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Chapter 14

Psychology 2030A/B Chapter 14: chapter 14

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Western University
Psychology 2030A/B
Ian Nicholson

Chapter 14 Neurodevelopmental disorder – show themselves early in life and often persist as the person grows older, so the term childhood disorder is misleading. All childhood disorders are presumed to be neurologically based. ¬ In childhood, brain changes significantly for several years after birth; this is also the time when critical developments occur in social, emotional, cognitive and other important competency areas. \from a developmental perspective, the absence of early and meaningful social relationships has serious consequences. ¬ Identifying a disorder such as autism at an early age is important for these children so their social deficits can be addressed before they affect other skill domains. Knowledge of normal development is important for understanding the nature of childhood psychological disorders such as autism. ADHD Attention Deficit/Hyperactivity Disorder One of the most common reasons children are referred for mental health services. Primary characteristics include a pattern of inattention (like being disorganized, forgetful about school or work-related tasks), hyperactivity, and impulsivity. These deficits can significantly disrupt academic efforts as well as social relationships. ¬ Clinical Description o People with this disorder have a great deal of difficulty sustaining their attention on a task or activity. o In addition to inattention, some display motor hyperactivity. Impulsivity is a common complaint made about people with ADHD. o DSM 5 differentiates two categories of symptoms ―▯Inattention: appear not to listen ―▯Hyperactivity and impulsivity: hyperactivity includes fidgeting, having trouble sitting for any length of time, and always being on the go. Impulsivity: includes blurting out answers before questions are completed and having trouble waiting turns. o Either the first or second set of symptoms need to be present for diagnosis o Genetic research on both ADHD and learning disabilities suggests that they may share a common biological cause. ¬ Statistics o Estimated to occur in 6% of school-aged children. Boys outnumber girls 4:1. o 68% of children with ADHD have ongoing difficulties through adulthood. Children with ADHD seem to be less impulsive, although inattention persists. o Study with men with ADHD in adulthood: employed in jobs but significantly lower positions with 2.5 years fewer in education. Less likely to hold higher degrees. More likely to be divorced and to have substance use problems and antisocial personality disorder. o Often comorbid with learning disorders ¬ Causes o ADHD is more common in families in which one person has the disorder. These families display an increase in psychopathology in general. Shared genetic deficits may contribute to the problems. Considered to be highly influenced by genetics. o Environmental influences play a relatively small role in the cause of the disorder. Multiple genes are responsible for ADHD. o Genetic: mutations that occur that either create extra copies of a gene on one chromosome or result in the deletion of genes (copy number variants) o Dopamine, GABA, serotonin, and norepinephrine are implicated in ADHD. Strong evidence that ADHD is associated with dopamine D4 receptor gene, the dopamine transporter gene (DAT1), and the dopamine D5 receptor gene. DAT1 is of particular interest because methylphenidate (Ritalin) (one of the most common medical treatments for ADHD) inhibits this gene and increases the amount of dopamine available. o The goal is to link attention deficits to specific brain dysfunctions. o Researchers found that children with a specific mutation involving the dopamine system (DAT1 genotype) were more likely to exhibit the symptoms of ADHD if their mothers smoked during pregnancy. But it may not be a direct link because other factors are involved like genes and SES o The volume or overall size of the brain is smaller in ADHD. Three areas of the brain appear smaller than typical: the frontal cortex, the basal ganglia, and the cerebellar vermis. o There may be a small but measurable impact of artificial food colours and additives on the behavior of young children. Other research now points to the possible role of the pesticides found in food as contributing to an increased risk of ADHD. ¬ Treatment o Two: biological and psychosocial interventions o The goal of biological treatments is to reduce the children’s impulsivity and hyperactivity and to improve their attentional skills. o Psychosocial treatments generally focus on broader issues such as improving academic performance, decreasing disruptive behavior, and improving social skills o Medication has proven helpful for approx. 70% of cases in at least temporarily reducing hyperactivity and impulsivity and improving concentration on tasks. o Ritalin improved both motor planning and response inhibition performance in children with ADHD. o Antidepressant and drug used for HBP seem to improve compliance and decrease negative behaviors in many children but they do not appear to produce substantial improvement in learning and academic performance. o Stimulant medication reinforces the brain’s ability to focus attention during problem-solving tasks. Use of stimulants and psychosocial in combination help improve children’s academic and social skills. o The first concern about the use of stimulant medications in treating ADHD pertains to stimulant drugs’ potential for abuse. A second concern is that these medications may be overprescribed and their long-term effects are not well-understood. o Some portion of children with ADHD do not respond to meds and so there are behavioral interventions to help children at home and in school. Other programs incorporate