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Lecture Notes - Developmental Disorders - Ch. 14.docx

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PSYC 3140
Kendra Thomson

Lecture 4: Developmental Disorders Lecture 4 – Developmental Disorders • Developmental Psychopathology and Disorders • Disorder – Quantitative Measure of not enough attention (ADHD) • Psychopathology – Qualitative Stress of someone’s daily living  Developmental Psychopathology: the study of how disorders arise, and how they change with time  Childhood is associated with significant developmental changes  Disruption of early skills disrupt development of later skills  Developmental Disorder: o Diagnosed first in infancy, childhood, or adolescence  Attention Deficit/Hyperactivity Disorder  Learning Disorders  Autism Spectrum Disorders (formerly pervasive DD)  Intellectual Disability Attention Deficit / Hyperactivity Disorder (ADHD) • Difficult to finish a task, trouble concentrating, don’t seem to pay attention when others speak • Associated with behavioural, cognitive, social and academic problems • Central features: inattention, hyperactivity, and impulsivity DSM-IV Symptom Clusters 1. Symptoms of inattention 2. Symptoms of hyperactivity and impulsivity • Either 1 or 2 must be present of a diagnosis • Goal is to link these deficits to a brain dysfunction – research still in motion on that Symptoms of ADHD • Inattention o Doesn’t pay attention, loses things frequently, easily distracted, forgetful, doesn’t follow through on instructions, avoids tasks requiring mental effort • Hyperactivity o Fidgets with hands/feet, squirms in seat, leaves seat when inappropriate, runs around, climbs excessively, talks excessively, had difficulty engaging in quiet activities • Impulsivity o Blurts out response while others are talking, has difficulty waiting his or her turn, often interrupts or intrudes on others DSM-V Changes • Criteria are the same (inattention, hyperactivity-impulsivity) but have updated to include more examples of symptoms to identify how disorder applies across lifespan, not just kids • Initial onset changed from 7 to 12 • Comorbidity with Autism now permissible • Have provided more examples of what symptoms look like and across lifespan – what inattention looks like when 7 or 16 • DSM V included Specifiers to illustrate what symptoms look like for adults since many children have problems as adults ADHD – Facts and Stats • Prevalence o Occurs in 6% of school aged children (6-12) o Symptoms are usually present around age 3 or 4 o 68% of children w/ ADHD have problems are adults (ex: inattention) • Gender Differences o Boys outnumber girls 4:1; reason is unknown • Comorbidity is high o As high as 50% with conduct disorder o Also comorbid w/ oppositional defiant disorder & learning disorders • Cultural Factors o Probability of ADHD diagnosis is greatest in the US, but has been increasing globally Causes • Genetic Contributions • Considered to be highly influenced by genetics, with a small role played by environmental influences • Multiple genes involved • ADHD runs in families • Familial ADHD may involve deficits on chromosome 20 • Gene for the D4 (dopamine) receptor is more common in ADHD children • Neurobiological Contributions • Volume (overall size) of the brain is smaller in children w/ ADHD o Inactivity of the frontal cortex and basil ganglia, and cerebellar vermis • Right hemisphere malfunction • Abnormal frontal lobe development & functioning • Yet to identify a precise neurobiological mechanism for ADHD -negative responses by parents, teachers and peers to the affected child’s impulsivity & hyperactivity may contribute to his feelings of low self-esteem • Role of Toxins • Debate going on for last 30 years or so, “Feingold diet” – removes all additives, artificial colours, aspartame, etc. but allergens & food additives DO NOT appear to cause ADHD • Consuming a lot more unnatural products • Maternal smoking increases risk of having child with ADHD • Psychosocial Factors can influence the disorder o Constant negative feedback from teachers, parents, peers o Peer rejection, resulting in social isolation o Low self-image o Need to take into accounts environment, people around you, etc. Biological Treatment for ADHD: Biological and Psychosocial • Goal of Biological Treatments • to reduce negative behaviours (hyperactive, impulsive behaviour) and improve attention and compliance • Stimulants Medications (ex: Ritalin) • reduce the core symptoms of ADHD in 70% of cases in at least temporarily reducing problem behaviours • many side effects (ex: nausea, insomnia) • Are we overmedicating? 