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PSYCH 257 (72)
Chapter 14

Chapter 14 Text Notes.docx

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Allison Kelly

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PSYCH 257: March 19, 2013 Chapter 14: Developmental Disorder Attention Deficit/ Hyperactivity Disorder (ADHD): developmental disorder featuring maladaptive levels of inattention, excessive activity, and impulsiveness CLINICAL DESCRIPTION - 2 different types of symptoms: 1. Inattention o Appears not to listen to others o Difficulty sustaining attention in tasks or in play activities o May not pay attention to details o Make careless mistakes o Easily distracted o Forgetful in daily activities 2. Hyperactivity o Fidgeting o Always on the go Impulsivity o Blurting out answers before the questions have been completed o Having trouble waiting turns - Either six or more symptoms present from one type persisting for at least six months to a degree that is maladaptive and inconsistent with developmental level - Inattention, hyperactivity, and impulsivity often cause other problems in academic performance, increased risk for minor injuries, unpopularity and rejection by peers, and low self-esteem from the negative feedback of people around them - Required for the child to be present with at least some ADHD symptoms must be present before childhood STATISTICS - Estimated to occur in about 6 percent of school-aged children - Boys outnumber girls four to one in having ADHD o The different prevalence rate between genders may be attributed to girls with ADHD less active than boys with ADHD - 68% of children with ADHD have ongoing difficulties through adulthood o Become less impulsive but inattention persists - Children are more likely to receive the label of ADHD in North America → overdiagnosis? - Frequently comorbid with other disruptive behaviour disorders and learning disorders o Oppositional defiant disorder: a pattern of negative, defiant, and hostile behaviour o Conduct disorder - ADHD is a risk factor for antisocial incomes in boys but not in girls CAUSES - ADHD is more common in families in which one person has the disorder o Relatives with display an increase in psychopathology in general - A little environmental influence present o Prenatal smoking interacts with the genetic predisposition (mutation in the DAT1 gene) to increase the risk for hyperactive and impulsive behaviour o Low socio-economic status o Parental martial instability and discord - Highly influenced by genetics but multiple genes are responsible for the disorder - ADHD is associated with the dopamine D4 receptor gene, the dopamine transporter gene (DAT1) and the dopamine D5 receptor gene - Endophenotypes are characteristics of ADHD scientists are looking for to link to specific brain dysfunctions (brain’s attention system, working memory functions, inattentiveness, and impulsivity) - Although there are no major damages in the brains of people with ADHD, there are subtle differences o Three areas of the brain appear smaller than normal: frontal (outer), basal ganglia (deep in the brain), and the cerebellar vermis (back) o Smaller volume seems to occur early in the development of the brain - A theory suggests that toxins such as allergens and food additives are possible causes of ADHD o The Feingold diet suggests eliminating these substances as a treatment for ADHD → little evidence supporting the effectiveness o Large-scale research does suggest that there may be a small but measurable impact of artificial food colours and additives on the behaviour of young children (increased levels of hyperactive behaviours like inattention, impulsivity, and overactivity) - Possible role of pesticides in food contributing to an increased risk in ADHD - Pregnancy complications can contribute to the increasing chance for ADHD for a child with a genetic predisposition - Psychological and social dimension contributions: negative response by the parent or teacher to the child → child’s increased feelings of low self-esteem → lower ability to make friends (rejection) TREATMENT - Biological treatments reduce the child’s impulsivity and hyperactivity to improve their attentional skills - Psychosocial treatments focus on improving academic performance, decreasing disruptive behaviour, and improving social skills - Drugs like methylphenidate (Ritalin, Metadate, Concerta), D-amphetamine (Dexedrine, Dexostrat) and pemoline (Cylert) haven proven to be helpful for about 70% of cases in temporarily reducing hyperactivity and impulsivity o Ritalin improved motor planning and response inhibition performance o Cylert has a greater chance of negative side effects so routine use is discouraged o Adderall is a longer-acting version of psychostimulants to reduce the need to take multiple doses of medication throughout the day - Certain antidepressants (bupopin, imipramine) and a drug used for treating high BP (clonidine) o improve compliance and decrease negative behaviours but do not produce substantial improvement in learning and academic performance and does not last over a long term when discontinued - Taking stimulants calms a child down because it reinforces the brain’s ability to focus attention during problem-solving tasks - Concerns regarding stimulants: o Potential abuse of the drug → methylphenidate abused for their ability to create elation and reduce fatigue o Medication may be overprescribed and long-term effects are still unknown  methylphenidate has side effects like insomnia, irritability, and appetite suppression  High doses of stimulants may have adverse effects on growth o Some children do not respond to the medication and do not show gains in the areas of academics and social skills - Behavioural interventions include programs with set goals, reinforcement programs rewarding and punishing (by the absence of reward) in children, programs training parents to respond constructively to their child’s behaviours & how to structure a child’s day to prevent difficulties o Not all children will benefit from these programs - Combined treatment (medication and behavioural treatments) faired equally with medication only treatments for ADHD symptoms o However, combined treatment has more advantages in symptoms beyond but still related to ADHD (social skills, academics, parent-child relations, oppositional behaviour Learning Disorders: reading, mathematics, or written expression performance substantially below levels expected relative to the person’s age, IQ, and education CLINICAL DESCRIPTION - Performance significantly below that of a typical person at the same ge, cognitive ability (IQ), and educational background Reading disorder (dyslexia): reading performance significantly below age norms Mathematics disorder: mathematics performance significantly below age norms Disorder of written expression: condition in which a person’s writing performance is significantly below age norms STATISTICS - Learning disability is one of the two most common disabilities suffered by