Developmental Disorders

1. Developmental Disorders Autism, Asperger’s, Intellectual Disabilities Developmental Disorders

2. Pervasive Developmental Disorders: Autism and Asperger’s Syndrome Developmental Disorders

3. Autism • Onset before age 3. It is not a congenital disorder. • Large reductions in intellectual ability • 70% have an IQ less than 75 (low). • Can learn some language, but have particularly poor social skills • Life of solitude • Stereotyped, ritualized behaviours · Occasional “splinter” skills – areas of great strength in comparison to intellect. Developmental Disorders

4. Autism Prevalence • Rare, 2-5:10 000 persons (APA, 1994) • Occurs more frequently in males than females (2.5-4 : 1) Developmental Disorders

5. Case Study • During the first years of life, “John” walked and talked at the expected milestones • The only exception was that he was very clingy to his mother--he was scared to venture outside alone (he would scream) and would not engage with anyone else. • John loved his building cups. However, he was disinterested in playing with his sister, preferring to place the cupsaround the room. If they were moved, or one was lost, he was inconsolable for the whole day. Developmental Disorders

6. Case Study • At the age of three, John hadnormal verbal skills and his memory seemed phenomenal. He could recite all the road signs in the highway code without error. • However, hewas extremelywary ofother people, always avoiding eye contact and getting increasingly difficult for his mother to manage. • He had tantrums which became worse as hestruggled to make sense of his world. Developmental Disorders

7. Case Study • His mother knew there was something wrong but no-one listened. Others said it was all her fault because she was too sensitive and over-protective. • When John started school, he seemed to be unteachable. He would not settle,and at last people took mother’s concerns seriously. • On the plus side, John was getting better developmental skills and could play the glockenspiel and piano if he was in the mood. He did it instinctively, playing any tune with one hand. Developmental Disorders

8. Case Study • John was manic, always anxious, often difficult. • John was a big fan of the Beatles, 60s music and the pop charts. He can tell you instantly what was number one in July 1967. He would listen to music for hours. • He was also becoming a very handsome young man who was starting to attract female attention but he was totally disinterested. Sexuality was never a part of his world. Developmental Disorders

9. Case Study • When his mother died at the age of 47 of cancer, John did notattend the funeral. He matter-of-factly said his sister had taken his mother’s place now. There was no other emotion. Developmental Disorders

10. DSM-IV criteria • Complicated diagnosis A. Total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3): • qualitative impairment in social interaction. • qualitative impairments in communication. • restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. LINK: http://www.psych.yorku.ca/mirabella/4080/documents/PDDDSMCriteria.pdf Developmental Disorders

11. DSM-IV criteria B. Delays or abnormal functioning with onset prior to age 3 years: • social interaction, • language as used in social communication, or • symbolic or imaginative play. Developmental Disorders

12. DSM-IV criteria C. The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder. • Rett’s: Only in girls who develop normally until 6 months of age and regress. • Associated with microcephaly (small head). • Genetic cause • CDD: Later onset, more severe effects on motor behaviour, adaptive skills (loss of bowel control) Developmental Disorders

13. Asperger’s Disorder • Also called high functioning autism • Children tend to have a higher verbal IQ than those with autism. • Low, but normal language skills. • May appear normal with many behaviours that are considered socially odd. • Low, but normal social skills. Developmental Disorders

14. DSM-IV criteria A. Qualitative impairment in social interaction B. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. Developmental Disorders

15. DSM-IV criteria D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years). E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood. F. Criteria are not met for another specific pervasive developmental disorder or schizophrenia. Developmental Disorders

16. Other Information • Autism is not a homogenous disorder • More of an umbrella term for disorders with multiple possible causes and outcomes • Specific type of mental retardation • Gross brain damage • Behaviour is thought of as eccentric, and may get in the way of having good relationships with others. Developmental Disorders

17. Etiology • Birth trauma • forceps delivery • viral infections (immunization) • metabolic problems, hormonal imbalances 2. Genetic causes? • No definitive research • High concordance in monozygotic twins (over 90%) • Does run in families (usually through father) Developmental Disorders

