Comer, Abnormal Psychology, 6e – Chapter 17 1 Chapter 17 Disorders of Childhood and Adolescence Slides & Handouts by Karen Clay Rhines, Ph.D. Seton Hall

Comer, Abnormal Psychology, 6e – Comer, Abnormal Psychology, 6e – Chapter 17Chapter 17

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Chapter 17Chapter 17

Disorders of Childhood and Disorders of Childhood and AdolescenceAdolescence

Slides & Handouts by Karen Clay Slides & Handouts by Karen Clay Rhines, Ph.D.Rhines, Ph.D.

Seton Hall UniversitySeton Hall University

2Comer, Abnormal Psychology, 6e – Comer, Abnormal Psychology, 6e –


Disorders of Disorders of Childhood and Childhood and AdolescenceAdolescence

Abnormal functioning can occur at Abnormal functioning can occur at any time in lifeany time in life

Some patterns of abnormality, Some patterns of abnormality, however, are more likely to emerge however, are more likely to emerge during particular periodsduring particular periods



Childhood and Childhood and AdolescenceAdolescence

Theorists often view life as a series of stages Theorists often view life as a series of stages on the road from birth to deathon the road from birth to death Freud proposed that each child passes through the Freud proposed that each child passes through the

same five stages of psychosexual development: same five stages of psychosexual development: oral, anal, phallic, latency, and genitaloral, anal, phallic, latency, and genital

Erikson added the stage of “old age”Erikson added the stage of “old age” Although theorists may disagree with the Although theorists may disagree with the

details of these schemes, most agree with the details of these schemes, most agree with the idea that we face key pressures during each idea that we face key pressures during each stage in life and either grow or decline stage in life and either grow or decline depending on how we meet those pressuresdepending on how we meet those pressures




People often think of childhood as a People often think of childhood as a carefree and happy time – yet it can also carefree and happy time – yet it can also be frightening and upsettingbe frightening and upsetting Children of all cultures typically experience at Children of all cultures typically experience at

least some emotional and behavioral problems least some emotional and behavioral problems as they encounter new people and situationsas they encounter new people and situations

Surveys indicate that worry is a common Surveys indicate that worry is a common experience experience

Bedwetting, nightmares, and temper tantrums are Bedwetting, nightmares, and temper tantrums are other problems experienced by many childrenother problems experienced by many children




Adolescence can also be a difficult Adolescence can also be a difficult periodperiod Physical and sexual changes, social and Physical and sexual changes, social and

academic pressures, personal doubts, academic pressures, personal doubts, and temptation cause many teenagers and temptation cause many teenagers to feel anxious, confused, and to feel anxious, confused, and depresseddepressed




Along with these common Along with these common psychological difficulties, at least one-psychological difficulties, at least one-fifth of all children and adolescents in fifth of all children and adolescents in North America also experience a North America also experience a diagnosable psychological disorderdiagnosable psychological disorder Boys with disorders outnumber girls with Boys with disorders outnumber girls with

disorders, even though most of the adult disorders, even though most of the adult psychological disorders are more psychological disorders are more common in womencommon in women




Certain disorders of children – childhood Certain disorders of children – childhood anxiety disorders and childhood anxiety disorders and childhood depression – have adult counterpartsdepression – have adult counterparts

In contrast, other childhood disorders – In contrast, other childhood disorders – conduct disorders, ADHD, and elimination conduct disorders, ADHD, and elimination disorders, for example – usually disappear disorders, for example – usually disappear or radically change form by adulthoodor radically change form by adulthood

There also are disorders that begin in There also are disorders that begin in birth or childhood and persist in stable birth or childhood and persist in stable forms into adult lifeforms into adult life These include mental retardation and autismThese include mental retardation and autism



Oppositional Defiant Oppositional Defiant Disorder and Conduct Disorder and Conduct

DisorderDisorder Children consistently displaying extreme Children consistently displaying extreme

hostility and defiance may qualify for a hostility and defiance may qualify for a diagnosis of oppositional defiant disorder diagnosis of oppositional defiant disorder This disorder is characterized by repeated This disorder is characterized by repeated

arguments with adults, loss of temper, anger, and arguments with adults, loss of temper, anger, and resentmentresentment

Children with this disorder ignore adult requests Children with this disorder ignore adult requests and rules, try to annoy people, and blame others for and rules, try to annoy people, and blame others for their mistakes and problemstheir mistakes and problems

Approximately 8% of children qualify for this Approximately 8% of children qualify for this diagnosisdiagnosis

The disorder is more common in boys than girls The disorder is more common in boys than girls before puberty but equal in both sexes after pubertybefore puberty but equal in both sexes after puberty




DisorderDisorder Children with conduct disorder, a Children with conduct disorder, a

more severe problem, repeatedly more severe problem, repeatedly violate the basic rights of othersviolate the basic rights of others They are often aggressive and may be They are often aggressive and may be

physically cruel and violentphysically cruel and violent Many steal from, threaten, or harm Many steal from, threaten, or harm

their victims, committing such crimes their victims, committing such crimes as shoplifting, vandalism, mugging, and as shoplifting, vandalism, mugging, and armed robberyarmed robbery




