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1

Neurodevelopmental Disorders
- includes?

Affecting children and adolescents that involve impaired brain functioning or development; affect childs psych, cog, social, or emotional development
• Includes: Autism spectrum, intellectual disability, specific learning disorder, communication disorders, ADHD

2

Abnormal behavior in children (2)
- cultural study

• Determining abnormal behavior in children depends on what is normal for child for given age/culture; Because children rarely label their own behavior as abnormal definitions of normality depend on how child’s behavior is filtered thru cultural lens
• Study of American and Thai parents presented with vignettes depicting two children; one with prob of overcontrol and one with undercontrol; Thai parents rated both types of problems as less serious than Americans. Thai’s also rated the children as more likely to improve over time even without treatment – imbedded in Thai Buddhist beliefs that tolerate boad ranges of childrens behavior and assume change to be inevitable.

3

Prevalence of Disorders in Children and Adolescents:
1. Adolescents in last year
2. Adolescents currently suffering
3. Children with impairing disorders
4. Most common in children (2)
5. In adolescents
6. Treatment rates
- risk for being untreated

1. 4 out of 10 Adolescents (40%) have had diagnosis in last year
2. 1 in 4 (23%) presently affected
3. 1 in 10 suffer from mental disorder severe enough to impair development
4. In children 6 to 17, most common disorder is learning disorders (11.5%) and ADHD (8.8%)
5. anxiety disorders
6. Great majority do not get treatment; only about 1/3 of adolescents with mental disorder received treatment
- Children who have internalized problems like anxiety and depression are at higher risk of being untreated

4

Depression survey

found 7% of boys and 14% of girls ages 12-17 suffered from major depression in preceding 6 months

5

Risk factors for childhood disorders
- risk areas
- parents
- SES
- Gender

• Include genetics, enviro, and family
• Children of depressed parents also stand higher risk of getting disorder
• Ethnic minority children higher risk for problems like ADHD, anxiety, depression (reason unknown)
• Boys at greater risk for many disorders ranging from autism to hyperacticity to elimination disorders; also anxiety and depression
However, in adolescents anxiety and mood disorders become more common in girls

6

Childhood Abuse
- linked to? (6)
- effects
- prevalence
- In US
- Death rate

• Physical and sexual abuse linked to increase risk of: ADHD, anxiety, depression, sub abuse, PTSD, conduct disorder
effects include: low self-esteem, depression, immature behaviors (bed wetting, thumbsuching), suicide thinking, poor school performance, failure to venture beyond the home. These behaviors often lead into adulthood
• 8% of men and 20% of women had suffered sexual abuse before 18
• More than 1.5 million children in US are victims of child abuse or neglect
• Between 1,000 and 2,000 children in US die each year from abuse more than twice the rate of Great Britain, France, Canada, or Japan

7

Autism (1)
- Term
- thinking
- first diagnosis
- gender
- signs
- onset diagnosis

Chronic, life-long condition; placed in ASD
• Term first used in 1906 by Eugen Bleuler to refer to a weird style of thinking among ppl with schizo
• Autistic thinking is the tendency to view oneself as the center of the universe; believe that external events somehow refer to oneself
• 1943, Leo Kanner applied diagnosis of early infantile autism to a group of disturbed children who couldn’t relate to others, creating autistic aloneness
- 5 times as common in boys as girls
•Signs of disorder start at 12 to 18 months – often “good” babies; however as they develop they begin to reject physical affection; speech then falls behind. Signs of social detachment often being during first year (failure to look at ppl’s face)
• Disorder diagnosed reliably by age 2 or 3 but avg autistic child doesn’t get diagnosis until age 6
* Delays are bad; earlier the better

8

Autism Spectrum Disorder
- Clinicians diagnosis
- includes?

developmental disorder characterized by significant deficits in communication and social interaction, as well as development of restricted or fixated interests and repetitive behaviors
• Clinicians need to rate severity of ASD as severe, moderate, or mild
• Asperger’s disorder and childhood disintegrative disorder used in prev DSM to describe distinct spectrum disorders but now are classified as forms of ASD

9

Asperger's disorder

pattern of behavior involving social awkwardness and repetitive behaviors without significant language or cognitive deficits assoc with more sever forms of ASD. They don’t show deficits in intellectual, verbal and self-care. They may have remarkable verbal skills (read paper by 5) and develop an obsessive interest in narrow topics.

10

Childhood disintegrative disorder

significant loss (disintegration) of prev acquired skills in areas like understanding or using language, social or adaptive functioning, bowel or bladder control, play, motor skills. Rare and appears more in boys.

11

Autism Spectrum Disorder Prevalence
- overall (2)
- US
- cause of rise?
- concern?

