOW imagination LOW
Hadwin, baron cohen, haulin and hill and teaching TOM
teach to pass TOM improve communication and alleviate social symptoms?
sally anne
- ask why they think they got it wrong and give correct answer - train to develop thier understanding of the situation
LEARN to pass BUT no discriminating improvement in communication or use of mental states in language
what is pervasive developmental disorder not otherwise specified
severe and invasive impairment in the development of reciprocal social interaction
assoc with impairment in verbal/non verbal communication skills or in the presence of stereotyped behaviors/interests/activities
not specific or severe enough to be diagnosed with ASD
normal functioning
may exhibit other disorders ie ADHD/motor deficits but not necessarily socially related
what is childhood disintegrative disorder
rare pervasive developmental disorder characterised by 2 years of typical development and them loss of skills across multiple domains ie language, social, cognitive, adaptive, play, motor, self help
onset may be insidious or abrupt
what is intellectual disability
deficit in general mentalising abilities
ie reasoning, problem solving, planning, abstract thinking, judgement, academia, learning from experience and impaired adaptive thinking
prev
what is ‘impaited adaptive thinking’ ?
lack personal independence, lack social responsibility
need help in everyday activities
testing for intellectual disability
abstract reasoning tasks logic tasks (ie what is heavier, 100g flower or 100g coal)
severity and prevailance of ID
1% population
6/1000 severe ID
more males than females
rare in severest form and often not notice
development of ID
delayed motor social and language milestones before 2 years
can be mild and unidentifiable until school age
challeged bya cademic learning
possible underlying causes of ID
generics ie genetic syndrome, downs syndrome
inborn error ie brain malformation, maternal disease
environmental influence ie alcohol, smoking
TOM and ID
TOM deficit in higher order tasks
may be due to linguistic demands of lang over actual TOM deficit
but language may contribute to TOM
correlational
what are communication disorders
cannot be diagnosied in the presence of repetitive behaviours, interests and activities language disorder speech sound disorder social pragmatic communication disorder childhood onset fluency disorder
describe language disorder
expressive or mixed receptive and expressive problems in language
4y/o+ and life long
describe speech sound disorder
phonological difficulty in pronouncing correct phonemes
lack of GPC - use immature phoneme simplification processess
3+ years but normal around 7
describe social pragmatic communication disorder
difficulty in social use of verbal and non verbal communication
rare
describe fluency disorder
exhibit repetitive perseverance on sounds
ie stutter
usually ok by 6
what is ADHD
attention deficit hyperactivity disorder
innattention and hyperactivity
a lot of symptomatic behaviours so usually diagnosed 6y/o or older
inattention diagnosis of ADHD
no attention to detail cant maintain attention disorganised distractable forgetful lose materials
hyperactivity diagnosis of ADHD
squirm/figit inappropriate running/climbing cant pay quietly driven excessive talking shouts answers
ADHD prevalence
1-19% population but DSM 4 suggest 3-5% and some not always diagnosed
4:1 m:f
can persist into adulthood but less severe (40%) - hyperactivity reduce but inattention may remain
Conduct disorder
conduct disorder = pattern of behaviour in which the rights of others and age related norms are violated
25-75% ADHD dont adhere to social norms so may imply co morbidity BUT may also reflect inattention to social surroundings
baker 2008 bio psycho social model of ADHD
individual influences: genetics, neuropscyhological and cognitive deficit in behaviour inhibition
socio-educational: socioeconomic disadvantage, educational difficulties, peer relationship problems
familiy: coercive parent-child relationship, parental depresion or alcohol abuse
what are specific learning disorders (SLD)
difficulties in learning and applying academic skill - exceedingly below age group but may not be manifest until demands exceed capabiltiies - in the absence of low IQ, SES and oppornity to learn ie
reading disorder
math disorder
disorder of written expression
learning disorder not otherwise specified
what kinds of motor disorders are there
developmental co ordination disorder
stereotypic movement disorder
tic disorders
what kinds of tic disorders (motor) are there
tourettes persistent motor or vocal tic disorder provisional tic disorder otherwise specified tic disorder unspecified tic disorder
describe developmental coordination disorder
acquisition and execution of co ordinated mtoor skills are substantially below expected given childs age and opportunity to develop skill learning
seem slow, clumsy and inaccurate
significantly interfereces with performance or participation of everyday activities, academic productivity, leisure and play
developmental coord disorder and comorbidity
link with ID, visual impairment or another neurological condition?
subype of dyspraxia?
