iv. developmental and cognitive disorders a. developmental disorder a. developmental disorder...

90
IV. Developmental and IV. Developmental and cognitive disorders cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early Identifying the disorder at an early age is important age is important Deficit at one stage influences another Deficit at one stage influences another stage stage Early detection leads to prevention of other Early detection leads to prevention of other disorders such as language and communication disorders such as language and communication Interaction between biological factors and Interaction between biological factors and learning factors learning factors

Upload: tyrone-sharp

Post on 25-Dec-2015

218 views

Category:

Documents


1 download

TRANSCRIPT

Page 1: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

IV. Developmental and IV. Developmental and cognitive disorderscognitive disorders

A. Developmental disorderA. Developmental disorder

Identifying the disorder at an early Identifying the disorder at an early age is importantage is important

Deficit at one stage influences another stageDeficit at one stage influences another stage Early detection leads to prevention of other Early detection leads to prevention of other

disorders such as language and disorders such as language and communicationcommunication

Interaction between biological factors and Interaction between biological factors and learning factorslearning factors

Page 2: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Accurate understanding of the Accurate understanding of the symptom is importantsymptom is important

- for example, - for example, echolalia is an echolalia is an aspect of normal developmentaspect of normal development

- consequently, echolalia which we - consequently, echolalia which we can observe in the behaviors of can observe in the behaviors of autistic children is not a sign of a autistic children is not a sign of a disorder, but a delayed learningdisorder, but a delayed learning

Page 3: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

1. Attention Deficit / 1. Attention Deficit / hyperactivity Disorder; hyperactivity Disorder;

ADHD) ADHD) < Clinical description< Clinical description >>

Have trouble with concentrationHave trouble with concentration don’t pay attention when others speakdon’t pay attention when others speak start many tasks but seldom finishes one start many tasks but seldom finishes one Inattention, motor hyperactivity, impulsivityInattention, motor hyperactivity, impulsivity Difficulty sustaining their attention on a task Difficulty sustaining their attention on a task

or activity (Popper et al., 2003)or activity (Popper et al., 2003) Unable to sit still for more than an few Unable to sit still for more than an few

minutesminutes

Page 4: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Act without thinking beforehandAct without thinking beforehand Respond to a question, before a teacher Respond to a question, before a teacher

finished his sentence.finished his sentence. Impairment both in social relationship Impairment both in social relationship

and academic achievementand academic achievement The most common reason a child is The most common reason a child is

referred to a clinicreferred to a clinic DSM-IV-TR differentiates 3 types of DSM-IV-TR differentiates 3 types of

symptomssymptoms

i) i) inattentioninattention don’t listen to othersdon’t listen to others lose books or tools, forget school lose books or tools, forget school assignmentsassignments

Page 5: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

ii) ii) hyperactivityhyperactivity

fidgeting, having trouble sitting fidgeting, having trouble sitting

for any length of time, always for any length of time, always

being on the gobeing on the go

iii) iii) impulsivityimpulsivity

blurting out answers beforeblurting out answers before

questions have been completed.questions have been completed.

and having trouble waiting turnsand having trouble waiting turns

Page 6: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Either the first or the second and third Either the first or the second and third domains of symptoms must be present domains of symptoms must be present for someone to be diagnosed with ADHDfor someone to be diagnosed with ADHD

Academic performance tends to sufferAcademic performance tends to suffer ADHD children are likely to be unpopular ADHD children are likely to be unpopular

and rejected by their peersand rejected by their peers

Frequent negative feedback from parents Frequent negative feedback from parents and teachers often result in low self and teachers often result in low self esteem among these childrenesteem among these children (Johnston (Johnston etet al, 1985)al, 1985)

Page 7: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

1. Statistics1. Statistics

Prevalence rate 6% (Popper et al., 2003) Prevalence rate 6% (Popper et al., 2003) Boys outnumbering girls roughly 4 to 1Boys outnumbering girls roughly 4 to 1 Identified as around Identified as around 3-4 years old3-4 years old they are described as active, mischievouthey are described as active, mischievou

s, slow to toilet training, and oppositional s, slow to toilet training, and oppositional (Conners et al., 2001)(Conners et al., 2001)

The symptoms become increasingly The symptoms become increasingly obvious during the school yearsobvious during the school years

Page 8: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

The problem usually continues through The problem usually continues through adolescence. 68% of children have ongoing adolescence. 68% of children have ongoing difficulties through adulthooddifficulties through adulthood

Impulsivity goes down as the patient gets oldImpulsivity goes down as the patient gets old But inattention lastsBut inattention lasts

ADHDADHD continues in adulthood continues in adulthood 10% have severe symptoms of10% have severe symptoms of ADHD in adult ADHD in adult

=> these patients violate traffic law and get => these patients violate traffic law and get involved frequently in traffic accidentsinvolved frequently in traffic accidents

2. C2. Causeause

Genetic factorsGenetic factors

Page 9: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

ADHDADHD is more often found in families whos is more often found in families whos

e members show ADHDe members show ADHD

Until recently it has been regarded as a braUntil recently it has been regarded as a brain damage. It was called “minimal brain dyin damage. It was called “minimal brain dysfunction” (sfunction” (RossRoss & & Pellham, 1981)Pellham, 1981)

Three areas of the brain of ADHD children Three areas of the brain of ADHD children are smaller. are smaller.

Frontal cortex, basal ganglia and the cerebFrontal cortex, basal ganglia and the cerebellar vermis (Popper et al., 2003)ellar vermis (Popper et al., 2003)

Page 10: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Feingold(1975) dietFeingold(1975) diet

The theory that food additives such as The theory that food additives such as artificial colors, flavorings, and artificial colors, flavorings, and preservatives are responsible for the preservatives are responsible for the symptoms of ADHD has had a substantial symptoms of ADHD has had a substantial impact. impact.

Feingold presented this view with Feingold presented this view with recommendations for eliminating these recommendations for eliminating these substances as a treatment for ADHD. substances as a treatment for ADHD. Hundreds of thousands of parents put Hundreds of thousands of parents put their children on the Feingold diet, their children on the Feingold diet, despite evidence that it has little or no despite evidence that it has little or no effect on the symptoms of ADHDeffect on the symptoms of ADHD

Page 11: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Maternal smoking

Mothers who smoke during pregnancy Mothers who smoke during pregnancy may be up to three times more likely to may be up to three times more likely to have a child with ADHD than mothers have a child with ADHD than mothers who do not smoke (Linnet et al., 2003) who do not smoke (Linnet et al., 2003)

Negative responses by parents, Negative responses by parents, teachers, and peers to the affected teachers, and peers to the affected child’s impulsivity ad hyperactivity may child’s impulsivity ad hyperactivity may contribute to his or her feelings of low contribute to his or her feelings of low self-esteem (Barkley, 1989) self-esteem (Barkley, 1989)

Which in turn can have a negative Which in turn can have a negative impact on their ability to make friends.impact on their ability to make friends.

