ch. 13

Question 1

Nature of Developmental Psychopathology: An Overview

Answer 1

Normal vs. abnormal development
Consider age and environment of child
Developmental psychopathology
Study of how disorders arise and change with time
Disruption of early skills can affect later development

Question 2

Neurodevelopmental Disorders

Answer 2

Diagnosed first in infancy, childhood, or adolescence
Include the following:
Attention deficit hyperactivity disorder (ADHD)
Specific learning disorder
Autism spectrum disorder
Intellectual Disability
Communication and Motor Disorders

Question 3

Communication and Motor disorders

Answer 3

Childhood Onset Fluency Disorder
Speech difficulty that may include repeated syllabus (stuttering), pauses or substituting words that are easier to pronounce

Language Disorder
Limited speech in all situations; understanding of speech is normal and problem may self-correct

Social (Pragmatic) Communication Disorder
Difficulty with social aspects of communication (e.g., dominating conversations, switching topics excessively), but lacks other features of autism spectrum disorder (e.g., restrictive behaviors and interests)

Tourette’s Disorder
Involuntary motor movements and/or vocalizations, which may include obscenities

Question 4

Nature of ADHD

Answer 4

Central features – inattention, overactivity, and impulsivity
Associated with numerous impairments
Behavioral
Cognitive
Social and academic problems

Question 5

DSM-5 symptom types

ADHD

Answer 5

Predominantly inattentive presentation
Predominantly hyperactive/impulsive presentation
Combined presentation

Question 6

ADHD: Facts and Statistics

Answer 6

Prevalence
Occurs in approximately 5% of school-aged children
Symptoms are usually present around age three or four
Children with ADHD have similar problems as adults
Gender differences: Boys outnumber girls 3:1
Cultural factors
ADHD most commonly diagnosed in the United States, although prevalence appears fairly constant worldwide

Question 7

The Causes of ADHD: Biological Contributions

Answer 7

Genetic contributions
ADHD seems to run in families
DAT1 – dopamine transporter gene has been implicated
Some ADHD drugs work by inhibiting DAT1

Neurobiological correlates of ADHD
Smaller brain volume
Inactivity of the frontal cortex and basal ganglia
Abnormal frontal lobe development and functioning

The role of toxins
Food additives (e.g., dyes, pesticides) may play very small role in hyperactive/impulsive behavior among children
Maternal smoking increases risk

Question 8

The Causes of ADHD: Psychosocial Contributions

Answer 8

Psychosocial factors
ADHD children are often viewed negatively by others > Frequent negative feedback from peers and adults
Peer rejection and resulting social isolation
Such factors foster low self-esteem

Question 9

Biological Treatment of ADHD

Answer 9

Goal of biological treatments
To reduce impulsivity and hyperactivity and to improve attention

Stimulant medications
Currently prescribed for approximately 4 million American children
Low doses of stimulants improve focusing abilities
Examples include Ritalin, Dexedrine, Adderall
Problem: May increase risk for later substance abuse

Other medications with more limited efficacy
Imipramine and clonidine (antihypertensive)
Genes affect individuals’ response to meds
Some trial and error is necessary
Effects of medications
Improve compliance, decrease negative behaviors
Do not affect learning/academics directly
Benefits are not lasting following discontinuation

Question 10

Behavioral and Combined Treatment of ADHD

Answer 10

Behavioral treatment
Reinforcement programs 
To increase appropriate behaviors
Decrease inappropriate behaviors
May also involve parent training
Combined bio-psycho-social treatments
Often recommended
May be superior to medication or behavioral treatments alone, but more research is needed

Question 11

Specific Learning Disorders: An Overview

Answer 11

Scope of learning disorders
Academic problems in reading, mathematics, and/or writing
Performance substantially below expected levels based on age and/or demonstrated capacity
Problems persist for 6+ months despite targeted intervention

Question 12

Specific Learning Disorder: Types

Answer 12

With impairment in reading, may include:
Word reading accuracy
Reading rate or fluency
Reading comprehension

With impairment in written expression, may include:
Spelling accuracy
Grammar punctuation and accuracy
Clarity/organization of written expression

With impairment in mathematics, may include:
Number sense
Memorization of arithmetic facts
Accurate or fluent calculation
Accurate math reasoning

Question 13

Specific Learning Disorder: Statistics

Answer 13

Prevalence of learning disorders
Six million children have been diagnosed in the United States
Highest rate of diagnosis in wealthier regions, but children with low SES more likely to have difficulties
Reading difficulties most common, affect 4-10% of the general population
School experience tends to be generally negative

Question 14

Biological and Psychosocial Causes of Specific Learning Disorder

Answer 14

Genetic and neurobiological contributions
Learning disorders run in families, but specific difficulties are not inherited
Evidence for subtle neurological difficulties is mounting (e.g., decreased functioning of areas responsible for word recognition)
Overall, contributions are unclear
Psychosocial contributions are likely important

Question 15

Treatment of Specific Learning Disorder

Answer 15

Requires intense educational interventions
Remediation of basic processing problems
Improvement of cognitive skills
Targeting skills to compensate for problem areas
Data support behavioral educational interventions

Question 16

Autism Spectrum Disorder

Answer 16

Problems occur in language, socialization, and cognition
Pervasive – problems span many life areas
Two main areas of impairment:
Communication and social interaction
25% don’t acquire effective speech
Restricted, repetitive patterns of behavior, interests, or activities
Need to maintain “sameness” - high level of consistency in activities or experience
Label is new to DSM-5
Encompasses several disorders previously classified as “pervasive developmental disorders”,
Including:
Autistic disorder
Asperger’s disorder
Childhood disintegrative disorder
Rett syndrome

