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Question 1

Neurodevelopmental disorders

Answer 1

start in early development (womb)
o Different brain development o Many different manifestations
▪ Unusual physical features
▪ Deficits in language
▪ Deficits in motor ability
▪ Patterns of behaviour like hyperactivity, aggressiveness, or stereotypy
(repetition of movement)
o Not caused by the social environment (of course, can exacerbate symptoms). Often
genetically random.

Question 2

Intellectual disability DSM criteria

Answer 2

Definition: A disorder with onset during the developmental period that includes both
intellectual and adaptive functioning deficits in conceptual, social, and practical domains o Three criteria:
▪ Deficits in intellectual functions
▪ Deficits in adaptive functioning
▪ Onset of these deficits during the developmental period

Question 3

intellectual disability outcomes

Answer 3

Mild, moderate, or severe/profound
▪ Mild impairment: independent, semiskilled job. 85% of cases. Difficult to grasp
more abstract/reasoning tasks
▪ Moderate: live supervised. 10% of cases.
▪ Severe/profound: often physical problems. Very dependent.

Question 4

Assessment for intellectual disability

Answer 4

Wechsler scale: most common. International.
o WAIS, WISC, WPPSI * Stanford-Binet Scales
o Very similar to Wechsler, just less international * Verbal comprehension index
-
* Working memory index
* Perceptual reasoning index
o Non-verbal IQ test * Processing speed index
* Visual spatial index

Question 5

measurements of intelligent

Answer 5

Intelligence was first measured by Sir Frances Galton. Measured by stimuli
response times.
* Alfred Binet made a more practical test. For sorting which children
needed help in school. Judgement, comprehension, and reasoning.
Average IQ is 100. Never intended for segregation!
* David Wechsler. Wechsler test.
▪ IQ is the most stable of the psychological traits. Can predict income, academic achievement, etc.

Question 6

problems with IQ

Answer 6

Criticized because it can be reductionist. Other factors can impact
performance.
* Do not consider sensory (children with autism can have a hard time
answering), motor, or language deficits (highly language-based)
* Individuals with intellectual disabilities typically have not received the
type of exposure to testing environments that others have
* The norms are limited when it gets to the extreme ends of the IQ curve.
Gets less precise.

Question 7

Vineland adaptive behaviour scales

Answer 7

Measures adaptive behaviour
o Conceptual skills: school skills. Reading, counting, etc.
o Social skills: obeying signs, keeping private info, making friends,
etc.
o Practical skills: crossing the street, using the washroom,
answering the phone, etc.
* Evaluates the level of support needed in each domain of functioning

Question 8

Interviewing strategies and its issues

Answer 8

Interviewing people that know the child (family members) Difficult when
borderline.
▪ Good functioning may lead to the “cloak of competence” that may hide aspects
of a developmental disorders
* Girls with a mild ID are underdiagnosed (do not show behavioural
issues)
▪ Cognitive and linguistic limitations, and social desirability may result in
acquiescence during an interview

Question 9

Genetic causes for neurodevelopmental disorders

Answer 9

• Dominant (Ex: tuberous sclerosis and neurofibromatosis) o More rare
• Recessive (Ex: phenylketonuria – PKU)
  o PKU: accumulation of AAs. Can result in intellectual disability.
  Can be prevented by diet/medication early on.
• Sex-linked (Ex: fragile X syndrome and Lesch-Nyah syndrome)

Question 10

Chromosomal abnormalities

Answer 10

Occurs at conception
* Ex: Down syndrome

Question 11

metabolic disorders

Answer 11

Ex: Phenylketonuria (PKU), congenital hypothyroidism, hyperammonemia, Gaucher’s disease, and Hurler’s syndrome

Question 12

Genetics as part of a disorders

Answer 12

both parents contribute half of their chromosomes
* Meiosis: cell division that produces gametes. 23 from each parent. If the
amount is atypical, this will affect fetal development

Question 13

Down syndrome

Answer 13

Trisomy 21 (extra 21st chromosome) in 95% of cases
o Mostly due to luck. Older mother = higher chance.
o Widely recognized physical markers
o Intellectual impairment can range from mild to severe
o Can also have heart problems (often need surgery)
o Delayed nonverbal cognitive development, deficits in verbal abilities (articulation,
sentence structure) and auditory short-term memory
▪ Strength in visuo-social skills, reasoning
▪ Develop more normally until preschool. Major deficits are in early childhood
o Higher risk for Alzheimer-type dementia