Page 12: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

3. C3. Causeause

Biological treatmentBiological treatment => decrease of impulsivity, hyperactivity=> decrease of impulsivity, hyperactivity

Psychosocial treatmentPsychosocial treatment => improvement of school work, control of inat=> improvement of school work, control of inat

tentive behavior, enhancing social skilltentive behavior, enhancing social skill recently combining both methodsrecently combining both methods

stimulant medication can be effective such as stimulant medication can be effective such as Ritalin, Dexedrine, Cylert => effective toRitalin, Dexedrine, Cylert => effective to 70% 70% of the patientsof the patients

=> reduction of hyperactivity, impulsivity, enh=> reduction of hyperactivity, impulsivity, enhanced attentionanced attention

Page 13: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Anti depressant such as Anti depressant such as imipramine or a drimipramine or a dr

ug used to treat high blood pressure (cloniug used to treat high blood pressure (clonidine) is known to have some effect (Popper dine) is known to have some effect (Popper et al., 2003)et al., 2003)

But these drugs don’t enhance academic pBut these drugs don’t enhance academic performance .erformance .

And their effect do not usually last over the And their effect do not usually last over the long term when the drugs are discontinued.long term when the drugs are discontinued.

Page 14: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Some children don’t respond to Some children don’t respond to the medicationthe medication

Side effects such as insomnia, Side effects such as insomnia, drowsiness, or irritabilitydrowsiness, or irritability

Combined with psychosocial Combined with psychosocial treatmenttreatment

Increasing the amount of time Increasing the amount of time the child remains seated by the child remains seated by reinforcement and punishmentreinforcement and punishment

Increasing the number of math Increasing the number of math papers completedpapers completed

Appropriate play with peersAppropriate play with peers

Page 15: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

2. Learning Disorders2. Learning Disorders

< < Clinical description Clinical description >>

Performance that is substantially Performance that is substantially below what would be expected given below what would be expected given the person’s age, IQ, and educationthe person’s age, IQ, and education

Learning deficit in reading, writing, Learning deficit in reading, writing, mathmath

Low self esteemLow self esteem

Reading disorderReading disorder Cannot remember most of the content of what one readCannot remember most of the content of what one read

Page 16: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Can remember better when one reads aloud or Can remember better when one reads aloud or listens to recorded voicelistens to recorded voice Writing disorder => difficulty in writingWriting disorder => difficulty in writing a story or a poema story or a poem

1. statistics1. statistics

5-10% (Young & Beitchman, 2001)5-10% (Young & Beitchman, 2001) Difficulties with reading 5-15% of the generDifficulties with reading 5-15% of the gener

al population (Popper et al., 2003)al population (Popper et al., 2003)

Page 17: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Math disorder 6%Math disorder 6% American children 4 millionAmerican children 4 million More boys than girlsMore boys than girls 34% drop out of school (Wagner, 34% drop out of school (Wagner,

1990)1990) Low employment rate (60 – 70%)Low employment rate (60 – 70%)

2. C2. Causeause

Genetic factorsGenetic factors Family members of learning Family members of learning

disability children tend to show disability children tend to show higher rate than general population higher rate than general population (Popper, 2003)(Popper, 2003)

Page 18: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Identical twin study shows 100% concordance Identical twin study shows 100% concordance

rate (Vandenberg, Singer, & Pauls, 1986)rate (Vandenberg, Singer, & Pauls, 1986) Genes on chromosomes 2, 3, 6, 15 and 18 arGenes on chromosomes 2, 3, 6, 15 and 18 ar

e linked to reading disorder (Kaminen et al., 2e linked to reading disorder (Kaminen et al., 2003) 003)

Problems in brain structure and function amonProblems in brain structure and function among children with learning disabilityg children with learning disability

They fails in distinguishing between the sound They fails in distinguishing between the sound “da” and “ga”“da” and “ga”

Individual difference in disorder depending on Individual difference in disorder depending on parent’s expectation, socioeconomic status, eparent’s expectation, socioeconomic status, educational attitude, school support systemducational attitude, school support system

Page 19: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

3. Treatment3. Treatment

Medication is ineffective except when it is coMedication is ineffective except when it is comorbid with morbid with ADHDADHD

Educational intervention is importantEducational intervention is important Teaching students visual and auditory perceptiTeaching students visual and auditory percepti

on skillson skills Improving cognitive skills through instruction iImproving cognitive skills through instruction i

n listening, comprehension and memoryn listening, comprehension and memory Behavioral skills to compensate for specific prBehavioral skills to compensate for specific pr

oblems the students may have with reading, oblems the students may have with reading, math, or written expressionmath, or written expression

Page 20: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Computer game that helps childrenComputer game that helps children distinguish soundsdistinguish sounds Developing behavioral strategies such asDeveloping behavioral strategies such as re-reading material and ask questions re-reading material and ask questions about what they readabout what they read

3. Communication and related disorders3. Communication and related disorders

3.1 stuttering3.1 stuttering

- disturbances in speech fluency - disturbances in speech fluency repeating syllables or wordsrepeating syllables or words prolonging certain soundsprolonging certain sounds

Page 21: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

- Making obvious pauses- Making obvious pauses substitutes words to replace ones thatsubstitutes words to replace ones that are difficult to articulateare difficult to articulate

1. Statistics 1. Statistics

Boys outnumbers girls more than twiceBoys outnumbers girls more than twice In many cases begins younger than 3 ageIn many cases begins younger than 3 age 98% of the children begins before 10 years98% of the children begins before 10 years old (Mahrold (Mahr & & Leith, 1992)Leith, 1992) 80% of the children who stuttered before80% of the children who stuttered before they enter school will no longer stutter afterthey enter school will no longer stutter after they have been in school a year or so they have been in school a year or so (Yairi & Ambrose, 1992)(Yairi & Ambrose, 1992)

