Chapter 13 Developmental Disorders & Cognitive Disorders

1. Chapter 13Developmental Disorders & 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 DSM-IV TR has 43 different categories/types Mental Health vs. Educational categories – IDEA 2004

3. Blind or Visually Impaired Hearing impaired (includes deaf) Orthopedic Other Health Impaired Mentally Retarded Specific Learning Disability Autism Emotional Disturbance Speech & Language Impaired Traumatic Brain Injury Developmental Delay (DD) < age 9 Needs special education services IDEA 97 Categories - PL 105-17IDEA 2004 – (Same)Individual Disabilities Education Act

4. Mental Disability (mild/functional) Hearing impairments Communication Disorders Visual Impairment Emotional Behavioral Disability Autism Deaf-Blind Orthopedic/physically disabled Traumatic Brain Injury Other Health Impaired Specific Learning Disability Multiple Disabilities Developmental Delay (DD) <age 9 Kentucky Regulations - IDEA

5. Nature of Developmental Psychopathology: An Overview (continued) • Developmental Disorders • Diagnosed first in infancy, childhood, or adolescence (43 diagnoses) • Attention deficit hyperactivity disorder (ADHD) • Learning disorders • Autism • Mental retardation

6. Attention Deficit HyperactivityDisorder (ADHD): An Overview • Nature of ADHD • Central features – Inattention, overactivity, and impulsivity • Associated with numerous impairments • Behavioral • Cognitive • Social and academic problems

7. Attention Deficit HyperactivityDisorder (ADHD): An Overview (continued) • DSM-IV-TR Symptom Types • Inattentive type • Hyperactive type • Impulsive type

8. ADHD: Facts and Statistics • Prevalence • Occurs in 6% of school-aged children • Symptoms are usually present around age 3 or 4 • 68% of children with ADHD have problems as adults

9. ADHD: Facts and Statistics (continued) • Gender Differences • Boys outnumber girls 4 to 1 • Cultural Factors • Probability of ADHD diagnosis • Greatest in the United States

10. The Causes of ADHD: Biological Contributions • Genetic Contributions • ADHD seems to run in families • DRD4, DAT1, and DRD5 genes have been implicated

11. The Causes of ADHD: Biological Contributions (continued) • Neurobiological Contributions • Smaller brain volume • Inactivity of the frontal cortex and basal ganglia • Abnormal frontal lobe development and functioning

12. The Causes of ADHD: Biological Contributions (continued) • The Role of Toxins • No evidence that allergens and food additives are causes • Maternal smoking increases risk

13. The Causes of ADHD: Psychosocial Contributions • Psychosocial Factors • Can influence the nature of ADHD • ADHD children are often viewed negatively by others • Constant negative feedback from peers and adults • Peer rejection and resulting social isolation • Such factors foster low self-esteem

14. 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

15. Biological Treatment of ADHD (continued) • Other Medications With More Limited Efficacy • Imipramine and Clonidine (antihypertensive) • Effects of Medications • Improve compliance and decrease negative behaviors • Do not affect learning and academic performance • Benefits are not lasting following discontinuation

16. Behavioral and Combined Treatment of ADHD • Behavioral Treatment • Reinforcement programs • To increase appropriate behaviors • Decrease inappropriate behaviors • May also involve parent training

17. Behavioral and Combined Treatment of ADHD (continued) • Combined Bio-Psycho-Social Treatments • Are highly recommended • Superior to medication or behavioral treatments alone

18. Learning Disorders: An Overview • Scope of Learning Disorders • Academic problems in reading, mathematics, and writing • Performance substantially below expected levels

19. Learning Disorders: An Overview (continued) • DSM-IV-TR Reading Disorder • Discrepancy between actual and expected achievement • Performance significantly below age or grade level • Cannot be caused by sensory deficits

20. Learning Disorders: An Overview (continued) • DSM-IV-TR Mathematics Disorder • Achievement below expected performance • DSM-IV-TR Disorder of Written Expression • Achievement below expected performance in writing

21. Learning Disorders: Some Facts and Statistics • Prevalence of Learning Disorders • 5-10% prevalence in the United States • Highest in wealthier regions of the United States • About 32% of these students drop out of school • 5-15% prevalence for reading difficulties • School experience tends to be generally negative

22. Fig. 13.1, p. 514

23. Biological and Psychosocial Causes of Learning Disorders • Genetic and Neurobiological Contributions • Reading disorder runs in families • 100% concordance rate for identical twins • Evidence for subtle forms of brain damage is inconclusive • Overall, contributions are unclear • Psychosocial Contributions are Largely Unknown

24. Treatment of Learning Disorders • Requires Intense Educational Interventions • Remediation of basic processing problems • Improvement of cognitive skills • Targeting skills to compensate for problem areas • Data Support Behavioral Educational Interventions

25. 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 Pervasive Developmental Disorders • Autistic disorder • Asperger’s syndrome

26. The Nature of Autistic Disorder: An Overview • Autism – Significant Impairments • Social interactions and communication • Restricted patterns of behavior, interest, and activities