desribe stereotypic motor disorder
perform repetitive, driven but purposeless behaviours
intereferes with social/academic etc
can cause injury
early onset in development
not substance misuse, neurological condition or attributable to other neurodevelopmental disorders
autism classification DSM 4
classified autism subtypes as 4 seperate disorders and that symptoms must be shown before 3 years
tendency to classify aspergers as a form of high functioning autism
autsim classification DSM 5
diagnoses all 4 conditions as the saem disorders with different levels of severity in social and motor domains
symptoms present in early childhood but may not be fully manifest until later
autism and aspergers
aspergers is a form of autism - average or above av intelligence and thought to be a ‘hidden disability’ - fewer prob with speech but find communication difficult ie comprehending facial expression and tone of voice cues
aspergers usually experience anxiety - struggle to maintian social relationships, find unpredictable and socially withdraw
autism diagnostic interview
le coutier et al 1989
focus diagnosis on the quality of recoprocal social interaction, communication and language , and on restricted repetitive behaviours
standardised semi structures interview based on the caregivers description of the child in question
feng, lo, tsai and cartledge 2008 tom and social skills training
define, model and practice social skills both guided and independently
then given feedback and skill applicatino to real life
11y/o 6th grade autistic child given training 4x week for 40 mins each - train independently then with peers
- increased social beh (73% from 29.4%)
- decrease in inappropriate social behaviours (27% from 70.6%)
PDD NOS DSM 4
subtyped PDDNOS, with autism, asperges and childhood disintegrative disorder under “pervasive developmental disorders”
thought to be interchangable with aspergers
anything that “didnt quite fit” autism
PDD NOS DSM 5
new diagnositc category under autism
overlap with PDD and autism
- not specific enought for PDD
impaired domains in childhood disintegrative disorder CDD
language social cognitive adaptive play motor self help - not necessarily just socially impaired - characterised by regression across a range of areas
CDD DSM4 to 5
classifies under autism
BUT important differences from other ASD based on acuity and severity of regression as well as other co occuring physical symptoms ie loss of bladder control
DSM 4 to 5
used term emntal retardation BUT ID more commonly used and socially accepted
no sepcific age requirement and disorder is chronic - often co occuring with other conditions
Yirmiya et al 1998 TOM and ID
meta analysis
comapred TOM between autistic, id and td children
autism and ID thought to have impaired tom
BUT ID more problems in higher order tasks (may be due to linguistic demands)
language, TOM and ID
insufficient linguistic capabilities in ID may be responisble for an inability for ID to complete higher order TOM tasks
BUT
language argued to contribute to the TOM deficit - if cant link behaviour to language then may fail to fully be able to comprehend beahviours
.. may be BIDIRECTIONAL
define language
form function and use of conventional system of symbols in a rule governed manner
define speech
expressive production of sounts
articulation, fluency, voice and resonance quality
define comunication
verbal and NV behaviours that influence the behaviours, attitudes and/or ideas of others
ADHD DSM 4-5
onset criterion change from impairment under 7 to several inattentive or hyperactive impulsive symptoms prior to 12y/o
threshold change - 5 symptoms instead of 6 required for diagnosis in inattention, hyperactvity and impulsiveness
placed with neurodevelopmental disorders - reflect brain development correlates
biedeman 2005 genetic influence of ADHD (biopsychsocial)
ADHD 2-8x more prevailant for parents and siblings of diagnosed
twin heritability = 0.77% and adoptive family significantly less likely to have same symptoms
pliszka 1998 neuropsychological influence of ADHD (biopsychosocial)
ADHD may be due to an imbalance in dopaminergic and noradrengergic systems
tannock 1998 neuropsychological influence of ADHD (biopsychsocial)
smaller right PFC and globus pallidus in ADHD than norm + males not show expected age related decrease in caudatte volume
barkley 1997 cognitive influence of ADHD (biopsychsocial)
ADHD likely to be due to abnormality in the structure and function of the PFC and its related networks
deficiency in behaviour inhibition deminishes influence on exec function, disrupting control of goal directed behaviours - more influenced by the immediate environment
lange et al 2005 family influence on ADHD (biopsychsocial)
diathesis-stress model
diathesis: bio vunerability
stress: bio cause overactive psychophysiological response to stressful life events
ie parents with increase stress and low social support less tolerant to children vunerable to ADHD - maintain or exacerbate symptoms as oppose to alleviate
ADHD children also increase stress, lower social suppoert and make family functioning more difficult
knopik et al 2009 alcoholism/smoking influence on ADHD (biopsychsocial)
maternal drinking and smoking sig contribte to ADHD risk in offcspring
BUT may also be higher genetic risk
social/educational influence on ADHD (biopsychsocial)
hoza 2007
lower SES link ot higher ADHD diagnosis
hoza - school is primary context to learn co operation, negotiation and conflict resolution as peers are of equal status BUT ADHD aversive as overbearing, impulsive etc therefore initially regected and may have self fulfilling prophecy
specific learning disorder DSM 4-5
combines DSM 4 reading, maths, written expression and learning NOS disoders because the deficits commonly co occur
who does developmental co ordination disorder affect
5-6% 5-11y/os
50-70% into teens
1-8% severe
develpmental co ordination disorder and co morbidity
ID
visual impairment
neurological conditions
developmental co ordination disorder and dyspraxia
gibbs appleton and appleton 2007
may be subtype of dyspraxia
DCD and dysprazia are very similar by definition - suggests should be regarded as synontmous - use one term to repvent confusion and facilitate a consistent understadning
NHS and dyspraxia foundation refer to as same phenomenon
stereotypic motor disorder onset
first 3 years and 80% within first 24 months showing complex sterotypies
difference between stereotypic motor disorder and tic disorders
SMD - arms/ hands/ body - fixed, rhythmic and prolonged
tic - eyes/head/shoulder/face - brief, rapid, randon and fluctuating