Page 22: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

2. Cause2. Cause

Rather than anxiety cause stuttering, Rather than anxiety cause stuttering,

stuttering makes people anxious stuttering makes people anxious (Miller &(Miller &

Watson, 1992) Watson, 1992) Multiple brain pathways appear to be Multiple brain pathways appear to be

involvedinvolved Genetic influenceGenetic influence 3. Treatment3. Treatment

- parent education- parent education - regulated breathing method- regulated breathing method

Page 23: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

instructed to stop speaking when stuttering einstructed to stop speaking when stuttering e

pisodes occurs and then to take a deep breatpisodes occurs and then to take a deep breath before proceedingh before proceeding

haloperidolhaloperidol => serious side effect => serious side effect verapamilverapamil may decrease the severity of stutter may decrease the severity of stutter

ing in some individualsing in some individuals

3.2 Expressive language disorders3.2 Expressive language disorders Limited speech in all situationsLimited speech in all situations Expressive language is significantly below theiExpressive language is significantly below thei

r usually average receptive languager usually average receptive language

Page 24: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

1. S1. Statisticstatistics

2.2% 2.2% of 3 years old infantsof 3 years old infants Boys are almost 5 times as likely as Boys are almost 5 times as likely as

girls to be affectedgirls to be affected Unfounded psychological Unfounded psychological

explanationexplanation -> parents may not speak to them -> parents may not speak to them

enough enough

A biological theory is that middle ear A biological theory is that middle ear infection is a contributory cause infection is a contributory cause

22. Treatment. Treatment

Without special intervention, many Without special intervention, many of them can self-correct the problemof them can self-correct the problem

Page 25: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

3.3 Selective mutism3.3 Selective mutism

Persistent failure to speak in specific situatiPersistent failure to speak in specific situations such as school, despite the ability to do ons such as school, despite the ability to do soso

1. Statistics1. Statistics

Less than Less than 1% of children1% of children More prevalent among girls than boysMore prevalent among girls than boys Most often between the ages of 5 and 7Most often between the ages of 5 and 7

Page 26: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

2. Causes2. Causes

Not much is knownNot much is known Anxiety is one possible causeAnxiety is one possible cause

3. 3. TreatmentTreatment

Contingency management : Contingency management : giving children praise and reinforces for giving children praise and reinforces for

speaking while ignoring their attempts to speaking while ignoring their attempts to communicate in other wayscommunicate in other ways

Page 27: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

3.4 Tic disorders3.4 Tic disorders

Involuntary motor movementsInvoluntary motor movements such as head twitching,such as head twitching, or vocalizations happen inor vocalizations happen in idiosyncratic or stereotyped waysidiosyncratic or stereotyped ways

In In Tourette'sTourette's disorder, involuntary disorder, involuntary repetition of obscenitiesrepetition of obscenities

1. S1. Statisticstatistics

Of all children Of all children 12-24% show some 12-24% show some

Page 28: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

tics during their growing yearstics during their growing years (Ollendick(Ollendick & & Ollendick, 1990)Ollendick, 1990)

2-8 out of every 10,000 have Tourette’s disorder (Lec2-8 out of every 10,000 have Tourette’s disorder (Leckmankman etet al., 1997)al., 1997)

2. Cause2. Cause

Genetic influenceGenetic influence AnxietyAnxiety

3. Treatment3. Treatment self monitoring, relaxation training, and habit reversalself monitoring, relaxation training, and habit reversal haloperidol and more recently pimozide and clonidinehaloperidol and more recently pimozide and clonidine

Page 29: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

4. Autistic Disorder4. Autistic Disorder

< C< Clinical description linical description >>

Significant impairment in social Significant impairment in social interaction and communicationinteraction and communication

Restricted patterns of behavior, interest Restricted patterns of behavior, interest and activitiesand activities

Don’t play with other childrenDon’t play with other children Also restricted contact with adultsAlso restricted contact with adults Only as an instrument to acquire Only as an instrument to acquire

needed objectsneeded objects

Page 30: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Not the amount of contacts, but the quality of Not the amount of contacts, but the quality of contact is the problemcontact is the problem

Don’t smile at the sight of motherDon’t smile at the sight of mother Prefer to be mother’s side in stress situationPrefer to be mother’s side in stress situation

(Dissanayake(Dissanayake & & Crossley, 1996)Crossley, 1996)

Lack of joint attentionLack of joint attention

( ( when sitting with a parent in front of a favorite toy, ywhen sitting with a parent in front of a favorite toy, young children will typically look back and forth the paroung children will typically look back and forth the parent and the toy, smiling, in an attempt to engage the ent and the toy, smiling, in an attempt to engage the parent with the toy. However, this skill in joint attentioparent with the toy. However, this skill in joint attention is noticeably absent in children with autismn is noticeably absent in children with autism) )

Show a picture of an autistic adultShow a picture of an autistic adult

Page 31: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Nearly always have severe problems Nearly always have severe problems

with communicatingwith communicating About 50% never acquire useful speechAbout 50% never acquire useful speech Those who have some speech show Those who have some speech show

unusual communicationunusual communication

Some repeat the speech of others Some repeat the speech of others => echolalia=> echolalia Often repeats not only words, but Often repeats not only words, but

intonationsintonations Maintenance of samenessMaintenance of sameness

Page 32: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Things must be always in the same Things must be always in the same

placeplace become extremely upset become extremely upset if a small if a small

change is introducedchange is introduced

Spend countless hours in stereotyped Spend countless hours in stereotyped and ritualistic behaviors such as :and ritualistic behaviors such as :

- spinning around in circles- spinning around in circles

- waving their hands in front of their - waving their hands in front of their eyeseyes

with their heads cocked to one sidewith their heads cocked to one side or biting their handsor biting their hands

Page 33: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

< Jim’s self report< Jim’s self report >>

27 year old graduate school students in 27 year old graduate school students in psychologypsychology

Diagnosed as autism in childhoodDiagnosed as autism in childhood => hospitalized at the age of 9 years old => hospitalized at the age of 9 years old

because of autismbecause of autism

Acquired considerable social skills through his Acquired considerable social skills through his own effortsown efforts

Page 34: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Still have many difficultiesStill have many difficulties

