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Developmental Disorders CHAP 14.docx

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Queen's University
PSYC 235
Christopher Bowie

Pervasive Developmental Disorders Severe & lasting impairment in: social interactions, communications, adaptive behaviors, Interests & activities 1) Autism: significant impairment in social interactions & communications by restricted patterns of behaviour, interests & activities A. At least 6 items from (1),(2),(3) with at least 2 from (1) and 1 each from (2) & (3) 1) Qualitive impairment in social interaction by at least 2 of: a. Marked impairment in multiple nonverbal behaviours (eye contact, facial expressions, body gestures) to regulate social interaction b. Failure to develop peer relationships appropriate to developmental level c. Lack of spontaneous seeking to share enjoyment, interests with other people d. Lack of social/emotional reciprocity 2) Qualitative impairments in communication by at least 1 of: a. Delay in/lack development of spoken language (no hand gestures) b. Difficulty initiating & maintaining conversations c. Stereotyped & repetitive use of language / idiosyncratic language d. Lack of make believe play/imitation of others at develop. Level 3) Restricted repetitive and stereotyped patterns in behaviour, interest & activities: a. Preoccupation with parts of objects that are abnormal b. Inflexible adherence to specific nonfunctional routines/rituals c. Stereotyped & repetitive motor mannerisms d. Persistent preoccupation with parts of objects e. Encompassing preoccupation with 1/more restricted patterns of interest that is abnormal in intensity or focus B. Experiences delays/abnormal functioning in at least 1 of (1,2,3) before age 3 C. Disturbance not due to Rett’s disorder or childhood disintegrative disorder Statistics :  2-20/10000 people OR 1/160 births  IQ under 35 autism is more prevalent in females/ higher = more in men  70-80% mental retardation; rest do not ½ are in moderate – profound mental retardation, ¼ in mild range Biological Dimensions- Medical Conditions: congenital rubella (German measles), tuberous sclerosis cytomegalovirus, and difficulties in pregnancy/labor Genetics:  90% of MZ twins = cognitive impairment/ 70% have ASD compared to DZ twins  Not 1 genetic cause b/c it is not 1 disorder  Genes coding of abnormal neurodevelopment, resulting in symptoms of the autism spectrum  Families with 1 autistic child = 3-5% of another child with disorder  Incidence rate: 0.0002-0.0005% Neurobiological influences  ¾ people w/ autism show levels of mental retardation -> 30-75% display neurological abnormalities *clumsiness/abnormal posture/gait  Suggest autism is physical in origin -> abnormalities of cerebellum including reduced sized Psychological & Social Dimensions Past theories/beliefs:  Historically seen as failed parenting -> cold, perfectionistic, aloof (high economic status with higher IQ)  Based on unusual speech patterns – avoid 1 person  Lack of self-awareness Difference: social deficiencies, socialization & communication -> biological Rise in Autism:  Increase in recognition?  “Male” brain  Vaccines?  Environmental Toxins?  Older parents? Psychosocial Treatments: successful using systematic & dedication teaching 1 a specific skill  Early = ego development  Behavioral Approach: can learn & be taught some skills they lack -> overlap in treatment with mental retardation Communication: shaping & discrimination training to teach nonspeaking children to imitate others  Reinforce a child with food/praise for making any sound while watching -> Only reinforce if they made a sound after being asked “Say ball” (discrimination training)  Sign language & vocal output devices Timing & Setting for Treatment:  Early intervention efforts -> behaviour treatment for communication/social for about 40 hours a week  Regular classroom placed children = highest level of improvement Integration is an important factor 2) Asperger’s Disorder  Social deficits similar to autism WITHOUT a) Significant language delays or deficits b) Cognitive impairment  Others features: a) Stilted speech b) Eccentricities (memorizing arcane facts) Statistics: Prevalence = uncertain approx. 1-36/10000 More often in males than females Treatment:  Instilling Social Skills  Nonverbal Skills training 3) Rett’s Disorder Relatively rare = 1/12000-15000 births st  1 5months normal and normal head circumference at birth but then deceleration of growth between 5-48 months  Loss of motor & social skills already learned/ poor development of new ones Treatment: focus on teaching self-help & communication skills to reduce problem 4) Childhood Disintegrative Disorder  Normal development for first 2 years followed by significant loss of skills between 2-10 years  1/100000 births, 60x less common than autism  More frequently in males  Treatment: behavioral intervention to regain lost skills & behavioral & pharmacological treatments to reduce problem behaviour Changing the diagnosis of Autism -> Autism spectrum disorder -> Replace Autistic/Asperger’s/Childhood disintegrative/ Pervasive developmental -> Social & Communication deficits become 1 = merge autism & Asperger’s  Distinction of this class from others is reliable & valid  Both defined by common set of behaviours -> best represented by 1 category -> Would be adapted to individual with clinical specifiers EX: someone with Asperger’s might be also diagnosed with Autism level 1 communication Controversies surrounding the changes  Greater stigma associated with autism  Potential changes to diagnostic threshold and inclusivity -> ASD is already diagnosed in 1/110 children  Personal costs: unnecessary treatment & educational interventions  Societal costs: moving educational & therapeutic resources away from those who need them most  Growing subculture of “Aspies” -> neurodiveristy movement Conduct Disorder : behaviours that violate the basic rights of others and the norms for social behaviour  Tantrums, defying wishes of adults, deliberately annoy others, angry resentful and vindictive  Aggressive towards people, hurting animals, property damage, theft Statistics:  5.5% prevalence in 4-16 year olds  3:1 boy to girl  Problem behaviours continue into adolescence  Chronic unemployment  Antisocial personality disorder as adults Oppositional defiant disorder : Argumentativeness, negativity, irritability, defiance but behaviours are not as sever as in conduct disorder  Earlier onset than CD  Tantrums, defying wishes of adults, deliberately annoy others, angry resentful and vindictive Treatment of OCD and CD a. Cognitive behavioral therapy  Teach to recognize triggers  Recognize automatic thoughts  Consider alternative ways of thinking about situation  Self-talk & relaxation techniques b. Medications (mood stabilizers, antipsychotics, stimulants, SSRI)  Appear to only help some symptoms and in only some people Separation Anxiety Disorder (SAD) A. Developmentally inappropriate & excessive anxiety concerning separation from home or from the person who the individual is attached to by 3 or more: a. Recurrent excessive distress when separation or anticipation of b. Persistent and excessive worry about losing attachment figure(s) c. Persistent and excessive worry about an untoward event (ex: getting lost/ being kidnapped) will lead to separation d. Persistent reluctance/refusal to go to school/elsewhere because of separation e. … to be home alone f. … to go to sleep without being near major attachment figure or to sleep away from home g. Repeated nightmare involving theme of separation h. Repeated somatic complaints (headaches, stomach aches) when separation occurs/ is anticipated Duration is at least 4 weeks Onset is before age 18 Clinically significant distress or impairment Statistics:  4% of children & young adolescents  Before age 6 considered “early onset”  Decreases in prevalence through childhood  May develop after a life stress  Majority of children-> free from anxiety disorders in adulthood st  More common in 1 degree biological relatives & Treatment Cognitive behavioral t
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