Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Disorders First Apparent in Childhood Why “first apparent”? May continue into adulthood May lead to other adult disorders May impact development Disorders 1. 2. 3. 4. 5. Attention Deficit Hyperactivity Disorder Learning Disorders Autism & Asperger’s Disorder Mental Retardation (Axis II) Conduct Disorder & Oppositional Defiant Disorder Symptoms of Inattention Inattention: lack of focus on detail & careless mistakes difficulty with sustained attn not listening when spoken to fails to follow through on tasks organizational problems dislikes sustained effort easily distracted forgetful in daily activities Symptoms of Hyperactivity Hyperactivity/Impulsivity Fidgets or squirms in seat Leaves seat when it is inappropriate Runs or climbs excessively Difficulty playing quietly Is often “on the go” or acts as if “driven by a motor” Talks excessively Blurts out answers before questions are finished Difficulty waiting for his/her turn Disrupts or interrupts others ADHD Symptoms are usually evident before schoolage, but more relevant in that setting Require more than one setting 6% of school-age children (drops with age) Associated Problems Significant social impairments Academic problems Comorbidities with ADHD mood disorders learning disorders substance use APD neurological problems physical accidents and injury What Happens When they Grow Up? Impulsivity decreases, inattention does not Accidents, etc Adults may self-select environments that result in less noticeable symptoms 68% have attention problems in adulthood Only 30% of children retain the diagnosis in adolescence, and 10% in young adulthood 25% do not finish school 1/5 develop APD w/ high levels of crime What Causes ADHD? Large genetic component Subtle brain differences Smaller brain volume Association with maternal smoking 2-3 times more likely What Causes ADHD? Higher rates of family general psychopathology Inability to inhibit behavior Executive functioning deficit (goals, planning) What Causes ADHD? Is the real problem our regimented modern classrooms? Decreased time for active play Change in environment penalizes students who would be normal under different circumstances Little evidence of brain abnormalities ADHD looks like extreme playfulness Function well outside the classroom (no control) Does Diet Affect ADHD? Some argue that dietary additives affect/cause ADHD (e.g., food coloring) Parents place children on special diets Evidence indicates that NO, diet is not responsible for ADHD How do we treat ADHD? Stimulant medications Increase arousal and help focus attention Short half-life Stimulants do affect growth hormones and can suppress appetite Many children take only during school hours Drug “holidays” are recommended Use the lowest therapeutic dose Multiple Approach to ADHD School Home Child How do we treat ADHD? Behavioral Therapy for Children Improve socialization skills Reinforce and reward improved behavior until the environment is rewarding alone Main techniques Progressive muscle relaxation Contingency plans Cognitive therapy to increase awareness How do we treat ADHD? Behavioral Therapy for Parents Parents are trained in behavior management, contingency management Reduce family stress Psychoeducation can reduce family blame Best treatment is meds + therapy Meds are often necessary for severe cases Sample Changes Home Reward plans Shorter lists of tasks Timers Reorganization of living space School Seating plans Folders for parents Reduced distractions for exams Shortened HW assignments Learning Disorders Deficits in reading, math, or written expression Child’s achievement level is below what would be predicted based upon their ability level Learning Disorders Diagnosis based on comparison of those tests, in those specific domains only 5% of American students have a learning disorder Reading is most common Consequences of Learning Disorders Many drop out of school (32%) Low employment rates (60-70%) Self-esteem problems Causes of Learning Disorders Genetic basis Almost 100% concordance between identical twins Neurological differences E.g., in sound recognition Treating Learning Disorders 1. Remediate processing of problems 2. Improve cognitive skills 3. Listening, comprehension, memory Target behavioral skills to compensate Visual and auditory perception skills Extended time for tasks Early diagnosis = better prognosis Pervasive Developmental Disorders: Autism Disruptions in social interaction Impaired communication skills Restricted behavior, interests and activities Disruptions in social interaction Lack of joint attention Lack of interaction with parents or other children Lack of attention to social cues Supported by eye tracking research Impaired communication skills 50% of patients do not acquire useful speech Unusual communication Echolalia (repeating of words/phrases) Inability to understand irony, sarcasm, pretend play Restricted behavior, interests and activities Restricted, repetitive, stereotyped behavior, interests, activities Abnormal in intensity/focus E.g. dates, phone numbers Lining up objects Inflexible patterns, routines, rituals Preoccupation with parts of interest Symptoms of Autism Apparent by age 3 20% report normal 1-2 years of development, followed by regression or lack of milestones Associated Features and Disorders Hyperactivity, short attention span, impulsivity, aggressiveness Self-injurious behavior & temper tantrums Odd responses to sensory stimuli (e.g. high threshold for pain, sensitive to sound, touch, light) Abnormal affect or fear reaction Asperger’s Disorder Mild autism No significant delays in early language Other language may be “odd” and preoccupied with certain topics No delay in cognition or self-help skills, adaptive behavior, curiosity about environment Little concern in infancy, may seem precocious Usually noticed after entrance to school Prevalence & Course of Autism 1 in every 166 births 4:1 boys to girls Some improve at school Some improve during adolescence, but others deteriorate IQ & functional language predictors of prognosis Causes of Autism: Genetic Contributions 1. 