4 Flashcards
(29 cards)
learning disorders
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
o About 2-10% of the population. Depends on how you count the borderline cases.
Underdiagnosed for a long time too.
o Children are more at risk for anxiety/mood/behavioural disorders due to their frequent
negative experience in classrooms
Diagnostic criteria
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)
Dyslexia
o Most common. Nearly 80%
o 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
Dyscalculia
Symptoms:
▪ Deficits in the processing of numerical quantities
▪ Problems with working memory (especially visuospatial)
* Spatial representation of numbers (ex: putting a number on a number line)
▪ Difficulties with symbols and the quantities they represent
o Difficult to identify and diagnose. Less systematic screening. May affect around 1% of
children
o Number sense hypothesis
o Often nonidentified, but an cooccur with dyslexia
▪ Can be confused with math anxiety
Dysgraphia
Least well understood of the learning disorders. Rarely happens alone ▪ May affect around 10% of children, but to varying degrees
o Symptoms: impairment in spelling, writing fluency, and written expression o May reflect deficits in a number of neuropsychological domains
▪ Processing speed
▪ Working memory
▪ Executive functioning ▪ Language processing ▪ Visual spatial
▪ (Fine motor deficits)
o Solutions: paper with raised lines, special larger pencils, word processing tools
Etiologies of learning disorders
Interaction of genetic, environmental risk, and protective factors
o 50-60% of variance is genetic (twin studies)
o Environmental changes (specific reading instruction) can influence neural systems in the
brain to ameliorate the difficulties
interventions and precautions of learning disorders
Response-to-intervention approach:
▪ Lower intensity intervention for children at risk of a reading disorder (struggling
with phonemes, etc.)
* Multisensory approach.
o Ex: tracing letters in sand.
▪ If that doesn’t work, they go onto more intensive interventions
o Evidence-based reading interventions:
▪ Target phonemic awareness, vocabulary development, reading fluency, and
reading comprehension
general issues in assessing and treating children
Parent/teacher reports are given more weight than the child’s input
- Examining the role the environment plays in children’s symptoms
- Some childhood problems persist/worsen into adulthood
o Homotypic continuity: predictive of future same diagnostic
o Heterotypic continuity: predictive of future different diagnosis
Prevalence:
▪ Ex: anxiety to depression, ADHD to ODD
Prevalence of childhood disorders
About 30% of youth have a psychological disorder
- Externalizing problems: problems of undercontrol/behaviour
o ADHD, ODD, conduct disorder
- Internalizing problems: problems of overcontrol
o Anxiety disorders, selective mutism, reactive attachment disorder, depressive disorders, disruptive mood dysregulation disorder (newly added. Mood disorder that looks like a behavioural disorder)
ADHD issues
“Reversible”. Often diagnosis is lost in adulthood (boost of brain maturation). o Wait until 7 to diagnose officially. Sometimes they just catch up.
- Issues with overdiagnosis
o Need to make sure the conditions are otherwise ideal. Must be a persistent pattern
lasting for at least 6 months, inconsistent with the developmental level
o Recent study last year in Quebec. Children born at the end of the year (or whenever the
cutoff is) were diagnosed 7% more
o Prescription of stimulants: 3x higher in Quebec vs other provinces
prevalence of ADHD
Prevalence (going up recently):
o 2% among preschool-aged children o 6% among children/adolescents
o 4% among adults
Comorbidity with ADHD
Oppositional defiant disorder/conduct disorder (40-60%)
o Learning disorders (25%)
o Anxiety disorders (50%)
o Depressive and substance use disorders (in later years) (30 and 50% respectively)
DSM Criteria with ADHD
Symptoms are grouped into three categories: hyperactivity, inaction, impulsivity o Main presenting symptom determines the diagnosis:
▪ ADHD-I (inattention): more common in girls
▪ ADHD-H (hyperactive): more common in boys
▪ ADHD-HI (combined): more common in boys and younger children (can morph
into just inattention as they age)
ADHD Assessment
parents/teachers
o Self-report (adolescents and adults)
o Clinical interview: onset, history, degree of impairment, o Standardized tests:
▪ WISC (IQ test):
* Atypical dips in parts of the assessment. Working memory (timed parts)
are often affected by impulsivity.
