Test 3 Flashcards
Autism Spectrum Disorder
a complex neurodevelopmental disorder characterized in the DSM-5-TR by persistent differences in social communication and social interaction across multiple contexts
Diagnostic criteria for ASD
− Significant and persistent differences in social interaction and communication skills
− Highly intense and repetitive patterns of interests and behaviors
* Symptoms must be present in early developmental period
* Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
* These disturbances are not better explained by intellectual developmental disorder or global developmental delay
Treatments for ASD
− Minimize the core concerns of ASD
− Maximize the autistic child’s independence and quality of life
− Help the child and family cope and manage
− Engaging children and families in services and supports
− Improving mood regulation and frustration tolerance
− Teaching developmentally-appropriate social behavior
− Teaching adaptive skills
− Speech and language therapy are commonly used
− For some children, antipsychotic medications may help decrease challenging behaviors
Socially oriented behaviors(autism treatment)
Pairing people with whom the child has contact with actions, activities, and events that the child finds pleasant
Teaching social toy play, social pretend play, specific social skills
UCLA PEERS social skills training program is targeted for teens
Communication skills(autism treatment)
Operant speech training
Joint attention, symbolic play, engagement, and regulation (JASPER)
ASD and Comorbid disorders
Often accompany ASD are IDD and epilepsy, anxiety disorders, ADHD, learning disabilities, oppositional and conduct problems, and mood disturbances
Some autistic children also engage in extreme, persistent, and sometimes potentially life-threatening, self-injurious behavior (SIB)
Positive Symptoms of Schizophrenia
Delusions
Hallucinations most common for children are auditory-and occur in 80% of cases with onset prior to age 11
40% to 60% experience visual hallucinations, delusions, and thought disorder
Negative Symptoms of Schizophrenia
Slowed thinking, speech, movement; emotional apathy; and lack of drive
Criteria for Schizophrenia
Severe disturbance in sensory functioning and/or behavior
Social/occupational dysfunction: when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning
Duration: signs of the disturbance persist for at least 6 months
Schizoaffective and Mood Disorder exclusion
Substance/medical condition exclusion
Relationship to autism spectrum or communication disorder
Causes of schizophrenia
Neurodevelopmental model: defective neural circuitry increases a child’s vulnerability to stress
Biological factors:
Strong genetic contribution
Molecular genetic studies have identified several potential susceptibility genes
Environmental factors:
Familial disorder, high communication deviance, stress, distress, and personal tragedy
Schizophrenia Treatment
COS is a chronic disorder with a poor long-term prognosis
Current treatments emphasize use of antipsychotic medications combined with psychotherapy and social and educational support programs
Medications help control psychotic symptoms
There can be serious side effects
DSM-5-TR criteria for intellectual developmental disorder
Diagnostic criteria for intellectual developmental disorder (DSM-5-TR)
Deficits in intellectual functions confirmed by both clinical assessment and individualized, standardized intelligence testing
Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility
Onset of intellectual and adaptive deficits during the developmental period (generally considered to be before age 18)
Changes in criteria focus more on the nature or qualities of the person rather than on the IQ score
Mild Severity for IDD
About 85% of people with IDD
This category has an overrepresentation of minority group members
Typically develop social and communication skills during the preschool years (modest delays in expressive language)
Minimal or no sensorimotor impairment
Engage with peers readily
Academic skills up to approximately the sixth-grade level
Social and vocational skills adequate for minimum self-support
Moderate Severity Level of IDD
About 10% of individuals with IDD
Show delays in reaching early developmental milestones
Usually identified during preschool years
Applies to many people with Down syndrome
Benefit from vocational training
Can perform supervised unskilled or semiskilled work in adulthood
Severe Severity Levels of IDD
About 4% of individuals with IDD
Often associated with organic causes
Usually identified at a very young age
Delays in developmental milestones and visible physical features are seen
May have mobility or other health problems
Need special assistance throughout their lives
Live in group homes or with their families
Profound Severity of IDD
About 2% of individuals with IDD
Identified in infancy due to marked delays in development and biological anomalies
Learn only the rudimentary communication skills
Require intensive training for:
Eating, grooming, toileting, and dressing behaviors
Require lifelong care and assistance
Types of cause for IDD
Genetic or environmental causes are known for almost two-thirds of individuals with moderate to profound IDD
Prenatal: genetic disorders and accidents in the womb
Perinatal: prematurity and anoxia
Postnatal: meningitis and head trauma
Role of the environment for IDD
Genetic influences are potentially modifiable by environment
Genotype: a collection of genes that pertain to intelligence
Phenotype: the expression of the genotype in the environment
Heritability: proportion of the variation of a trait attributable to genetic influences in the population
Ranges from 0% to 100%
The heritability of intelligence is about 50%
Major environmental variations affect cognitive performance and social adjustment in children from disadvantaged backgrounds