- Information processing- Information processing

- Cannot do several things- Cannot do several things

simultaneouslysimultaneously

- Have to turn off the radio to read - Have to turn off the radio to read

a traffic signa traffic sign

Page 35: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Involuntary movements come out when stressedInvoluntary movements come out when stressed Have to try hard to learn social skills that are necessHave to try hard to learn social skills that are necess

ary in social interactionary in social interaction

1. Statistics1. Statistics

Prevalence 2 out of 10,000 (Gillberg, 1984)Prevalence 2 out of 10,000 (Gillberg, 1984) More girls IQ level below 34More girls IQ level below 34 More boys IQ level above 34More boys IQ level above 34 Found in most culturesFound in most cultures Onset before 36 months (APA, 1994)Onset before 36 months (APA, 1994)

Page 36: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

IQ of autistic patients varyIQ of autistic patients vary In ¾ of the cases comorbid with mental retardatIn ¾ of the cases comorbid with mental retardat

ionion Better prognosis for patients with high IQ and lanBetter prognosis for patients with high IQ and lan

guage abilityguage ability

2. Cause2. Cause

Cannot find a single causeCannot find a single cause Psycho-social influencePsycho-social influence Classic theory -> difference in parental educationClassic theory -> difference in parental education Perfectionistic, cold, aloof Perfectionistic, cold, aloof rejected in recent research (Koegel et al., 1983)rejected in recent research (Koegel et al., 1983)

Page 37: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Classic theory -> lack of self-awareness

was attributed as a cause (Do you want something to drink ? -> he wants something to drink, instead of I want … )

Also rejected in recent research self-concept may be lacking because of cognitive disabilities or delays, not because of autism itself

It is now regarded as a matter of delayed

development

Page 38: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Stimulus over-selectivityStimulus over-selectivity Too much attention is given to Too much attention is given to

details of things in learning details of things in learning

Only the name of things on the Only the name of things on the right edge of the table are right edge of the table are remembered => this is also a remembered => this is also a problem of delayed developmentproblem of delayed development

They are also observable in the They are also observable in the development of the normal childrendevelopment of the normal children

Page 39: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Echolalia, self injurious behavior can Echolalia, self injurious behavior can

be also be also observed in the normal observed in the normal children in their early phase of children in their early phase of developmentdevelopment

The deficit of social interaction is the The deficit of social interaction is the key factor of autismkey factor of autism

Poor parenting is not responsible for Poor parenting is not responsible for autismautism

Page 40: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Biological dimensionsBiological dimensions

Rubella virus, hypsarhythmia Rubella virus, hypsarhythmia (( 간질의 특이 간질의 특이 EEG), tuberous sclerosis (EEG), tuberous sclerosis ( 뇌뇌 , , 폐폐 ,, 신장의 종양신장의 종양 ), cytomegalo-virus, difficulties), cytomegalo-virus, difficulties during pregnancy and labor etc.during pregnancy and labor etc.

Although a few mother who was exposed to rubella vAlthough a few mother who was exposed to rubella virus have children with autism, most of others don’t irus have children with autism, most of others don’t have the problemhave the problem

We still don’t know why certain conditions sometimeWe still don’t know why certain conditions sometimes result in autisms result in autism

Page 41: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Genetic influencesGenetic influences

It is now clear that autism has a genetic coIt is now clear that autism has a genetic component (Cook, 2001)mponent (Cook, 2001)

Families that have one autism child have a Families that have one autism child have a 3-5%3-5%

Risk of having another child with this disorRisk of having another child with this disorderder

Michael Rutter’s research (1971)Michael Rutter’s research (1971) 11 identical twins11 identical twins 36% 36% concordanceconcordance 10 not identical twins 0% 10 not identical twins 0% concordanceconcordance

Page 42: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

If other developmental disorder included:If other developmental disorder included: identical twins 82% identical twins 82% concordanceconcordance Not identical twins 10% Not identical twins 10% concordanceconcordance

NNeurobiological influenceseurobiological influences

¾ of autism patients have mental ¾ of autism patients have mental retardationretardation

30-75%30-75% have neurobiological anomalies have neurobiological anomalies MRIMRI -> part of autism patient show -> part of autism patient show

reduced size of reduced size of cerebellum(cerebellum( 소뇌소뇌 ))

Page 43: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

3.T3.Treatmentreatment

Still today there is no effective therapyStill today there is no effective therapy that would eliminate the social problems of that would eliminate the social problems of

autistic patients autistic patients Enhancing their communication and daily Enhancing their communication and daily

living skills and reducing problem living skills and reducing problem behaviors such as tantrums and self-injurybehaviors such as tantrums and self-injury

Psychodynamic approach Psychodynamic approach -> inappropriate parenting -> inappropriate parenting ->-> not proven not proven yet yet

Behavior shaping, social skill trainingBehavior shaping, social skill training

Page 44: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Foods and praise are offered as a reinforcerFoods and praise are offered as a reinforcer Imitation of other people’s speech-Imitation of other people’s speech-> shaping > shaping

+ physical prompting+ physical prompting

Long term research of FersterLong term research of Ferster & & LovaasLovaas Mainly focuses on enhancing communication Mainly focuses on enhancing communication

and social interactionand social interaction There is no successful treatment yet which woThere is no successful treatment yet which wo

uld improve social interaction remarkablyuld improve social interaction remarkably

UUCLACLA prof. prof. LovaasLovaas 40 hours weekly training 40 hours weekly training -> improvement in int-> improvement in int

ellectual and academic performanceellectual and academic performance

Page 45: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

-> possibilities of early intervention-> possibilities of early intervention expenses and effectiveness of expenses and effectiveness of

investmentinvestment

Integrating treatment with regular class Integrating treatment with regular class in school -in school -> inclusion> inclusion

special psychological programs, and special psychological programs, and psychotherapypsychotherapy

Supported living arrangement and work Supported living arrangement and work settings -settings -> > integrated into communityintegrated into community

community home, foster homecommunity home, foster home No effect of medicationNo effect of medication Restricted effect on specific symptomsRestricted effect on specific symptoms

Page 46: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

5. Mental Retardation5. Mental Retardation

< clinical description >< clinical description >

Far below the average intelligenceFar below the average intelligence Low social adjustmentLow social adjustment Difficult to carry out independent daily Difficult to carry out independent daily

lifelife Individual differences in personality Individual differences in personality

andand capabilitiescapabilities Also differences in communication,Also differences in communication, socialization and learning abilitiessocialization and learning abilities

Page 47: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Mental retardation is included on Mental retardation is included on

Axis II of DSM-IV-TR. Separating Axis II of DSM-IV-TR. Separating disorders by axes serve two disorders by axes serve two purposes:purposes:

First, indicating that disorders on First, indicating that disorders on Axis II tend to be more chronic and Axis II tend to be more chronic and less amenable to treatment.less amenable to treatment.