children - Difficulties with reading is the most common (5-15%), then mathematics (6%), while the prevalence of written expression is uncertain - Learning disorder can lead to several different outcomes: o 32% dropped out of school o Low employment rates – from the student’s low expectations and/or the inability to hold a job o Increased risk for substance-use disorders o Increased risk for later development of psychiatric disorders o School experiences are generally negative and more difficult - Verbal or communication disorders closely related to learning disorders: o Stuttering: disturbance in the fluency and time patterning of speech o Expressive language disorder: problems in spoken communication (markedly limited vocabulary or errors in verb tense), measured by significantly low scores on standardized tests of expressive language relative to nonverbal intelligence test scores o Selective mutism: developmental disorder characterized by the individual’s consistent failure to speak in specific social situations despite speaking in other situations o Tic disorders: disruption in early development involving involuntary motor movements or vocalizations CAUSES - The parents and siblings of people with reading disorders are more likely to display these disorders than relatives of people without reading problems o If one twin has a reading disorder, there is a 100% chance that the second twin will as well - Structural difference: link between phonological processing problems and reading disabilities - Functional difference: weaker and more delayed response during reading of sentences by dyslexic readers o Neuropsychological deficit that interferes with the processing of certain essential language information - Physiological deficits differ among individuals - Socio-economic status, cultural expectations, parental interactions and expectations, child management practices, neurological deficits, and support provided by the school help determine the outcome for people with learning disorders TREATMENT - An assessment must be done before beginning treatment o Administer an intelligence test (ie.Wechsler Intelligence Scales) and an achievement test o A significant discrepancy between the aptitude and actual achievement on a particular area (reading, writing, math) gives the diagnosis of a special learning disorder - Primary form of treatment is educational intervention: 1. Efforts to remediate directly the underlying basic processing of problems 2. Efforts to improve cognitive skills through general instruction in listening, comprehension, and memory 3. Targeting the behavioural skills needed to compensate for specific problems the student may have with reading, mathematics, or written expression - For children with learning disorders who have difficulties processing language, treatment using exercises such as specially designed computer games help children distinguish among sounds - Teaching behavioural skills necessary to improve academic skills - Biological treatment is typically for those that also have ADHD Pervasive Developmental Disorders: wide-range, significant, and long-lasting dysfunctions that appear before the age of 18 - Autistic disorder (autism) - Asperger’s disorder: characterized by impairments in social relationships and restricted or unusual behaviours, but without language delays seen in autism o Might be a mild form of autism - Rett’s disorder: progressive neurological development disorder featuring constant hand- wringing, intellectual disability, and impaired motor skills - Childhood disintegrative disorder: disorder involving severe regression in language, adaptive behaviour, and motor skills after a two-year to four-year period of normal development - Pervasive developmental disorder- not otherwise specified (PDD-NOS): severe and pervasive impairments in the social interactions that do not meet all the diagnostic criteria for autistic disorder AUTISTIC DISORDER: pervasive developmental disorder characterized by impairment in social interactions and communications, and restricted patterns of behaviour, interest, and activity Clinical Description - 3 major sets of symptoms: social-communication deficits, inflexible language and behaviour, and repetitive sensory and motor behaviour - 3 major characteristics of autism expressed in the DSM are: impairment in social interactions, impairment in communication, and restricted behaviour, interests, and activities Impairments in Social Interactions - People with autism do not develop the social relationships expected of their age - For children, it is the inability to engage in skills like joint attention - At an older age, people with autism may not be interested in social situations o Therefore, may not be interested in social situations, enjoy meaningful relationships with others, or have the ability to develop them - Theory that they may lack theory of mind (the ability to appreciate that others have a point of references that differs from their own) - Autistic individuals’ poor performance on theory of mind may be attributed to general difficulties with executive planning Impairment in Communication - 50% of those with autism never acquire useful speech - Their communication is unusual; repeating the speech and intonation of others (echolalia) - Some who can speak are unable or unwilling to carry on conversations with others - Autistic children lack spontaneous pretend play or social imitative play appropriate to the child’s development level Restricted Behaviours, Interests, and Activities - Maintenance of sameness: upset when something is not in order - Stereotyped and ritualistic behaviours o Spinning around in circles, waving their hands in from of their face with head cocked to one side, biting their hands o Rituals can be complex and cannot be interrupted from completion (eg. must touch each doorknob while walking down the hall, touch each desk in a classroom Statistics - There is an increase in the prevalence of autism o May be the result of increased awareness by professionals o Other environmental factors (eg. toxic exposure) may have contributed to this - Gender differences for autism vary depending on IQ o <35: more prevalent in females o Higher IQ: more prevalent in males - Most people with autism develop the associated symptoms within 36 months - Autism is identified in every part of the world - A higher IQ score means a better prognosis (less likely to need extensive support by family members or people in the helping professions) o The better the language skills and IQ test performance, the better the prognosis Causes - There is no single cause but a combination of biological and psychosocial influences Biological Dimensions - Several medical conditions have been associated with autism: o Congenital rubella: German measles o Hypsarrhythmiya: type of brain wave abnormality sometimes observed in infants o Tuberous sclerosis: a genetic disease characterized by benign tumor-like nodules in the brain, inte
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