Download Neurodevelopmental Disorders

Neurodevelopmental Disorders
I. General Overview
A. Prevalence
About 25% of adolescents have a diagnosable mental disorder at any given
time and 10% of children suffer from a mental disorder severe enough to
impair development.
The most commonly diagnosed psychological disorders in children age 6 to
17 are learning disabilities (12%) and attention-deficit hyperactivity disorder
(9%).
B. Risk Factors
C. Cultural Factors
II. Tourette’s Disorder: a neurological condition
producing a chronic combination of motor tics
and vocal tics.
A. Tic: a rapid, recurring involuntary movement or vocalization.
B. Some Common Motor Tics…
1) Eye blinking
2) Clearing the throat
3) Head twitching or shaking
4) Flailing one’s arms about
5) Copropraxia: involuntarily performing obscene or
forbidden gestures.
6) Echopraxia: the involuntary repetition or imitation of the
observed movements of another.
C. Some Common Vocal Tics…
1) Coprolalia: involuntary swearing or the involuntary
utterance of obscene words or socially inappropriate and
derogatory remarks.
2) Echolalia: the automatic repetition of vocalizations made
by another person.
3) Palilalia: the repetition or echoing of one's own spoken
words.
4) Screaming / Yelling / Grunting
5) Other random bizarre noises
D. Description of tics from the perspective of those with the
condition
E. Comorbidity
F. Demographics
It’s found all over the world among people of all ethnic / racial backgrounds.
It is 3 to 4 more times likely to show up in males.
The onset of symptoms is usually between the ages of 7-11 (middle
childhood).
It occurs in less than 1% of the population.
G. Genetic Causes
H. Treatment
1) Psychotherapy
2) Drug Therapy
III. Autism Spectrum Disorder: a disorder
marked by extreme unresponsiveness to other
people, severe communication deficits, and
highly rigid and repetitive behaviors, interests,
and activities.
A. Key Features
People with ASD are diagnosed along this spectrum as being severe,
moderate, or mild.
One key feature of moderate to severe ASD is the child’s aloneness.
Other features of moderate to severe ASD include cognitive deficits that lead
to language and communication problems.
People with moderate to severe ASD also can engage in limited symbolic
and imaginative play and have trouble thinking abstractly.
They have very repetitive and rigid behavior. This has been called a
“perseveration of sameness”.
The motor movements of people with this disorder may be unusual.
The intellectual abilities, as assessed using standardized tests like an IQ test,
of those who are autistic can vary widely, just as with people without ASD.
Therefore, it is not considered an intellectual disability.
B. Asperger’s Syndrome: characterized by significant
difficulties in social interaction and nonverbal communication,
along with restricted and repetitive patterns of behavior and
interests. It differs from other autism spectrum disorders by its
relative preservation of linguistic and cognitive development and
functioning.
C. Prevalence
Symptoms appear early in life, before age 3.
Around 80% of all cases appear in boys.
Researchers estimate that 1% - 2% of children in the U.S. are affected by
some form of Autism Spectrum Disorder.
D. General Causes
The specific cause is still unknown.
Researchers have consistently failed to find links between autism and use of
childhood vaccines.
1) Abnormal brain circuitry among neural networks.
2) Structural abnormalities in cerebellum.
3) Multiple genetic factors are likely involved.
E. Treatment
1) Applied Behavior Analysis: using operant conditioning
methods, therapists and parents systematically use rewards
and mild punishments to increase the child’s ability to attend
to others, to play with other children, to develop academic
skills, engage in self-care, and to eliminate self-harming
behavior.
The most widely used behavioral treatment programs are highly intensive
and structured, offering a great deal of individual, one-to-one instruction.
People with ASD are often taught other forms of communication,
including sign language and communication systems, such as
“communication boards” or computers that use pictures, symbols, or
written words, to represent objects or needs.
F. Savant Syndrome: a condition in which a person
demonstrates profound abilities that far exceed what normal
people are capable of doing.
About 50% of savants are autistic. The other 50% often have some form of
central nervous system injury or disease.
Savant skills are usually found in the areas of memory, art, musical abilities,
calendar calculation, mathematics, and spatial skills.
IV. Intellectual Disability: a generalized delay
or impairment in the development of intellectual
and adaptive abilities (a.k.a. Intellectual
Developmental Disorder “IDD”).
IDD affects 1% – 2% of the population and is roughly two times more likely to
develop in males than females.
Symptoms must appear before age 18.
IDD is present when there are notable deficits in one or more of the following
domains...
1) Conceptual/Academic: abilities in math, language,
reading, problem solving, memory, etc.
2) Social: awareness of others, communication, acquiring
and maintaining friends.
3) Practical: self-care, maintain job, manage money,
complete schoolwork, etc.
The severity of IDD ranges from mild (roughly 85% of all cases) to profound.
A. Down Syndrome: a condition caused by the presence of an
extra chromosome on the 21st pair and characterized by
intellectual disability and various physical anomalies.
Fewer than 1 of every 1000 live births result in Down Syndrome, but this rate
increases greatly when the mother’s age is over 35.
They have trouble with following instructions and remembering, especially
information that is presented verbally.
The life expectancy is under 50 years of age.
B. Fragile X Syndrome: an inherited form of intellectual
disability caused by a mutated gene on the X chromosome.
This affects 1 out of 1,000 to 1,500 males and 1 out of 2,000 to 2,500
females.
This IDD disorder can range from mild to profound in severity.
C. Fetal Alcohol Syndrome: occurs when pregnant mothers
drink heavily, although even moderate drinking can negatively
affect the brain.
Affects as many as 1 in 700 children.
These kids usually have unusually small heads and distorted facial features.
There are always brain abnormalities.