Comorbid Disorders for IDD
Rate is three to five times greater than in typically developing children
Due to limited communication skills, additional stressors, and neurological deficits
Most common psychiatric diagnoses are impulse control disorders, anxiety disorders, and mood disorders
Internalizing problems and mood disorders in adolescence are common
ADHD-related symptoms are common
Pica is seen in serious form among children and adults with IDD
Self-injurious behavior (SIB) affects about one in five young children with IDD
IQ versus adaptive functioning
General intellectual functioning is now defined by an intelligence quotient (IQ or equivalent)
IDD is no longer defined on the basis of IQ
Level of adaptive functioning is also important
Learning Disability
learning problems that occur in the absence of other obvious conditions
The DSM-5-TR uses more specific terms: communication disorders and learning disorders
Affects how individuals with average or above-average intelligence take in, retain, or express information
A learning disability is not visible and is often undetected in young children
Main characteristic all children with learning disorders share is not performing at their expected level in school
Communication disorder
deficits in language, speech, and communication
Communication disorders include the following diagnostic categories
Language disorder
Speech sound disorder
Childhood-onset fluency disorder
Social (pragmatic) communication disorder
specific learning disorder
specific problems in learning and using academic skills
Language disorder
communication disorder characterized by difficulties in the comprehension or production of spoken or written language
Despite verbal examples and proper language stimulation
Some children do not develop in some areas of speech and language
Vocabulary often is limited, marked by short sentences, and has simple grammatical structure
Speech sound disorder
when the developmental language problem involves articulation or sound production rather than word knowledge
Children with this disorder have trouble controlling their rate of speech, or lag behind playmates in learning to articulate certain sounds
The speech quality of these children may be unusual, and even unintelligible
Assessment and intervention are warranted when
These issues persist beyond the typical developmental range (age 4)
Or interfere with academic and social activities by age 7
Treatment for language disorders
Promote the child’s language competencies
Adjust the environment in ways that accommodate the child’s needs
Therapy to equip them with knowledge and skills to reduce behavioral and emotional symptoms
Childhood onset fluency disorder
The repeated and prolonged pronunciation of certain syllables that interferes with communication
Social communication disorder
Persistent difficulties in pragmatics involving both expressive and receptive skills
Deficits in using communication for social purposes
Difficulties changing their communication to match the situation or the listener
Problems following the rules of language
Difficulties understanding what someone is not explicitly saying
Children with SCD may experience lasting impairments in peer relations
Specific Learning Disorder Characteristics
is difficulties learning keystone academic skills: reading, writing, spelling, or math
Learning difficulties: specific, not due to intellectual developmental disorder, and not due to global developmental delay
Achievement test scores are at least 1.5 standard deviations below average for their age and sex
Performance difficulties interfere with academic achievement or daily living
Must persist for more than six months despite efforts to improve
A child or adult can have more than one form of SLD
SLD with Impairment in reading
Most common underlying feature: inability to distinguish or separate sounds in spoken words
Difficulty learning sight words
Errors in reversals (b/d, p/q), transpositions (was/saw, scared/sacred), inversions (m/w, u/n), and omissions (place for palace, section for selection)
Dyslexia is sometimes used to describe this pattern of reading difficulties
Core deficits: decoding rapidly enough to read the whole word and problems reading single, small words
SLD Impairment in Written Expression
Writing disorders are often associated with problems with eye/hand coordination
Leads to poor handwriting
Children with writing disorders:
Produce shorter, less interesting, and poorly organized essays
Are less likely to review spelling, punctuation, and grammar to increase clarity
SLD with Impairment in Mathematics
Difficulties in number sense, memorization of arithmetic facts, accurate or fluent calculation, and/or accurate math reasoning
Dyscalculia: alternative term sometimes used to describe this pattern of math difficulties
May include problems in comprehending abstract concepts or in visual-spatial ability
Involves core deficits in arithmetic calculation and/or mathematics reasoning abilities
Treatment for Learning Disorders
Interventions rely primarily on educational and psychosocial methods
No biological treatments exist
In coexistent challenges in concentration and attention, some children respond favorably to stimulant medications
Issues of identification are important
There is a brief window of opportunity for successful treatment
Prevention involves training children in phonological awareness activities at an early age
Computer Assisted Learning
Provides more academic engagement and achievement than traditional pencil-and-paper-methods
Some children with communication and learning disorders are unable to process information that flashes by too quickly
Computer programs slow down grammatical sounds allowing young children to process them more slowly and carefully
Treatment for Communication Disorders