Second, reminding clinicians to Second, reminding clinicians to consider whether these disorders, if consider whether these disorders, if present, are affecting an Axis I present, are affecting an Axis I disorder.disorder.

Page 48: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

< Three conditions required by DSM-IV< Three conditions required by DSM-IV to to be diagnosed as mental retardation > be diagnosed as mental retardation >

1) 1) IQ below IQ below 70 70

2) Deficit in 2) Deficit in adaptive functioning adaptive functioning (communication, self care, home life, (communication, self care, home life, use of community resources, goal use of community resources, goal setting, academic performances, setting, academic performances, occupational activities, leisure, health, occupational activities, leisure, health, safety behaviors etc)safety behaviors etc)

3) onset below 18 age (brain abnormality, 3) onset below 18 age (brain abnormality, dementia are excluded)dementia are excluded)

Page 49: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

< 4 levels of mental retardation< 4 levels of mental retardation > >

1) Mild -> 1) Mild -> IQ IQ 50-7050-70 home living, academic performance home living, academic performance

possiblepossible2) Moderate -> IQ2) Moderate -> IQ 35-4935-49 home living, academic performance home living, academic performance

possiblepossible3) severe -> IQ3) severe -> IQ 20-34 20-34 language use and daily life severelylanguage use and daily life severely impairedimpaired4) Profound -> IQ below4) Profound -> IQ below 19 19 language use and daily life severely language use and daily life severely impairedimpaired

Page 50: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

1. S1. Statisticstatistics

90% of MR fall under the label of mild 90% of MR fall under the label of mild mental retardation (IQ of 50 to 70)mental retardation (IQ of 50 to 70)

Mild mental retardationMild mental retardation --> > 3-43-4 out of 1,000 general population out of 1,000 general population Including severe MRIncluding severe MR --> 6-8 > 6-8 out of 1,000 general populationout of 1,000 general population do not recover, become chronicdo not recover, become chronic Through education and support Through education and support => daily => daily

life possiblelife possible Male outnumbers female (1.6 :Male outnumbers female (1.6 : 1)1) No sexual differences in severe MRNo sexual differences in severe MR

Page 51: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

2. C2. Causeause

Environmental Environmental ->-> deprivation, abuse, neglect deprivation, abuse, neglect prenatal prenatal ->-> disease, drugs while in the womb disease, drugs while in the womb perinatalperinatal->difficulties during labor->difficulties during labor and deliveryand delivery postnatal -> infections, head injurypostnatal -> infections, head injury Heavy use of alcohol among pregnant womenHeavy use of alcohol among pregnant women ->-> fetal alcohol syndrome => fetal alcohol syndrome => learning disabilitylearning disability

Lack of oxygen during birthLack of oxygen during birth Malnutrition and head injuries during the developmentMalnutrition and head injuries during the development

al periodal period

In 75% of cases, specific causes are not found (ZigleIn 75% of cases, specific causes are not found (Ziglerr & & Hodapp, 1986)Hodapp, 1986)

Page 52: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

< < Biological dimensions >Biological dimensions >

Usually multiple genes are involvedUsually multiple genes are involved Certain dominant, recessive, or X linked genesCertain dominant, recessive, or X linked genes In most cases , MR are not likely to marry and give thIn most cases , MR are not likely to marry and give th

eir genes to their children -> natural selection, even teir genes to their children -> natural selection, even though some mild MR people do marryhough some mild MR people do marry

Phenylketonuria(PKUPhenylketonuria(PKU)) Patients who cannot digest phenylalaninePatients who cannot digest phenylalanine if they intake phenylalanine -> their children become if they intake phenylalanine -> their children become

MRMR Every one out of Every one out of 14,000 newborn baby is diagnosed14,000 newborn baby is diagnosed Now it is possible to detect and prevent byNow it is possible to detect and prevent by diet diet

Page 53: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

< < Chromosomal influences Chromosomal influences >>

In 1956, the number of chromosomes in huIn 1956, the number of chromosomes in human cells was first correctly identified asman cells was first correctly identified as 4646

Gene anomalities that lead to MR are more tGene anomalities that lead to MR are more than hundred different wayhan hundred different way

< Down Syndrome >< Down Syndrome >

First identified in 1866 by an British physiciaFirst identified in 1866 by an British physiciann LangdonLangdon Down Down

Page 54: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

It was called firstIt was called first mongoloidism, because of mongoloidism, because of

resemblance of these patients to mongolian and resemblance of these patients to mongolian and then replaced later by the term “Down Syndrome”then replaced later by the term “Down Syndrome”

The disorder is caused by the presence of an extrThe disorder is caused by the presence of an extra 21a 21stst chromosome chromosome

Folds in their upwardly slanting eyesFolds in their upwardly slanting eyes Flat nose, small mouth, protruded tongueFlat nose, small mouth, protruded tongue

Heart malformationHeart malformation After 40 age, develop dementia Alzheimer’s typeAfter 40 age, develop dementia Alzheimer’s type

Page 55: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Correlates with the age of mother’s Correlates with the age of mother’s

age age Woman’s ova (egg) are all Woman’s ova (egg) are all

produced in youthproduced in youth ->-> exposed to harmful substances exposed to harmful substances ->-> disorder of division of disorder of division of

chromosomechromosome

Hormonal change with agingHormonal change with aging ->-> disorder in chromosome division disorder in chromosome division

Possible to detect Down syndrome Possible to detect Down syndrome by amniocentesis by amniocentesis by testing a by testing a sample of the fluid that surrounds sample of the fluid that surrounds the fetus in the amniotic sacthe fetus in the amniotic sac

Page 56: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

< Fragile X syndrome >< Fragile X syndrome >

Abnormality on the x-chromosomeAbnormality on the x-chromosome A mutation that makes the tip of A mutation that makes the tip of

the chromosome look as if it were the chromosome look as if it were hanging from a thread, giving it the hanging from a thread, giving it the appearance of fragilityappearance of fragility

Mostly males are affected, because Mostly males are affected, because they don’t have a second x-they don’t have a second x-chromosome to balance out the chromosome to balance out the mutationmutation

Page 57: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Women who carry fragile x syndrome commonly dWomen who carry fragile x syndrome commonly d

isplay mild to severe learning disabilitiesisplay mild to severe learning disabilities

