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Lecture 2

Lecture 2 - Risk Factors and Children at Risk (Chapter 3).docx

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Psychology 2043A/B
Esther Goldberg

Risk Factors and Children at Risk Associated Reading: Chapter 3 Terminology – Risk and Resilience  There are factors that make it more (risk factors) or less (resiliency) likely that a child will develop a certain disorder or behaviour Risk Factors (Vulnerability Factors):  These are factors that increase a child’s vulnerability or conditions that are associated with an increased probability of negative outcomes  Risks are factors that precede a negative outcome and increase the chance that it will occur  Example; walking outside in the rain without an umbrella or coat puts one at higher risk for developing a cold  Risk factors can be anything from environmental triggers to biological abnormalities  They can affect any are of development; cognitive, social, behavioural, physical etc.  When talking about risk factors, we talk about both acute situations and chronic cases  Risk factors, for most, are relatively easy to list – some examples are: o Community violence o Natural disasters o Divorce o Family break-up o Socio-economic status o Inadequate parenting o Pre-natal stress  We can classify risk factors in two ways: o Life events or environmental factors that bring stress into a child’s life o Individual factors which make a child respond maladaptively  There are a few things that we know about risk factors: o Some risk factors are more influential than others  This depends on the disorders that are involved o Children may be more vulnerable to risk factors at certain times in their development  There are windows of time during which risk factors are more likely to have a negative impact on children o Risk factors can also work together  We can have complex interactions that make the outcomes that much worse o Risk can accumulate  SO, what do we know about risk factors? o They can be individual, at the level of the family, and at the level of the environment o They can work together and be cumulative in their effects o They can have different influences at different points in development o They are not necessarily specific to specific disorders or outcomes (i.e. the same risk factor can have several different outcomes) Established Risk Factors  Established risk involves medical conditions that invariably (always) result in disability or developmental delay  Established risk factors involve: o Chromosomal abnormalities (both by number and structure) o Genetic disorders Numerical Chromosomal Abnormalities  Most people have 46 chromosomes (23 pairs) in every cell of the body  NOTE: this ‘rule’ does not apply to sex cells (sperm and ova) in which there are only half the number of chromosomes (i.e. 23)  There are different abnormalities that sometimes show-up in the chromosomes  If this abnormality is numerical in nature, it indicated that the number of chromosomes is not correct  There are different categories of numerical abnormalities: o Monosomy – the individual is missing either of the chromosomes from the pair (not a pair anymore) o Trisomy – the individual has more than two chromosomes in a pair (not a pair anymore)  Downs Syndrome (trisomy 21) is the result of a numerical abnormality  These individuals have 3 chromosome 21’s instead of 2  Downs Syndrome is one of the most common genetic abnormalities that has been identified  There have been thousands of genetic abnormalities identified, however often when something goes wrong, it is so infrequent that it doesn’t ‘count’ as being a syndrome  On the other hand, if the issue arises in enough people and we start to notice recognizable signs of what that particular abnormality looks like, it will likely be recognized as a syndrome (ex. trisomy 21)  There are a number of other disorders that are also linked to numerical abnormalities  Some of these involve regular chromosomes and others involve the sex chromosomes  Disorders that are a result of an abnormalities involving the sex chromosomes are known as sex-linked disorders: o Klinefelter’s Syndrome, a sex-linked disorder, occurs when an individual has 3 specific sex chromosomes (XXY)  This indicates that Klinefelter’s Syndrome is a trisomy of the sex chromosomes  These individuals are males (based on the presence of the Y chromosome)  They are usually sterile, have longer limbs and are taller than average  There is also a personality type that is associated with Klinefelter’s Syndrome – the individual tends to be quiet and more at risk for speech problems and learning disabilities  These individuals are also often given testosterone treatments o Turner’s Syndrome, another sex-linked disorder, occurs when an individual only has 1 X chromosome (i.e. they’re missing the other sex chromosome)  This indicates that Turner’s Syndrome is a monosomy of the sex chromosome  NOTE: page 77 in the textbook says that Turner’s Syndrome involves 3 X chromosomes (XXX), however, this is not correct  The lack of a Y chromosome means that individual’s with this syndrome are female  They have the sexual features of a female but are