Download Basic Statistics for the Behavioral Sciences

Chapter 13
Developmental and Cognitive
Disorders
Nature of Developmental
Psychopathology: An Overview
• Normal vs. abnormal development
• Developmental psychopathology
– Study of how disorders arise and change with time
– Disruption of early skills can affect later
development
Nature of Developmental
Psychopathology: An Overview
Developmental disorders
– Diagnosed first in infancy, childhood, or
adolescence
– Attention deficit hyperactivity disorder (ADHD)
– Learning disorders
– Autism
– Mental retardation
3 Types of (Attention-deficit hyperactivity
disorder (ADHD)
• Predominately inattentive
• Predominately
hyperactive/impulsive
• Combined
– Associated with numerous
impairments
• Behavioral
• Cognitive
• Social and academic problems
Barkley’s model (2006)
ADHD: Facts and Statistics
• Prevalence
– Occurs in 3% - 7% of school-aged children
– Symptoms are usually present around
age three or four
– Children with ADHD have problems
as adults
• Gender differences
– Boys outnumber girls 3:1
• Comorbid with Conduct disorder, oppositional
defiant disorder, obsessive-compulsive disorder,
tic disorder
The Causes of ADHD: Biological
Contributions
• Genetic contributions
– ADHD seems to run in families
– DAT1 - gene has been implicated
The Causes of ADHD: Biological
Contributions
• Neurobiological contributions
– Smaller brain volume (3-4%)
– Inactivity of the frontal cortex and basal ganglia
– Abnormal frontal lobe development and
functioning
The Causes of ADHD: Biological
Contributions (continued)
• The role of toxins
– Small evidence that allergens and food additives
are causes
– Maternal smoking increases risk
• Psychosocial factors
– Can influence the nature of ADHD
– Constant negative feedback from peers and adults
Biological Treatment of ADHD
• Goal of biological treatments
– To reduce impulsivity and
hyperactivity and to improve
attention
• Stimulant medications
– Reduce core symptoms in 70% of
cases
– Examples include Ritalin,
Dexedrine, Focalin, Cylert,
Vyvanse, Adderall, Strattera
Biological Treatment of ADHD
• Other medications with more limited efficacy
– Imipramine and clonidine (antihypertensive)
– Designer drugs (psychopharmacogenetics)
• Effects of medications
– Improve compliance and decrease negative
behaviors
– Do not affect learning and academic performance
– Benefits are not lasting following discontinuation
Behavioral and Combined Treatment of
ADHD
• Behavioral treatment
– Reinforcement programs
• To increase appropriate behaviors
• Decrease inappropriate behaviors
– May also involve parent training
• Combined bio-psycho-social
treatments
– Are highly recommended
– Superior to medication or behavioral
treatments alone
Academic Characteristics
• Deficits in:
Reading
(dyslexia)
Written
language
Mathematics
(dyscalculia)
(dysgraphia)
Learning Disorders:
An Overview
– Discrepancy between actual and expected
achievement (IQ and achievement test)
– Performance significantly below age or grade level
– Response to Intervention (RTI)
– Cannot be caused by sensory deficits or lack of
educational possibilities
Learning Disorders: Statistics
• Prevalence of learning disorders
– 5-10% prevalence in the United States
– Highest in wealthier regions of the United States
– Six million children have been diagnosed
– School experience tends to be generally negative
Biological and Psychosocial Causes of
Learning Disorders
• Genetic and neurobiological contributions
– Dyslexia, dyscalculia run in families
– “Minimal brain dysfunction”
Dyslexia
Disability in Metacognition
• Lack of awareness of strategies and resources
needed to perform effectively
• Inability to monitor, evaluate, and adjust
performance to ensure successful task
completion
Recommended Educational Practices
• Strategy instruction
– Techniques, principles, and rules that
guide students to complete tasks
independently
A self-regulation model
Direct Instruction
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•
•
•
•
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Well-organized, sequenced lessons
Short review of previously learned skills
Clear statement of lesson goals
Presentation of new material in small steps
Frequent opportunities for practice
Questions to check for understanding
Autism Spectrum Disorder
Pervasive Developmental Disorder (PDD)
PDD
Autism
Asperger
