Disorders of Childhood and Adolescence (Neurodevelopmental Disorders)

What is intelligence?

a wide range of mental activities such as the ability of logical reasoning and practical intelligence (problem-solving), ability in learning, verbal skills, and so on.

What is a intelligence quotient (IQ)?

a total score obtained from standardized tests (IQ tests) developed fir evaluating human intelligence

• below 70 = cognitive dekays, major deficits in adaptive functioning

• 100 = mean

• 15 - SD

What are specific learning disorders?

a classification of disorders in which a person has difficulty learning in a typical manner within one of several domains

• includes dyslexia, dyscalculia, dysgraphia

What is dyslexia?

deficit in reading ability (most common learning disability)

What is dyscalculia?

difficulties with learning math-related concepts, memorizing math-related facts, organizing numbers, and understanding how problems are organized on the page

What is dysgraphia?

deficiency in writing related concepts, such as grammer, punctuation, poor paragraph organization, spelling, poor penmanaship

What is intellectual development disorder (ID)?

a generalized neurodevelopmental disorder characterized by signifcantly impaired intellectual and adaptive functioning. These criteria must be met..

• significant limitation in general mental abilities

• significant limitations in one or more areas of adaptive behavior across multiple envionments, self-help skills, interpersonal skills, and more.

• evidence that the limitations became apparent in childhood or adolescence.

What causes intellectual development disorder (ID)?

Genetic

• Down syndrome (extra copy of chromosome 21)

  • some cases of mosaicism, where only some cells have an extra copy of chromosome 21, milder cognitive symptoms

• Fragile X syndrome (mutation on the FMR1 gene)

Environment

• meternal exposure to toxin, infectious agent, uncontrolled maternal condition, and birth complications

  • ex) Fetal Alcohol Syndrome

What is a communication disorder?

any disorder that affects an individuals ability to comprehend, detect, or apply language and speech to engage in discourse effectively with others.

What is the definition of a language disorder?

difficulties in learning and using language, which is caused by problems with vocabulary, with grammar, and with putting sentences together in a proper manner.

What is the definition of a speech sound disorder?

also called phonological disorder, difficulties with pronunciation and articulation of speech

What is the definition of a childhood-onset fluency disorder?

standard fluency and rhythm of speech is interrupted, often causing the repetition of whole words and syllables (STUTTERING)

What is the definition of social (pragmatic) communication disorder?

difficulties with social use of verbal and nonverbal communication, which affects the development of social relationships and discourse comprehension

difficulties in the social uses of verbal and nonverbal communication

What is the definition of unspecified communication disorder?

doesn’t meet the full required symotoms of a communcation disorder, but still causes distress or impairment

What is oppositional defiant disorder?

a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness in childern and adolescents.

symptoms

• Frequent loss of temper

• Touchiness or being easily annoyed

• Anger and resentfulness

• Arguing with authority figures or for children and adolescents, with adults

• Defying or refusing to comply with requests from authority figures or rules

• Deliberately annoying others

• Blaming others for their mistakes or misbehavior

• Being spiteful or vindictive at least twice within the past 6 months

What is oppositional defiant disorder listed under in the DSM-5?

disruptive, impulse-control, and conduct disorders

What are conduct disorders?

repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated.

The four main groups of symptoms are described below:

• Aggression to people and animals

• Destruction of property

• Deceitfulness or theft

• Serious violations of rules

What are motor disorders?

malfunctions of the NS that causes involuntary or uncontrollable movements or actions of the body

ex) developmental coordination disorder (DCD), Tourette’s syndrome, persistent tic disorder

What is developmental coordination disorder (DCD)?

a chronic neurological disorder beginning in childhood.

What is Tourette’s syndrome (TS)?

a common neurodevelopmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) tic.

What is persistent tic disorder?

have one or more motor tics or vocal tics, but not both, have tics that occur many times a day nearly every day or on and off throughout a period of more than a year,

• tics that start before age 18 years, are not due to taking medicine, drugs, a medical condition, and not have been diagnosed with TS.

What is the classification of externalizing disorders?

characterized by outward-directed behaviors

noncompliance, aggressiveness, overactivity, impulsiveness

includes ADHD, conduct disorder, and ODD

more common in boys

What is the classification of internalizing disorders?

characterized by inward-focused behaviors

depression, anxiety, social withdrawl

includes childhood anxiety and mood disorders

more common in girls

What is ADHD (attention-deficit/hyperactivity disorder)?

excessive levels of activity (Fidgeting, squirming, running around when inappropriate, incessant talking)

distracitbility and difficulty concentrating (careless mistakes, cannot follow instructions, forgetful)

May have difficulty with peer interactions

falls under a both disinhibiting externalizing and antagonistic externalizing in the HiTOP model

What is the DSM-5 criteria for ADHD?

Either A or B:

A. Six or more manifestations of inattention present for at least 6 months to a maladaptive degree and greater than what would be expected given a person’s developmental level,

• ex) careless mistakes, not listening well, not following instructions, easily distracted, forgetful in daily activities

B. Six or more manifestations of hyperactivity-impulsivity present for at least 6 months to a maladaptive degree and greater than what would be expected given a person’s developmental level.

• ex) fidgeting, running about inappropriately (in adults, restlessness), acting as if “driven by a motor,” interrupting or intruding, incessant talking

• Several of the above present before age 12

• Present in two or more settings, e.g., at home, school, or work

• Significant impairment in social, academic, or occupational functioning

• For people age 17 or older, only five signs of inattention and/or five signs of hyperactivity-impulsivity are required to meet the diagnosis.