2. 3. Strongest genetic component Early studies thought not genetic But, hard to study: 1 in 240,000 possible twin studies (1000 in US) Autistic adults unlikely to have children Autistic children have less siblings Twin Studies Solve the Mystery: Heritability index = .90 (risk) Genetically heterogeneous Unable to isolate genes Some evidence for viral infections during pregnancy Causes of Autism Few think psychological or social influences play a role in the onset Psychologists (and other professionals) can assist with management of disorder Behavioral Treatments for Autism Decrease undesirable behavior & shape desirable Positive reinforcement & extinction Social punishment Families are important Language + social skills = improved prognosis Alternative Treatments for Autism Vitamins Other medications Diet Auditory Integration Training Facilitated Communication What are “Alternative” Treatments? Scientifically unverified Randomized control studies Replication Large samples What’s so bad about alternative treatments? They give parents false hope They can violate patient rights Can allow others to control decisions “made by” patients In some cases, have led to abuse allegations Facilitated Communication Provide assistance for communicating Alphabet board, computer, typewriter, etc Support hand/arm May isolate fingers Requires extensive training Claims: Produces (“frees”) unexpected literacy Shows normal/superior intelligence Provides a means to communicate (for those who have no means, but otherwise would) What does the research say? Facilitators unintentionally influence May even actively influence Many well-designed studies: Single- and double-blind Repeated measures Participant as control The Best Type of Treatment… Structured educational programs geared to the person’s developmental level of functioning It is, however, important to be openminded Majority of other treatments not scientifically proven Be educated Consider the individual child Do a thorough assessment and reevaluate Behavioral Disorders Conduct Disorder General pattern of disrespect for others Violation of norms Includes criminal activity Oppositional Defiant Disorder Pattern of negative, hostile, defiant behaviors Symptoms of Conduct Disorder Disrespect for rights of others + violation of rules/norms Bullies, threatens, intimidates others Initiates physical fights, uses weapons Physically cruel to people and/or animals Stolen while confronting a victim Forced sexual activity Symptoms of Conduct Disorder Deliberately sets fires w/ intention of doing damage or destroys property in other ways Broken into someone’s house/building/car Lies to obtain goods or avoid responsibility Stolen costly items without confronting victim Stays out at night before age 13 Has run away, overnight, >2 times Is truant from school prior to age 13 Conduct Disorder Children also have poor interpersonal skills Often experience peer rejection Seem to have problem-solving deficits Do not generate as many options as non-CD children Inability to take another’s perspective Interpret ambiguous gestures as hostile Oppositional Defiant Disorder Pattern of negative, hostile, defiant behaviors Arguing for the sake of arguing, hostility toward parents/teachers Usually begins at home (which can impede diagnosis) May develop into later conduct disorder Typically emerge by age 8, est. 5-10% prevalence What Causes Conduct Disorders? Neurological differences Temperament Poor coordination, fine motor skills Usually have significantly lower IQ than peers Easily distressed, reactive to change, react to intense stimuli (more likely behavior problems) Family Links Parent with APD increases chances of CD Criminal and/or alcoholic parents Family history of aggression What Causes Conduct Disorders? Family Links cont.. Poor maternal mental health, prenatal health Poor supervision Spousal aggression Lax, erratic and inconsistent parenting/discipline Less acceptance, warmth, affection, support Reinforce CD behavior, ignore/reward other (coercive process) Child-parent interactions are also bidirectional The Coercive Process Jimmy’s parents tell him to go to bed Jimmy refuses: “I want to play 1 more video game!” Parent says “No! Its late and you have school.” Jimmy gets upset, hitting table, screaming “Just one more game. You’re mean - you never let me have fun!” Parent feels guilty at having spent little time together, and is too tired after work to argue - says “Okay, 1 more game” Jimmy stops screaming and plays his game Parent, relieved fight is over, goes to kitchen. Does not monitor or play with child The Coercive Process 1. Jimmy is rewarded for screaming 2. Reward for screaming = increased probability of screaming in future 3. Parent is rewarded for giving in 4. Parents likelihood of giving in is increased Conduct Disorder & APD A minority of CD children develop Antisocial Personality Disorder Treatment for conduct disorder is of interest, as preventing APD would reduce associated financial and criminal costs to society Remember, APD is untreatable! Treating CD and ODD 1. 