parent training. o Generally, a combined approach is superior. Specific Learning Disorder This is characterized by academic performance that is substantially below what would be expected given the person’s age, IQ, and education. ¬ Clinical Description o Dyslexia is when they can read but have difficulty doing so. o The criteria 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 o This disability cannot be caused by a sensory difficulty such as trouble with hearing or sight. There are varying severities. ¬ Statistics o Frequency of diagnosis seems to be increasing in wealthier regions o Learning disability is one of the two most common disabilities in children up to 14 years of age. In fact, more than half of all Canadian school children classified as having a disability have a learning disability. o Difficulties with reading are the most common of the learning disorders and occur in approximately 5% to 15% of the general population. Mathematics disorder appears in approx. 6% of the population. o Learning disorders may be related to the later development of other mental health problems and are also at an increased risk for substance use disorders. o The negative outcomes for adults may be mitigated by providing the proper supports, such as having a positive relationship with caring adults and providing accommodations in postsecondary education and employment settings. o Language disorder, previously called stuttering, is closely related to learning disorders. ¬ Causes o Complex origin: genetic, neurobiological, and environmental factors. o Genetics of disorders of reading are complex, and genes on chromosomes 2, 3, 6, 15, and 18 have all been repeatedly linked to these difficulties. o There are structural and functional differences in the brains of people with learning disabilities. ¬ Treatment o To assess learning disorders is to administer two types of tests and compare the scores between them ―▯Intelligence tests like the Wechsler Intelligence Scales are thought to tap academic aptitude or potential ―▯Achievement tests tap performance in particular areas [reading, writing, and math]. o If a significant discrepancy exists between aptitude and actual achievement in a particular subject, then a specific learning disorder is diagnosed. o Learning disorders primarily require educational intervention. o Biological treatment is for those with a comorbid ADHD diagnosis. o Educational efforts an broadly be categorized into: ―▯Efforts to remediate directly the underlying basic processing of problems ―▯Efforts to improve cognitive skills through general instruction in listening, comprehension, and memory. ―▯Targeting the behavioral skills needed to compensate for specific problems the student may have with reading, mathematics, or written expression. o Good way is to teach behavioural skills necessary to improve academic skills. o Integrated program: Phonology and Strategy Training Program for reading disorder. Autism Spectrum Disorder A neurodevelopmental disorder that, at its core, affects how one perceives and socializes with others. A new disorder on the DSM 5: social (pragmatic) communication disorder, includes the difficulties seem in ASD, but without restricted, repetitive patterns of behavior. Individuals in this disorder do not easily learn the social rules when communicating with others. Clinical Description Three major characteristics of ASD are expressed in DSM 5: 1. Impairments in social communication and interaction 2. Restricted, repetitive patterns of behavior, interests, or activities 3. Impairments present in early childhood and they limit daily functioning. ¬ The degree of impairment in each of these characteristics that presumably distinguish individuals previously diagnosed with the separate disorders of autism, Asperger’s, and pervasive developmental disorder. ¬ To accommodate the range of difficulties in the two symptom clusters, the DSM 5 introduced three levels of severity: Level 1 – “Requiring support” Level 2 – “Requiring substantial support” Level 3 – “Requiring very substantial support” Impairment is Social Communication and Social Interaction ¬ People with ASD fail to develop age-appropriate social relationships ¬ Defined by the inclusion of three aspects – problems with social reciprocity, nonverbal communication, and initiating and maintaining social relationships. All these must be present for a diagnosis. ¬ Social reciprocity for individuals with more severe symptoms of ASD involves the inability to engage in joint attention. It might present itself as appearing self- focused and not showing interest in things other people care about. ¬ People with ASD lack a theory of mind. Argued to be a deficit in nonverbal communication. It can involve problems with a range of actions in persons with severe forms of ASD (not pointing to things you want) and among those with milder forms of ASD (standing too close to someone). ¬ Those with the less severe form of ASD may also lack appropriate facial expressions or tone of voice (prosody). Give the appearance of general nonverbal awkwardness. ¬ The deficits in social reciprocity and nonverbal communication can combine to influence the third symptom – problems maintaining relationships. ¬ Approx. 25% do not develop speech proficiency sufficient to communicate their needs effectively. Some who do have speech may have unusual communication. On the other end of the spectrum, these individuals can be very verbal, but because of the social deficits and their tendency to have restricted interests, they often have one sided conversations about the topics they want to discuss. ¬ Another aspect of the communication deficits of children with ASD is a lack of spontaneous pretend play or social imitative play appropriate to the child’s developmental level. Restrictive, Repetitive Patterns of Behavior
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