under-developed  As a result, they tend to be short  They also may have abnormal facial and physical development o XXY males (an unnamed syndrome) also suffer from a sex-linked disorder  They are usually tall and more at risk for learning problems  In past studies, XXY males have been misconstrued as begin overly aggressive and prone to criminal activity, however this is not true o XXX females (another unnamed syndrome) also suffer from a sex-linked disorder  They tend to be tall, thin, shy, and at a higher risk for learning problems (especially reading disorders) Structural Chromosomal Abnormalities  In addition to numerical chromosomal abnormalities, we can have something happen in development where the chromosomes are altered structurally – these are known as structural chromosomal abnormalities  Alteration to the structure of a chromosomes can occur in many ways: o Deletion – part of the chromosome is missing o Duplication – part of the chromosomes is duplicated, leaving the individual with extra genetic material o Translocation – part of one chromosome is transferred to another chromosome o Fragility – chromosomes can have fragile points; this can lead to breakage and thereby, abnormalities in development (ex. Fragile X Syndrome – Autism) Summary  Genes are arranged in specific order along chromosomes  Each chromosome has thousands of genes, which are made up of DNA  DNA holds chemical messages  Those messages determine what every cell in the body is going to become  If we have flaws, or changes in our DNA, it will lead to abnormalities  Because these are genetic, or based in our cells, those will be hereditary, or possibly passed on to future generations Biological Risk Factors  Biological risk factors are those that can cause threat to a child’s developing system before, during, or after birth  They can be divided into three categories: Prenatal Factors (During Pregnancy)  There are 3 stages of the prenatal period: 1) Ovum/zygote/pre-embryo/blastocyst-fertilization: o This stage occurs in the first 2 weeks of pregnancy (post-conception) o This is usually around the time when the mother finds out they are pregnant 2) Embryo: o This stage lasts from the fist 2 weeks up until 10 weeks into the pregnancy 3) Fetus: o This stage lasts from 10 weeks post-conception until the birth of the child  The first 2 stages of the prenatal period are known as the first trimester – the first 1/3 of the pregnancy  In all three stages, there are sensitive times that occur, during which certain influences are enhanced  Since different systems in the body develop at different stages during pregnancy, certain systems will be more at risk during these sensitive times than others  The above diagram shows sensitive periods in prenatal development  The bars show when the key body parts and systems are developing  Most of the major development occurs in the first 4 months  NOTE: the first 2 columns on the left-hand side occur before the individual even knows that they’re pregnant (i.e. in the first two weeks)  The red bars on the graph indicate when each developing system is most vulnerable  If interference occurs in this time (i.e. something that can impact that specific developing system), major abnormalities are more likely to occur  However, if interference occurs during the period indicated by the yellow bars, only minor abnormalities are likely to affect those specific systems Teratogenic Agents:  Biological risk during the prenatal period is often associated with toxic substances – a range of agents that upon entrance into the mother’s system, can impact the developing fetus  These are known as teratogens; any agent that can cause an abnormality following fetal exposure during pregnancy  This area gets a lot of attention (ex. there are many campaigns to prevent drinking during pregnancy)  Teratogenic agents include a range of substances; drugs, pollutants (ex. pregnant women shouldn’t eat fish because of the mercury), conditions (ex. severe stress), poor nutrition etc.  There are different classes of teratogenic agents: o Infectious agents (e.g. rubella, herpes simplex, toxoplasma, syphilis etc.) o Physical agents (e.g. ionizing agents, hyperthermia etc.) o Maternal health factors (e.g. diabetes, maternal PKU etc.) o Environmental chemicals (e.g. herbicides and industrial solvents)  Environmental factors that influence prenatal development include different occupational hazards, such as exposure to radiation, lead, mercury etc. o Alcohol and drugs (e.g. prescription, over-the-counter, recreational etc.)  