Chapter 14.docx

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Earth & Planetary Sciences
EPSC 180
Meredith Chivers

Chapter 14: Developmental Disorders in this chapter we cover those disorders that are revealed in a clinically significant way during a child’s developing years & that are of concern to families & educational systems. for the most part: a child develops one skill before acquiring the next. this pattern of change implies that any disruptions in the development of early skills will, by the very nature of this sequential process, disrupt the development of latter skills. knowing what processes are disrupted will help us underst& the disorder better & may lead to more appropriate intervention strategies. - attention deficit/hyperactivity disorder (ADHD): involves characteristics of inattention or hyperactivity & impulsivity, & learning disorders, which are characterized by one or more difficulties in areas such as reading & writing. - autism: a more severe disability, in which a child shows significant impairment in social interactions & communication & restricted patterns of behaviour, interest, & activities. - mental retardation: involves significant deficits in cognitive abilities Attention Deficit/Hyperactivity Disorder Clinical Description - primary characteristics of people include a pattern of inattention, such as not paying attention to school or work-related tasks, or of hyperactivity & impulsivity. many have a great deal of difficulty sustaining their attention on a task or activity. some also display motor hyperactivity, as well as impulsivity (acting w/o thinking... shouting out responses to questions before the prof is done) - DSM differentiates two types of symptoms (one of them must be present to be diagnosed w/ ADHD) • problems of inattention o appear not to listen to others o they may lose necessary assignments or books o may not pay attention to details, making careless mistakes • hyperactivity o fidgeting o having trouble sitting for any length of time o always being on the go o impulsivity (blurting out answers before questions have been completed/ waiting turns) - academic performance tends to suffer & they engage in more frequent dangers & risky behaviours. children w/ADHD are also likely to be unpopular & rejected by their peers, mostly because inattention, hyperactivity & impulsivity get in the way of establishing & maintaining friendships. thus, creating low self-esteem. Statistics - some ADHD symptoms should be present in childhood, before 7. they are identified as being different from their peers around 3 or 4; their parents describe them as very active, mischievous, slow to toilet train, & oppositional. - 68% of children w/ADHD have ongoing difficulties through adulthood (less impulsive, but driving difficulties due to inattention, speeding, or license suspended) - frequently comorbid w/ other disruptive behaviour disorders (ex. odd & conduct disorder) Causes Genetics -ADHD is common in families in which one person has the disorder. families display an increase in psychopathology in general, including conduct disorder, mood & anxiety disorders, & substance abuse. - most attention is focused on genes associated w/ the neurochemical dopamine (& also serotonin). evidence shows adad is associated w/ the dopamine d4 receptor gene (the dopamine transporter gene) & the dopamine d5 receptor gene. - the overall size (volume) of the brain is smaller in children w/ADHD, including smaller areas of the frontal cortex, the basal ganglia & the cerebellar vermis (part of the back of the cerebellum). ADHD is associated w/ maternal smoking. 3 times more likely to have a child w/ ADHD. negative response by parents or peers to the child’s impulsivity & hyperactivity may contribute to low self-esteem. Treatments Biological & Psychosocial Interventions - the goal of biological treatments is to reduce the children’s impulsivity & hyperactivity & to improve their attention skills. psychosocial treatments focus on broader issues such as improving academic performance, decreasing disruptive behaviour, & improving social skills. • psychostimulants include: methylphenidate (ritalin, concerta), d-amphetamine & pemoline (works 70%) - stimulant medications appear to reinforce brain’s ability to focus attention during problem-solving tasks - 2 main concerns regarding the use of stimulant medication: 1. potential stimulant drug abuse o methylphenidate are sometimes abused for their ability to create elation & reduce fatigue 2. medications may be overprescribed & long-term effects not well understood o over-prescription effects might include insomnia, irritability & appetite suppression - most children who don’t respond to medications do not show gains in the important areas of academic & social skills. the programs set such goals as increasing the amount of time the child remains seated, increasing the number of math papers completed, or engaging in appropriate play w/ peers. reinforcement programs reward the children. Learning Disorders - reading disorder: a significant discrepancy b/w a person’s reading achievement & what would be expected for someone of the same age (ie. dyslexia) • it is required that the person read at a level significantly below that of a typical person of the same age, cognitive ability (iq test) & educational background. - mathematics disorder: achievement below expected performance in mathematics disorder of written expression – achievement below expected performance in writing -> interfere w/ the student’s academic achievement & disrupts their daily activities Causes - learning disability is one of the two most common disabilities suffered by children up to 14 years biological cause -> (genetic basis) parents & siblings of people w/ reading disorders are more likely to display these