• Rates rising over past 20 years
- more than 1 million total- affected by some form
• 2013 estimated 1 in 50 children (2%) in US
- not sure; one cause is couples are postponing having kids more than other generations (Autism linked in children with older fathers)—Still risk is low, only 2% for father’s 40+
- MMR vaccine (measles, mumps, rubella)

12

Autism features -3 core
- general (7)*
-weird language
- peculiar (4)
- IQ

1. Most distinct feature is child’s utter aloneness
2. Others are: deficits in social skills, language, and communication
3. ritualistic stereotyped behavior
4. One of primary features is repetitive, purposelsess, stereotyped movements—interminably twirling, flapping hand, rocking
5. Some children mutilate themselves, bang heads, slap face, bite hands, pull hair
6. Another feature is aversion to environmental changes—preservation of sameness- when fam objects moved even slightly children throw tantrums
7. lack a differentiated self-concept, sense of themselves as distinct individuals
-May be mute; if some language skills present may use peculiarly as in:
1. Echolalia—parroting back what the child has heard in high pitched monotone
2. Pronoun reversals (using you, or he instead of I)
3. Making up own language
4. Raising voice at end of sentences
• Nonverbal communication may also be impaired (avoid eye contact; absence of facial expressions)
• Some have norm IQ’s but many don’t

13

Theoretical Perspective of Autism
1.
2.
3. bio
4. bio-2
5. Overall, scientists believe?-2
6. Bio

1. Old belief that autistic child’s aloofness was reaction to parents who were cold and detached - don't know what causes it
2. O. Ivar Lovaas and colleagues offered a cognitive learning perspective on autism—suggest that they have perceptual probs that limit them to processing only one stimulus at a time; results in slow learning by means of classical conditioning. Normal children become attached to caregiver through assocs with primary reinforcers like food and hugging. Autistic children attend either to food or cuddling and don’t assoc with parent
3. Autistic children often have trouble integrating info from various senses; sometimes seem insensitive other times very. Perceptual and cog deficits seem to diminish their capacity to make use of info—to comprehend and apply social rules
4. Prenatal influence on abnormal brain circuit and structural damage involving loss of brain tissue. Evidence links greater risk of ASDs to prenatal risk factors like flu or prolonged fevers in mother maybe affecting fetus’s brain
5. brain of child with autism develops abnormally due to combo of genes and enviro (toxins/virus)-discovered mutations on three genes linked to autism
6. parts of brain in charge of language and social behavior grow slower

14

Treatment for autism
1.
2. a type
3. study
4. infant treatment
5. drugs
6. success

• Early intensive behavioral programs that apply learning principles in child’s environment can improve learning and language skills--The earler the treatment is started (before age 5) and the more intense the better results
• Applied behavior analysis (ABA) learning based model- no other has had comparable results; uses operant conditioning where parents and therapists engage in the painstaking work, systematically using rewards and punishments to increase child’s ability to attend to others, play with others, develop academic skills, and reduce or eliminate self-mutilation
• O. Ivar Lovaas study: showed impressive gains in autistic children who go more than 40 hours of treatment for each week for two years
-benefit from early training focusing on imitation skills
- antipsych drugs to control disruptive behavior but work better when combined with learning treatment
• Small subset who appear to overcome disorder

15

Intellectual Disability
- Prevalence
- onset/course
- diagnostic criteria
- diagnostic types
- most common type

(formerly called MR) generalized delay or impairment in development of intellectual and adaptive abilities; lack basic conceptual, social, and practical skills of daily living. Children tend to have deficits in reasoning and problem solving, abstract thinking, judgment, school performance
- 1%
- before 18; lifelong course however many improve over time
- basis of low IQ score and impaired adaptive functioning resulting in impairment in meeting expected standards of independent functioning and social responsibility. Impairments involve difficulty preforming common tasks of daily life in three domains:
1. Conceptual (skills relating to use of language, reading, writing, math)
2. Social (skills relating to awareness of other peoples experiences, communicate with others, form friendships)
3. Practical (ability to meet personal care need, fulfill job responsibilities, manage money)
- based on severity; Level of severity is based on child’s adaptive functioning
• Most with ID (85%) fall into mild range—able to meet basic academics like reading simple passages; as adults they are capable of independent functioning

16

Causes of ID (2)
1. (4)
2.(1)

• Include bio and psychosocial factors
• Biological causes: chromosomal and genetic disorders, infectious diseases, and maternal alcohol use.
• Psychosocial causes: exposure to impoverished home environment with lack of intellectually stimulating activities

17

Chromosomal Abnormalities

Down syndrome, Klinefelter’s syndrome, Turner’s syndrome

18

Down syndrome
- prevalence
- cause
- increased risk
- features
- other problems
- disabilities

• Most frequent ID; condition cause by extra chromo on 21st pair (resulting in 47 chromos rather than 46) and characterized by intellectual developmental disorder and physical abnormalities
• Occurs in 1 in 800 births
• Happens when 21st pair in either egg or sperm fails to divide normally resulting in extra chromo
• Expectant couples in mid 30’s; Down syndrome can be traced to mother’s egg in about 90% of cases
- Round broad face, flat nose, small downward sloping folds of skin at inside corners of eyes—gives impression of slanted eyes. A protruding tongue, small arms, curved fifth finger
- many suffer from physical probs like malformations of heart and respiratory difficulties; almost all have ID; LE is 49
- Tend to be uncoordinated, lack muscle tone, suffer memory deficits especially verbal info presented; Despite disabilities most can learn to read, write, and perform simple math