What are the specifiers of ADHD in the DSM-5?

1. Predominantly inattentive type

2. Predominantly hyperactive-impulsive type

3. Combined type (majority of diagnoses)

What is the difference between ADHD and conduct disorder?

ADHD is more off-task behavior, cognitive and achievement deficits whereas Conduct Disorder is more aggressive, act out in most settings, antisocial parents, family hostility.

What does ADHD share a comorbid with?

anxiety and depression

features of girls with ADHD

Girls with ADHD more likely to: be anxious and depressed, exhibit neurological deficits (e.g., poor planning, problem-solving), have symptoms of eating disorder and substance abuse by adolescence.

combined type viewed more negatively than inattentive type and inattentive type view more negatively than girls w/out ADHD.

What are the genetic factors of ADHD?

70-80% heritability w/ 2 dopamine receptor genes involved (DRD4 and DAT1)

What are the neurobiological factors of ADHD?

dopaminer

What are the perinatal and prenatal factors of ADHD?

ADHD risk increases w/ low birth weight and maternal tobacco/EtOH use

What are environmental toxins that contribute to ADHD?

nicotine from maternal smoking, may damage dopaminergic systems, resulting in behavioral disinhibition.

limited evidence that food additives, food coloring, or that refined sugar causes ADHD.

Does parent-child relationships cause ADHD?

No, family factors interact with genetic and neurobiological factors and may contribute/maintain behaviors, but do NOT cause them.

How is ADHD treated?

medications (Ritalin, Adderall, Concerta, Strattera)

• reduce disruptive behavior

• Improve interactions with parents, teachers, peers

• Improve goal-directed behavior and concentration

• Reduce aggression

• Effective in about 75 percent of children with ADHD but there are side effects

  • Loss of appetite, weight, sleep problems

behavioral treatment + meds gives a slightly better improvement since social skills improve

psychological

• Parental training

• Change in classroom management

• Behavior monitoring and reinforcement of appropriate behavior

Supportive classroom structure

• Brief assignments

• Immediate feedback

• Task-focused style

• Breaks for exercise

Symptoms of conduct disorder?

Pattern of engaging in behaviors that violate social norms and the rights of others, and are often illegal

• Aggression

• Cruelty towards other people or animals

• Damaging property

• Lying

• Stealing

• Vandalism

• Often accompanied by viciousness, callousness, and lack of remorse

What is Dodge’s Cognitive Theory of Aggression?

ambiguois act interpreted as hostile → aggression towards others → retaliation from others → further angry aggression towards others (cycle repeats)

What are some family interventaions of conduct disorder treatment?

Family check-ups (FCU) associated with less disruptive behavior

Parental management train (PMT)

• Teach parents to reward prosocial behavior

What diagnoses fall under the Autism Spectrum disorder?

Autistic disorder, Asperger’s disorder, pervasive developmental disorder not otherwise specified, and childhood disintegrative disorder

• Research did not support distinctive categories since they share similar clinical features

Can be specified w/ intellectual impairment, language impairment, or cataonia

What is the DSM-5 criteria for Autism Spectrum Disorder?

A total of six or more items from A, B, and C below, with at least two from A and one each from B and C:

A. Deficits in social communication and social interactions as manifested by all of the following:

• Deficits in nonverbal behaviors such as eye contact, facial expression, body language

• Deficit in development of peer relationships appropriate to developmental level

• Deficits in social or emotional reciprocity such as not approaching others, not having a back-and-forth conversation, reduced sharing of interests and emotions

B. Restricted, repetitive behavior patterns, interests, or activities manifested by at least two of the following:

• Stereotyped or repetitive speech, motor movements, or use of objects

• Excessive adherence to routines, rituals in verbal or nonverbal behavior, or extreme resistance to change

• Very restricted interests that are abnormal in focus, such as preoccupation with parts of objects

• Hyper- or hypo-reactivity to sensory input or unusual interest in sensory environment, such as fascination with lights or spinning objects

C. Onset in early childhood

D. Symptoms limit and impair functioning

Features of Autism Spectrum Disorder?

SOCIAL WORLD PROBLEMS

Rarely approach others, may look through people

Problems in joint attention

Pay attention to different parts of faces than do people without autism; focus on mouth, neglect eye region (This neglect likely contributes to difficulties in perceiving emotion in other people)

THEORY OF MIND

Understanding that other people have different desires, beliefs, intentions, and emotions

• Crucial for understanding and successfully engaging in social interactions

• Typically develops between 2½ and 5 years of age

• Children with ASD seem not to achieve this developmental milestone

COMMUNICATION DEFICITS

early language distrubances (echolalia:immediate/delayed repeating of what was heard), pronoun reversal (refers to themselves as “he” or “she”, literal use of words

REPETITIVE AND RITUALISTIC ACTS

• upset when routine is altered

• engage in obessional play and ritualistic body movements

• attachment to inanimate objects

What are the comorbidity of Austism Spectrum disorder?

an IQ lower than 70 is common due to scoring poorly on all parts of an IQ test

Etiology of Autisitic Spectrum disorder?

0.80 heritability

concordance rate of 47-90% for monozygotic twins, 0-20% for dizygotic twins

deletion on chromosome 16