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Developmental and Cognitive Disorders. Chapter 13. Perspectives on Developmental Disorders. Normal vs. Abnormal Development Childhood is associated with significant developmental changes Disruption of early skills will likely disrupt development of later skills Developmental Disorders

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Perspectives on developmental disorders
Perspectives on Developmental Disorders

  • Normal vs. Abnormal Development

    • 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 hyperactivity disorder adhd an overview
Attention Deficit Hyperactivity Disorder (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
ADHD: Facts and Statistics Overview

  • 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

Adhd biological contributions
ADHD: Biological Contributions Overview

  • Genetic Contributions

    • ADHD runs in families

    • Familial ADHD may involve deficits on chromosome 20

  • 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 Role of Toxins

    • Allergens and food additives do not appear to cause ADHD

    • Maternal smoking increases risk of having a child with ADHD

Adhd psychosocial contributions
ADHD: Psychosocial Contributions Overview

  • 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
Biological Treatment of ADHD Overview

  • 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

  • Effects of Medications

    • Improve compliance and decrease negative behaviors in many children

    • Beneficial effects are not lasting following drug discontinuation

    • Negative side effects include insomnia, drowsiness, and irritability

Behavioral and combined treatment of adhd
Behavioral and Combined Treatment of ADHD Overview

  • 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
Learning Disorders 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)

  • 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
Learning Disorders: Some Facts and Statistics Overview

  • 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

Biological and psychosocial causes of learning disorders
Biological and Psychosocial Causes of Learning Disorders Overview

  • 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

  • Psychological and motivational factors seem to affect eventual outcome

Treatment of learning disorders
Treatment of Learning Disorders Overview

  • Requires Intense Educational Interventions

    • Remediation of basic processing problems (e.g., teaching visual skills)

    • Efforts to improve 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
Pervasive Developmental Disorders: An Overview 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

Autistic disorder
Autistic Disorder 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

Autistic disorder facts and statistics
Autistic Disorder: Facts and Statistics Overview

  • Prevalence and Features of Autism

    • Affects 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
Causes of Autism: Early and More Recent Contributions Overview

  • Historical Views

    • Bad parenting

    • Unusual speech patterns

    • Lack of self-awareness

    • Echolalia

  • 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

Treatment of pervasive developmental disorders
Treatment of Pervasive Developmental Disorders Overview

  • 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
Mental Retardation (MR) 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 subaverage intellectual functioning (IQ below 70)

    • Concurrent deficits or impairments 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
DSM-IV and DSM-IV-TR Levels of Mental Retardation (MR) Overview

  • 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
Other Classification Systems for Mental Retardation (MR) Overview

  • 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)

Mental retardation mr some facts and statistics
Mental Retardation (MR): Some Facts and Statistics Overview

  • 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 1.6:1

  • Course of MR

    • Tends to be chronic, but prognosis varies greatly from person to person

Mental retardation mr biological contributions
Mental Retardation (MR): Biological Contributions Overview

  • 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

Mental retardation mr psychosocial contributions
Mental Retardation (MR): Psychosocial Contributions Overview

  • 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. Developmental 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
Treatment of Mental Retardation (MR) Overview

  • 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
Summary of Developmental Disorders Overview

  • Developmental Psychopathology and Normal and Abnormal Development

  • Attention Deficit Hyperactivity Disorder

    • Deficits in inattention, 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

    • Subaverage IQ, deficits in adaptive functioning, onset before age 18

    • Prevention and Early Intervention Are Critical for Developmental Disorders

Cognitive disorders an overview
Cognitive Disorders: An Overview Overview

  • Perspectives on Cognitive Disorders

    • Affect cognitive processes such as learning, memory, and consciousness

    • Most develop later in life

  • Three Classes of Cognitive Disorders

    • Delirium – Often temporary confusion and disorientation

    • Dementia – Degenerative condition marked by broad cognitive deterioration

    • Amnestic disorders – Memory dysfunctions caused by disease, drugs, or toxins

  • Shifting DSM Perspectives

    • From “organic” mental disorders to “cognitive” disorders

    • Broad impairments in memory, attention, perception, and thinking

    • Profound changes in behavior and personality

Delirium Overview

  • Nature of Delirium

    • Central features – Impaired consciousness and cognition

    • Impairments develop rapidly over several hours or days

    • Examples include confusion, disorientation, attention, memory, and language deficits

  • Facts and Statistics

    • Affects 10% to 30% of persons in acute care facilities

    • Most prevalent in older adults, AIDS patients, and medical patients

    • Full recovery often occurs within several weeks

Medical conditions related to delirium
Medical Conditions Related to Delirium Overview

