1. Chapter 13 Developmental and Cognitive Disorders

2. Nature of Developmental Psychopathology: An Overview • Normal vs. abnormal development • Developmental psychopathology • Study of how disorders arise and change with time • Disruption of early skills can affect later development

3. Nature of Developmental Psychopathology: An Overview Developmental disorders • Diagnosed first in infancy, childhood, or adolescence • Attention deficit hyperactivity disorder (ADHD) • Learning disorders • Autism • Mental retardation

4. 3 Types of (Attention-deficit hyperactivity disorder (ADHD) • Predominately inattentive • Predominately hyperactive/impulsive • Combined • Associated with numerous impairments • Behavioral • Cognitive • Social and academic problems

5. Barkley’s model (2006)

6. ADHD: Facts and Statistics • Prevalence • Occurs in 3% - 7% of school-aged children • Symptoms are usually present around age three or four • Children with ADHD have problems as adults • Gender differences • Boys outnumber girls 3:1 • Comorbid with Conduct disorder, oppositional defiant disorder, obsessive-compulsive disorder, tic disorder

7. The Causes of ADHD: Biological Contributions • Genetic contributions • ADHD seems to run in families • DAT1 - gene has been implicated

8. The Causes of ADHD: Biological Contributions • Neurobiological contributions • Smaller brain volume (3-4%) • Inactivity of the frontal cortex and basal ganglia • Abnormal frontal lobe development and functioning

9. The Causes of ADHD: Biological Contributions (continued) • The role of toxins • Small evidence that allergens and food additives are causes • Maternal smoking increases risk • Psychosocial factors • Can influence the nature of ADHD • Constant negative feedback from peers and adults

10. Biological Treatment of ADHD • Goal of biological treatments • To reduce impulsivity and hyperactivity and to improve attention • Stimulant medications • Reduce core symptoms in 70% of cases • Examples include Ritalin, Dexedrine, Focalin, Cylert, Vyvanse, Adderall, Strattera

11. Biological Treatment of ADHD • Other medications with more limited efficacy • Imipramine and clonidine (antihypertensive) • Designer drugs (psychopharmacogenetics) • Effects of medications • Improve compliance and decrease negative behaviors • Do not affect learning and academic performance • Benefits are not lasting following discontinuation

12. Behavioral and Combined Treatment of ADHD • Behavioral treatment • Reinforcement programs • To increase appropriate behaviors • Decrease inappropriate behaviors • May also involve parent training • Combined bio-psycho-social treatments • Are highly recommended • Superior to medication or behavioral treatments alone

14. Academic Characteristics Reading (dyslexia) Written language (dysgraphia) Mathematics (dyscalculia) • Deficits in:

15. Learning Disorders: An Overview • Discrepancy between actual and expected achievement (IQ and achievement test) • Performance significantly below age or grade level • Response to Intervention (RTI) • Cannot be caused by sensory deficits or lack of educational possibilities

16. Learning Disorders: Statistics • Prevalence of learning disorders • 5-10% prevalence in the United States • Highest in wealthier regions of the United States • Six million children have been diagnosed • School experience tends to be generally negative

18. Biological and Psychosocial Causes of Learning Disorders • Genetic and neurobiological contributions • Dyslexia, dyscalculia run in families • “Minimal brain dysfunction”

19. Dyslexia

20. Disability in Metacognition • Lack of awareness of strategies and resources needed to perform effectively • Inability to monitor, evaluate, and adjust performance to ensure successful task completion

21. Recommended Educational Practices • Strategy instruction • Techniques, principles, and rules that guide students to complete tasks independently

22. A self-regulation model

23. Direct Instruction • Well-organized, sequenced lessons • Short review of previously learned skills • Clear statement of lesson goals • Presentation of new material in small steps • Frequent opportunities for practice • Questions to check for understanding

24. Autism Spectrum Disorder

25. Pervasive Developmental Disorder (PDD)

26. Pervasive Developmental Disorders: An Overview • Nature of pervasive developmental disorders • Problems occur in language, socialization, and cognition • Pervasive – problems span many life areas • Examples of autism spectrum disorders • Autistic disorder • Asperger’s syndrome • Pervasive developmental not otherwise specified (PDD-NOS)

27. The Nature of Autistic Disorder: An Overview • Three central DSM-IV-TR features of autism • Qualitative impairment of social interaction • Problems in communication • 50% never acquire useful speech • Restricted patterns of behavior, interests, and activities

