46-355 Lecture Notes - Pervasive Developmental Disorder, Cognitive Disorder, Childhood Disintegrative Disorder
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DEVELOPMENTAL AND COGNITIVE DISORDERS
I. Common Developmental Disorders
A. Developmental psychopathology is the study of how disorders arise and change with
time. In general, childhood is associated with significant developmental changes that
follow a specific pattern. As a result, any disruption in the development of early skills will
likely disrupt the development of later skills.
B. The disorders covered in this chapter are usually diagnosed first in infancy, childhood, or
adolescence and include attention deficit/hyperactivity disorder (ADHD), learning
disorders, autism, and lastly mental retardation.
C. Attention deficit/hyperactivity disorder
1. The primary characteristics of persons with attention deficit/hyperactivity
disorder (ADHD) are inattention, overactivity, and impulsivity. Such persons
start many tasks but rarely finish them, have trouble concentrating, and do not
seem to pay attention when others speak. Children with ADHD are often
described as fidgety in school, and often are unable to sit still for more than a few
minutes. The textbook illustrates ADHD with the case of Danny.
2. The DSM-IV-TR differentiates two clusters of ADHD symptoms.
a. The first cluster includes problems of inattention.
b. The second cluster includes symptoms of hyperactivity and
c. Either the first (inattention) or the second (hyperactivity and impulsivity)
cluster must be present for the diagnosis of ADHD.
3. Inattention, hyperactivity, and/or impulsivity often result in other problems that are
secondary to ADHD. Examples include poor academic performance, unpopularity
and peer rejection, and low self-esteem resulting from frequent negative
feedback by parents and teachers.
4. ADHD is estimated to occur in 4% to 12% of children who are 6 to 12 years of
age, with boys outnumbering girls 4 to 1. Reasons for this large gender
difference are unknown. Children with ADHD are first identified as different from
their peers around age 3 or 4, and the symptoms of inattention, impulsivity,
and/or hyperactivity become increasingly obvious during the school years. 68%
of children with ADHD continue to have problems as adults, mostly with
inattention. The ADHD label is more likely to be used for children in the United
States than anywhere else.
5. The causes of ADHD have centered on genetics, brain damage, toxins and food
additives, and maternal smoking.
a. With regard to genetics, it has been known for some time that ADHD is
more common in families with one person having the disorder, and such
families display an increase in psychopathology in general, including
conduct disorder, mood disorders, anxiety disorders, and substance
abuse. More than one gene appears responsible for ADHD, leading
researchers to consider possible subtypes of ADHD.
i. Families with many persons with ADHD seem to have a very
specific deficit in the region of chromosome number 20.
ii. The gene for the D4 receptor — which appears involved in
novelty-seeking behavior — appears more often in children
iii. It is also suspected that the protein that assists with reuptake
of dopamine is involved in ADHD.
b. Brain damage has been implicated as a cause of ADHD for several
decades as reflected in use of labels such as "minimal brain damage" or
"minimal brain dysfunction."
i. Relative inactivity of the frontal cortex and the basal ganglia
have been associated with ADHD.
ii. Other evidence suggests right hemisphere malfunction, and
abnormal frontal lobe development and functioning.
iii. Research has yet to unearth precise neurological mechanisms
underlying the basic symptoms of ADHD.
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c. Toxins, such as allergens and food additives have been considered as
possible causes of ADHD, though there is little evidence for this link.
Yet, many families continue to put their children on fad diets (e.g., the
Feingold Diet), despite the absence of evidence that such diets help.
d. Maternal smoking during pregnancy results in a threefold increased
probability having a child with ADHD.
e. Psychological and social factors of ADHD also can influence the
disorder itself. For instance, impulsive and hyperactive behavior can
evoke negative responses by parents, teachers, and peers. Such
responses, in turn, may foster a low-self image in ADHD children.
6. Treatment of ADHD has proceeded on two fronts: biological and psychosocial
a. The goal of biological treatments is to reduce impulsivity and
hyperactivity and to improve attention.
i. Hundreds of studies have documented the effectiveness of
stimulant medication in reducing the core symptoms of ADHD.
