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CHAPTER 13 NEURODEVELOPMENTAL AND NEUROCOGNITIVE DISORDERS CHAPTER OVERVIEW This chapter outlines the primary features of neurodevelopmental disorders, with a particular emphasis on attention deficit/hyperactivity disorder, specific learning disorders, autism spectrum disorders, and intellectual disability. Major features of each of these disorders are outlined within a developmental framework, including integrative coverage of biological, psychological, and sociocultural variables that cause and/or maintain them. Available biological and psychosocial treatments for the developmental disorders are described, including efforts underway to prevent such problems. In addition, this chapter outlines the primary features of neurocognitive disorders, which involve delirium and major and mild neurocognitive disorders. In so doing, forms of each of these cognitive disorders are described, with an emphasis on Alzheimer’s disease. Coverage also includes discussion of known biological, environmental, and psychosocial factors that cause, maintain, or are related to the prevention and alleviation of neurocognitive disorders. LEARNING OBJECTIVES 1. 2. 3. 4. 5. 6. 7. 8. 9. Describe why knowledge of critical developmental stages is important for understanding neurodevelopmental disorders. Describe the central defining features of ADHD. Identify the main features of specific learning disorder, and explain how it is typically treated. Identify the major characteristics of autism spectrum disorder. Define intellectual disability, and identify the categories used to classify intellectual disabilities. Identify major prevention efforts for the neurodevelopmental disorders. Identify the defining features of neurocognitive disorders. Describe the symptoms of delirium, and describe how it is typically treated. Describe the symptoms of the major and mild neurocognitive disorders, and explain how they are typically treated. 197 CHAPTER OUTLINE OVERVIEW OF NEURODEVELOPMENTAL DISORDERS ATTENTION-DEFICIT/HYPERACTIVITY DISORDER Clinical Description Statistics Causes Treatment of ADHD SPECIFIC LEARNING DISORDER Clinical Description Statistics Causes Treatment of Learning Disorders AUTISM SPECTRUM DISORDER Clinical Description Statistics Causes: Psychological and Social Dimensions Causes: Biological Dimensions Treatment of Autism Spectrum Disorder INTELLECTUAL DISABILITY (INTELLECTUAL DEVELOPMENTAL DISORDER) Clinical Description Statistics Causes Treatment of Intellectual Disability PREVENTION OF NEURODEVELOPMENTAL DISORDERS OVERVIEW OF NEUROCOGNITIVE DISORDERS DELIRIUM Clinical Description and Statistics 198 Causes Treatment Prevention MAJOR AND MILD NEUROCOGNITIVE DISORDERS Clinical Description and Statistics Neurocognitive Disorder Due to Alzheimer’s Disease Vascular Neurocognitive Disorder Other Medical Conditions That Cause Neurocognitive Disorder Substance/Medication-Induced Neurocognitive Disorder Causes of Neurocognitive Disorder Treatment Prevention DETAILED OUTLINE Overview of Neurodevelopmental Disorders Why is knowledge of critical developmental stages important for understanding neurodevelopmental disorders? Developmental psychopathology is the study of how disorders arise and change with time. These changes usually follow a pattern, with the child mastering one skill before acquiring the next. This aspect of development is important because it implies that any disruption in the acquisition of early skills will, by the very nature of the developmental process, also disrupt the development of later skills. Attention-Deficit/Hyperactivity Disorder What are the central defining features of attention-deficit/hyperactivity disorder? The primary characteristics of people with attention deficit/hyperactivity disorder (ADHD) are a pattern of inattention (such as not paying attention to school- or work-related tasks), impulsivity, and/or hyperactivity. These deficits can significantly disrupt academic efforts and social relationships. DISCUSSION POINT: What are the possible explanations for gender differences in the diagnosis of ADHD? Specific Learning Disorder 199 What is specific learning disorder, and how is it typically treated? DSM-5 describes specific learning disorder as academic performance that is substantially below what would be expected given the person’s age, intelligence quotient (IQ) score, and education. These problems can be seen as difficulties with reading, mathematics, and/or written expression. All are defined by performance that falls short of expectations based on intelligence and school preparation. Communication and motor disorders seem closely related to specific learning disorder. They include childhood speech fluency disorder (stuttering), a disturbance in speech fluency; language disorder, limited speech in all situations but without the types of cognitive