chapter 13 developmental disorders. nature of developmental psychopathology: an overview normal vs....
TRANSCRIPT
Chapter 13Developmental Disorders
Nature of Developmental Psychopathology: An Overview
Normal vs. Abnormal Development Developmental Psychopathology
Study of how disorders arise and change with time Childhood is associated with significant developmental
changes Disruption of early skills will likely disrupt development of
later skills Developmental Disorders
Diagnosed first in infancy, childhood, or adolescence Attention deficit hyperactivity disorder (ADHD) Learning disorders Autism Mental retardation
Attention Deficit HyperactivityDisorder (ADHD): An Overview
Nature of ADHD Central features – Inattention, overactivity, and impulsivity Associated with behavioral, cognitive, social, and
academic problems DSM-IV and DSM-IV-TR Symptom Clusters
Cluster 1 – Symptoms of inattention Cluster 2 – Symptoms of hyperactivity and impulsivity
cluster Either cluster 1 or 2 must be present for a diagnosis
ADHD: Facts and Statistics
Prevalence Occurs in 4%-12% of children who are 6 to 12 years
of age Symptoms are usually present around age 3 or 4 68% of children with ADHD have problems as adults
Gender Differences Boys outnumber girls 4 to 1
Cultural Factors Probability of ADHD diagnosis is greatest in the United
States
The Causes of ADHD: Biological Contributions
Genetic Contributions ADHD runs in families Familial ADHD may involve deficits on chromosome 20 Gene for the D4 receptor is more common in ADHD
children Neurobiological Contributions: Brain Dysfunction and
Damage Inactivity of the frontal cortex and basal ganglia Right hemisphere malfunction Abnormal frontal lobe development and functioning Yet to identify a precise neurobiological mechanism for
ADHD
The Causes of ADHD: Biological Contributions (cont.)
The Role of Toxins Allergens and food additives do not appear to cause
ADHD Maternal smoking increases risk of having a child with
ADHD
The Causes of ADHD: Psychosocial Contributions
Psychosocial Factors Can Influence the Disorder Itself Constant negative feedback from teachers, parents, and
peers Peer rejection and resulting social isolation Such factors foster low self-image
Biological Treatment of ADHD
Goal of Biological Treatments To reduce impulsivity/hyperactivity and to improve
attention Stimulant Medications
Reduce the core symptoms of ADHD in 70% of cases Examples include Ritalin, Dexedrine
Other Medications Imipramine and Clonidine (antihypertensive) have some
efficacy
Biological Treatment of ADHD (cont.)
Effects of Medications Improve compliance and decrease negative behaviors in
many children Medications do not affect learning and academic
performance Beneficial effects are not lasting following drug
discontinuation
Behavioral and Combined Treatment of ADHD
Behavioral Treatment Involve reinforcement programs Aim to increase appropriate behaviors and decrease
inappropriate behaviors May also involve parent training
Combined Bio-Psycho-Social Treatments Are highly recommended
Learning Disorders: An Overview
Scope of Learning Disorders Problems related to academic performance in reading,
mathematics, and writing Performance is substantially below what would be
expected DSM-IV and DSM-IV-TR Reading Disorder
Discrepancy between actual and expected reading achievement
Reading is at a level significantly below that of a typical person of the same age
Problem cannot be caused by sensory deficits
(e.g., poor vision)
Learning Disorders: An Overview (cont.)
DSM-IV and DSM-IV-TR Mathematics Disorder Achievement below expected performance in
mathematics DSM-IV and DSM-IV-TR Disorder of Written Expression
Achievement below expected performance in writing
Learning Disorders: Some Facts and Statistics
Incidence and Prevalence of Learning Disorders 1% to 3% incidence of learning disorders in the United
States Prevalence is highest in wealthier regions of the United
States Prevalence rate is 10% to 15% among school age
children Reading difficulties are the most common of the learning
disorders About 32% of students with learning disabilities drop out
of school School experience for such persons tends to be quite
negative
Learning Disorders: Some Facts and Statistics (cont.)
Figure 14.1
Half of school children classified as disabled have learning disabilities. Twenty years ago
the proportion was 25%
Learning Disorders: Some Facts and Statistics (cont.)
Figure 14.2
Uneven distribution of learning disabilities in the United States in the wealthiest states
Biological and Psychosocial Causes of Learning Disorders
Genetic and Neurobiological Contributions Reading disorder runs in families, with 100%
concordance rate for identical twins Evidence for subtle forms of brain damage is inconclusive Overall, genetic and neurobiological contributions are
unclear Psychosocial Contributions are Largely Unknown
Treatment of Learning Disorders
Requires Intense Educational Interventions Remediation of basic processing problems (e.g., teaching
visual skills) Improvement of cognitive skills (e.g., instruction in
listening) Targeting behavioral skills to compensate for problem
areas Data Support Behavioral Educational Interventions for
Learning Disorders
Pervasive Developmental Disorders: An Overview
Nature of Pervasive Developmental Disorders Problems occur in language, socialization, and cognition Pervasive – Means the problems span the person’s entire
life Examples of Pervasive Developmental Disorders
Autistic disorder Asperger’s syndrome
The Nature of Autistic Disorder: An Overview
Autism Significant impairment in social interactions and
communication Restricted patterns of behavior, interest, and activities
Three Central DSM-IV and DSM-IV-TR Features of Autism Problems in socialization and social function Problems in communication – 50% never acquire useful
speech Restricted patterns of behavior, interests, and activities –
Most striking feature!