Question 14

Fragile X syndrom

Answer 14

Most common inherited intellectual disability o More common in boys
▪ In most girls, the unaffected X chromosome protects them. It is often milder in girls.
▪ Hereditary
▪ 1/4000 males, 1/8000 females
o Sometimes larger ears and forehead, but subtle o Intellectual disability (mild to moderate)
▪ Sometimes declines in puberty
o ADHD symptoms (concentration, impulsivity) (comorbid) o Anxiety, aggression
▪ Typically, friendly/personable aside from anxiety
Autistic behaviours (comorbid) ▪ As high as 20-30%
▪ Fragile X syndrome is the etiology, autism spectrum disorder can be a diagnosis o Mutation in FMR1 gene. Not enough protein. More repeated CGG sequences will have
more severe impairments.

Question 15

environmental etiologies

Answer 15

Pollutants:
* Toxic metals, synthetic hormones, plastic ingredients, pesticides,
herbicides
* Air/water pollution
* Lead
▪ Nutrition
* Can mostly be fixed/compensated for by prenatal vitamins
* Spina bifida
* Neural tube defects

Question 16

Drug etiologies

Answer 16

Thalidomide
* Used to be common anti-nausea for pregnancy
* Dependent effects. When exactly the mother took it. Mouth
development. ▪ Antidepressants
▪ Opioids
▪ Marijuana ▪ Nicotine
* Restricts O2 levels in fetal bloodstream. Impacts prefrontal cortex, growth. Increased risk of preterm birth, complicationsAl

Question 17

Alcohol as an etiology

Answer 17

Fetal alcohol spectrum disorder (FASD)
o Alcohol consumption during pregnancy affects fetus
▪ We don’t know the amount that is safe, so we advise
total sobriety o Effects:
▪ Facial deformities (small eye openings, smooth philtrum (upper lip), cleft palate, thin upper lip, small head (below third percentile))
▪ Intellectual disabilities, attention problems, hyperactivity

Question 18

Disease etiologies

Answer 18

▪ Rubella: deafness, cataracts, heart defects, brain disorders, intellectual disabilities, etc.
▪ Zika virus: can lead to microcephaly
▪ Infections (influenza, etc.): linked to mental disorders
* Maternal infection (even just a cold) during the first trimester can increase the risk of schizophrenia 7 times

Question 19

Maternal stress etiologies

Answer 19

▪ Circadian rhythm disruption: sleep disorders
▪ Effect on HPA axis of fetus
* Increased maternal cortisol = sensitive HPA axis = more easily stressed
▪ Increases risk of ASD and ADHD
▪ Difficult or irritable temperament
▪ Internalized and externalized problems
* Difficulty in regulating emotions, sleep.
▪ Elevated risk for schizophrenia and depression (again, HPA axis)
▪ Can reduce hippocampal plasticity (sensitive to cortisol): learning/memory
deficits
▪ Larger amygdala (overprocessing negative emotions): mood disorders
▪ Autonomic underarousal (low heartrate, etc. because their baseline is skewed):
conduct problems and psychopathic traits

Question 20

par asocial disadvantages as etiologies

Answer 20

any sort of harsh early environment. Lack of stimulation,
care, etc.
▪ Ex: Romanian orphanages

Question 21

Autism Spectrum disorder

Answer 21

First identified as a childhood disorder in 1943 by Leo Kanner
o Restricted repetitive patterns of behaviour, interest, activities o Impaired social communication
o Hyper or hyporeactivity to sensory input
o Lack of eye contact
o Rocking, stimming
o Self-injurious behaviour
o Intellectual ability: most of those with ASD have IQ scores below average (30% at average/above average), though not necessarily in the range for intellectual disability
▪ High non-verbal skills, low verbal skills
▪ How well can IQ tests even measure IQ in ASD? o Comorbid with ADHD
o Usually, symptoms are clear early in life
o More literal

Question 22

prevalence of autism

Answer 22

o US: 1 out of 68 school-aged children (3-4x more in boys)
o Canada: 1 out of 66 children in 2015
o Can be misdiagnosed. Language acquisition disorders
o Diagnostics are improving, and perhaps more triggers. Not necessarily increasing
prevalence

Question 23

Diagnostic issues with ASD

Answer 23

o In the DSM5, ASD is a consolidation of disorders that were once diagnosed separately o Asperger’s disorder: not actually qualitatively different enough.
▪ Typical language/cognition development
▪ Odd/eccentric behaviours in social interactions
▪ Hard to detect as people are often “high functioning”