deficits that lead to language problems in people with intellectual disability or one of the pervasive developmental disorders; and Tourette’s disorder, which includes involuntary motor movements such as head twitching and vocalizations such as grunts that occur suddenly, in rapid succession, and in idiosyncratic or stereotyped ways. DISCUSSION POINT: What are the benefits of “mainstreaming” children with learning disorders versus delivering special education services? What are the drawbacks of this approach? Autism Spectrum Disorder What are the major characteristics of autism spectrum disorder? People with ASD all experience trouble progressing in language, socialization, and cognition. This is not a relatively minor problem (like specific learning disorder) but is a condition that significantly affects how individuals live and interact with others. Autistic spectrum disorder is a childhood disorder characterized by significant impairment in social communication skills and restricted, repetitive patterns of behavior, interests, or activities. This disorder does not have a single cause; instead, a number of biological conditions may contribute, and these, in combination with psychosocial influences, result in the unusual behaviors displayed by people with ASD. Impressive advances have been made in improving outcomes for many young children with ASD using early intervention programs. Treatment for older children involves behavioral interventions focused on their social communication deficits and the restricted, repetitive patterns of behavior, interests, or activities. Intellectual Disability (Intellectual Developmental Disorder) How is intellectual disability defined, and what categories are used to classify intellectual disabilities? 200 The definition of intellectual disability has three parts: significantly sub-average intellectual functioning, concurrent deficits or impairments in present adaptive functioning, and an onset before the age of 18. DISCUSSION POINT: What are the possible causes of the Flynn effect? Down syndrome is a type of intellectual disability caused by the presence of an extra 21st chromosome. It is possible to detect the presence of Down syndrome in a fetus through a process known as amniocentesis. Two other types of intellectual disability are common: Fragile X syndrome, which is caused by a chromosomal abnormality of the tip of the X chromosome, and cultural–familial intellectual disability, a rare problem resulting from adverse environmental conditions. Prevention of Neurodevelopmental Disorders What prevention efforts for the neurodevelopmental disorders have taken place? Prevention efforts for the neurodevelopmental disorders are in their early stages. These efforts include early intervention. Although many children can make significant progress if interventions are initiated early in life, not all children benefit significantly from such efforts. Given recent advances in genetic screening and technology, it may someday be possible to detect and correct genetic and chromosomal abnormalities. Overview of Neurocognitive Disorders What are the defining features of neurocognitive disorders? Most neurocognitive disorders develop much later in life. Two classes of neurocognitive disorders exist: delirium and mild or major neurocognitive disorder. Delirium What are the symptoms of and treatment for delirium? Delirium is a temporary state of confusion and disorientation that can be caused by brain trauma, intoxication by drugs or poisons, surgery, and a variety of other stressful conditions, especially among older adults. DISCUSSION POINT: Delirium was one of the first psychological disorders to be recognized and described over 2,500 years ago. Why might this be the case? Major and Mild Neurocognitive Disorders 201 What are the symptoms of and treatment for major and mild neurocognitive disorders? Major neurocognitive disorder is a progressive and degenerative condition marked by gradual deterioration of a range of cognitive abilities including memory, language, and planning, organizing, sequencing, and abstracting information. Mild neurocognitive disorder is a condition in which there are early signs of cognitive decline such that it begins to interfere with activities of daily living. Alzheimer’s disease is the leading cause of neurocognitive disorder, affecting approximately 4 million Americans; there is currently no known cause or cure. DISCUSSION POINT: Describe to the class the Nun Study, the longitudinal study of aging and Alzheimer’s disease conducted by David A. Snowdon with the School Sisters of Notre Dame. What are some of the ethical issues involved in the Nun Study? Do the findings from this study outweigh these ethical considerations? To date, there is no effective treatment for the irreversible neurocognitive disorder caused by Alzheimer’s disease, Lewy bodies, vascular