Neurodevelopmental Disorders PSYCH 3830
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This 8 page Class Notes was uploaded by Margaret Bloder on Wednesday March 23, 2016. The Class Notes belongs to PSYCH 3830 at Clemson University taught by Pam Alley in Winter 2016. Since its upload, it has received 43 views. For similar materials see Abnormal Psychology in Psychlogy at Clemson University.
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Date Created: 03/23/16
Neurodevelopmental Disorders I. Overview All of these disorders have an onset in the developmental period (before age 18) New category in the DSM-5 II. Intellectual Disability (Intellectual Developmental Disorder) Diagnostic Criteria Deficits in mental abilities or intellectual functioning (IQ score 70 or below) Impairment in adaptive functioning for the individual’s age and sociocultural background (ex: not communicating, not caring for themselves, not dressing themselves, not functioning at appropriate age) All symptoms must have an onset during the developmental period (prior to age 18) Prevalence About 2.5% of the population will have an IQ of 70 or below But, only 1% will fill all 3 categories of the diagnostic criteria More common in boys Severity Levels: tests actual functioning vs. IQ scores Mild (Large majority): able to function at about a 6 grade level Moderate Severe Profound *Less and less are occurring at the more severe types Etiology Etiology Example Description Heredity Tay-Sachs Disease Brain disease: affects nervous system (more common in eastern European/Jewish ancestry) -inherent recessive gene from mom/dad th -die before 5 birthday -degenerative disease Aberrations in Down’s Syndrome Abnormality in Chromosomal chromosomes: child st Development inherits 3 21 chromosomes -most common of all chromosomal disorders -more likely to be born with eye, heart defects, & respiratory problems -occurrence increases with age of parent Prenatal and Pregnancy Prenatal Alcohols Other examples: fetal Problems Exposure malnutrition/toxins/pre- mature babies at greater risk General Medical Trauma Child born with normal Conditions Acquired in IQ, something effects the Infancy/Childhood child early on Environmental Influences Deprivation Child institutionalized early on, child needs to be able to engage with others Prenatal Alcohol Exposure: occurs when an expectant mother consumes alcohol, predisposing her unborn child to increased likelihood of ID and birth defects Leading preventable cause of birth defects in the US/within moms control Most common cause of intellectual disability Fetal Alcohol Spectrum Disorder (FASD): a group of disorders caused by prenatal alcohol exposure. Alcohol Effects represents the less serious end of the spectrum of FASD, and Fetal Alcohol Syndrome represents the more serious end of the spectrum. 1 out of 10 children Symptoms: o Smaller/low birth weight o Facial and/or body abnormality o Some degree of intellectual disability o Increased risk for intellectual disability, learning disorders, & ADHD Treatment Special Education: educational programs that help children with disabilities (I.D.E.A.: all children get public education) Rehabilitative Measures: skill-training programs for adolescents and adults that include sheltered workshops (learn how to do a simple task; repetitive) Community-Based Programs: programs that aim to teach self- supporting skills, such as ClemsonLIFE Institutionalization: last resort for disabled individuals (intended only for individuals who are profoundly disabled) III. Specific Learning Disorder (used to be called learning disorder in DSM-IV) What is it? A Specific Learning Disorder is diagnosed when the individual’s achievement on an individually administered standardized test in reading, mathematics, or written expression is substantially below that expected for their level of intelligence as measured on an individually administered aptitude test. Aptitude Test: measures IQ Achievement Test: measures what they know currently If they score higher on IQ than achievement, learning disorder suspected Learning Skill Deficiencies 1. Reading (most common) Word reading accuracy Reading rate or fluency Reading comprehension 2. Mathematics Number sense Memorization of arithmetic facts Accurate or fluent calculation Accurate math reasoning 3. Written Expression (least common) o Spelling accuracy o Grammar and punctuation accuracy o Clarity or organization of written expression Depending on the child’s skill deficiency, we would add one or more of the above impairments as a specifier to the diagnosis Prevalence Age of onset: early elementary 5-15% of all children have some degree of a learning disorder In the DSM-IV, it was about equal in boys & girls; more likely to be recognized and diagnosed in boys because they want attention…In DSM-5, more common in boys Associated Features Typically have at least average or above average IQ Typically have normal vision and hearing More common in lower socioeconomic groups Children having difficulty processing sensory information Lower self esteem More likely to have difficulty with social skills Disruptive in class More likely to drop out of high school (40%) Prognosis, Etiology, Treatment Lifelong diagnosis; can’t cure Genetic Prenatal factors (FASD) Environmental factors Treatment: different programs that teach children how to compensate IV. Attention Deficit/Hyperactivity Disorder (ADHD) Diagnostic Criteria A. Either (1) or (2): (1)Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Inattention: Often fails to give close attention to details or makes careless mistakes Often has difficulty sustaining attention Often does