Childhood
Disintegrative
Disorder
Rett’s Disorder
PDD (NOS) –
Not otherwise
specified
Pervasive Developmental Disorders: An
Overview
• Nature of pervasive developmental disorders
– Problems occur in language, socialization, and
cognition
– Pervasive – problems span many life areas
• Examples of autism spectrum disorders
– Autistic disorder
– Asperger’s syndrome
– Pervasive developmental not otherwise specified
(PDD-NOS)
The Nature of Autistic Disorder: An
Overview
• Three central DSM-IV-TR features of autism
– Qualitative impairment of social interaction
– Problems in communication
• 50% never acquire useful speech
– Restricted patterns of behavior, interests, and
activities
Autistic Disorder: Statistics
• Prevalence and features of autism –
One in every 500 births
– More prevalent in females with IQs below 35
– More prevalent in males with higher IQs
– Occurs worldwide
– Symptoms usually develop before 3 years of age
Autistic Disorder: Statistics
• Autism and intellectual functioning
– 40-55% with autism have intellectual disabilities
(IQ below 70)
• Reliable indicators of good prognosis
– Language ability and IQ
Causes of Autism: Early and More
Recent Contributions (continued)
• Current understanding of autism
– Medical conditions – not always related to autism
– Genetic component is largely unclear
– Neurobiological evidence of brain damage
– Substantially reduced cerebellum size
• Psychosocial contributions are unclear
Treatment of Pervasive Developmental
Disorders: Example of Autism
• Psychosocial “behavioral” treatments
– Skill building
– Reduction of problem behaviors
– Target communication and language problems
– Address socialization deficits
– Early intervention is critical
Intellectual disability (ID):
An Overview
• DSM-IV-TR criteria
– Significantly sub-average intellectual functioning
(70 or less IQ)
– Deficits or impairments in present adaptive
functioning
– Must be evident before the person is 18 years of
age
Vineland Adaptive Behavior Scales II (VABS – II)
Parent/Caregiver Rating
Form, Interview Form 0 through 90
Teacher Rating Form 3 through 21 years,11
months
DSM-IV-TR Levels of Intellectual
disability (ID)
• Mild ID
– IQ score between 55 and 70
• Moderate ID
– IQ range of 40 to 54
• Severe ID
– IQs ranging from 25 to 39
• Profound ID
– IQ scores below 25
Intellectual disability (ID): Some Facts
and Statistics
• Prevalence
– About 1-3% of the general population
– 90% are labeled with mild intellectual disability
• Course of ID
– Tends to be chronic
– Prognosis varies greatly from person to person
Causes of Intellectual disability (ID):
Biological Contributions
• Hundreds of known causes
– Environmental – deprivation, abuse
– Prenatal – exposure to disease or a drug/toxin
– Perinatal – difficulties during labor
– Postnatal – head injury
Causes of Intellectual disability (ID):
Biological Contributions
• Genetic research
– Multiple genes, and at times single genes
• Chromosomal abnormalities
– Down syndrome and fragile X syndrome
– PKU
– Lesch-Nyhan syndrome
Trisomy 21
Down Syndrome (Trisomy 21)
• Physical Deformities
flattening of the back of
the head
slanting of the eyelids
short stubby limbs
thick tongues
• Cultural-familial intellectual disability
– Believed to cause about 75% of ID cases
– Is the least understood
– Associated with
• Mild levels of retardation on IQ tests
• Good adaptive skills
Treatment of Intellectual disability (ID)
• Parallels treatment of pervasive
developmental disorders
• Teach needed skills
– To foster productivity
– To foster independence
– Educational and behavioral management
– Living and self-care skills via task analysis
– Communication training – often most challenging
Nature of Cognitive Disorders: An
Overview
• Perspectives on cognitive disorders
– Affect learning, memory, and consciousness
– Most develop later in life
• Three classes of cognitive disorders
– Delirium – temporary confusion and
disorientation
– Dementia – marked by broad cognitive
deterioration
– Amnestic disorders – memory dysfunctions
Nature of Cognitive Disorders: An
Overview
• Shifting DSM perspectives
– From “organic” mental disorders to “cognitive”
disorders
– Broad impairments in cognitive functioning
– Profound changes in behavior and personality
Delirium: An Overview
• Nature of delirium
– Central features – impaired consciousness and
cognition