27. The Nature of Autistic Disorder: An Overview (continued) • 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: Facts and Statistics • Prevalence and Features of Autism – 1 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 36 months of age

29. Autistic Disorder: Facts and Statistics (continued) • Autism and Intellectual Functioning • 50% have IQs in the severe-to-profound range • 25% test in the mild-to-moderate IQ range • Remaining test in the borderline-to-average IQ range • Reliable indicators of good prognosis • Language ability and IQ

30. Causes of Autism: Early and More Recent Contributions • Historical Views • Bad parenting • Unusual speech patterns • Lack of self-awareness • Echolalia

31. Causes of Autism: Early and More Recent Contributions (continued) • Current Understanding of Autism • Medical conditions – Not always related with autism • Genetic component is largely unclear • Neurobiological evidence of brain damage • Substantially reduced cerebellum size • Psychosocial Contributions Are Unclear

32. Asperger’s Disorder: Part of the Autistic Spectrum • The Nature of Asperger’s Disorder • Show significant social impairments • Restricted and repetitive stereotyped behaviors • May be clumsy • Often quite verbal • No severe language and/or cognitive delays

33. Asperger’s Disorder: Part of the Autistic Spectrum (continued) • Prevalence of Asperger’s Disorder • Often under diagnosed • Affects about 1 to 36 persons per 10,000 people • Causes of Asperger’s Disorder Are Somewhat Unclear

34. 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

35. Treatment of Pervasive DevelopmentalDisorders: Example of Autism (continued) • Biological and Medical Treatments Are Unavailable • Integrated Treatments: The Preferred Model • Focus on children, their families, schools, and home • Build in appropriate community and social support

36. Mental Retardation (MR): An Overview • Nature of Mental Retardation/Intellectual Disability (new term) • Disorder of childhood • Below-average intellectual and adaptive functioning • Range of impairment varies greatly across persons

37. Mental Retardation (MR): An Overview (continued) • DSM-IV-TR criteria • Significantly sub-average intellectual functioning • Deficits or impairments in present adaptive functioning • Must be evident before the person is 18 years of age

38. DSM-IV-TR Levels of Mental Retardation (MR) • Mild MR/ID • IQ score between 50 or 55 and 70 • Moderate MR/ID • IQ range of 35-40 to 50-55 • Severe MR/ID • IQs ranging from 20-25 up to 35-40 • Profound MR/ID • IQ scores below 20-25

39. Other Classification Systems for Mental Retardation (MR) • American Association of Mental Retardation (AAMR) • Defines MR based on levels of assistance required • Levels of assistance • Intermittent, limited, extensive, pervasive

40. Other Classification Systems for Mental Retardation (MR) (continued) • Classification of MR/ID in Educational Systems • Educable (IQ of 50 to 70-75) • Trainable (IQ of 30 to 50) • Severe (IQ below 30) • Implications of Different MR/ID Classification Systems

41. Mental Retardation (MR)/Intellectual Disabilities (ID): Some Facts and Statistics • Prevalence • About 1-3% of the general population • 90% are labeled with mild mental retardation

42. Mental Retardation (MR): Some Facts and Statistics (continued) • Gender Differences • MR occurs more often in males • Male-to-female ratio of about 1.6:1 • Course of MR • Tends to be chronic • Prognosis varies greatly from person to person

43. Causes of Mental Retardation (MR):Biological Contributions • Hundreds of known causes • Environmental – Deprivation, abuse • Prenatal – Exposure to disease or a drug / toxin • Perinatal – Difficulties during labor • Postnatal – Head injury

44. Causes of Mental Retardation (MR):Biological Contributions (continued) • Genetic Research • Multiple genes, and at times single genes • Chromosomal Abnormalities • Down syndrome and Fragile X syndrome • Maternal Age and Risk of Having a Down’s Baby • Nearly 75% of Cases Have No Known Cause

45. Causes of Mental Retardation (MR):Psychosocial Contributions • Cultural-Familial Retardation • Believed to cause about 75% of MR cases • Is the least understood • Associated with • Mild levels of retardation on IQ tests • Good adaptive skills

46. Causes of Mental Retardation (MR):Psychosocial Contributions (continued) • Difference vs. Developmental Views • Difference view - Kind and degree of impairment • Developmental view – Rate of developmental delay

47. Treatment of Mental Retardation (MR) • 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

48. Treatment of Mental Retardation (MR) (continued) • Community and Supportive Interventions • Persons with MR can benefit from such interventions

49. Summary of Developmental Disorders • Developmental Psychopathology • Attention Deficit Hyperactivity Disorder • Deficits in attention, hyperactivity, or impulsivity • Learning Disorders • Deficits in performance below expectations

50. Summary of Developmental Disorders (continued) • Pervasive Developmental Disorder • All share deficits in language, socialization, and cognition • Mental Retardation • Sub-average IQ, deficits in adaptive functioning • Onset before age 18 • Prevention and Early Intervention Are Critical