Autistic Disorder: Facts and Statistics
Prevalence and Features of Autism Rare condition – Affecting 2 to 20 persons for every 10,000
people More prevalent in females with IQs below 35, and in males
with higher IQs Autism occurs worldwide Symptoms usually develop before 36 months of age
Autism and Intellectual Functioning 50% have IQs in the severe-to-profound range of mental
retardation 25% test in the mild-to-moderate IQ range (i.e., IQ of 50 to 70) Remaining people display abilities in the borderline-to-
average IQ range Better language skills and IQ test performance predicts better
lifetime prognosis
Causes of Autism: Early and More Recent Contributions
Historical Views Bad parenting Unusual speech patterns Lack of self-awareness Ecolalia
Current Understanding of Autism Medical conditions – Not always associated with autism Autism has a genetic component that is largely unclear Neurobiological evidence for brain damage – Link with
mental retardation Cerebellum size – Substantially reduced in persons with
autism Psychosocial Contributions Are Unclear
Asperger’s Disorder: Part of the Autistic Spectrum
The Nature of Asperger’s Disorder Such persons show significant social impairments Restricted and repetitive stereotyped behaviors May be clumsy, and are often quite verbal (i.e., pedantic
speech) Do not show severe delays in language and other
cognitive skills Prevalence of Asperger’s Disorder
Often under diagnosed Affects about 1 to 36 persons per 10,000 people
Causes of Asperger’s Disorder Are Somewhat Unclear
Treatment of Pervasive DevelopmentalDisorders: Example of Autism
Psychosocial “Behavioral” Treatments Skill building and treatment of problem behaviors Communication and language problems Address socialization deficits Early intervention is critical
Biological and Medical Treatments Are Unavailable Integrated Treatments: The Preferred Model
Focus on children, their families, parents, schools, and the home
Build in appropriate community and social support
Mental Retardation (MR): An Overview
Nature of Mental Retardation Disorder of childhood Below-average intellectual and adaptive functioning Range of impairment varies greatly across persons
Mental Retardation and the DSM-IV and DSM-IV-TR Significantly sub-average intellectual functioning (IQ
below 70) Concurrent deficits or impairments in two or more areas
of adaptive functioning MR must be evident before the person is 18 years of age
DSM-IV and DSM-IV-TR Levels of Mental Retardation (MR)
Mild MR Includes persons with an IQ score between 50 or 55
and 70 Moderate MR
Includes persons in the IQ range of 35-40 to 50-55 Severe MR
Includes people with IQs ranging from 20-25 up to 35-40 Profound MR
Includes people with IQ scores below 20-25
Other Classification Systems for Mental Retardation (MR)
American Association of Mental Retardation (AAMR) Defines MR based on levels of assistance required Examples of levels include intermittent, limited, extensive,
or pervasive assistance Classification of MR in Educational Systems
Educable mental retardation (i.e., IQ of 50 to approximately 70-75)
Trainable mental retardation (i.e., IQ of 30 to 50) Severe mental retardation (i.e., IQ below 30)
Implications of Different MR Classification Systems
Mental Retardation (MR): Some Facts and Statistics
Prevalence About 1% to 3% of the general population 90% of MR persons are labeled with mild mental
retardation Gender Differences
MR occurs more often in males, male-to-female ratio of about 6:1
Course of MR Tends to be chronic, but prognosis varies greatly from
person to person
Causes of Mental Retardation (MR):Biological Contributions
Genetic Research MR involves multiple genes, and at times single genes
Chromosomal Abnormalities and Other Forms of MR Down syndrome – Trisomy 21 Fragile X syndrome – Abnormality on X chromosome
Maternal Age and Risk of Having a Down’s Baby Nearly 75% of cases cannot be attributed to any known
biological cause
Causes of Mental Retardation (MR):Biological Contributions (cont.)
Figure 14.3
The increasing likelihood of Down syndrome with maternal age
Causes of Mental Retardation (MR):Psychosocial Contributions
Cultural-Familial Retardation Believed to cause about 75% of MR cases and is the
least understood Associated with mild levels of retardation on IQ tests and
good adaptive skills Cultural-Familial Retardation: Difference vs. Develop-
mental Views Difference view – Mild MR is a matter of degree and kind Developmental view – Mild MR reflects a slowing or delay
of normal development
Treatment of Mental Retardation (MR)
Parallels Treatment of Pervasive Developmental Disorders Teach needed skills to foster productivity and
independence Educational and behavioral management Living and self-care skills via task analysis Communication training – Often most challenging
treatment target! Community and supportive interventions
Persons with MR Can Benefit from Such Interventions
Summary of Developmental Disorders
Developmental Psychopathology and Normal and Abnormal Development
Attention Deficit Hyperactivity Disorder Deficits in attention, hyperactivity, or impulsivity Disrupt academic and social functioning
Learning Disorders All share deficits in performance below expectations for IQ
and school preparation Pervasive Developmental Disorder
All share deficits in language, socialization, and cognition Mental Retardation
Sub-average IQ, deficits in adaptive functioning, onset before age 18
Prevention and Early Intervention Are Critical for Developmental Disorders
Summary of Developmental Disorders (cont.)
Figure 14.x1
Exploring developmental disorders, attention deficit/hyperactivity disorder, learning
disorders, and communication disorders
Summary of Developmental Disorders (cont.)
Figure 14.x1 (cont.)
Exploring developmental disorders, attention deficit/hyperactivity disorder, learning
disorders, and communication disorders
Summary of Developmental Disorders (cont.)
Figure 14.x2
Exploring developmental disorders, pervasive developmental disorders, mental retardation
Summary of Developmental Disorders (cont.)
Figure 14.x2 (cont.)
Exploring developmental disorders, pervasive developmental disorders, mental retardation