disease, Parkinson’s disease, Huntington’s disease, and various less common conditions that produce progressive cognitive impairment. Treatment often focuses on helping patients cope with the continuing loss of cognitive skills and helping caregivers deal with the stress of caring for affected individuals. DISCUSSION POINT: How can non-medical clinicians aid in the treatment and prevention of neurocognitive disorder? KEY TERMS neurodevelopmental disorders, 481 attention-deficit/hyperactivity disorder (ADHD), 483 copy number variants, 486 specific learning disorder, 489 childhood-onset speech fluency disorder (stuttering), 491 language disorder, 491 Tourette’s disorder, 493 autism spectrum disorder (ASD), 493 childhood disintegrative disorder, 493 Rett syndrome, 493 pervasive developmental disorder, not otherwise specified, 493 joint attention, 494 prosody, 495 naturalistic teaching strategies, 498 intellectual disability (ID), 499 phenylketonuria (PKU), 502 Lesch-Nyhan syndrome, 503 Down syndrome, 503 amniocentesis, 503 chorionic villus sampling (CVS), 503 fragile X syndrome, 504 cultural-familial intellectual disability, 504 delirium, 507 major neurocognitive disorder (dementia), 510 mild neurocognitive disorder, 510 agnosia, 512 202 facial agnosia, 512 Alzheimer’s disease, 513 neurocognitive disorder due to Alzheimer’s type, 513 vascular neurocognitive disorder, 514 head trauma, 515 frontotemporal neurocognitive disorder, 515 Pick’s disease, 515 traumatic brain injury (TBI), 515 neurocognitive disorder due to traumatic brain injury, 515 neurocognitive disorder due to Lewy body disease, 516 neurocognitive disorder due to Parkinson’s disease, 516 Parkinson’s disease, 516 human immunodeficiency virus type 1 (HIV1), 516 neurocognitive disorder due to HIV infection, 516 aphasia, 516 Huntington’s disease, 516 neurocognitive disorder due to Huntington’s disease, 516 neurological disorder due to prion disease, 517 Creutzfeldt-Jakob disease, 517 substance/medication-induced neurocognitive disorder, 518 deterministic, 518 susceptibility, 519 IDEAS FOR INSTRUCTION 1. Activity: Would You Want to Know? Genetic research raises several interesting ethical questions, particularly with regard to the disorders discussed in this chapter. Ask students to consider whether they would want to know as parents whether their unborn child would have Down syndrome or perhaps even autism (if such a test were available). Also ask students to consider the ethical implications involved if and when routine genetic testing for development disorders comes of age. Would such testing be advantageous or potentially harmful? 2. Activity: The Movie Rainman. In the film Rainman, Dustin Hoffman plays the role of Raymond, a man with autism spectrum disorder. Many students will likely be familiar with the film, but what they may not know or appreciate is whether Hoffman’s character accurately depicts the condition. Most experts agree that Hoffman’s character does not accurately represent autism spectrum disorder, and the textbook similarly reinforces this point. After discussing the diagnosis, show the film and ask students to identify whether Raymond displays the three main features of autism spectrum disorder and whether the film fits the facts with regard to autistic behavior. You may also open the discussion to issues related to media depiction of persons with other neurodevelopmental disabilities. 3. Activity: Guest Lecture by a Special Education Instructor. Ask a special education instructor to visit the class to talk about the intervention methods he or she uses to assist people with neurodevelopmental disorders. You may also supplement this with a speaker from your college or university student disabilities services. 4. Video Activity: Autism and Mainstreaming. Show the segment titled “Autism,” from Abnormal Psychology: Inside/Out. In this segment, Dr. Durand discusses the nature of autism, its characteristics, and symptoms. There is live footage of a public school in New 203 York where the teachers and children with autism are in a mainstreamed setting with other students. Aside from the real footage, this segment highlights the ongoing controversy regarding whether such children should be mainstreamed into regular classes or placed in special education classes. You may use this segment as a springboard to discuss student reactions to the idea of mainstreaming, particularly in light of the assets and liabilities of this approach. Stress that there are no right or wrong answers. 5. Activity: Warning Signs of Alzheimer’s. The Alzheimer’s Association developed a list of warning signs for the disease. Because normal forgetfulness and early dementia are not easily distinguished, mistaken worry about Alzheimer’s is commonplace. Also common is ignoring the early signs of the disease. A handout is provided with the association’s warning signs for Alzheimer’s disease. Caution students that this information does not qualify them to engage in amateur diagnostics. Nevertheless, it can help them determine whether an impairment is of potential concern or not. Source Information: The Alzheimer’s Association, Inc., Chicago, Illinois. Reprinted by permission. 