Neurodevelopmental Disorders

What is an intellectual disability? and what are the levels to it

• score 2 SDs below the average

• must also have at least one area of functional impairment

• levels

  • profound

  • severe

  • moderate

  • mild

    • vast majority with ID have mild (between 50-70 IQ)

What are some known genetic causes of intellectual disability?

• down syndrome — abnormality in chromosome 21

• Rett’s (only females) — abnormality in X chromosome

• Fragile X — successively worse each generation

  • most common cause of inherited ID

• congenital hypothyroidism (if not deteced by 3 months of age, cannot be reversed → inadequate production of thyroid hormone 

What are some known environmental causes of ID

• teratogens → harmful environmental agents 

  • drugs, viruses, radiation, lead, pesticides, methyl mercury, etc. 

  • exposure during first trimester is most damaging to CNS 

• impoverished environments 

  • might not have received enough stimulation during a critical period 

what does treatment of ID look like

• can’t be cured obviously 

• can prevent certain things like obviously avoid teratogens

• enriched environments

• special ed accomodations 

  • IEP (individualized education program) facilitates inclusion (group of special education kids in one class that looks entirely like a normal class, but they all have ID so they all feel included)

• PKU (phenylketonuria) → all newborns since the 50s have had a test to see if they have PKU, which addresses a problem metabolizing a certain enzyme that i’m not going to remember nor write out

  • with a positive test, lifelong dietary modifications can prevent brain damage, preventing an ID

What are the two types of problematic behaviours that people with intellectual disability typically engage in

• stereotyped behaviours

  • repetitive behaviours that don’t serve a function

    • e.g., hand flapping, fast finger and hand motions, body rocking

• self-injurious behaviours

  • e.g., hitting their head against something, hitting or biting oneself

• people experiencing both have a harder time socially and verbally

What is autism spectrum disorder?

• deficits

  • socialization / communication

  • restricted interests/repetitive behaviours

• approx 50% have an intellectual impairment but like 20% are also like cracked at one specific thing

• insistence on sameness

• may speak with monotone voice

• severity ratings:

  • level 1: requiring support

  • level 2: requiring substantial support

  • level 3: requiring very substantial support

Explain neurological aspects of ASD

• large head circumference 

  • probably due to above average increase in white and gray matter during infancy

• potential abnormalities in mirror neuron system

  • certain neurons will fire in response to watching something else

  • mimicking behaviour

• connections and communications between brain regions appears to be abnormal

  • hypersensory abilities/detection so thats why they get overstimulated — can see the flickering of fluorescent lights

Explain the 2 growth phases in ASD

• excessive neurogenesis peaks between 2-4 years 

  • overgrowth compared to typical children, more neurons

  • as brain expands, so does cranium, hence the larger head

• apoptosis begins in late childhood/early adolescence (compensatory process)

  • brain starts to cull many of the connections in favour of short-range versus long range

Explain joint attention and laughter and ASD

• lack of joint attention and social referencing one of the earliest signs of ASD

  • like if prof was talking about a remote, we would pay attention to the remote and his face to know what he might be feeling towards it, but if you showed a kid with ASD, theyw ould just continue what they are doing or look at you, ignoring the remote control

• laughter — most people laugh unvoiced (not using vocal chords) whereas people on spectrum laugh solely with vocal chords

ASD treatment

• treatment not rally possible because structure of brain can’t be changed

• early intervention important though (screening by 2 years)

• applied behavioural analysis

  • discreet trial training using reinforcement principles to shape behaviour, like eye contact

  • must be like 25+hrs/week to be effective so super costly

  • focus — increase communication and social sills

  • social stories/scripts so they know expected behaviour in a specific social circumstance

What is conduct disorder

• in childhood, violation of basic rights of others or of societal norms

• if a child is still 14 and engaging in violent acts against other people, they have conduct disorder because they are too grown for that (like has to be weird for the age range too) 

• Four categories of behaviours

  • aggression to people and animals

  • destruction of property

  • deceitfulness or theft

  • serious violation of rules

• if behaviour persists past 18yo, antisocial personality disorder

• more likely to abuse substances early

• more likely to have poor academic achievement and have often been physically abused or around caregivers that model aggression

What are the two types of onset (Regarding timing) of conduct disorder

• adolescent-onset type

  • no symptoms pre-10yo

• childhood-onset type

  • more severe, clinicians worry about this more

  • first symptoms before 10

  • two types

    • childhood onset type with callous and unemotional traits

      • worst prognosis of conduct disorder

      • less natural empathy in the child because it happened earlier and no remorse

    • childhood-onset type without callous and unemotional traits

What is oppositional defiant disorder

• in childhood — overt disobedience, hostility, defiance, and negativity toward people in authority 

• just a childhood diagnosis 

• > 6 months diagnosis 

• symptoms are grouped into three types:

  • angry/irritable mood

  • argumentative/defiant behaviour

  • vindictiveness (highest crossover to conduct disorder)

    • doing things to get at authority figures

What are disruptive behaviours of oppositional defiant disorder

• generally directed toward authority figures

• not usually violent or causing severe harm

• often exhibited only in specific situations with parents or other well known adults like usually fine with other kids or teachers