18. Etiology 3. Comorbid with other developmental abnormalities: • Trisomy 21 (Down’s), phenylketonuria • Asperger’s may be related to neuronal migration disorders (Berthier, Starkstein, & Leiguarda, 1990) Developmental Disorders

19. Neuropathology 1. High (15-30%) incidence of seizures occur in autism (Smalley, Levitt, & Bauman, 1998) 2. Numerous neurological abnormalities: • Increased brain volume (Deb & Thompson, 1998; Rapin & Katzman, 1998) • Decreased number of cells in limbic system and cerebellar cortex (Rapin & Katzman, 1998) • Diminished corpus callosum (Piven et al., 1997) • 25-30% of adults with autism have elevated serum serotonin levels (Cummings & Mega, 2003) Developmental Disorders

20. Intellectual Disability Developmental Disorders

21. Information and Prevalence • An umbrella term for a number of diseases and injuries in infants and children that result in severely reduced intellectual functioning • High prevalence: 1-3% of the population. • Also occurs in many infants with in utero abnormalities Developmental Disorders

22. DSM-IV system criteria 1. Low IQ based on standardized IQ tests • Mild ID – 55-70 IQ • Moderate ID – 40-55 IQ • Severe ID – 25-40 IQ • Profound ID – below 25 IQ 2. Identification before age 18 Developmental Disorders

23. American Association on Intellectual Disability(1992) • Subaverage intellectual functioning (DSM-IV). • And limitations in at least two of the following: • Communication • Self care skills • Home living • Social skills • Community use • Self-direction • Health and safety • Functional academics • Leisure • Work Developmental Disorders

24. American Association on Intellectual Disability(1992) • Takes into account supports, emotional development, physical health and environmental considerations • Emphasis on adaptive functioning. • Not widely used in Canada Developmental Disorders

25. Etiology • Down’s syndrome, other genetic disorders • Trisomy 21 • Occurs 1-1.5 times per 1000 live births • Occurs more often in mothers over 40 years of age (18 in 1000) • Intelligence can range from severely impaired to normal • Many metabolic diseases as well: Phenylketonuria, Maple syrup urine disease, Galactosemia, etc. Developmental Disorders

26. Etiology 2. X-chromosome abnormalities (1:1500-2500) • Fragile X syndrome: defective X chromosome – more common in males • Turner’s syndrome (XO): in females, short stature and lack of sexual development at puberty • Klinefelter’s syndrome (XXY): in males, incomplete sexual development, infertility • mild to moderate ID is associated with these diseases. Developmental Disorders

27. Etiology 3. Premature Birth • Infants born 35 weeks gestation or sooner • Usually low birthweight • 1 in 20 births (5%) • Many organs have not developed sufficiently, especially brain and lungs. • Most common in mothers < 15 years and > 40 years. • Maternal nutrition is a factor: anemia, thyroid deficiency, diabetes. Developmental Disorders

28. Etiology 4. Other maternal factors • First trimester insult to fetus – this is when the nervous system undergoes its fastest development. • Infections : German measles, syphilis, toxoplasmosis (comes from eating undercooked pork) are most common and serious. • Chemicals, drugs, smoking, alcohol, and radiation during pregnancy may also be related to intellectual disability. Developmental Disorders

29. Etiology 5. Malformations of the cerebral hemispheres (1:2000 births) • Spina Bifida and Cranium Bifidum: Failure of closure of the neural tube during the first few weeks of gestation (day 27-28) • A complication of these diseases is Hydrocephalus: accumulation of CSF • Enlarged head • Brain atrophy Developmental Disorders

30. Interventions and ID • It is difficult to say whether all children with intellectual disability need intervention. • Some are perfectly happy the way they are. • Others may have emotional or behavioural difficulties. • Some parents may have more or less support in coping with these children. • The less support there is, the more likely they are to seek help. • Typical interventions are aimed at educating the child and remediating any language deficits • There is no treatment, only supportive education or counseling. Developmental Disorders