  • Medical Conditions

    • Drug intoxication, poisons, withdrawal from drugs

    • Infections, head injury, and several forms of brain trauma

    • Sleep deprivation, immobility, and excessive stress

  • DSM-IV and DSM-IV Subtypes of Delirium

    • Delirium due to a general medical condition

    • Substance-induced delirium

    • Delirium due to multiple etiologies

    • Delirium not otherwise specified

Treatment and prevention of delirium
Treatment and Prevention of Delirium Overview

  • Treatment

    • Attention to precipitating medical problems

    • Psychosocial interventions include reassurance, coping strategies

  • Prevention

    • Address proper medical care for illnesses

    • Address proper use and adherence to therapeutic drugs

Dementia Overview

  • Nature of Dementia

    • Gradual deterioration of brain functioning

    • Affects judgment, memory, language, and advanced cognitive processes

    • Dementia has many causes and may be reversible or irreversible

  • Progression of Dementia: Initial Stages

    • Memory impairment, visuospatial skills deficits

    • Agnosia – Inability to recognize and name objects (most common symptom)

    • Facial agnosia – Inability to recognize familiar faces

    • Other symptoms – Delusions, depression, agitation, aggression, and apathy

  • Progression of Dementia: Later Stages

    • Cognitive functioning continues to deteriorate

    • Person requires almost total support to carry out day-to-day activities

    • Death results from inactivity combined with onset of other illnesses

Dementia facts and statistics
Dementia: Facts and Statistics Overview

  • Onset and Prevalence

    • Can occur at any age, but most common in the elderly

    • Affects 1% of those between 65-74 years of age

    • Affects over 10% of persons 85 years and older

    • 47% of adults over the age of 85 have dementia of the Alzheimer’s type

  • Incidence of Dementia

    • Affects 2.3% of those 75-79 years of age and 8.5% of persons 85 and older

    • Rates of new cases appear to double with every 5 years of age

  • Gender and Sociocultural Factors

    • Dementia occurs equally in men and women

    • Dementia occurs equally across educational level and social class

Dsm iv and dsm iv tr classes of dementia
DSM-IV and DSM-IV-TR Classes of Dementia Overview

  • Dementia of the Alzheimer’s type

  • Vascular Dementia

  • Dementia Due to Other General Medical Conditions

  • Substance-Induced Persisting Dementia

  • Dementia Due to Multiple Etiologies

  • Dementia Not Otherwise Specified

Dementia of the alzheimer s type
Dementia of the Alzheimer’s Type Overview

  • DSM-IV-TR Criteria and Clinical Features

    • Multiple cognitive deficits that develop gradually and steadily

    • Predominant impairment in memory, orientation, judgment, and reasoning

    • Can include agitation, confusion, depression, anxiety, or combativeness

    • Symptoms are usually more pronounced at the end of the day

  • Range of Cognitive Deficits

    • Aphasia – Difficulty with language

    • Apraxia – Impaired motor functioning

    • Agnosia – Failure to recognize objects

    • Difficulties with planning, organizing, sequencing, or abstracting information

    • Impairments have a marked negative impact on social and occupational functioning

  • An Autopsy Is Required for a Definitive Diagnosis

Alzheimer s disease some facts and statistics
Alzheimer’s Disease: Some Facts and Statistics Overview

  • Nature and Progression of the Disease

    • Deterioration is slow during the early and later stages, but rapid during middle stages

    • Average survival time is about 8 years

    • Onset usually occurs in the 60s or 70s, but may occur earlier

  • Prevalence of Alzheimer’s Disease

    • Affects about 4 million Americans and many more worldwide

    • Prevalence is greater in poorly educated persons and women

    • Prevalence rates are low in some ethnic groups (e.g., Japanese, Nigerian, Amish)

Vascular dementia
Vascular Dementia Overview

  • Nature of Vascular Dementia

    • Progressive brain disorder caused by blockage or damage to blood vessels

    • Second leading cause of dementia next to Alzheimer’s

    • Onset is often sudden (e.g., stroke)

    • Patterns of impairment are variable, and most require formal care in later stages

  • DSM-IV and DSM-IV Criteria and Incidence

    • Cognitive disturbances are identical to dementia

    • Unlike Alzheimer’s, obvious neurological signs of brain tissue damage occur

    • Incidence is believed to be about 4.7% or men and 3.8% of women

Dementia due to hiv disease
Dementia Due to HIV Disease Overview

  • Overview and Clinical Features

    • HIV causes neurological impairments and dementia

    • Cognitive slowness, impaired attention, forgetfulness, and clumsiness

    • Repetitive movements (e.g., tremors/leg weakness), apathy, and social withdrawal

  • Progression of HIV-Related Cognitive Impairments

    • Tend to occur during the later stages of HIV infection

    • Impairments are observed in 29% to 87% of people with AIDS

    • Subcortical dementia – Refers to deficits that affect inner brain regions

    • Aphasia is uncommon in subcortical dementia, but anxiety and depression occur

Other causes of dementia head trauma and parkinson s disease
Other Causes of Dementia: Head Trauma and Parkinson’s Disease