6. Activity: Guest Lecture by a Local Advocate. Invite a guest speaker from your local Council on Aging organization or Alzheimer’s support group to talk to the class about the many problems that face the elderly in the areas of health and mental health. The speaker should also discuss the kinds of services available in your area for individuals with Alzheimer’s and their families, as well as other services for the elderly. Several of your students might work for assisted living or nursing homes, so ask them for their input on cognitive disorder and old age. Use http://www.alz.org/index.asp as a reference site for you lectures on Alzheimer’s disease and old age. SUPPLEMENTARY READING MATERIAL Additional Readings: Barkley, R. A. (1997). ADHD and the nature of self-control. New York: Guilford. Barkley, R. A. (2010). Taking charge of adult ADHD. New York: Guilford Press. Caplan, L. R., Dyken, M. L., & Easton, J. D. (1994). American Heart Association family guide to stroke treatment, recovery, and prevention. New York: Time Books. Christophersen, E. R., & Mortweet, S. L. (2001). Treatments that work with children. Washington, DC: American Psychological Association. Clipson, C., & Steer, J. (1998). Case studies in abnormal psychology. Boston, MA: Houghton Mifflin Company. Chapter 14, Attention-Deficit Hyperactivity Disorder: All Wound Up and Out of Control. 204 Clipson, C., & Steer, J. (1998) Case studies in abnormal psychology. Boston, MA: Houghton Mifflin Company. Chapter 16, Dementia of the Alzheimer's Type: Descent into Darkness. Cohen, S. (2006). Targeting autism: What we know, don't know, and can do to help young children with autism spectrum disorders (3rd ed.). Berkeley: University of California Press. Cummings, J. L. (Ed.) (1990). Subcortical dementia. New York: Oxford University Press. Davies, P. (1994). Starting again: Early rehabilitation after traumatic brain injury or other severe brain lesion. New York: Springer. Edwards, A. J. (1994). When memory fails: Helping the Alzheimer’s and dementia patient. New York: Plenum. Eide, M. (1987). Alzheimer’s disease. Phoenix, AZ: Oryx Press. Fisher, J. E., & Carstensen, L. L. (1990). Behavior management of the dementias. Clinical Psychology Review, 10, 611-629. Fouse, B. A. (1997). Treasure chest of behavioral strategies for individuals with autism. Arlington, TX: Future Horizons. Frith, U. (Ed.) (1991). Autism and Asperger’s syndrome. New York: Cambridge University Press. Gatz, M., & Smyer, M. A. (1992). The mental health system and older adults in the 1990s. American Psychologist, 47, 741–751. Hantz, P., Caradoc-Davies, G., Caradoc-Davies, T., Weatherall, M., & Dixon, G. (1994). Depression in Parkinson’s disease. American Journal of Psychiatry, 151, 1010–1014. Jackson, J. E., Katzman, R., & Lessin, P. J. (Eds.) (1992). Alzheimer’s disease: Long term care. San Diego: San Diego State University Press. Jordan, D. R. (1992). Attention deficit disorder: ADHD and ADD syndromes. Austin, TX: PRO-ED. Kazdin, A. E. (1990). Psychotherapy for children and adolescents. Annual Review of Psychology, 41, 21–54. Klin, A., Volkmar, F. R., & Sparrow, S. S. (Eds.) (2000). Asperger syndrome. New York: Guilford. 205 Kozloff, M. A. (1998). Reaching the autistic child: A parent training program. Cambridge, MA: Brookline Books. Kurlan, R. (2005). Handbook of Tourette's syndrome and related tic and behavioral disorders (2nd ed.). New York: Marcel Dekker. Mace, N., & Rabins, P. (2011). The 36-hour day: A family guide to caring for people who have alzheimer disease, related dementias, and memory loss (5th ed.). Baltimore: Johns Hopkins University Press. McGowin, D. F. (1993). Living in the labyrinth: A personal journey through the maze of Alzheimer’s. New York: Delacorte. Pliszka, S. R., Carlson, C. L., & Swanson, J. M. (1999). ADHD with comorbid disorders: Clinical assessment and management. New York: Guilford. Quay, H. C., Routh, D. K., & Shapiro, S. K. (1988). Psychopathology of childhood: From description to validation. Annual Review of Psychology, 38, 491–532. Sacks, O. (1998). The man who mistook his wife for a hat and other clinical tales. New York, NY: Simon & Schuster. Sattler, D., Shabatay, V., & Kramer, G. (1998). Abnormal psychology in context: Voices and perspectives. Boston, MA: Houghton Mifflin Company. Chapter 11, Cognitive Disorders. Sattler, D., Shabatay, V., & Kramer, G. (1998). Abnormal psychology in context: Voices and perspectives. Boston, MA: Houghton Mifflin Company. Chapter 12, Disorders of Childhood and Adolescence, Mental Retardation, and Eating Disorders. Seifert, C. D. (1990). Theories of autism. Lanham, MD: University Press of America. Shapiro, E. (2011). Academic skills problems: Direct assessment and intervention (Fourth ed.). New York: Guilford Press. Siegel, B. (1996). The world of the autistic child: Understanding and treating autistic spectrum disorders. Oxford: Oxford University Press. Shonkoff, J., & Meisels, S. (2000). Handbook of early childhood intervention (2nd ed.). Cambridge, U.K.: Cambridge University Press. Silverman, F. (2004). Stuttering and other fluency disorders (3rd ed.). Long Grove, Ill.: Waveland Press. 