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Lecture

PSYCH257 Lecture Notes - Attention Deficit Hyperactivity Disorder, Pervasive Developmental Disorder, Developmental Disorder


Department
Psychology
Course Code
PSYCH257
Professor
Uzma Rehman

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Developmental Disorders
March-24-11
2:31 PM
Disorders revealed in a clinically significant way during a child's developing years and are a concern
to families and the educational system
Difficulties often persist into adulthood and are typically lifelong
Overview
Developmental psychopathology
o Study of how disorders arise and change with time
o Childhood is associated with significant developmental changes
o Disruption of early skills will likely disrupt development of later skills
Developmental Disorders
o Diagnosed first in infancy, childhood or adolescence
o Tend to be more severe
o Attention deficit hyperactivity disorder, autism, learning disorders, mental retardation
o Autism spectrum includes low levels of autism, extreme levels of autism, Asperger's
o Symptoms of ADHD: impulsive disorganised behaviour, restlessness, average intelligence.
Video: fidgety, talking, can't pay attention, repetitive
Perspectives
Brain changes significantly for several years after birth, time when critical developments occur in
social, emotional, cognitive and other important competency areas
Child develops one skill before acquiring the next. Any disruption in the development of early skills
will disrupt the development of later skills
o Ex. Believed that those with autism suffer from disruption in early social development
Absence of early and meaningful social relationships has serious consequences; may have difficulty
learning to communicate
Knowing what processes are disrupted will help to understand the disorder better, may lead to
more appropriate intervention strategies
Echolalia: involves repeating the speech of others. Once thought to be a sign of autism, but is
actually an intermediate step in language development
Attention Deficit Hyperactivity Disorder
March-24-11
2:57 PM
Attention deficit hyperactivity disorder (ADHD): developmental disorder featuring maladaptive
levels of inattention, excessive activity and impulsiveness
One of the most common reasons children are referred to mental health professionals
Clinical Description
Difficulty sustaining attention
May display motor hyperactivity
ADHD symptoms clustering into two categories

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o Lack of attention
o Hyperactive and impulsive behaviour
Either cluster 1 or 2 must be present for a diagnosis
Inattention, hyperactivity and impulsivity often cause secondary problems: academic performance
tends to suffer, increased risk for minor injuries
Symptoms get in the way of establishing and maintaining friendships
Problems with peers combined with frequent negative feedback from parents and teachers often
results in low self esteem.
Nature of ADHD
o Central features - inattention, over activity, and impulsivity
o Associated with behavioural, cognitive, social and academic problems
Symptoms show up in more than one place; home and school
Symptoms more severe in an unorganised home
Statistics
6% of school aged children
Some ADHD symptoms can be present before the age of 7
Gender differences in ADHD is 4:1 for males
o Unsure of why we get the gender difference
o Possible that symptoms don't show up as severely or manifests differently
68% of children with ADHD have ongoing difficulties in adulthood
Less impulsive over time, but inattention persists
Adults with ADHD more likely to have driving accidents
More likely to receive label of ADHD in North America compared to anywhere else
o Concerns about over diagnosis, efforts to develop more objective measures
Frequently comorbid with other disruptive disorders: oppositional defiant disorder and conduct
disorder
Risk factor for antisocial behaviour in boys but not girls
Also frequently comorbid with learning disorders
Causes
More common in families in which one person has the disorder
Some shared genetic deficits may contribute to the problem
More than one gene probably responsible
Most attention so far has focused on genes associated with dopamine; serotonin also implicated
Strong evidence that ADHD is associated with dopamine D4 receptor gene, the transporter gene,
and the D5 receptor gene
o Serotonin genes also important risk factors - not surprising, serotonin contributes to
regulation of dopamine transmission in the brain
No major brain damage found in those with ADHD, but there are subtle differences
o Overall size of the brain is smaller in children with ADHD; the frontal cortex, the basal ganglia,
and the cerebellar vermis are all smaller
o Smaller volume occurs early in development, meaning general progressive damage is not
occurring
o Inactivity of the right frontal cortex (implicated in organisation, inhibition) and basal ganglia
o Right hemisphere malfunction
o Abnormal frontal lobe development and functioning
Little evidence supports accusations of diet being implicated

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Mothers who smoke during pregnancy are up to three times more likely to have a child with ADHD.
Not clear if it's the toxic effect of smoking or an associated process
Negative responses by parents, teachers and peers contribute to feelings of low self esteem
Treatment
Biological and psychological interventions
Goal of biological treatments is to reduce impulsivity and hyperactivity and improve attention
o Stimulant medication (methylphenidate , D-amphetamine, pemoline) reduces core symptoms
of ADHD in 70% of cases
o Cyclert greater likelihood of negative side effects
o Certain antidepressants may have similar effects
o Drugs seem to improve compliance and reduce negative behaviour, but no improvement in
learning or academic performance
o Stimulants reinforce brain's ability to focus
o Concern for potential abuse, over prescription and long term effects which are not well
understood
o Behavioural programs implemented to help with academics
o Controversy around prescribing stimulants to children
o Beneficial effects are not long lasting following drug discontinuation
Multimodal Treatment of Attention Deficit Hyperactivity Disorder
o Combination of medication and behavioural treatment or medicine alone better than
behavioural alone or community care intervention for ADHD symptoms
o For social problems and academic skills, combination was the best
Psychosocial treatments focus on improving academic performance, decreasing disruptive
behaviour and improving social skill
o Involve reinforcement programs
o Aim to increase appropriate behaviour and decrease inappropriate behaviours
o May also involve parent training
o Combined biopsychosocial treatments are highly recommended.
o Behaviour therapy alone not as effective as behaviour therapy plus medication.
Learning Disorders
April-09-11
10:31 PM
Learning disorders: reading, mathematics, or written expression performance substantially below
levels expected relative to the person's age, IQ and education
Clinical Description
Reading disorder: reading performance significantly below age norms
o Also known as dyslexia
Mathematics disorder: mathematics performance significantly below age norms
Disorder of written expression: condition in which a person's writing performance is significantly
below age norms
Statistics
5-10% prevalence
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