– Develops rapidly over several hours or days
– Appear confused, disoriented, and inattentive
– Marked memory and language deficits
Delirium: An Overview (continued)
• Facts and statistics
– Affects up 30% of persons in acute care facilities
– Most prevalent in older adults
• Those undergoing medical procedures
• AIDS patients and cancer patients
– Full recovery often occurs within several weeks
Medical Conditions Related to Delirium
• Medical conditions
– Drug intoxication, poisons, withdrawal from drugs
– Infections
– Head injury and several forms of brain trauma
– Sleep deprivation, immobility, and excessive stress
Medical Conditions Related to Delirium
• DSM-IV-TR subtypes of delirium
– Delirium due to a general medical condition
– Substance-induced delirium
– Delirium due to multiple etiologies
– Delirium not otherwise specified
Treatment and Prevention of Delirium
• Treatment
– Attention to precipitating medical problems
– Psychosocial interventions include reassurance
• Focus on coping strategies
• Inclusion of patients in treatment decisions
• Prevention
– Address proper medical care for illnesses
– Address proper use and adherence to therapeutic
drugs
Dementia: An Overview
• Nature of dementia
– Gradual deterioration of brain functioning
– Deterioration in judgment and memory
– Deterioration in language / advanced cognitive
processes
– Has many causes and may be irreversible
Dementia: Initial and Later Stages
• Initial stages
– Memory and visuospatial skills impairments
– Agnosia – inability to recognize and name objects
– Facial agnosia – inability to recognize familiar
faces
– Other symptoms
• Delusions, apathy, depression, agitation, aggression
Dementia: Initial and Later Stages
• Later stages
– Cognitive functioning continues to deteriorate
– Total support is needed to carry out day-to-day
activities
– Death due to inactivity and onset of other
illnesses
DSM-IV-TR Classes of Dementia
• Dementia of the Alzheimer’s type
• Vascular dementia
• Dementia due to other general medical
conditions
• Substance-induced persisting dementia
• Dementia due to multiple etiologies
• Dementia not otherwise specified
Dementia of the Alzheimer’s Type: An
Overview
• DSM-IV-TR criteria and clinical features
– Multiple cognitive deficits
– Develop gradually and steadily
– Memory, orientation, judgment, and reasoning
deficits
– Additional symptoms may include
• Agitation, confusion, or combativeness
• Depression and/or anxiety
– “Sundowner syndrome”
Dementia of the Alzheimer’s Type:
Extent of Deficits
• Range of cognitive deficits
– Aphasia – difficulty with language
– Apraxia – impaired motor functioning
– Agnosia – failure to recognize objects
– Difficulties with
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•
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Planning
Organizing
Sequencing
Abstracting information
– Negative impact on social and occupational
functioning
Alzheimer’s Disease: Some Facts and
Statistics
• Nature and progression of the disease
– Deterioration is slow during the early and later
stages
– Deterioration is rapid during middle stages
– Average survival time is about eight years
– Onset usually occurs in the 60s or 70s
• Prevalence of Alzheimer’s disease
– Prevalence greater in
• Poorly educated persons
– Prevalence rates are low in some ethnic groups
Vascular Dementia:
An Overview
• Nature of vascular dementia
– Caused by blockage or damage to blood vessels
– Second leading cause of dementia next to
Alzheimer’s
– Onset is often sudden (e.g., stroke)
– Patterns of impairment are variable
– Most require formal care in later stages
Vascular Dementia:
An Overview
• DSM-IV-TR criteria and incidence
– Cognitive disturbances – identical to dementia
– Obvious neurological signs of brain tissue damage
– Prevalence 1.5% in people 70 and 15% for people
over 80
– Risk slightly higher in men
Other Causes of Dementia:
Head Trauma
• Head trauma – accidents are leading cause
– Memory loss is the most common symptom
Other Causes of Dementia:
HIV-1
• HIV-1
– Causes neurological impairments and dementia
– Cognitive slowness, impaired attention, and
forgetfulness
– Apathy and social withdrawal
HIV (human
immunodeficiency virus) and
AIDS (acquired immune
deficiency syndrome
Other Causes of Dementia:
Parkinson’s Disease
• Parkinson’s disease – degenerative brain
disorder
– Affects about one out of 1,000 people worldwide