206 Storandt, M., & VandenBos, G. R. (Eds.) (1994). Neuropsychological assessment of dementia and depression in older adults: A clinician’s guide. New York: American Psychological Association. Teeter, P. A. (2000). Interventions for ADHD: Treatment in developmental context. New York: Guilford. Weiner, M. (2003). The dementias: Diagnosis, treatment, and research (3rd ed.). Washington, DC: American Psychiatric Pub. Wright, L. K. (1993). Alzheimer’s disease and marriage: An intimate account. Newbury Park, CA: Sage. Zigler, E., & Hodapp, R. M. (1991). Behavioral functioning in individuals with mental retardation. Annual Review of Psychology, 42, 29–50. SUGGESTED VIDEOS As many of the names of these disorders have changed, some of these videos may appear to be out of date. Please be selective in which you choose to use based on good information with older names and advise your students of such. Abnormal Psychology Inside/Out. (Available through your Cengage Learning representative). An interview with a patient named Mike is presented. Mike suffered a brain injury after racing his car and cannot learn or remember new information. However, he has retained over-learned memories, such as how to build an engine. He carries a notebook with him at all times containing information regarding activities he must do every half hour. Consequences of the brain injury include development of a temper control problem, depression, loss of his job, wife, and home. (14 min) Abnormal Psychology Inside/Out. (Available through your Cengage Learning representative). The segment titled, “Attention Deficit Hyperactivity Disorder,” presents Jim Swanson of the University of California, Irvine, interviewing the parent of an 11-year-old child with ADHD. This segment covers the DSM-IV characteristics of attention deficit/ hyperactivity disorder, and shows how this child behaved at ages 5 and 6, prior to behavioral treatment combined with medication. Dr. Swanson discusses the theories of neuropsychological causes of ADHD and the role of dopamine as well. A second segment titled, “Autism,” presents an interview with V. Mark Durand of SUNY-Albany. Dr. Durand discusses the nature of autism, its characteristics, and symptoms. There is live footage of a public school in New York where the teachers and children with autism are in a mainstreamed setting with other students. The footage also shows the clinical, school, and home settings of the child, giving a full picture of how this child’s behavior changed pre- to post-therapy. 207 ADHD: Adolescence to Adulthood. (Insight Media). In this program, a panel of key experts and opinion leaders outlines the characteristics of ADHD; examines diagnosis; and discusses appropriate treatment options for children, adolescents, and adults with the disorder. (53 min) Agitation...it’s a sign. (Fanlight Productions). A variety of caregivers share their experiences and thoughts on providing for residents with Alzheimer’s disease while providing vivid examples of the techniques and concepts that have worked in their facilities. (14 min) Autism: A world apart. (Fanlight Productions). This film depicts the stories of three families and what it is like to love and care for children with autism. (29 min) Communicating with older adults: Dementia. (Insight Media). This program explores the communication barriers posed by sensory and memory impairments. It outlines the principles of good communication and shows how to clarify one’s message when communicating with dementia patients. (30 min) Dress him while he walks. (Fanlight Productions). This sensitive and realistic video addresses several difficult behavior patterns of Alzheimer's patients. It demonstrates practical ways of dealing with behaviors such as wandering, angry outbursts, and delusions. For example, in the case of one patient who constantly paces around the facility, staff have developed methods of dressing him "on the run." Another patient is offered finger food while she wanders. Although not easy to watch at times, this video shows caring and concerned staff dealing with difficult situations in a practical manner and with a sense of humor. Though designed primarily for nursing home staff, it will be a valuable training and discussion tool for family caregivers as well. (20 min) Dyslexia. (Fanlight