disorders. chromosomes 2, 3, 6, 15 & 18 seem to be linked - psychological & motivational factors that have been reinforced by others seem to play an important role in the eventual outcome for those w/ learning disorders. people w/ learning disabilities display very different types of cognitive problems & therefore probably represent a number of etiological subgroups. Treatment - 2 common methods of assessing learning disorders is through two types of tests: 1. intellectual tests (ex. wechsler intelligence scales) 2. achievement tests & comparing the results of both - biological treatment is typically restricted to those individuals who may also haveADHD, which we have seen involves impulsivity & an inability to sustain attention & which can be helped w/ certain stimulant medications such as methylphenidate (ritalin). - educational efforts can be categorized into: 1. basic processing of problems (ie. by teaching students visual & auditory perception skills 2. improve cognitive skills through general instruction in listening, comprehension & memory 3. targeting behavioural skills needed to compensate for specific problems that student may have Communication & Related Disorders Stuttering a disturbance in speech fluency that includes a number of problems w/ speech, such as repeating syllables or words, prolonging certain sounds, making obvious pauses, or substituting words to replace ones that are difficult to articulate. causes: genetics, multiple brain pathways may be a factor treatment: psychological -> parents are counseled about how to talk to their children regulated-breathing method (stop speaking when a stutter occurs & then take a deep breath) pharmacological -> verapamil may decrease the severity of stuttering in some individuals Expressive Language Disorder limited speech in all situations; expressive language (what is said) is significantly below their average receptive language (what is understood) causes: psychological explanation = parents may not speak to their child enough biological theory = middle ear infection is a contributory cause treatments: self-correcting / may not require special intervention Selective Mutism persistent failure to speak in a very specific situation (like school), despite the ability to do so. causes: anxiety is one possible cause, particularly social anxiety treatment: contingency management – giving children praise & reinforcers for speaking Tic Disorders involuntary motor movements (tics/head twitching) or vocalizations (grunts) that come on suddenly. in one type, tourette’s disorder, vocal ties often include the involuntary repetition of obscenities. causes: inherited dominant gene(s) treatment: psychological – self-monitoring, relaxation training Pervasive Developmental Disorders - people w/ pervasive developmental disorders all experience problems w/ language, socialization, & cognition. the word pervasive means that these problems are not relatively minor & significantly affect individuals throughout their lives. - the main focused pervasive developmental disorder is autistic disorder (or autism). others include: Asperger’s Disorder Impaired social relationships & restricted or unusual behaviours or activities, but w/out language delays (that are associated w/ autism); few severe cognitive impairments; often exhibit clumsiness & poor coordination; a mild form of autism. cause: evidence suggests it runs in families = genetic contribution treatment: focus on helping improve social skills (similar to treatment for autism) Rett’s Disorder a progressive neurological disorder that primarily affects girls; characterized by constant h& wringing, increasingly severe mental retardation, & impaired motor skills – appear after normal start in development motor skills deteriorate progressively over time; social skills develop normally, then decline, then improve. cause: relatively rare; possibly a genetic disorder involving the x chromosome treatment: teaching self-help & communication skills & on efforts to reduce problem behaviours Childhood Disintegrative Disorder involves severe regression in language, adaptive behaviour, & motor skills after 2-4 year period of normal development. causes: several factors suggest a neurological origin, w/ abnormal brain activity treatment: behavioural interventions to regain lost skills & behavioural & pharmacological treatments to help reduce behavioural problems. Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) severe & pervasive impairments in social interactions that do not meet all the criteria for autistic disorder; may not display the early avoidance of social interaction, but still may exhibit significant social problems; exhibit fewer repetitive stereotyped behaviours than autistic children; cause: likely similar genetic influences & neurobiological impairments common in autism treatment: teaching socialization & communication skills; efforts towards reducing problem behaviours Autistic Disorder - autistic disorder, or autism, is a childhood disorder characterized by significant impairment in social interactions & communication & by restricted patterns of behaviour, interest & activities - iq tests can measure autism w/ genders; 70-80% of autistic people have mental retardation - 3 major characteristics of autism in dsm are: 1. impairment in social interactions 2. impairment in communication 3. restricted behaviour, interests & activities Impairment in Social Interactions - never make friends among their peers & often limit their contact w/ adults to using them as tools (ex. taking the adult’s h& to reach for something). the signs of social problems usually include a failure to engage in skills such as joint attention (when sitting w/ a parent in front of a favourite toy, young children will typically look back & forth b/w the parent & toy, smiling, in