Question 24

communication impairments with ASD

Answer 24

Miss social cues important for development
o Inconsistent use of early preverbal communications
▪ Protoimperative gestures (for what they want) but not protodeclarative (look at that!) gestures
▪ 50% do not develop any useful language skills
o Qualitative language impairments
▪ Pronoun reversals (I vs you)
▪ Echolalia (repeating what someone else said)
▪ Perseverative speech (repeating what they said. “Stuck”) ▪ Impairments in pragmatics (social cues. Indirect language)
o Either develop language by the age of 5, or likely do not. ▪ About a third do not speak

Question 25

ASD DSM criteria

Answer 25

These are illustrative, not exhaustive ▪ Be sure what you are seeing is not an intellectual disability or global developmental delay. ▪ Importance of a lot of opinions

Question 26

gender bias in ASD

Answer 26

o o o o Less common in girls (3-4 times less) ▪ Differences in people in Level 1 account for most of this Female protective effect: ▪ Harder to trigger in girls. They are genetically “protected” from triggers. To get the same pattern of symptoms, there needs to be a greater accumulation of risk factors Some conditions that trigger ASD are more common in boys (Fragile X syndrome) Typical female vs male phenotype ▪ Underdiagnosed: they don’t “seem” autistic ▪ Beggiato et al. (2016). Females have... * Range of facial expressions * Imaginative play * Less repetitive behaviours * Different obsessions ▪ Most of the DSM5 research is based on boys ▪ Boys have more symptoms that trigger assessment (hyperactivity, etc.)

Question 27

biological etiology for ASD

Answer 27

▪ Problems in early development, genetic components, brain abnormalities, etc. ▪ Brain areas involved in social development o Problems in early development ▪ Have more health problems during pregnancy, at birth, immediately following birth ▪ Prenatal/neonatal complications can increase risk * Parent age, IVF, maternal drug use o Genetic influences ▪ Chromosomal/gene disorders ▪ Fragile X in 2-3% of children with ASD ▪ ASD individuals have a 5% elevated risk for chromosomal anomalies ▪ About 25% of children with tuberous sclerosis (non-cancerous tumors) have ASD o Family/twin studies ▪ 14-20% of siblings of individuals with ASD have the disorders ▪ 70-90% concordance in identical twins ▪ Family of those with ASD often have similar types of traits o Molecular genetics ▪ Causally implicated by not a direct cause ▪ Likely complex genetic disorder ▪ May be influenced by environmental factors in fetal brain development ▪ Epigenetic dysregulation could be a factor

Question 28

treatment and intervention with ASD

Answer 28

Psychological interventions ▪ Minimize core difficulties (ex: self-injurious behaviour) ▪ Maximize independence/quality of life ▪ Help the child/family cope better ▪ Ex: Applied Behaviour Analysis (ABA) * Backlash against it. Can focus (depending on schools of thought) on appropriate social interactions with operant conditioning (including punishment) * Push to mask. “Appear normal” * Should put the child first, not the parent’s needs ▪ Ex: Early Intensive Behavioural Intervention (EIBI) o Pharmacological interventions (especially for more severe cases) ▪ Reduce aggression, repetitive behaviour, distractibility ▪ Ex: anti-depressants, anti-psychotic medication, Ritalin

Question 29

Learning disorders

Answer 29

Neurologically based. Umbrella term. Not specific in the DSM for reading vs writing vs math o Processing, remembering, perceiving and learning skills o May interfere with oral language, reading, written language, mathematics, organization, social skills o Identified in the 1900s (1960s). o More males than females, but there is a referral bias

Question 30

Diagnostic Criteria of learning disorder

Answer 30

Four essential features: ▪ Persistent difficulties learning and using key academic skills despite interventions that target those difficulties ▪ Performance of academic skills that is well below average for chronological age ▪ Appearance of the learning difficulties in the school years ▪ Determination that the learning difficulties are not attributable to, or better explained by another neurological condition or intellectual disabilities (IQ is normal)

Question 31

Dyslexia

Answer 31

Problem with manipulating language, not seeing it. ▪ Rely more on the right hemisphere of the brain than the left ▪ This can be helped through interventions o Occurs on a continuum o Heritable o Involves an impairment in phonological processing o Difficulties with fluent reading o Difficulties with phonological awareness