Productions). This film, part of the The Doctor Is In series, examines the experiences of people with learning disabilities as well as the potential value to society of their alternative ways of learning. (30 min) Forrest Gump. This film traces the life of a character named Forrest Gump, with an IQ of 75. The film is useful to examine stereotypes about intellectual disability. He’s doing this to spite me. (Fanlight Productions). In this frank video, three caregivers openly share their experiences of conflict and frustration in interactions with their loved one who has a neurocognitive disorder. These scenes are integrated with comments and guidance from professionals in neurocognitive disorder care. The result is a program that teaches both family and professional caregivers how to reframe the dynamic into one which is more comfortable and productive for both caregiver and patient. (22 min) Philadelphia. This film, starring Tom Hanks, depicts a young man who suffers from AIDS and the effects of the illness on his neurological functioning. One of us. (Fanlight Productions). This film depicts four stories about integrating people with developmental disabilities into mainstream society. (27 min) 208 Rainman. In this film, Dustin Hoffman stars as Raymond, a man with autism spectrum disorder and savant syndrome. On one hand, the film nicely illustrates some of the more salient features of autistic behavior. On the other, it also misrepresents the nature of autism spectrum disorder. Raymond’s portrait. (Fanlight Productions). Raymond Hu is an accomplished artist who was born with Down syndrome. This moving documentary looks at what can happen when a child is encouraged to develop to his full potential. (27 min) Regarding Henry. This film depicts a man who experienced a stroke as a result of a gunshot wound and the impact it had on his family and how they learned to cope. Wandering: Is it a problem? (Fanlight Productions). A variety of caregivers share their experiences and thoughts on providing for residents with Alzheimer’s disease while providing vivid examples of the techniques and concepts that have worked in their facilities. (14 min) What’s eating Gilbert Grape. This film portrays a 17-year-old boy with intellectual disability and how he and his family attempt to cope with his problems. ONLINE RESOURCES Alzheimer’s Association http://www.alz.org/ The Alzheimer’s Association website contains information on local chapters, coping strategies for caregivers, and scientific progress toward effective treatment and understanding of this disorder. The American Academy of Child and Adolescent Psychiatry Homepage http://www.aacap.org/ This site provides information for children and their families (including research, education, and treatment) on many childhood disorders. Attention-Deficit/Hyperactivity Disorder http://www.mentalhealth.com/home/dx/adhd.html This site contains a wealth of scholarly information and links related to ADHD. Autism Spectrum Disorder http://www.mentalhealth.com/home/dx/autistic.html This site contains a wealth of scholarly information and links related to autism spectrum disorder. Autism Speaks http://www.autismspeaks.org/ 209 The website for the Autism Speaks non-profit organization contains scholarly information, scientific news, personal stories, and information about advocacy and events related to autism spectrum disorder. Center for Autism and Related Disabilities http://www.albany.edu/psy/autism/autism.html This site provides a wealth of information related to research and treatment of autism. CH.A.D.D. (Children and Adults with Attention-Deficit/Hyperactivity Disorder) http://www.chadd.org/ CH.A.D.D. is a non-profit organization devoted to educating the public about attention deficit and hyperactivity disorders. This site includes information on the symptoms of ADHD, treatments, and CH.A.D.D. chapters throughout the country. Delirium http://www.mentalhealth.com/home/dx/delirium.html This webpage provides diagnostic and clinically relevant research information and links about delirium. The Division for Early Childhood http://www.dec-sped.org/ This website provides links related to early intervention information for developmental disorders. Learning Disabilities Association of America http://ldaamerica.org/ This website provides information and news updates on learning disabilities. This site is aimed at parents, teachers, and other professionals. Lewy Body Dementia Association http://www.lbda.org/ This website offers a wealth of information and resources related to Lewy body dementia. Neurocognitive Disorder Due to Alzheimer’s Disease http://www.mentalhealth.com/home/dx/dementiaalzheimer.html This webpage provides diagnostic and clinically relevant research information and links about dementia of the Alzheimer’s type. NLDline http://www.NLDline.com This is a non-verbal learning disabilities website with a huge array of information about learning disabilities common in people with pervasive developmental disorders. 