– Motor problems – central feature of this disorder
• Caused by damage to dopamine pathways
– 75% survival rate for 10 years
Other Causes of Dementia:
Huntington’s
• Huntington’s disease
– Genetic autosomal dominant disorder
– Manifests initially as chorea, usually later in life
– About 20-80% display dementia
– Dementia follows a subcortical pattern
HUNTINGTON’S DISEASE
Single dominant gene on chromosome 4
Rapid, jerky involuntary movements
Dementia, cognitive decline, depression, occasional delusions
Hallucinations, OCD
Other Causes of Dementia:
Pick’s Disease
• Pick’s disease
– Rare neurological condition
– Produces a cortical dementia like Alzheimer’s
– Also occurs later in life (around 40s or 50s)
– Little is known about what causes this disease
• Creutzfeldt-Jakob disease
– Affects one out of 1,000,000 persons
– Linked to mad cow disease
Other Dementias: Substance-Induced
Dementia
• Substance-induced persisting dementia
– Results from drug use in combination with poor
diet
– Several drugs can lead to symptoms of dementia
– Resulting brain damage may be permanent
– Dementia is similar to that of Alzheimer’s
– Deficits may include
• Aphasia, apraxia, agnosia
• Disturbed executive functioning
Causes of Dementia:
The Example of Alzheimer’s Disease
• Early and largely unsupported views
– Implicated smoking, negative correlation
Causes of Dementia:
The Example of Alzheimer’s Disease
• Current neurobiological findings
– Neurofibrillary tangles
– Amyloid plaques
– The role of deterministic genes
• Beta-amyloid precursor gene
• Presenilin-1 and Presenilin-2 genes
– The role of susceptibility genes - ApoE4 gene
– Brains of Alzheimer’s patients tend to atrophy
Causes of Dementia:
The Example of Alzheimer’s Disease
• Current neurobiological findings
– Multiple genes are involved in Alzheimer’s disease
– Chromosomes 21, 19, 14, 12,
– Chromosome 14
• Associated with early onset Alzheimer’s
– Chromosome 19
• Associated with late onset Alzheimer’s
The Contributions of Psychosocial
Factors in Dementia
• Psychosocial factors
– Do not cause dementia directly
– May influence onset and course
– Lifestyle factors – drug use, diet, exercise, stress
– Cultural factors
• Risk for certain conditions vary by ethnicity and class
– Psychosocial factors
• Educational attainment, coping skills, social support
Medical and Psychosocial Treatment of
Dementia
• Medical treatment: Best if enacted early
– Few exist for most types of dementias
– Most attempt to slow progression of deterioration
– Do not stop progression of dementia
– Caregiver can be negatively impacted
Medical and Psychosocial Treatment of
Dementia
• Psychosocial treatments – aims
– To enhance lives of patients and their families
– To teach compensatory skills
– To use memory enhancement devices, if needed
– Psychosocial interventions appear to focus on
caregivers
Prevention of Dementia
• Reducing risk of dementia in older adults
– Estrogen-replacement therapy
– Proper treatment of cardiovascular diseases
– Use of anti-inflammatory medications
– Control blood pressure and lead an active social
life
• Other targets of prevention efforts
– Increasing safety behaviors to reduce head trauma
– Reducing exposure to neurotoxins and use of
drugs
Amnestic Disorder:
An Overview
• Nature of amnestic disorder
– Circumscribed loss of memory
– Inability to transfer information into long-term
memory
– No loss of other high-level cognitive functions
Amnestic Disorder:
An Overview
• Causes may include
– Medical conditions, head trauma, or long-term
drug use
• DSM-IV-TR criteria
– Inability to
• Learn new information or recall learned information
– Significant impairment in functioning
Amnestic Disorder:
An Overview
• The example of Wernicke-Korsakoff syndrome
– Damage to the thalamus
– Thiamine (vitamin B-1) deficiency
– Resulting from stroke or chronic heavy alcohol use
• Prevention
– Use of thiamine supplements with heavy drinkers
• Research on amnestic disorders is scant
Dementia: Statistics
• Onset and prevalence
– Can occur at any age, but most common in the elderly
– Affects over 10% of persons 85 years and older
• Incidence of dementia
– Affects 8.5% of those 85 and older
– Rates seem to double with every five years of age
• Gender and sociocultural factors
– Occurs equally in men and women
– Occurs equally across educational level and social class