42% of Ritalin prescriptions are ordered by family doctors • Antidepressants and high blood pressure medication also shown to be somewhat effective Psychosocial Treatments • generally focus on broader issues such as improving academic performance, decreasing disruptive behaviour, and improving social skills Effects of Medications • improve compliance and decrease negative behaviours in many children • medications do not affect learning, academic & social skills • beneficial effects are not lasting following drug discontinuation.. you relapse & symptoms come back Behavioural & Combines Treatment of ADHD • Behavioural Treatement/Contingency Management o Reinforcement programs (ex: token economies, reward behaviours & punish others) o Aim to increase appropriate behaviours, decrease inappropriate behaviours o May also involve parent training to teach families how to respond constructively to their child’s behaviours & how to structure the child’s day to help prevent difficulties o Many children have benefited from these types of programs o Most clinicians recommend a combination of approaches designed to individualize treatments for children with ADHD • Combined Bio-Psycho-Social Treatments are highly recommended Conduct Disorder & Oppositional Defiant Disorder • Conduct Disorder: chronic pattern: a repetitive and persistant pattern of behaviour in which the basic rights of others or major society rules are violated o At least 3 of the following over 12 months:  Aggression to people & animals, destruction of property, deceit and theft, serious violations of rules before the age of 13 • Oppositional Defiant Disorder: argumentativeness, negativity, irritability, defiance, but behaviours not as severe as in conduct disorder o No chronic aggression towards others or animals, property, or theft Prognosis • All adults w/ antisocial personality disorder have a history of conduct disorder • 40% of children w/ conduct disorder are diagnosed with antisocial personality disorder in adulthood • Early onset of conduct disorder and severity of problems strongest predictors of poor outcome Learning Disorders • Scope of Learning Disorders: o Problems related to academic performance in reading, mathematics, and writing o Performance substantially below what would be expected given the persons age, IQ, and education. • DSM-IV and DSM-IV-TR Reading Disorder or Dislexia o Discrepancy b/w actual/expected reading achievement o Reading is at a level significantly below that of a typical person of the same age o Problem can’t be caused by sensory deficits (ex: sight or hearing) • Mathematics Disorder o Achievement below expected performance in mathematics • Disorder of Written Expression o Achievement below expected performance in writing DSM-V Changes • Specific learning disorder replaces disorders like disorder of mathematical expression, etc. • Co-occurrence – if you are having trouble reading, may also have trouble writing • Specifiers for impairment in reading, writing, and mathematics Facts & Stats: • 1 of 2 most common disabilities in children up to age 14 • More than 50% of all Canadian school children classified as having a disability have a learning disability Biological and Psychosocial Causes of Learning Disorders • Genetic & neurobiological contributions • Reading disorder runs in families o 100% concordance rate for identical twins • Evidence for subtle forms of brain damage unclear • Genetic/neurobiological contributions unclear • PSYCHOSOCIAL contributions are largely unknown Treatment of Learning Disorders • requires intense Educational intervention • Before beginning treatment, an assessment must be conducted • Conduct 2 tests (ex: intelligence & achievement) and compare scores on each o If a significant discrepancy exists b/w aptitude and actual achievement in a particular subject, then a specific learning disorder is diagnosed • Educational Intervention: o Remediation of basic processing problems (ex: teaching visual and auditory perception skills) o Improvement of cognitive skills (ex: instruction in listening) o Targeting behavioural areas to compensate for problem areas (ex: reading out loud if person can’t study reading inside their head) • Data supports the usefulness of teaching behavioural skills necessary to improve academic skills Pervasive Developmental Disorders (PDD) • Pervasive – problem will span person’s entire life • Problems occur in language, socialization, and cognition • PDD Triad - social interaction, communication and repetitive, stereotypes behaviour or interests • Including in PDD o Autism • Asperger’s o Same impaired social relationships & restricted/unusual behaviour as Autism except without the language delays • Childhood Disintegrative Disorder (CDD) o Severe regression in language, adaptive behaviour, & motor skills o Rett’s • CDD is somewhat like autism – more severe form, child developed normally until 2-4 and all of a sudden they have a huge loss of skills (expressive interceptive language skills, social skills, adaptive functioning (brushing teeth), may lose bladder control) Rett Syndrome • Most prevalent is loss of hand functioning • Regressive disorder • Mostly affects girls • Mutation on long arm of X chromosome Autistic Disorder • Problems in social interactions & communication o Social interactions:  Impairment in use of non-verbal behaviours (eye contact, facial expression, body posture, and gestures)  Not able to develop relationship appropriate for age  Lack of spontaneous seeking to share enjoyment, interests, etc. with others o Communication:  Delay or lack of spoken language development  With individuals who have spoken language, they’re unable to initiate or sustain conversation
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