28. Autistic Disorder: Statistics • Prevalence and features of autism – One in every 500 births • More prevalent in females with IQs below 35 • More prevalent in males with higher IQs • Occurs worldwide • Symptoms usually develop before 3 years of age

29. Autistic Disorder: Statistics • Autism and intellectual functioning • 40-55% with autism have intellectual disabilities (IQ below 70) • Reliable indicators of good prognosis • Language ability and IQ

30. Causes of Autism: Early and More Recent Contributions (continued) • Current understanding of autism • Medical conditions – not always related to autism • Genetic component is largely unclear • Neurobiological evidence of brain damage • Substantially reduced cerebellum size • Psychosocial contributions are unclear

31. Treatment of Pervasive DevelopmentalDisorders: Example of Autism • Psychosocial “behavioral” treatments • Skill building • Reduction of problem behaviors • Target communication and language problems • Address socialization deficits • Early intervention is critical

32. Intellectual disability (ID): An Overview • DSM-IV-TR criteria • Significantly sub-average intellectual functioning (70 or less IQ) • Deficits or impairments in present adaptive functioning • Must be evident before the person is 18 years of age

33. Vineland Adaptive Behavior Scales II (VABS – II) Parent/Caregiver Rating Form, Interview Form - 0 through 90 Teacher Rating Form - 3 through 21 years,11 months

34. DSM-IV-TR Levels of Intellectual disability (ID) • Mild ID • IQ score between 55 and 70 • Moderate ID • IQ range of 40 to 54 • Severe ID • IQs ranging from 25 to 39 • Profound ID • IQ scores below 25

35. Intellectual disability (ID): Some Facts and Statistics • Prevalence • About 1-3% of the general population • 90% are labeled with mild intellectual disability • Course of ID • Tends to be chronic • Prognosis varies greatly from person to person

36. Causes of Intellectual disability (ID): Biological Contributions • Hundreds of known causes • Environmental – deprivation, abuse • Prenatal – exposure to disease or a drug/toxin • Perinatal – difficulties during labor • Postnatal – head injury

37. Causes of Intellectual disability (ID): Biological Contributions • Genetic research • Multiple genes, and at times single genes • Chromosomal abnormalities • Down syndrome and fragile X syndrome • PKU • Lesch-Nyhan syndrome

38. Trisomy 21

39. Down Syndrome (Trisomy 21) • Physical Deformities flattening of the back of the head slanting of the eyelids short stubby limbs thick tongues

41. Cultural-familial intellectual disability • Believed to cause about 75% of ID cases • Is the least understood • Associated with • Mild levels of retardation on IQ tests • Good adaptive skills

43. Treatment of Intellectual disability (ID) • Parallels treatment of pervasive developmental disorders • Teach needed skills • To foster productivity • To foster independence • Educational and behavioral management • Living and self-care skills via task analysis • Communication training – often most challenging

44. Nature of Cognitive Disorders: An Overview • Perspectives on cognitive disorders • Affect learning, memory, and consciousness • Most develop later in life • Three classes of cognitive disorders • Delirium – temporary confusion and disorientation • Dementia – marked by broad cognitive deterioration • Amnestic disorders – memory dysfunctions

45. Nature of Cognitive Disorders: An Overview • Shifting DSM perspectives • From “organic” mental disorders to “cognitive” disorders • Broad impairments in cognitive functioning • Profound changes in behavior and personality

46. Delirium: An Overview • Nature of delirium • Central features – impaired consciousness and cognition • Develops rapidly over several hours or days • Appear confused, disoriented, and inattentive • Marked memory and language deficits

47. Delirium: An Overview (continued) • Facts and statistics • Affects up 30% of persons in acute care facilities • Most prevalent in older adults • Those undergoing medical procedures • AIDS patients and cancer patients • Full recovery often occurs within several weeks

48. Medical Conditions Related to Delirium • Medical conditions • Drug intoxication, poisons, withdrawal from drugs • Infections • Head injury and several forms of brain trauma • Sleep deprivation, immobility, and excessive stress

49. Medical Conditions Related to Delirium • DSM-IV-TR subtypes of delirium • Delirium due to a general medical condition • Substance-induced delirium • Delirium due to multiple etiologies • Delirium not otherwise specified

50. Treatment and Prevention of Delirium • Treatment • Attention to precipitating medical problems • Psychosocial interventions include reassurance • Focus on coping strategies • Inclusion of patients in treatment decisions • Prevention • Address proper medical care for illnesses • Address proper use and adherence to therapeutic drugs