What are the three types of ADHD

• Hyperactive/impulsive type

  • disruptive behaviours, accidents, rejection by peers

  • can’t inhibit their impulse, so kind of ostracized by other kids

• Inattentive type

  • difficulty remembering a sequence of behaviours, moniroting and shifting direction of attention, organizing material to be memorized, and inhibiting interference during recall

• Combined type

What are specifics about ADHD criteria in the DSM

• lifetime diagnosis

• considered a neurodevelopmental disorder, so if no signs of it in childhood then its probs something else

• must impair functioning in at least 2 settings (school and home for example)

What are some factors than can reduce symptoms of ADHD

• frequent rewards for appropriate behaviour

  • ADHD kids more receptive to rewards

• close supervision

• being in a new setting or situation

  • too much repetition can make them disruptive

• having someone else’s undivided attention

• group settings can make symptoms more severe

What are some neurological aspects of ADHD

• impaired frontal lobe functioning and smaller frontal lobe size

• portions of temporal lobes, corpus callous, basal ganglia, and cerebellum are smaller than normal

  • cerebellum → smaller, which is noteworthy because this affects attention and timing

• problems in interactions between brain areas more so than a specific area

  • abnormal brain functioning could also affect autonomic nervous system, causing the low arousal and subsequent stimulation-seeking behaviour in people with ADHD

• multiple neurotransmitters implicated, such as dopamine

Define specific learning disorders and what are the types of specific learning disorders

• significant disparity between academic performance and expected level of performance based on age, intelligence, and education level

• achievement is 2 SD’s below IQ

Types

• Impairment in reading → dyslexia 

• impairment in mathematics

• impairment in writing 

How do specific learning disorders work neurologically (think dyslexia and think lobes and hemispheres)

• some forms of dyslexia appear to reflect a specific problem in processing visual stimuli independent of problems in connecting them to sounds (like an eye delay issue kind of)

• less activation in the left hemisphere during the reading tasks:

  • junction of left parietal and temporal lobes → converting visual input to sounds

  • junction of left parietal and occipital lobes → recognizing whole words, based on their visual forms (so this would be like the eye delay issue)

• structural differences within the brains of dyslexic patients

  • reduced grey matter in temporal lobes

  • portions of frontal lobes are kind of larger

• most SLDs are moderately to highly heritable

What are some treatments for specific learning disorders?

• treatments for dyslexia

  • phonological practice

    • learning to divide words into individual sounds and indentifying rhyming words

  • alphabetic principle

    • governs the way in which letters signal elementary speech sounds

  • other treatments

    • often a trial-and-error process

    • allowing more time for a task

    • use of cue cards, breaking things down into smaller steps and giving immediate feedback

What are two physucal things about ADHD? like think about time and executive function

• impaired executive function (because of issues in frontal lobe)

  • like can’t resist eating a marshmallow

• inability to estimate time accurately

  • comparatively speaking, like having difficulty planning and estimating, affecting ability to plan and follow through on commitments

Explain ADHD and other people ?? like think attributions and perception ?? idk this question is ass

• problems recognizing facial expressions 

• attributional style creates vulnerability to low self esteem

  • initially overestimate ability to perform a task and attribute failure to internal factors

  • self-esteem could be related to parents’ attributions

    • like they might give enough credit for positive behaviours as parents of kids who don’t have ADHD

    • may act out of frustration

• slow cognitive tempo

  • tempo of neural firing is slower, which is why stimulants work

  • hyperactivity because their brain is seeking stimulation all the time

What are social factors contributing to Oppositional Defiant and Conduct Disorder

• harsh or inconsistent punishment, family history of substance abuse

• exposure to neglect or violence

• parental neglect or inconsistent parenting

How are disruptive behaviour disorders treated neurologically

• no medications for ODD specifically or CD

  • medication for ADHD could possible help comorbid ODD and CD

• most medications for ADHD are stimulants

  • increases attention, reduces general activity levels, and reduces impulsive behaviours

  • disrupts the reuptake of dopamine

How are disruptive behaviour disorders psychologically treated — think squid games

• CBT to address disruptive behaviours

  • also cognitive methods seek to enhance children’s social problem-solving abilities through skills-building, modeling, and role-playing

• behavioural methods may focus on helping children restrain behaviour and accept delayed reward

  • red light, green light game is actually good for learning inhibition

  • training the brain to be responsive to directions

  • reinforcement programs use concrete rewards

What doesn’t work to treat conduct disorder

• trying to teach children to have empathy for conduct disorder doesn’t work well like in pedophilia

  • instead think more about the consequences: what is going to happen to you if you get caught for what you did

What are social treatment for disruptive behaviour disorders?

• helping parents and teachers make more systemic and consistent use of operant conditioning principles

• parent training

  • Lisado ratio

• multisystemic therapy

  • based on family systems therapy, focuses on the context in which the child’s disruptive behaviour occurs

What is the lisado ratio in treating disruptive disorders?

• 4 or 5 positive interaction with child, for every 1 negative interaction