▪ NEPSY (developmental NEuroPSYchological Assessment) ▪ TEA/TEAch (test of everyday attention)
* Measuring different kinds of attention. Should be low across the board. Not uniquely auditory, for example (auditory processing disorder?)
Genetic etiology for ADHD
Heritability at around 77% (one of the highest!) ▪ Diathesis-stress perspective
Prenatal and psychosocial risk factors for ADHD Etiology
Prenatal toxin exposure: poor diet, mercury, lead exposure
▪ Pregnancy and delivery complications
▪ Exposure to alcohol and maternal smoking
▪ Low socio-economic status, maternal mental health, foster care, etc. These
factors could also be related to genetics.
Brain structure ADHD Etiology
▪ Decreased brain size (3-8% reduction)
▪ Abnormalities in metabolism of dopamine and noradrenergic
neurotransmitters/genes regulating them
* Mesolimbic pathway underactivity. “Pleasure pathway”. Motivation.
Respond better to immediate reinforcement. ▪ Abnormalities of the prefrontal cortex
* Executive functions
▪ Abnormalities of the basal ganglia
* Motor control, learning, memory, cognition, emotional regulation
ADHD Pharmacological Intervention
Stimulant medication is effective for most children with ADHD
▪ Ritalin (methylphenidate), Dexedrine (dextroamphetamine), Adderall
(dextroamphetamine/levoamphetamine)
▪ Stimulates the dopamine system, and can also increase norepinephrine and
serotonin
▪ Decreases hyperactivity, restlessness, impulsivity, disruptive behaviour,
aggression, socially inappropriate behaviours
▪ Can be accompanied by insomnia, decreased appetite, stomachaches, dizziness
ADHD Psychoeduactional Interventions
Caregivers/teachers are educated about the symptoms, course of the disorder,
deficits associated with ADHD, and how to play to the child’s strengths
Parent training ADHD intervention
Teach behaviour modification/behaviour therapy principles to parents
▪ Focus on positive parent-child interactions/communication o Academic skill facilitation and remediation
▪ School-focused interventions o Other treatments (less helpful)
▪ Family therapy, CBT, individual psychotherapy, social skills training
DSM Criteria for ODD and Conduct Disorder
A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictivenessnThe disturbance in behaviour is associated with distress in the individual or others in
their immediate social context, or it impacts negatively on social, educational,
occupational, or other important areas of functioning A repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated; the presence of at least three of these criteria in the past 12 months from any of the categories, with at least one criterion present in the past 6 months.
prevalence of ODD and CD
Sex differences:
▪ CD: 3-4x more boys
▪ ODD: slightly more boys
o Assortive mating: women with CD are more likely to have partners with CD as well o Stats:
▪ Vary based on criteria
▪ ODD: 9-12% (3-6% in adolescence) ▪ CD: 1-10%
trajectory of CD and ODD
o 25% of boys with ODD will develop a CD
▪ Some researchers have argued that ODD is just an earlier expression of CD, but around half those with a CD didn’t have ODD. ODD and CD can be comorbid
o ODD may be linked to emotional disorders in adulthood (ex: depressive disorders)
▪ Due to discord in relationships with parents. Unhappy childhood.
▪ Especially those that are more on the irritable side of the profile
o CD may be linked to behavioural problems in adulthood (criminal offenses, difficulty
with responsibility)
o Common trajectory: ODD -> CD -> antisocial personality disorder
genetic etiology CD and ODD
Twin studies. Around 71% heredity for CD
* More aggression that is the heritable bit
▪ Strong link between CD and the family (also environment!)