  • Head Trauma

    • Accidents are leading causes of such cognitive impairments

    • Memory loss is the most common symptom

  • Parkinson’s Disease

    • Degenerative brain disorder

    • Affects about 1 out of 1,000 people worldwide

    • Motor problems are characteristic of this disorder

    • Damage to dopamine pathways is believed to cause motor problems

    • Pattern of impairments are similar to subcortical dementia

Other causes of dementia huntington s and pick s disease
Other Causes of Dementia: Huntington’s and Pick’s Disease

  • Huntington’s Disease

    • Genetic autosomal dominant disorder (i.e., chromosome 4)

    • Manifests initially as chorea, usually later in life (around 40s or 50s)

    • About 20% to 80% of persons go on to display dementia of the subcortical pattern

  • Pick’s Disease

    • Rare neurological condition that produces a cortical dementia like Alzheimer’s

    • Also occurs later in life (around 40s or 50s)

    • Little is known about what causes this disease

Other dementias creutzfeldt jakob disease and substance induced dementia
Other Dementias: Creutzfeldt-Jakob Disease and Substance-Induced Dementia

  • Creutzfeldt-Jakob Disease

    • Affects 1 out of 1,000,000 persons

    • Linked to mad cow disease

  • Substance-Induced Persisting Dementia

    • Results from drug use in combination with poor diet

    • Examples include alcohol, inhalants, and sedative, hypnotic, and anxiolytic drugs

    • Resulting brain damage may be permanent

    • Dementia is similar to that of Alzheimer’s

    • Deficits may include aphasia, apraxia, agnosia, or disturbed executive functioning

Causes of dementia the example of alzheimer s disease
Causes of Dementia: The Example of Alzheimer’s Disease Substance-Induced Dementia

  • Early and Largely Unsupported Views: The Example of Smoking

  • Current Neurobiological Findings

    • Neurofibrillary tangles – Occur in all brains of Alzheimer’s patients

    • Amyloid plaques–Accumulate excessively in brains of Alzheimer’s patients

    • Brains of Alzheimer’s patients tend to atrophy

  • Current Neurobiological Findings

    • Multiple genes are involved in Alzheimer’s disease (chromosomes 21, 19, 14, 12, 1)

    • Chromosome 14 – Associated with early onset Alzheimer’s

    • Chromosome 19 – Associated with a late onset Alzheimer’s

The contributions of psychosocial factors in dementia
The Contributions of Psychosocial Factors in Dementia Substance-Induced Dementia

  • Do not cause dementia directly, but may influence onset and course

  • Lifestyle factors – Drug use, diet, exercise, stress

  • Cultural factors – Risk for certain diseases and accidents vary by ethnicity and class

  • Psychosocial factors – Educational attainment, coping skills, social support

Medical and psychosocial treatment of dementia
Medical and Psychosocial Treatment of Dementia Substance-Induced Dementia

  • Medical Treatment: Best if Enacted Early

    • Few medical treatments exist for most types of dementia

    • Most medical treatments attempt to slow progression of deterioration

    • Examples include glial cell-derived neurotrophic factor, Cognex, vitamin E, aspirin

    • Medical treatments do not stop progression of dementia

  • Psychosocial Treatments

    • Focus on enhancing the lives of dementia patients and their families/caregivers

    • Teach adaptive skills

    • Use memory enhancement prosthetic devices (e.g., memory wallet)

    • Main emphasis of psychosocial interventions appears to be on the caregivers

Prevention of dementia
Prevention of Dementia Substance-Induced Dementia

  • Reducing Risk of Dementia in Older Adults Via

    • Estrogen-replacement therapy – Reduces risk of Alzheimer’s dementia in women

    • Proper treatment of cardiovascular diseases

    • Use of anti-inflammatory medications

  • Other Targets of Prevention Efforts

    • Increasing safety behaviors to reduce head trauma

    • Reducing exposure to neurotoxins and use of drugs

Amnestic disorder
Amnestic Disorder Substance-Induced Dementia

  • Nature of Amnestic Disorder

    • Inability to transfer information from short-term memory into long-term memory

    • Often results from medical conditions, head trauma, or long-term drug use

  • DSM-IV and DSM-IV-TR Criteria for Amnestic Disorder

    • Cover the inability to learn new information

    • Inability to recall previously learned information

    • Memory disturbance causes significant impairment in functioning

  • The Example of Wernicke-Korsakoff Syndrome

    • Caused by thalamic damage resulting from stroke or chronic heavy alcohol use

    • Attempt to restore thiamine deficiency in the case of chronic alcohol abuse

  • Research on Amnestic Disorders Is Scant