Psychology 2030A/B Chapter Notes - Chapter 14: Dopamine Receptor D4, Through The Ashes Of Empires, Motor Planning

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Chapter 14
Developmental disorders in the sense that they change over time – originate in childhood, although full presentation of
problem may not manifest till later
Perspectives
Implies disruption in the development of early skills will, by the nature of the sequential process, disrupt the development of
later skills
Changes at the bio level or psychosocial may reduce the impact of the disorder
Knowledge of normal development is important for understanding the nature of childhood psychological disorders
Attention-Deficit/Hyperactivity Disorder
One of the most common reasons children are referred for mental health services
Primary characteristic of such include: pattern of inattention or of hyperactivity and impulsivity
Clinical Description
Issues sustaining their attention on a task/activity
oOften left unfinished
oDisplay motor hyperactivity
Impulsivity –acting without thinking
DSM 5 differentiates 2 categories of symptoms
o1. Inattention
o2. Hyperactivity and impulsivity
either firs tor second set must be present for someone to be diagnosed
these two clusters of ADHD symptoms appear to be consistent across different cultures
increased risk of minor injuries thus causing their parents more worry
genetic research on both ADHD and learning disabilities suggests that they may share a common bio cause
likely to be rejected and unpopular
obc inattention/hyperactivity gets in way of establishing and maintaining friendships
oresult of genetic factors and environmental influences
low self esteem can root from negative feedback from parents and teachers
Statistics
estimated to occur in about 6% of school aged children – boys outnumber 4 to 1
despite perception that children grow out of ADHD, problems usually continue
o68% have ongoing issues through adulthood
overtime seem to be less impulsive, although inattention persists
Rachel Klein – studied 200 boys over 33 years
oWhen compared w/ a group w/out ADHD, majority of men (84%) were employed but in significantly lower
positions
o2.4 years less of education; less likely to hold higher degrees
olikely to be divorced, substance problems and antisocial personality disorder
although manifestation of ADHD change as people grow older, many of the problems persist
children in North America are more likely to receive this label than anywhere else in the world
omay be lack of tolerance; although is a disorder that affects children globally
often co-occurring with other disruptive behaviours like oppositional or conduct
orisk factor for antisocial outcomes in boys but not in girls
also often comorbid with learning disorders
Causes
more common in families in which one person has the disorder
display an increase in psychopathology in general, including conduct disorder, mood, anxiety and substance abuse
oshared genetic deficits may contribute to the problems experienced
highly influenced by genetics – env. Influences play a relatively small role
mutations occur that either create extra copies of a gene on one chromosome or result in the deletion of genes (called copy
number variants)
additions or deletions of one or more genes result in disrupted development
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more attention to date focuses on genes associated with the neurochemical dopamine, although norepinephrine, serotonin,
and GABA also implicated causes of ADHD
associated w/ dopamine D4 receptor gene, dopamine transporter gene (DAT1), and dopamine D5 receptor gene
DAT1 is of particular interest because methylphenidate (Ritalin) is one of the most common treatments
oInhibits this gene and increases the amount of dopamine available
Looking for endophenotypes, those basic deficits (such as specific attentional problems) characteristic of ADHD
oOne genetic marker (endophenotype) is poor inhibitory control
Researchers found that children w/ a specific mutation involving the dopamine system (called the DAT1 genotype) were
more likely to exhibit the symptoms of ADHD if their mothers smoked during pregnancy
oPrenatal smoking seemed to interact w/ this genetic predisposition to increase the risk
Environmental factors such as maternal stress and alcohol use, and martial instability and discord
Although no major brain damage is found in the brains of those with ADHD, there are subtle differences
oVolume (overall brain size) of the brain is smaller in children
3 areas of the brain appear smaller
o1) frontal cortex
o2) basal ganglia
o3) cerebellar vermis
little evidence that allergens play an impact
Treatment
proceeded on two fronts: bio and psychosocial interventions
typically goal of bio treatments is to reduce the children’s impulsivity and hyperactivity and to improve their attentional skills
psychosocial treatments generally focus on broader issues such as improving academic performance, decreasing disruptive
behaviour
recent efforts combine them in order to have a broader impact on people with ADHD
drugs such as methylphenidate (Ritalin), d-ampthetamine and pemoline have proven helpful for approx. 70% of cases in at
least temporary reducing hyperactivity and impulsivity and improving concentration
oRitalin improved both motor planning and response inhibition performance