19

Klinefelter's syndrome
- cause
- prevalence
- features

• Abnormalities on sex chromos which can result in an ID
Occurs only in males – presence of extra X chromo resulting in an XXY pattern
• Only 2 per 1,000 male births
• These men fail to get secondary sex charactersitics resulting in breasts, small testes, low sperm, and infertility.
• Often don’t know they have it until tested for fertililiy

20

Turner's syndrome
- cause
- features

• Occurs only in females
• Presence of single X instead of normal two
• Develop normal external genitals but ovaries are poorly developed producing reduced amounts of estrogen
• As woman they are infertile, have endocrine and CV probs
• Show mild ID in math and science skills especially

21

Genetic abnormalities

Fragile X, Phenylketonuria (PKU)

22

Fragile X syndrome
- prevalence
- cause
- features

Most common genetic cause; affects 1 of 1,000 to 1,500 males and 1 of 2,000 to 2,500 females
Second common form of ID after down syndrome
• Caused by mutation on single gene in area of X chromo that appears fragile
• range from mild learning disorders to ID so profound that they can hardly speak or function
• Females normally have two X chromos; males one. Females two X’s provide protection against disorder if defective gene turns up –which only leads to mild disability
• Many males and females carry the fragile X mutation without showing any signs

23

Phenylketonuria (PKU)
- prevalence
- cause
- treatment

•Occurs in 1 in 10,000 to 15,000 births
• Caused by recessive gene that prevents child from metabolizing the amino acid phenylalanine which is found in many foods. Results in it accumulating along with phenyplpyruvic acid in body causing damage to CNS leading to intellectual disabilities
• PKU can be found in newborns with testing urine and blood
• No cure but can be placed on special diet to suffer less damage; receive protein supplements to give nutrition

24

Prenatal tests - 2

• Today there are many prenatal tests that can detect chromo and genetic disorders
• Amniocentesis is conducted 14 to 15 weeks following conception where small sample of amniotic fluid is drawn

25

Prenatal factors in ID -5

1. Some cases of ID caused by maternal infections like: Rubella, syphilis, cytomegalovirus, genital herpes but Immunizations in women before pregnancy have reduced risk of transmission
2. Fetal alcohol syndrome is one of the most prominent causes of ID
3. Birth complications (oxygen depreivation) place children at risk of ID; Prematurity also increases
4. Brain infections (encephalitis, meningitis) can result in ID
5. Toxins like paint chips can cause it also

26

Cultural/familial causes of ID - 6

• Most cases of ID fall in the mild range of severity and have no apparent biological cause or distinguishing feature
• These cases are cultural-familial roots like impoverished homes or social enviro lacking stimulating activities
• Lack of toys, books, economic burden of parent being away at work, all lead to underdevelopment of language skills and motivation to learn
• Vicious cycle of poverty and impoverished intellectual development repeated from generation to generation (ID parent=ID child)
• Children with family form of ID may respond dramatically when given chance to learn
• Head start social program has helped many function in normal range

27

Interventions for ID
- Prognosis (2)
- controversy
- revolutionary
- population of institutions
- Emotions in ID

• With training, children with mild forms of ID may reach six grade level of competence. Other extreme cases placed in residential care – often based on need to control aggressive behavior not bc of severity of ID
• Disagreement over whether ID children should be mainstreamed into reg classes—some improve others don’t
•Trend towards deinstitutionalization of ppl with more severe ID motivated by public outrage over appalling conditions that formaly existed in many institutions Developmentally disabled assistance and bill of rights act, passed in 1975 gave ppl with ID the right to receive approp treatment in least restrictive treatment setting
• Nationwide the pop of insituions for ppl with ID shrank by 2/3’s in years following bill
• Those with ID stand high risk of developing other psych disorders like depression and anxiety. Emotional life of ppl with ID received lil attention—many assume that ppl with ID are somehow immune to these probs or lack verbal skills for therapy. However evidence shows that they can benfit from psych treatment


28

Treatments for ID (2)

• Psych counseling with behavioral techs help them acquire skills in personal hygiene, work , social relationships
• Structural behavioral approaches used to teach those with more severe ID to master basic hygiene like tooth brushing, dressing, hair combing

29

Learning Disorders
- types

deficiency in a specific learning ability in context of normal intelligence and exposure to learning opportunities; Typically chronic disorders that affect into adulthood
Children with this often viewed as failures; often have other probs like low self-esteem and high risk of developing ADHD
- Specific learning disorder
also problems with reading, writing, math, and executive functions

30

Specific learning disorder
- prevalence
- onset
- diagnosis
- deficits

− DSM single diagnosis to encompass various LD’s involving deficits in skills of reading, writing, arithmetic and executive functions.
- 5 to 15% school aged children
− Deficits emerge during grade school years but may not be recognized until academic demands exceed the individuals abilities
− Diagnosis also requires that learning deficits cannot be better explained by a generalized delay in intellectual development (ID) of by underlying neuro med conditions.
− Commonly combo of specific deficits in academic, social, and occupational functioning