Men with fragile x syndrome display moderate to Men with fragile x syndrome display moderate to severe levels of MR and have higher rates of hypsevere levels of MR and have higher rates of hyper activity, short attention spans, gaze avoidanceer activity, short attention spans, gaze avoidance

Large ears and testiclesLarge ears and testicles

1 of every 1 of every 2,000 males is born with fragile x synd2,000 males is born with fragile x syndrome (Dykensrome (Dykens etet al., 1988)al., 1988)

Page 58: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

< Psychological and social dimensions >< Psychological and social dimensions >

Up to 75% of the MR is caused by cultural and Up to 75% of the MR is caused by cultural and familial retardationfamilial retardation

These individuals tend to score mild mental These individuals tend to score mild mental retardation and have relatively good adaptive retardation and have relatively good adaptive skillsskills

Specific mechanisms that lead to this type of Specific mechanisms that lead to this type of MR is not yet known MR is not yet known

Psychological and biological influence Psychological and biological influence combinedcombined

Or just delayed developmentOr just delayed development MR group influenced by psycho-social MR group influenced by psycho-social

influenceinfluence such as such as abuse, neglect, social deprivationabuse, neglect, social deprivation -> higher IQ compared to those influenced -> higher IQ compared to those influenced by biological factors by biological factors

Page 59: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

2. T2. Treatmentreatment

Biological treatmentBiological treatment

Currently not availableCurrently not available Rat experimentRat experiment -> Healthy brain cell transplantation-> Healthy brain cell transplantation Gene examination -> gene Gene examination -> gene

treatmenttreatment

psychological treatmentpsychological treatment

The same principle used to LD, The same principle used to LD, autismautism

Basic skills to live in community Basic skills to live in community

Page 60: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Task analysis tailored to individual needTask analysis tailored to individual need Shaping through praise and access to objeShaping through praise and access to obje

cts and activities the person desires (reinfcts and activities the person desires (reinforcers)orcers)

Learning communication skillsLearning communication skills Severe MR -> learning sign languageSevere MR -> learning sign language Augmentative communication strategies -> Augmentative communication strategies ->

teaching the person to make a request by teaching the person to make a request by pointing to a picturepointing to a picture

Page 61: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Communication with the help of Communication with the help of

computercomputer one can press a button to produce a one can press a button to produce a

complete sentence (would you please complete sentence (would you please come here ? I need your help.) come here ? I need your help.)

-> reduction of self destructive-> reduction of self destructive, ,

aggressive behavioraggressive behavior More effective treatment programs More effective treatment programs

need toneed to be developed be developed -> more investments are needed-> more investments are needed

Occupation and community need to be Occupation and community need to be integratedintegrated

Page 62: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

B. cognitive disorderB. cognitive disorder

There are three categories in cognitive disorder, There are three categories in cognitive disorder, namely, namely, delirium, dementia, and amnestic disorder

- They used to be called in the past as "organic They used to be called in the past as "organic mental disorder“mental disorder“

- In DSM-IV-TR the name “organic” was dropped, In DSM-IV-TR the name “organic” was dropped, because all other psychological disorders are albecause all other psychological disorders are also more or less organically influencedso more or less organically influenced

Page 63: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Memory, attention, perception, and thinkinMemory, attention, perception, and thinkin

g are impairedg are impaired

Consequencies of the disorderConsequencies of the disorder influence person’s behavior, influence person’s behavior, personalitypersonality

Intense anxiety and depression are commoIntense anxiety and depression are common, especially among people with dementian, especially among people with dementia

Page 64: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

1. Delirium1. Delirium

< Clinical description< Clinical description >>

Confused, disoriented, Confused, disoriented, Out of touch with the surroundingsOut of touch with the surroundings Impairment of attention, memory, languageImpairment of attention, memory, language

Confusion of consciousnessConfusion of consciousness Lasts hours or several daysLasts hours or several days Disappears relatively quicklyDisappears relatively quickly

Page 65: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

1. Statistics1. Statistics

10-30% of emergency cases of old people10-30% of emergency cases of old people Most common illness among the elderlyMost common illness among the elderly Most prevalent among older adults, people Most prevalent among older adults, people

undergoing medical procedures, cancer undergoing medical procedures, cancer patients, and people with AIDSpatients, and people with AIDS

2. 2. CauseCause

Intoxication by drugs and poisons, withdrawal Intoxication by drugs and poisons, withdrawal from alcoholfrom alcohol

Infections, head injury, and brain traumaInfections, head injury, and brain trauma Age, lack of sleep, physical exercise, stressAge, lack of sleep, physical exercise, stress

Page 66: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Improper use of medicationImproper use of medication among elderly => among elderly => fall -fall -> hip fracture (> hip fracture (annually annually 32,000)32,000) Traffic accidents Traffic accidents ((annually annually 16,00016,000 명명 ))

High fever or drug -High fever or drug -> delirium of children> delirium of children Also in the process of dementia (WolaninAlso in the process of dementia (Wolanin & Philips, & Philips,

1981)1981)

3. T3. Treatmentreatment

Delirium caused by withdrawal of alcohol Delirium caused by withdrawal of alcohol -> -> benzodiazepinebenzodiazepine Delirium by infection, brain injury, brain tumorDelirium by infection, brain injury, brain tumor ->-> medical treatmentmedical treatment

Page 67: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Acute deliriumAcute delirium -> -> haloperidolhaloperidol Agitation, anxiety, hallucinationAgitation, anxiety, hallucination ->-> psychotherapy psychotherapy

Patient’s participation in the process of Patient’s participation in the process of decision makingdecision making

-> enhanced feeling of self control-> enhanced feeling of self control

Supervision of drug use Supervision of drug use -> prevention -> prevention

Page 68: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

2. Dementia2. Dementia

1. clinical description and statistics1. clinical description and statistics

Impairment of judging, memory, languageImpairment of judging, memory, language MedicationMedication, drug abuse, rupture of blood vess, drug abuse, rupture of blood vess

el by strokeel by stroke Syphilis andSyphilis and HIV, parkinson’s disease, Hunting HIV, parkinson’s disease, Hunting

tonton’s disease, Alzheimer’s disease’s disease, Alzheimer’s disease Progress slowlyProgress slowly Memory of several years ago remainMemory of several years ago remain