210 COPYRIGHT ©2016 Cengage Learning WARNING SIGNS OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER Often fidgeting with hands or feet, or squirming while seated Difficulty remaining seated when required to do so Easily distracted by extraneous stimuli Difficulty awaiting turn in games or group activities Often blurting out answers before questions are completed Difficulty in following instructions Difficulty sustaining attention in tasks or play activities Often shifting from one uncompleted task to another Difficulty playing quietly Often talking excessively Often interrupting or intruding on others Often not listening to what is being said Often forgetting things necessary for tasks or activities Often engaging in physically dangerous activities without considering possible consequences 211 COPYRIGHT ©2016 Cengage Learning WARNING SIGNS OF SPECIFIC LEARNING DISABILITY (PRESCHOOL) Does the child have trouble with or delayed development in the following? Learning the alphabet Rhyming words Connecting sounds and letters Counting and learning numbers Being understood when he or she speaks to a stranger Using scissors, crayons, and paints Reacting too much or too little to touch Using words or, later, stringing words together into phrases Pronouncing words Walking forward or up and down stairs Remembering the names of colors Dressing self without assistance 212 COPYRIGHT ©2016 Cengage Learning WARNING SIGNS OF SPECIFIC LEARNING DISABILITY (ELEMENTARY SCHOOL) Does the child have trouble with the following? Learning new vocabulary Speaking in full sentences Understanding the rules of conversation Retelling stories Remembering newly learned information Playing with peers Moving from one activity to another Expressing thoughts orally or in writing Holding a pencil Handwriting Computing math problems at his or her grade level Following directions Self-esteem Remembering routines Learning new skills Understanding what he or she reads Succeeding in one or more subject areas Drawing or copying shapes Understanding what information presented in class is important Modulating voice (may speak too loudly or in a monotone) Keeping notebook neat and assignments organized Remembering and sticking to deadlines Understanding how to play age-appropriate board games 213 COPYRIGHT ©2016 Cengage Learning. WARNING SIGNS OF SPECIFIC LEARNING DISABILITY (ADULTHOOD) Does the adult have trouble with the following? Remembering newly learned information Staying organized Understanding what he or she reads Getting along with peers or coworkers Finding or keeping a job Sense of direction Understanding jokes that are subtle or sarcastic Making appropriate remarks Expressing thoughts orally or in writing Following directions Basic skills (such as reading, writing, spelling, and math) Self-esteem Using proper grammar in spoken or written communication Remembering and sticking to deadlines 214 COPYRIGHT ©2016 Cengage Learning. WARNING SIGNS OF AUTISM SPECTRUM DISORDER Difficulty interacting with other children Insistence on sameness; resists changes in routine Inappropriate laughing and giggling No real fear of dangers Little or no eye contact Sustained odd play Apparent insensitivity to pain Echolalia (repeating words or phrases in place of normal language) Prefers to be alone; aloof manner May not want cuddling or act cuddly Spins objects Not responsive to verbal cues; acts as though deaf Inappropriate attachment to objects Difficulty in expressing needs; uses gestures or pointing instead of words Noticeable physical overactivity or extreme underactivity Tantrums; displays extreme distress for no apparent reason Unresponsive to normal teaching methods Uneven gross/fine motor skills (e.g., may not want to kick ball but can stack blocks) 215 COPYRIGHT ©2016 Cengage Learning “EARLY” WARNING SIGNS OF AUTISM SPECTRUM DISORDER If your child displays any of these signs, bring it to the attention of your doctor: No babbling by 12 months No pointing, waving, and other gesturing by 12 months No single words by 16 months No two-word spontaneous (not echoed) phrases by 24 months Any loss of language or social skills at any age Inability to make or hold eye contact Inability to respond to the child’s name being called Inability to look where you point Lack of interest in pretend play by 18 months Arches back to avoid touch Rocks or bangs head Makes little attempt to communicate 216 COPYRIGHT ©2016 Cengage Learning WARNING SIGNS OF ALZHEIMER’S DISEASE Memory loss that affects job skills Difficulty performing familiar tasks Problems with language Disorientation of time and place Poor or decreased judgment Problems with abstract thinking Misplacing things Changes in mood or behavior Changes in personality Loss of initiative 217