2. 3. 4. Problem-Solving Skills Parent Management Training Family Therapy School & Community Based Treatments Problem-Solving Skills Children tend to have poor problem-solving & interpret intentions/actions as hostile Combines modeling, role-playing, and reinforcement contingencies to increase problemsolving and prosocial behavior Parent Training & Family Therapy Break cycle of coercive process Promote prosocial behavior in child Apply proper discipline techniques by parent Increase reciprocity & positive reinforcement between family members Parent Training and Family Therapy Outcomes positive (reduce arrest, increase school performance, family relationships) Most families may be unwilling/able to participate School & Community Based Treatments Target children at school (easier) Often has more attendance than individual therapy Available to all children (universal intervention) Increased likelihood of reaching those who need it Minimizes stigma Offers opportunity to interact with other children Cognitive Disorders Dementia Dementia Gradual deterioration of brain function Affects judgment, memory, language, other executive functions Some are reversible Others are degenerative and eventually fatal Emotional changes are common Kinds of Dementia (DSM) 1. 2. 3. 4. 5. 6. Alzheimer’s Disease Vascular Dementia Dementia due to HIV, Head Trauma, Parkinson’s, Huntington’s Pick’s Disease Creutzfeldt-Jakob Disease Substance Abuse Other Causes of Dementia Drugs & alcohol Nutritional deficits Brain tumors Thyroid Problems Neurosyphilis Korsakoff’s Disease Alzheimer’s Disease Most develop during old age Prevalence for < 65 = 1%, 90+ = 22% Higher rates, as people are living longer Annual Cost = $112 billion US Associated Symptoms of Alzheimer’s Impaired memory, orientation, judgement, reasoning Inability to integrate/learn new information Forget events, lose objects Decreased interest in nonroutine activities Increasing depression, agitation, aggression with disease progession Symptoms & Course Mild memory & attention Language problems Forgetting appts, directions, names Loss of ability to do basic tasks Personality changes Increased Speed of Disease Progression Loss of function, death Global Deterioration Scale (Reisberg et al., 1982) 1. 2. 3. 4. 5. 6. 7. No cognitive/functional impairment Mild forgetfulness, some work problems Mild concentration problems, some problems working/travelling alone Increased problems in planning, finances, denial of symptoms & withdrawal Poor recall of recent events. Reminders needed Daily Living Assistance, Personality Changes Loss of verbal abilities, incontinence, walking, coma Normal Aging vs. Possible AD (Hooyma & Kiyak, 2002) Forgetting to set alarm clock Forgetting a name & remembering later Having to search for keys b/c forgot location Forgetting where your car is Forgetting how to set alarm clock Forgetting a name & never remembering it even when told Forgetting places you might find keys Forgetting how you arrived at a location Intellectual Functioning and Alzheimer’s Less formal education = increased risk “mental reserve” Cognitive reserve hypothesis More synapses an individual requires, the more neuronal death required before dementia is obvious Causes of Dementia Proximal causes Distal Causes Biological Causes Psychological & Social Influences Neurofibrillary Tangles & Amyloid Plaques Normal, but excessive Proximal Causes - Senile Plaques Protein deposits Also normal, but excessive Unclear why, or how this impacts Both overrepresented in hippocampus & parts of cerebral cortex = thought process What are Distal Causes? Genes (esp. early onset) Estrogen can be protective Down syndrome = virtually guaranteed Alzheimer’s by 40 Education & Cognitive Ability Protecting with Cognitive Ability 2x more likely in people with < 8th gr. Education Friedland et al. 2000 - 193 AD vs. 358 Control Control elderly more likely intellectual & physical noneducational past-times in middle years Greatest effect for intellectual past-times Regardless of education, gender, current age Assessment of Alzheimer’s Medical evaluation Neuropsychological Tests Observations Interviews Self-reports How do we definitively diagnose Alzheimer’s? Rule out other possible diagnoses Autopsy following patient death Tangles Plaques Dementia is a very heterogeneous disorder Dementia & Pseudodementia Depression most common psychopathology in old age Est. 20% for elderly community sample (Hooyman & Kiyak) 10-15% for institutionalized elderly sample Older adults often have “masked depression” Does not express/denies mood changes Reports somatic complaints Complains of problem solving/memory problems Medical Treatment for Dementia Medication enhancing cognitive ability Initial effect (to 6 months earlier) No long-term improvement over placebo Prevent breakdown of acetylcholine Decline continues Loss of gain if medication is quit $250/month Psychosocial Treatments for Dementia Compensation for lost abilities Memory wallets Cues and reminders