Drugs such as antidepressants and drug used for treating high blood pressure may have similar effects on people with ADHD
All these drugs seem to improve compliance and decrease negative behaviours
oEffects do not usually last for the LT
Stimulant medications reinforce the brains ability to focus attention during problem solving tasks
Two main concerns about the use of stimulant medications
oAbuse
oOverprescribed and LT effects that aren’t well understood
Both medication and behavioural interventions have shortcomings
Determine whether or not a combined approach to treatment is the most effective, large scale study initiated
Labelled by the Multimodal Treatment of ADHD Disorder (MTA) study
oGroup of children received routine care without medication or specific behavioural interventions
The three treatment groups consisted of medication management, intensive behavioural treatment and a combination of the
two treatments
Initial reports suggested that the combination of behavioural treatments and medication, and medication alone, were superior
to behavioural treatment alone and community intervention
Problems that went beyond the specific symptoms of ADHD, such social skills suggested slight advantage of combination
over single treatments (medication management, behavioural treatment) and community care
No difference between these two treatments, most opt for medication bc ease of use and lesser time commitment
Specific Learning Disorder
Characterized by performance that is below what would be expected given the persons age, IQ and education
Clinical Description
Specific learning disorder, which is defined as a significant discrepancy b/w a persons academic achievement and what
would be expected for someone of the same age
oAlso known as dyslexia
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Require that the person perform academically at a level significantly below that of a typical person of the same age, cognitive
ability and educational background and cant be caused by a sensory difficulty
Statistics
Approx. 6.5 million students b/w 3-21 were receiving services for specific learning disorder between 2009-2010
Although the frequency of these diagnosis appears to increase in wealthier regions
Learning disability is one of the two most common disabilities in children up to 14 years of age
Issues with reading most common, 5-15% of general population
Mathematics approx. 6%
One study found that about 32% of students w/ learning disabilities dropped out of school
Learning disorders may be related to the later development of other mental health problems
oIncreased risk for substance use and psychiatric disorders
Negative outcomes may be mitigated by providing proper supports
Childhood onset fluency disorder (stuttering) and language disorder (combines expressive and mixed receptive expressive
language disorders from DSM-IV-TR)
Causes
If one twin receives diagnosis of reading disorder, appears to be almost 100% chance that second twin will receive the same
diagnosis
Genes on chromosomes 2, 3, 6, 15, 18 have all been linked to difficulties
Various forms of subtle brain damage also been thought to be responsible for learning disabilities
Suggests structural as well as functional differences in the brains of people with learning disabilities
Such findings imply a neuropsychological deficit that interferes with the processing of a certain essential language
information
Psych and motivational factors that have been reinforced by others seem to play an important role in the eventual outcome for
people with learning disorders
Factors such as socio-economic status, cultural expectations, parental interactions and expectations, and child management
practice, together with existing neurological deficits and the types of support provided in the school seem to determine
outcome
Treatment
Most common method of assessing learning disorders is to administer two types of tests
Intelligence tests such as Wechsler Intelligence Scales are thought to tap academic aptitude or potential, whereas
achievement tests tap performance in particular areas
If significant discrepancy exists, then specific learning disorder is diagnosed
Bio treatment is typically restricted to those individuals who may also have comorbid ADHD
Educational efforts can be categorized into
o1) efforts to remediate directly the underlying basic processing
o2) efforts to improve cognitive skills
o3) targeting behavioural skills needed to compensate for specific problems the student may have
Autism Spectrum Disorder (ASD)
neurodevelopmental disorder, at its core, affects how one perceives and socializes with others
disorder new to the DSM-5 – social (pragmatic) communication disorder – includes the difficulties in social communication
seen in ASD, but w/out restricted, repetitive patterns of behaviour
Clinical Description
3 major characteristics of ASD are expressed in DSM-5
o1) impairments in social communication and social interaction
o2) restricted, repetitive patterns of behaviours, interests
o3) impairments are present in early childhood and that they limit daily functioning
it’s the degree of impairment that distinguishes individuals
DSM-5 introduced 3 levels of severity
oLevel 1: requiring support
oLevel 2: requiring substantial support
oLevel 3: requiring very substantial support
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