Parental changes: speak to the child slowly in short sentences
Contingency management procedures
Habit reversal procedures
If left untreated, children with severe communication and language difficulties
Will lag behind their peers
Are at risk of having behavioral or social concerns
Treatment is based on three principles
Promote the child’s language competencies
Adjust the environment in ways that accommodate the child’s needs
Therapy to equip them with knowledge and skills to reduce behavioral and emotional symptoms
Childhood Obesity
The prevalence of obesity is at 19.7%
Childhood obesity is a chronic medical condition
Obesity usually is defined in terms of a body mass index (BMI)
On any given day, 30% of American children eat fast food
Avoidant/Restrictive Food Intake Disorder(ARFID)
Avoidance or restriction of food intake, leading to significant weight loss (or failure to maintain usual growth) and/or nutritional deficiency
Significant weight loss
Significant nutritional deficiency
Dependence on enteral feeding or oral nutritional supplements
Marked interference with psychosocial functioning
Pica
Ingestion of inedible, nonnutritive substances (e.g., hair, insects, and paint) for a period of at least one month
One of the more common and usually less serious eating disorders
Affects mostly very young children and those with intellectual disability
May be life-threatening if it continues into adolescence
Anorexia Nervosa
Characterized by refusal to maintain minimally typical body weight, intense fear of gaining weight, and significant disturbance in perception and experiences of body size
DSM-5-TR subtypes
Restricting type: individual loses weight through diet, fasting, or excessive exercise
Binge-eating/purging type
Bulimia Nervosa
Much more common than anorexia
Primary feature is recurrent binge eating
Binge is an episode of overeating that must involve
An objectively large amount of food
Lack of control over what or how much food is eaten
Followed by compensatory behaviors: purging or non-purging
Medical consequences are severe, but not as severe as consequences resulting from anorexia
Binge Eating Disorder
Has become increasingly widespread during this age of abundant fast food and obesity
Similar to bulimia without the compensatory behaviors
Involves periods of eating more than other people would, accompanied by feeling of loss of control
Affects 1.5% to 3% of adolescents
Has negative health correlates
Those with BED are often above average weight
Sexual Orientation and Eating Disorders
Relationship between sexual orientation and eating disorders has attracted increasing attention from researchers
Gay men appear to be
At greater risk for behavioral symptoms of eating disorders than heterosexual men
More susceptible than heterosexual men to media images promoting thinness
More likely than heterosexual men to experience poor body image and body dissatisfaction and symptoms of related eating disorders
Ethnic/Cultural/Socioeconomic influences on Eating Disorders
Anorexia occurs around the world, although it may manifest differently
Bulimia is a culture-bound syndrome
Arising predominately in Western regions of the world
Higher SES for women was considered a risk factor in the past
Upon reaching a certain level of affluence, the association between high SES and eating disorders may no longer exist
Causes of EDs
Single best predictor or risk for developing an eating disorder is being an adolescent female
Biological dimension: may contribute to the maintenance of the disorder
Genetic and constitutional factors: eating disorders run in families
Neurobiological factors
Imbalances of serotonin, which regulates hunger and appetite, may be implicated
Biochemical similarities have been found between people with eating disorders and those with OCD
Other causes of eating disorders
Social dimension
Features of contemporary Western culture may be implicated in eating disorders
Sociocultural factors
Western culture self-worth, happiness, and success are determined primarily by physical appearance
Teenage girls: weight loss and being skinny are more important than many other issues
Mass media influences perceptions of body dissatisfaction
Family influences on EDs
Teen’s eating disorder may be functional
Directing attention away from basic family conflicts
Family processes may contribute to an overemphasis on weight and dietary control
Child sexual abuse may be a risk factor for eating disorders, especially bulimia
General risk factor for psychopathology, rather than specific risk factor for eating disorders
Treatment for Eating Disorders
Family therapy and individual therapy
Cognitive–behavioral therapy and interpersonal psychotherapy,
Cognitive training and dialectical behavioral therapy
More recently, virtual or telehealth-based practices
Behavioral family-based treatment modalities (FBT) for both adolescent anorexia nervosa and bulimia nervosa met well established treatment criteria
CBT was the most effective treatment
Especially for bulimia nervosa, binge eating disorder and the night eating syndrome
For anorexia nervosa, the family approach showed greater effectiveness
Pharmacological treatments
Gaining recognition for assistance in the management of eating disorders
Family involvement often is necessary and practical
Joint Attention
The ability to coordinate one’s focus of attention on another person and an object of mutual interest
operant speech training
a step-by-step approach that first increases the child’s vocalizations and then teaches imitation of sounds and words, the meanings of words, labeling objects, making verbal requests, and expressing desires
theory of mind
The cognition and understanding of mental states that cannot be observed directly, such as beliefs and desires, both in one’s self and in others. Also referred to as mentalization.