Page 69: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Cannot remember events happened hours Cannot remember events happened hours

agoago AgAgnosianosia -> cannot recognize an object -> cannot recognize an object Facial agnosiaFacial agnosia -> cannot recognize faces of -> cannot recognize faces of

family members or friendsfamily members or friends

Accompanies delusionAccompanies delusion AnxietyAnxiety, agitation, depression, aggression, , agitation, depression, aggression,

feel helplessfeel helpless Difficult to establish cause-and-effect relatiDifficult to establish cause-and-effect relati

onshiponship

Page 70: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Interplay between disease, anxiety, social isolationInterplay between disease, anxiety, social isolation Age 75-79 Age 75-79 : : 2.3%2.3% Age 80-84Age 80-84 : : 4.6%4.6% Age above 85 :Age above 85 : 8.5% (Paykel8.5% (Paykel etet al., 1994)al., 1994)

No difference between sex, education, socio-No difference between sex, education, socio-economic stateseconomic states

More women in Alzheimer’s dementiaMore women in Alzheimer’s dementia Medical and economical burdenMedical and economical burden Severe social and familial burdenSevere social and familial burden

Page 71: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

< 6 kinds of dementia< 6 kinds of dementia >>

1) Alzheimer's1) Alzheimer's type type

2) vascular dementia2) vascular dementia

3) dementia due to general medical3) dementia due to general medical

conditionsconditions

4) substance-induced persisting dementia4) substance-induced persisting dementia

5) dementia due to multiple 5) dementia due to multiple etiologiesetiologies

6) dementia not otherwise specified6) dementia not otherwise specified

Page 72: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

2.1 Dementia of the Alzheimer's2.1 Dementia of the Alzheimer's type type

In 1906, German psychiatrist In 1906, German psychiatrist AloisAlois AlzheimerAlzheimer Progressive complex cognitive disorderProgressive complex cognitive disorder Memory disorder Memory disorder -> difficulty to process new informations-> difficulty to process new informations

Forget objects, appointmentsForget objects, appointments Diminished social activitiesDiminished social activities Aphasia, apraxia, agnosiaAphasia, apraxia, agnosia Difficulty in planning, Difficulty in planning, organizing, integrating informationsorganizing, integrating informations

Page 73: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Examination of mental status Examination of mental status - orientation, registration, attention and - orientation, registration, attention and calculationcalculation

Recall, name of objectsRecall, name of objects Research with catholic nuns in aResearch with catholic nuns in a longitudinal studylongitudinal study Problem of restricted samplingProblem of restricted sampling Diary Diary -> idea density is related to -> idea density is related to

dementiadementia Both at the early and last stageBoth at the early and last stage -> progress slowly-> progress slowly In the middle phase In the middle phase -> progress quickly-> progress quickly

Page 74: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Can live in average 8 years after the onsetCan live in average 8 years after the onset In most cases, begins at In most cases, begins at 60-7060-70 age age Those who begins in 40-50age -> pre-Those who begins in 40-50age -> pre-

senilesenile dementia dementia

50% of all dementia -> Alzheimer’s type50% of all dementia -> Alzheimer’s type In U.S : 4 millionsIn U.S : 4 millions More among low education levelMore among low education level High educationHigh education -> compensation by -> compensation by

intellectual strategiesintellectual strategies => prevention of or => prevention of or delaying the development of dementia delaying the development of dementia (Stern et(Stern et al., 1994)al., 1994)

Page 75: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

High prevalence among womenHigh prevalence among women => unexplainable only by longer => unexplainable only by longer life expectancylife expectancy the role of estrogenthe role of estrogen

Estrogen treatment after menopauseEstrogen treatment after menopause => late onset or reduced incidence of=> late onset or reduced incidence of Alzheimer’s disease (Lambert, coyle, &Alzheimer’s disease (Lambert, coyle, & Lendon, 2004)Lendon, 2004)

Differences in different racial groupDifferences in different racial group Japan, Nigeria, Cherokee American IndianJapan, Nigeria, Cherokee American Indian

Page 76: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

2.2 Vascular Dementia2.2 Vascular Dementia

high percentage next to Alzheimer’s high percentage next to Alzheimer’s diseasedisease

As a result of As a result of strokestroke Similar symptoms to those of Similar symptoms to those of

Alzheimer’s diseaseAlzheimer’s disease Impairment of memory, cognitionImpairment of memory, cognition Abnormalities in walking and weakness Abnormalities in walking and weakness

in the limbsin the limbs Prevalence of men 4.7%Prevalence of men 4.7% Prevalence of women 3.8%Prevalence of women 3.8%

Page 77: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

2.3 Dementia due to other general medical cond2.3 Dementia due to other general medical cond

itionsitions

HIVHIV virus, brain injury virus, brain injury Parkinson’s disease, Huntington’s diseaseParkinson’s disease, Huntington’s disease Pick’s disease, Creutzfeld-Jakob’s diseasePick’s disease, Creutzfeld-Jakob’s disease Hydrocephalus (excessive water in the cranium Hydrocephalus (excessive water in the cranium

because of brain shrinkage) because of brain shrinkage) Hypothyroidism ( an under-active thyroid gland)Hypothyroidism ( an under-active thyroid gland) Brain tumor and vitamin Brain tumor and vitamin BB1212 deficiency deficiency

Page 78: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

< Infection of HIV virus >< Infection of HIV virus >

Cognitive slowness,Cognitive slowness, Impaired attention, Impaired attention, Forgetfulness, clumsy, Forgetfulness, clumsy, Tremors, weakness, Tremors, weakness, Become apathetic, Become apathetic, Socially withdrawnSocially withdrawn

29-87% of AIDS patients29-87% of AIDS patients -> impairment of cognitive -> impairment of cognitive

functionfunction 30% 30% -> diagnosed as having dementia -> diagnosed as having dementia (Heaton et al., 1994)(Heaton et al., 1994)

Page 79: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

AIDS, parkinson’s disease, Huntington’s diseaseAIDS, parkinson’s disease, Huntington’s disease -> sub-cortical dementia (The inner areas of the brain -> sub-cortical dementia (The inner areas of the brain below outer labelow outer la

yer called cortex yer called cortex )) -> impairment of the motor skills-> impairment of the motor skills -> severely depressive, anxious-> severely depressive, anxious

Alzheimer’s dementia, Pick’s dementiaAlzheimer’s dementia, Pick’s dementia -> cortical dementia-> cortical dementia -> aphasia (language disorder)-> aphasia (language disorder)