Question 17

Autism Spectrum Disorder: Prevalence

Answer 17

1 in 50 school-aged children meet criteria
More commonly diagnosed in males
IQ interaction
38% show intellectual disabilities
Occurs worldwide

Question 18

Psychological and Social Dimensions Autism

Answer 18

Historical views 
Failed parenting
Perfectionistic, cold, and aloof
High socioeconomic status
Higher IQs
Lack of self-awareness
Behavioral correlates
Echolalia (immediate, delayed, mitigated)
Self-injury

Question 19

Biological Dimensions Autism

Answer 19

Significant genetic component
Familial component: If have one child with autism, the chance of having a second child with autism is 20% (100x greater risk than general population)
Numerous genes on several chromosomes involved
Oxytocin receptor genes
Bonding and social memory
Older parents associated with increased risk

Neurobiological influences
Amygdala
Larger size at birth = higher anxiety, fear
Elevated cortisol
Neuronal damage in the amygdala results from high stress, which may affect processing of social situations
Oxytocin
Lower levels

Question 20

Causes of Autism Spectrum Disorder : Biological

Answer 20

Neurobiological influences
Vaccinations do NOT increase the risk of autism
Mercury in some vaccinations was rumored to increase autism risk
Large scale studies do NOT support this
High rates of vaccinations do NOT increase risk for autism in the community at large
Health risk of not vaccinating is substantial

Question 21

Treatment of Autism Spectrum Disorder

Answer 21

Psychosocial  treatments
Behavioral approaches
Skill building
Reduce problem behaviors
Communication and language training
Increase socialization
Naturalistic teaching strategies
Early intervention is critical – may “normalize” the functioning of the developing brain

Biological treatments
Medical intervention has had little positive impact on core dysfunction
Some drugs decrease agitation 
Tranquilizers 
SSRIs
Indicators of good prognosis
High IQ, good language ability

Integrated treatments
Preferred model: Multidimensional, comprehensive focus
Children offered special education at school focusing on communication
Judicious use of medication in some cases
Families given support too
When older, focus on integrating into the community while maximizing independence

Question 22

Intellectual Disability

Answer 22

Overview
Below-average intellectual and adaptive functioning
First evident in childhood
Range of impairment varies greatly
Previously called mental retardation

IQ typically below 70-75
Previously distinguished different levels of severity; IQ may be as low as under 20
Previously diagnosed on DSM-IV Axis II
Reserved for conditions that 1) are chronic and pervasive and 2) are likely to influence the presentation of other mental disorders

DSM-5 identifies difficulties in three domains
Conceptual (e.g., skill deficits in areas such as language, reasoning, knowledge, and memory)
Social (e.g., problems with social judgment and the ability to make and retain friendships)
Practical (e.g., difficulties managing personal care or job responsibilities)
Devalued by society

Question 23

Other Classification Systems for Intellectual Disability

Answer 23

American Association of Intellectual and Developmental Disabilities (AAIDD)
Based on assistance required
Intermittent
Limited
Extensive
Pervasive
Keeps the emphasis on what assistance is needed

Question 24

Intellectual Disability: Statistics

Answer 24

Prevalence = 2% of general population
9 in 10 people with ID have mild impairment (IQ 50-70)
Chronic course
Highly variable individual prognosis
Independence is possible for many individuals with mild impairment when provided with appropriate resources (e.g., skills training)

Question 25

Causes of Intellectual Disability

Answer 25

``` Hundreds of known causes Environmental (e.g., neglect) Prenatal Perinatal (e.g., problems with delivery) Postnatal ``` ``` Examples Fetal alcohol syndrome Exposure to other illness in the womb Lack of oxygen (anoxia) during birth Malnutrition Head injuries Childhood abuse ``` Genetic influences Chromosomal disorders (e.g., Down Syndrome) Multiple genetic mutations Single genes can be responsible Dominant genes less often responsible for ID (because people with ID are less likely to have children) Recessive genes more often responsible Most cases of ID have no identified etiology Genetic influences De novo disorders Lesch-Nyham syndrome Intellectual disability, symptoms of cerebral palsy, self-injurious behavior Recessive allele on the X chromosome > only affects males (females have an additional X chromosome to balance)

Question 26

Phenylketonuria (PKU)

Answer 26

Cannot break down phenylalanine, which is found in some foods Results in ID when the individual eats phenylalanine Now, test at birth can detect PKU > diets without phenylalanine actually prevent development of intellectual disability and other problems

Question 27

Chromosomal influences

Answer 27

Down syndrome Most common chromosomal cause of intellectual disability Extra 21st chromosome (Trisomy 21) Distinctive physical symptoms

Question 28

Down syndrome

Answer 28

Higher risk with advanced maternal age Detectable with some prenatal tests Amniocentesis Chorionic villus sampling (CVS) Mother’s blood tests Tests do not indicate severity of impairment 1 in 4 mothers elects to terminate the pregnancy

Question 29

Fragile X syndrome

Answer 29

``` Symptoms Learning disabilities Hyperactivity Short attention spans Gaze avoidance Perseverative speech Gender differences Primarily affects males Women with Fragile X have mild symptoms ```

Question 30

Cultural-familial intellectual disability

Answer 30

Refers to intellectual disability influenced by social environmental factors, such as: Abuse Neglect Social deprivation These factors likely interact with existing biological factors

Question 31

Treatment of Intellectual Disability

Answer 31

Severe ID: Treatment similar to that for autism spectrum disorder Mild ID: Treatment similar to that for learning disorders Goals are similar across severity; level of assistance differs Behavioral interventions teach: Basic skills (e.g., dressing, hygiene) Social skills Practical skills (e.g., paying bills)

Question 32

Common goals | Treatment of Intellectual Disability

Answer 32

Participate in community life Benefit from education hold a job or other productive pursuits (e.g., volunteering) Build meaningful relationships