D. Hydrocephalus: occurs from the accumulation of an
abnormally large amount of cerebrospinal fluid under the skull.
Normally, cerebrospinal fluid flows continually from the ventricles in the brain
to the thin space that surrounds the brain and spinal cord. Eventually, it exits
through the blood stream and is replaced by new cerebrospinal fluid.
For some children, there is a blockage which leads to a buildup.
In congenital cases, the skull is already enlarged at birth or begins to enlarge
soon thereafter.
This condition affects about one in every 1000 births.
E. Intellectual Disability Causes Occurring After Birth
After birth, particularly up to age 6, certain injuries and accidents can affect
intellectual functioning.
Examples include poisoning, serious head injury, excessive exposure to xrays, and excessive use of certain chemicals, minerals, and/or drugs (e.g.,
lead paint).
Certain infections, such as meningitis and encephalitis, can lead to IDD if
they are not diagnosed and treated in time.
F. Intervention
The services that children with intellectual disability need depend on the
level of severity and type of intellectual disability.
People with intellectual disability who are capable of functioning in the
community have the right to receive less-restrictive care than is provided in
large institutions.
V. Learning Disorders: a deficiency in a
specific learning ability in the context of normal
intelligence and typical exposure to learning
opportunities.
Learning disorders are typically chronic disorders that affect development
well into adulthood.
Children with learning disorders tend to perform poorly in school.
A. Problems with Reading (often referred to as Dyslexia):
characterizes children who have poorly developed skills in
recognizing words and comprehending written text.
Among children diagnosed with a learning disorder, 80% have Dyslexia.
Dyslexia is estimated to affect about 4% of school-age children and is much
more common in boys than in girls.
It is often inherited.
B. Problems with Writing: refers to children with grossly
deficient writing skills.
The deficiency may be characterized by errors in spelling, grammar, or
punctuation, or by difficulty in composing sentences and paragraphs.
C. Problems with Arithmetic and Mathematic Reasoning
Skills: refers to children with problems in understanding basic
mathematical terms or operations, such as addition or
subtraction; decoding mathematical symbols (+, =, etc.); or
learning multiplication tables.
D. Problems with Executive Functions: refers to children with
problems in organizing, planning, and coordinating tasks
needed to manage and complete assignments.
VI. Attention-Deficit Hyperactivity Disorder
(ADHD): characterized by persistent inattention
and distractibility, impulsivity, low tolerance for
frustration, and inappropriate overactivity.
A. Hyperactivity: an abnormal behavior pattern characterized
by difficulty in maintaining attention and extreme restlessness.
B. The ADHD Subtypes
1) a predominantly inattentive type
2) a predominantly hyperactive or impulsive type
3) a combination type characterized by high levels of
both inattention and hyperactivity–impulsivity
ADHD affects about 9% of school-age children, as many as 70% of them boys.
Between 35% and 60% continue to have ADHD as adults (about 4% of the
general U.S. adult population).
C. Theoretical Perspectives
1) Biological Perspectives
We know that ADHD tends to run in families. It has an 35-40% heritability
rate if one parent has the disorder and a 75% - 80% concordance rate
among identical twins.
Rapidly accumulating evidence from brain-imaging studies of children
with ADHD shows dysfunctions in parts of the brain, especially the
prefrontal cortex, that regulate attention and impulsive behavior.
2) The Sociocultural Perspective
3) The Evolutionary Perspective
D. Treatment
1) Drug Therapy
Stimulants, such as Ritalin, have often been prescribed.
2) Psychotherapy
Cognitive-Behavioral Therapy has proven successful in teaching
children with ADHD methods for recognizing and resisting their
impulsive urges.
VII. Conduct Disorder (CD): a repetitive,
persistent pattern of aggressive, antisocial
behavior violating societal norms or the rights of
others.
Conduct Disorder usually begins between 7 and 15 years of age.
About 10% of children are diagnosed with Conduct Disorder (twice as
common among boys).
Children with a mild conduct disorder may improve over time, but severe
cases frequently continue into adulthood and develop into Antisocial
Personality Disorder.
VIII. Oppositional Defiant Disorder (ODD): a
pattern of behavior marked by negativity,
hostility, and defiance toward authority figures
such as teachers and parents.
As many as 10% of children qualify for this diagnosis.
The disorder is more common in boys than girls before puberty, but equal in
both sexes after puberty.
A. Theoretical Perspectives: CD and ODD
Some theorists believe that the opposition to authority in Oppositional Defiant
Disorder is an expression of an underlying temperament described as the
“difficult-child” type.
Many cases of Conduct Disorder have been linked to genetic and biological
factors, drug abuse, poverty, traumatic events, and exposure to violent peers
or community violence.
Both disorders have often been tied to troubled parent-child relationships,
inadequate parenting, family conflict, marital conflict, and family hostility.
B. Treatment: CD and ODD
Treatment provides strategies for parents to develop more consistent
discipline strategies, to use positive reinforcement, and to increase the
frequency of positive interactions between the parent and the child.
More aggressive interventions are used when necessary such as being
placed in residential treatment programs that establish explicit rules with clear
rewards and mild punishments.
IX. Childhood Anxiety and Depression
A. Separation Anxiety Disorder: a condition involving
excessive, prolonged anxiety concerning separation from
home or from people to whom a child is attached.
Separation anxiety disorder is displayed by about 7% of all children.
Separation anxiety disorder may further take the form of a school phobia or
school refusal.
B. Childhood Depression: characterized by such symptoms as
a sense of friendlessness, inability to have fun or concentrate,
fatigue, irritability, apathy, feelings of worthlessness, weight
change, physical complaints, and thoughts of death or suicide.
C. Play Therapy: a therapeutic approach in which a child plays
freely while a therapist observes and occasionally comments,
asks questions, or makes suggestions.