Such medications include methylphenidate (Ritalin), d-
amphetamine (Dexedrine), and pemoline (Cylert). Such
medications are effective in 70% of cases. Cylert is
discouraged from use on a regular basis due to the greater
likelihood of negative side effects. Most common side effects
include insomnia, drowsiness, and/or irritability.
ii. Other drugs such as antidepressants (imipramine) and a drug
used to treat high blood pressure (clonidine) appear to offer
some therapeutic benefit.
iii. All of these drugs seem to improve compliance and decrease
negative behaviors in ADHD children, but they do not affect
learning and academic performance. The beneficial effects do
not last in the long term once drugs are discontinued.
iv. The paradoxical effects of stimulant medication are the similar
in children and adults with and without ADHD. Stimulant
medications reinforce the brain’s ability to focus attention
during problem-solving tasks. The theory that these
medications produce a paradoxical effect is not supported.
b. Behavioral interventions for ADHD involve reinforcement programs to
increase appropriate sitting, work, and play. Other programs incorporate
c. Most clinicians recommend a combination of biological and
psychological approaches to treat short-term management issues and
long-term concerns such as improving social skills and preventing and
reversing academic decline.
D. Learning disorders
1. Learning disorders cover problems related to academic performance in
reading, mathematics, and writing. Performance across such domains is
substantially below what would be expected given the person’s age, IQ, and
education. The textbook illustrates a reading disorder with the case of Alice.
a. DSM-IV-TR defines a reading disorder as a significant discrepancy
between a person’s reading achievement and what would be expected
for someone of the same age.
i. DSM criteria require that the person read at a level significantly
below that of a typical person of the same age, cognitive ability
(as measured with an IQ test), and educational background.
ii. The reading problem cannot be caused by a sensory deficit
such a trouble with sight or hearing.
b. Similarly, the DSM-IV-TR defines a mathematics disorder as
achievement below expected levels in mathematics.
c. The DSM-IV-TR disorder of written expression represents
achievement below expected levels in writing.
2. Definitions of learning disorders vary greatly, making estimates of incidence
and prevalence difficult.
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a. Conservatively, there is a 1% to 3% incidence of learning disorders in
the United States, with increased frequency of such disorders in
wealthier regions of the U.S.
b. The prevalence rate of learning disorders is 10% to 15% among school
c. Reading difficulties are the most common learning disorder, affecting
5% to 15% of the general population. Mathematics disorder appears in
6% of the population. Girls and boys are equally likely to be diagnosed
with reading disorder.
d. About 32% of students with learning disabilities drop out of school, and
employment rates for this group tend to be quite low.
e. Most adults with learning disabilities report that their school experiences
were generally negative, with such effects lasting beyond graduation.
3. Etiological theories of learning disorders include genetic, neurobiological, and
a. Regarding genetics, reading disorders tend to run in families, and the
concordance rate of reading disorders in identical twins is 100%.
i. Reading disorder may be linked to genetic material on
chromosome 6 and 15, but is likely influenced by several
biological and psychosocial factors.
b. Subtle forms of brain damage may be related to learning disabilities;
though findings are somewhat mixed.
4. Treatment for learning disorders requires intense educational intervention and
biological treatment and is typically restricted to those individuals who may also
5. Educational interventions focus on the following:
a. Remediation of the underlying basic processing problems (e.g.,
teaching students visual and auditory perception skills).
b. Improvement in cognitive skills through general instruction in
listening, comprehension, and memory.
c. Targeting behavioral skills needed to compensate for specific
problems in reading, math, or written expression.
d. Considerable research supports the usefulness of teaching behavioral
skills as a means to improve academic skills.
II. Pervasive Developmental Disorders
A. All persons with pervasive developmental disorders have problems with language,
socialization, and cognition. Pervasive means that the problems affect persons
throughout their lives, and includes autistic disorder, Asperger’s syndrome, Rett’s
disorder, childhood disintegrative disorder, and pervasive developmental disorder
— not otherwise specified. The textbook focuses on autistic disorder.
B. Autistic disorder, or autism, is a childhood disorder characterized by significant
impairment in social interactions and communication and by restricted patterns of
behavior, interest, and activities. The textbook illustrates autism with the case of Amy.
1. The DSM-IV-TR notes three major characteristics of autism: impairment in
social interactions, impairment in communication, and restricted behavior,
interests, and activities.
a. Persons with autism do not develop the types expected social
relationships expected for their age. Such problems are often more
qualitative than quantitative. Such persons are not totally unaware of
others, but they do not seem to enjoy meaningful relationships with
others or have the ability to develop them.
b. Persons with autism have severe problems with communication, with
about 50% never acquiring useful speech. Some with speech engage in
echolalia, and others are unable or unwilling to carry on conversations
c. Restricted patterns of behavior, interests, and activities are the
most striking aspects of autism. Many persons with autism prefer that
things remain the same; a phenomenon referred to as maintenance of
sameness. Such persons may also spend countless hours engaging in
stereotyped and ritualistic behaviors (e.g., spinning around in circles,
biting their hands). Prevention of such rituals may result in a severe
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