not seem to listen when spoken to directly Often does not follow through on instructions and fails to finish activities Often has difficulty organizing tasks and activities Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental efforts Often loses things Is often easily distracted Is often forgetful (2)Six (or more) of the following symptoms of hyperactivity- impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Hyperactivity: Often fidgets or squirms while seated Often leaves seat in classroom when should be seated Often runs about or climbs excessively Often has difficulty playing or engaging in leisure activities quietly Is often “on the go” Often talks excessively Impulsivity: Often blurts out answers Often has difficulty awaiting turn Often interrupts or intrudes on others B. Some hyperactive-impulsive or inattention symptoms that caused impairment were present prior to age 12 years (Was age 7 in the DSM-IV) C. Some impairments from the symptoms is present in two or more settings D. There must be clear evidence of clinically significant impairment in functioning Specify whether: 1. Predominantly inattentive presentation 2. Predominantly hyperactive/impulsive presentation 3. Combined presentation Prevalence Age of onset: elementary school age 5% of all American public school children have ADHD More common in boys Commonly co-occur with specific learning disorder More likely to have social problems Most frequent reason that children are referred to a psychiatrist Etiology Strong genetic component Structural abnormalities Environmental factors (prenatal, born prematurely, post natal: exposed to environment) Treatment Medication (stimulants): Ritalin (most common) I.D.E.A.: individualized program V. Autism Spectrum Disorder (ASD) Autistic Disorder Impairment in social interaction Impairment in ability to communicate Restricted, repetitive, and stereotyped behaviors, interests, or activities Onset prior to age three years Asperger’s Disorder Impairment in social interaction Typically evidence at least normal language and cognitive development Restricted, repetitive, and stereotyped behaviors, interests, or activities Autism Spectrum Disorder (includes both above) Deficits in social communication and social interactions o Deficit in the ability to communicate nonverbally o Deficit in developing relationships with others o Deficit in understanding the emotions of others o Deficit in the ability to initiate/sustain a conversation with others 1. Stereotyped and repetitive use of language (ex: echolalia: parrot-like repetition of a few words 2. Idiosyncratic language (ex: pronoun reversal: refers to themselves as she/he instead of I) Restricted, repetitive behavior patterns, interests, or activities o Adherence to routines or rituals (want everything exactly the same) o Persistent preoccupation with parts of objects (ex: spinning the wheels of a toy truck) o Self-stimulatory activity (ex: banging head on wall, rocking, waving arms) o Devotion of large amounts of time to specialized interests (ex: knows everything there is to know about dinosaurs, more typical for higher functioning individuals) Onset in early childhood Specifiers With or without accompanying intellectual impairment With or without accompanying language impairment Autism Spectrum Disorder and Intellectual Disability In many cases, the diagnosis of Autism Spectrum Disorder co- occurs with a diagnosis of Intellectual Disability If this is the case, the individual will need to fully meet the DSM criteria for both disorders Autism Spectrum Disorder and Savant Syndrome Savant Syndrome is a condition whereby individuals with a developmental disorder demonstrate exceptional, usually isolated, abilities In some cases, individuals with Autism Spectrum Disorder will evidence Savant Syndrome If this is the case, the individual with Autism Spectrum Disorder will evidence an exceptional, usually isolated, cognitive or other ability which is inconsistent with their overall cognitive and social development Causal Factors of Autism Spectrum Disorder Autism Spectrum Disorder has a strong genetic component and is probably the most heritable form of psychopathology in the DSM In that the genetic contribution to Autism Spectrum Disorder is not 100%, it appears that environmental factors must also play a role In the past, a link between vaccines and Autism Spectrum Disorder was speculated, but no evidence has been found to substantiate the claim At this point, specific environmental factors are unknown Associated Features Difficulty maintaining eye contact Typically don’t use facial expressions/body language Difficulty establishing/maintaining a relationship Would prefer to play alone Can recognize others emotions, but don’t understand them (haven’t developed a theory of mind: beliefs, intentions, emotions that may be different from one’s own) More hyperactive, impulsive, aggressive, temper tantrums Prevalence Age of onset: symptoms are recognized in the 2 nd year of life most typically; early childhood (prior to age 6) Seems to be increasing; on the rise Approaching 1% of the population Much more aware of this disorder than we used to be More common in boys Prognosis Depends on: Degree to which their behavior patterns are restricted How severe is their inability to communicate If they have an impairment, prognosis is not as good Etiology Strong genetic component (most heritable form of psychopathology in DSM) Biological defect Obesity (maybe; not enough research) Treatment No medication Most effective treatment: behavior therapy Mapping the brain Difficult, long term process
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