< head trauma >< head trauma > Brain damage through traffic accident or other accidents Brain damage through traffic accident or other accidents -> disorder of cognitive functioning, memory-> disorder of cognitive functioning, memory

Page 80: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

< < Parkinson’s disease >Parkinson’s disease >

I out of every 1,000 peopleI out of every 1,000 people Stooped posture, slow body movements Stooped posture, slow body movements

(called bradykinesia)(called bradykinesia) Tremors, and jerkiness in walkingTremors, and jerkiness in walking Speaks in a soft monotoneSpeaks in a soft monotone Damage to dopamine pathwaysDamage to dopamine pathways Prevalence twice as high as in general pPrevalence twice as high as in general p

opulationopulation

Page 81: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

< < Huntington’s disease Huntington’s disease >>

Involuntary movements of limbsInvoluntary movements of limbs 20-80% of Huntington’s disease develops 20-80% of Huntington’s disease develops dementiadementia Strong heredityStrong heredity Abnormality in chromosome 4Abnormality in chromosome 4

2.4 2.4 substance-induced persisting dementiasubstance-induced persisting dementia

Drug abuse, alcohol abuse, inhalation of glue or gasoline, sedDrug abuse, alcohol abuse, inhalation of glue or gasoline, sedative, hypnotic and anxiolytic drugsative, hypnotic and anxiolytic drugs

Similar symptoms to those in Alzheimer’s dementiaSimilar symptoms to those in Alzheimer’s dementia Impairment in memory, languageImpairment in memory, language movements, recognition, organizing and planningmovements, recognition, organizing and planning

Page 82: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

2. Cause2. Cause

Alzheimer’s diseaseAlzheimer’s disease neurofibrillaryneurofibrillary tangles tangles dead cells of neurons (amyloid plagues or dead cells of neurons (amyloid plagues or nuriticnuritic plaqu plaqu

es)es)

Too small to be observed in a living organ, which is wToo small to be observed in a living organ, which is why a definitive diagnosis of Alzheimer’s disease requirhy a definitive diagnosis of Alzheimer’s disease requires an autopsyes an autopsy

Atrophy of brain cellsAtrophy of brain cells Multiple genes are relatedMultiple genes are related Chromosome Chromosome 21, 19, 14, 121, 19, 14, 1

Page 83: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Abnormality of chromosome Abnormality of chromosome 21 in Down syndrome -> 21 in Down syndrome ->

high prevalence of dementia Alzheimer’s typehigh prevalence of dementia Alzheimer’s type

Abnormality of chromosome 14Abnormality of chromosome 14 -> early onset -> early onset (30-60(30-60 age age)) Abnormality of chromosome 19Abnormality of chromosome 19 -> late onset ( after age -> late onset ( after age 60 )60 )

Individual’s life styleIndividual’s life style diet, exercise, stessdiet, exercise, stess -> vascular dementia-> vascular dementia

Education, cultural factorsEducation, cultural factors -> influences on the process of dementia-> influences on the process of dementia -> low expectancy of social activity to the elderly-> low expectancy of social activity to the elderly

Page 84: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

3. 3. TreatmentTreatment

There is no absolute cure, because neurons are currently irreparableThere is no absolute cure, because neurons are currently irreparable

Preventive certain conditions such asPreventive certain conditions such as

- substance abuse, reduction of stress- substance abuse, reduction of stress - trying to stop the brain damage from - trying to stop the brain damage from spreading and becoming worsespreading and becoming worse - attempting to help these individuals and their care givers cope with - attempting to help these individuals and their care givers cope with

the advancing deterioration. the advancing deterioration.

Page 85: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Education of coping strategiesEducation of coping strategies - more than 50% - more than 50% of the family membersof the family members are severely depressed and stressedare severely depressed and stressed

High doses of vitamin High doses of vitamin E E delayed progressiodelayed progression of dementia compared with a placebon of dementia compared with a placebo

TacrineTacrine hydrochloride ( hydrochloride (cognex)cognex) Donepezil (Ariecept)Donepezil (Ariecept)

Page 86: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Aspirine, nonsteroidalAspirine, nonsteroidal anti-inflammatory drugsanti-inflammatory drugs Estrogen treatmentEstrogen treatment => => temporary effecttemporary effect

Psycho-social treatmentPsycho-social treatment - Cognitive strategies- Cognitive strategies -- memory wallets memory wallets -- name, short career, memory cardsname, short career, memory cards -- improve dialoguesimprove dialogues

Page 87: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Safety lineSafety line

-> red line is drawn on the floor-> red line is drawn on the floor

Verbal and nonverbal aggressiveVerbal and nonverbal aggressive

behaviorbehavior

-> caregivers need to be protected-> caregivers need to be protected

-> self assertive behaviors-> self assertive behaviors

-> -> prevention of patients prevention of patients abuse abuse

Page 88: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

3. Amnestic disorder 3. Amnestic disorder

1. 1. Clinical description and statisticsClinical description and statistics

Inability to change from a short term memory Inability to change from a short term memory to a long term memoryto a long term memory

Apple, bird, roofApple, bird, roof Counting backwards from 100 extracting 3 Counting backwards from 100 extracting 3

each timeeach time

Remembering 5Remembering 5 words for 5 minutes words for 5 minutes - checking the memory intermittently- checking the memory intermittently - no impairment in high cognitive functioning- no impairment in high cognitive functioning - relatively simple memory disturbance- relatively simple memory disturbance

Page 89: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Normal language, able to count simple numbersNormal language, able to count simple numbers Difficulty in recalling recent eventsDifficulty in recalling recent events unstable unstable orientation orientation

Cannot remember what he or she ate as a Cannot remember what he or she ate as a breakfastbreakfast

Forget names, the anniversary of one’s marriage, Forget names, the anniversary of one’s marriage, home addresshome address

Change in personalityChange in personality

Page 90: IV. Developmental and cognitive disorders A. Developmental disorder A. Developmental disorder Identifying the disorder at an early age is important Identifying

Wernicke-KorsakoffWernicke-Korsakoff syndrome syndrome Impairment of thalamusImpairment of thalamus => station of information transmission=> station of information transmission influence of brain injury, drug abuse, alcinfluence of brain injury, drug abuse, alc

ohol abuseohol abuse AlcoholicsAlcoholics -> deficiency of-> deficiency of vitamin vitamin B1B1 -> vitamin therapy-> vitamin therapy -> no long term effectiveness-> no long term effectiveness