Teratogens can cause damage to body structures, growth rate, neural networks or all 3  Abnormalities can include obvious physical problems (ex. the boy who had no limbs), or can be subtle impairments that occur as the result of these agents  These impairments may not even be apparent until the child enters school for instance  NOTE: there are no absolute teratogens o This means that there is no saying that if you are exposed to any of these that you will have a certain outcome o There is nothing absolute about biological risks, however established risks can be absolute  Example: it is possible that a pregnant woman could eat an apple laced with pesticides and still have a normal baby, but if a baby has trisomy 21, it will have Downs Syndrome  Teratogenic agents can have damaging effects under certain circumstances o For instance, the same agent can have different effects on different people o The time of exposure can play an important role in the severity of damage, or even the type of defect o The dose (how much the individual takes or is exposed to) is also important  The dose-response effect holds that the greater the dose is, the larger the effect will be o In general, we know that the first stages of pregnancy are much more vulnerable than the fetal period, because much of the major development is occurring during the first trimester  It is also important to realize that there are pregnant women that need to take medication  Unfortunately, some medications have been associated with fetal abnormalities o Example: Thalidomide o This drug was administers in the 1970’s as an aid in reducing nausea during pregnancy o Unfortunately, it was not tested as well as it should’ve been o This children that were born to mothers taking thalidomide had severe physical abnormalities – they were born with ‘flipper’ limbs (not well formed)  Because of this, there are strategies for if mothers need medication during pregnancy o Administer the lowest possible does (because of the dose-response effect) o Attempt to reduce combination therapy (i.e. mixing medications) o If a medication is known to have teratogenic effects, a different one will be temporarily prescribed o Sometimes, mothers will go without the medication for at least the first trimester (when most of the major development occurs)  Although many teratogens have devastating effects on fetal development, at low levels they can have more subtle effects o Example: If you drink very lightly during pregnancy your baby may only be born with fetal alcohol effects, rather than fetal alcohol syndrome o Even though gross physical affects aren’t apparent, less obvious teratogenic effects can still occur  The behavioural effects that come as a result of teratogenic agents may not be entirely traceable to that teratogen – it can depend on the child’s physical make-up or genetic pre-disposition o These factors may influence how strong of an affect the teratogen will have; the interaction between a child’s genetic make-up and the specific teratogen that they are exposed to is important  There are some other factors (not listed above) that are linked to many developmental disabilities  Example: age – as women age there are more risks for abnormalities in fetal development  There have also been studies done on the male’s contribution to abnormalities in children (i.e. if the father has been exposed to or ingested a teratogen, there tends to be a higher incidence of abnormal children) Perinatal Factors (During Delivery)  The perinatal period is divided up into 3 stages: o Labour o Delivery o Immediate after-birth  This period somewhat overlaps both of the other two periods  Example: some already discussed prenatal factors can lead to prematurity and LBW  Although the cause for these abnormalities is technically prenatal, the results are considered as part of the perinatal period because they are occurring at the point of delivery  Full fetal development takes a certain amount of time, however, in some cases, babies are born before this period is fully over  A baby is considered pre-term is it is born before 37 weeks gestation  Often, when a child is born pre-term (or sometimes even if they are born on time) they will be born with a low birth weight  A baby is considered to be of low birth weight (LBW) if they weigh 5.5 lbs (2500g) or less  However, these issues are less common in Canada than they are in the US  This can be attributed to a number of different factors: o The lack of universal health care in the US o The higher rate of teen pregnancy o The lack of pre-natal care (based on the above two factors)  The table below lists some of the risk factors for premature births  Prematurity and LBW tend to go hand in hand – children who are born prematurely are more likely to be of LBW than of regular weight  As more and more children are born this way, the likelihood of infant death increases o LBW is associated with approximately 75% of infant death in the US (slightly less in Canada) o In Canada, approximately 5-6% of children are born of LBW o 90% of infants weighing over 3lbs will survive, and 40% of infants weighing 1.5lbs or less will survive o Of these surviving children, anywhere from 10-25% of them will have a mild developmental problem and 5-10% will have a severe problem  Similar to the dose-response effect, the smaller the baby is at birth, the more likely they are to have problems  The cost of care for babies who are born prematurely or are of LBW is very high, so this poses a financial problem for many families  Premature births are associated with a number of different abnormalities, one of which is respiratory distress syndrome o A babies lungs develop closer to the end of pregnancy o If they are born too early, they will have under-developed lungs that won’t properly functio
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