an attempt to engage the parent w/ the toy). this skill in joint attention is noticeable absent in children w/ autism. - one current view is that people w/ autism lack a theory of mind (the ability to appreciate that others have a point of reference that differs from their own). Impairment in Communication - 50% of people w/ autism never acquire useful speech. - some repeat the speech of others (echolalia) as well as the tone. - *a lack of spontaneous pretend play or social imitative play appropriate to the child’s development level Restricted Behaviour, Interests & Activities - this broader category consists of 2 distinct dimensions: maintenance of sameness (like things to stay the same, become upset when a small change occurs) stereotyped & ritualistic behaviour (s = spinning around in circle or biting their h&s) (r = touch each door down a hallway or desks in classroom –if interrupted, may have severe tantrum) Causes - autism is a puzzling condition – there are numerous theories of why it develops Biological Dimensions - several different medical conditions have been associated w/ autism, including: - congenital rubella (german measles) - hypsarrhythmia (type of brain wave abnormality sometimes observed in infants) - tuberous sclerosis (genetic disease characterized by benign tumour-like nodules in the brain, mental retardation, & seizures) - cytomegalovirus (an infection caused by a specific type of herpes virus) - difficulties during pregnancy & labour - more research is required - deficits in such skills as socialization & communication appear to be more biological in origin Genetic Influences - has a genetic component - autism may be the most heritable of all psychiatric disorders – genes unknown neurological influences - evidence shows that autism is associated w/ some form of organic (brain) damage. 3⁄4 people of autism have some level of mental retardation. abnormalities of the cerebellum, including smaller size. Treatment - no completely effective treatment exists (unsuccessful in eliminating social problems). most efforts at treating people w/ pervasive developmental disorder focus on enhancing their communication & daily living skills & on reducing problem behaviours, such as tantrums & self-injury. Psychosocial Treatments - behavioural approaches that focus on skill building & behavioural treatment of problem behaviours - the types of psychosocial interventions that are most successful are those that are very systemic & dedicated to teaching a specific skill - there is a great deal of overlap b/w the treatment of autism & mental retardation & so several treatment areas that are important for people w/ autism includes communication & socialization. Communication - problems w/ communication & language are among the defining characteristics of this disorder. -people w/ autism often do not acquire meaningful speech; they tend to have either very limited speech or use unusual speech such as echolalia. - teaching people to speak in a useful way is difficult. think about how we teach languages: it mostly involves imitation (teaching girl to say spaghetti). an autistic child can’t or won’t imitate. - shaping & discrimination training are basic behavioural procedures used to teach nonspeaking children to imitate others verbally. - other children do not respond to this training & workers sometimes use alternatives to vocal speech, such as sign language & devices that vocal output & can literally speak for the child. -one such alternative is the Picture Exchange Communication System to teach functional communication to individuals w/ limited speech, such as children w/ autism spectrum disorders. children are taught to exchange a single picture for a desired item Socialization - adolescents w/ autism show significantly fewer interactions w/ their peers, & limited progress has been achieved in developing social skills. - behavioural procedures have increased behaviours such as playing w/ toys or peers (limited quality). Timing & Settings For Treatment - inclusion – helping children fully participate in the social & academic life of their peers – applies not only to school but all aspects of life. even community housing is being recommended – inclusion is very important Biological Treatments - psychotropic drugs may help to reduce some symptoms of autism. - vitamins & dietary changes have been promoted as one approach to treating autism – little research Integrating Treatments - for children, most therapy consists of school education combined w/ special psychological supports for problems w/ communication & socialization. behavioural approaches have been most clearly documented as benefiting children. for adults, integrating them into the community (living/work settings) Mental Retardation - mental retardation is a disorder evidenced in childhood as significantly below-average intellectual & adaptive functioning. people w/ mental retardation experience difficulties w/ day-to-day activities. - individuals experience impairments that affect most areas of functioning. language & communication skills are often the most obvious. people w/ more severe forms of mental retardation may never learn to use speech as a form of communication, requiring alternatives such as sign language or special communication devices to express even their most basic needs -> have difficulty learning. - the DSM-IV-TR criteria for mental retardation are in three groups. a person must have: 1. significantly subaverage intellectual functioning (through IQ tests) 2. concurrent deficits or impairments in adaptive functioning (a person must have significant difficulty in at least 2 of the following areas: communication, self-help, home living, social & interpersonal skills, use of community resources, s
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