DisorderDisorder Conduct disorder usually begins between 7 Conduct disorder usually begins between 7

and 15 years of ageand 15 years of age Around 10% of children, three-quarters of Around 10% of children, three-quarters of

them boys, qualify for this diagnosisthem boys, qualify for this diagnosis Children with a mild conduct disorder may Children with a mild conduct disorder may

improve over time, but severe cases improve over time, but severe cases frequently continue into adulthoodfrequently continue into adulthood These cases may turn into antisocial personality These cases may turn into antisocial personality

disorder or other psychological problemsdisorder or other psychological problems




DisorderDisorder Many clinical theorists believe that there are Many clinical theorists believe that there are

actually several kinds of conduct disorderactually several kinds of conduct disorder One term distinguishes four patterns:One term distinguishes four patterns:

Overt-destructiveOvert-destructive Overt-nondestructiveOvert-nondestructive Covert-destructiveCovert-destructive Covert-nondestructiveCovert-nondestructive

Some individuals display only one of these patterns, Some individuals display only one of these patterns, while others display a combination of themwhile others display a combination of them

It may be that the different patterns have different causesIt may be that the different patterns have different causes




DisorderDisorder Other researchers distinguish yet Other researchers distinguish yet

another pattern of aggression found another pattern of aggression found in certain cases of conduct disorder in certain cases of conduct disorder – relational aggression – in which – relational aggression – in which individuals are socially isolated and individuals are socially isolated and primarily display social misdeedsprimarily display social misdeeds Relational aggression is more common Relational aggression is more common

in girls than boysin girls than boys




DisorderDisorder More than one-third of boys and one-More than one-third of boys and one-

half of girls with conduct disorder half of girls with conduct disorder also display also display attention-deficit/hyperactivity attention-deficit/hyperactivity disorder (ADHD)disorder (ADHD) In most cases, ADHD is believed to In most cases, ADHD is believed to

precede and help cause the conduct precede and help cause the conduct disorderdisorder




DisorderDisorder Many children with conduct disorder Many children with conduct disorder

also experience depressionalso experience depression In such cases, the conduct disorder In such cases, the conduct disorder

typically precedes the onset of typically precedes the onset of depressive symptomsdepressive symptoms

This combination of symptoms places This combination of symptoms places the individual at higher risk for suicidethe individual at higher risk for suicide




DisorderDisorder Many children with conduct disorder Many children with conduct disorder

are suspended from school, placed are suspended from school, placed in foster homes, or incarceratedin foster homes, or incarcerated When children between the ages of 8 When children between the ages of 8

and 18 break the law, the legal system and 18 break the law, the legal system often labels them juvenile delinquentsoften labels them juvenile delinquents



What Are the Causes of What Are the Causes of Conduct Disorder?Conduct Disorder?

Cases of conduct disorder have been Cases of conduct disorder have been linked to genetic and biological factors, linked to genetic and biological factors, drug abuse, poverty, traumatic events, drug abuse, poverty, traumatic events, and exposure to violent peers or and exposure to violent peers or community violencecommunity violence

They have most often been tied to They have most often been tied to troubled parent-child relationships, troubled parent-child relationships, inadequate parenting, family conflict, inadequate parenting, family conflict, marital conflict, and family hostilitymarital conflict, and family hostility



How Do Clinicians Treat How Do Clinicians Treat Conduct Disorder?Conduct Disorder?

Because disruptive behavior patterns become Because disruptive behavior patterns become more locked in with age, treatments for more locked in with age, treatments for conduct disorder are generally most effective conduct disorder are generally most effective with children younger than 13with children younger than 13

A number of interventions have been developed A number of interventions have been developed but no one of them alone is the answer for this but no one of them alone is the answer for this difficult problemdifficult problem Given that conduct disorder affects all spheres of a Given that conduct disorder affects all spheres of a

child’s life, today’s clinicians are increasingly child’s life, today’s clinicians are increasingly combining several approaches into a wide-ranging combining several approaches into a wide-ranging treatment programtreatment program




Sociocultural TreatmentsSociocultural Treatments Given the importance of family factors in Given the importance of family factors in

conduct disorder, therapists often use family conduct disorder, therapists often use family interventionsinterventions One such approach is called parent-child interaction One such approach is called parent-child interaction

therapytherapy A related family intervention is videotape modelingA related family intervention is videotape modeling

When children reach school age, therapists often When children reach school age, therapists often use a family intervention called parent management use a family intervention called parent management trainingtraining

These treatments often have achieved a measure of These treatments often have achieved a measure of successsuccess




Sociocultural TreatmentsSociocultural Treatments Other sociocultural approaches, such as Other sociocultural approaches, such as

residential treatment in the community and residential treatment in the community and programs at school, have also helped some programs at school, have also helped some children improvechildren improve

One such approach is treatment foster careOne such approach is treatment foster care In contrast to these other approaches, In contrast to these other approaches,

institutionalization in “juvenile training institutionalization in “juvenile training centers” has not met with much success and centers” has not met with much success and may, in fact, strengthen delinquent behaviormay, in fact, strengthen delinquent behavior




Child-Focused TreatmentsChild-Focused Treatments Treatments that focus primarily on the Treatments that focus primarily on the

child with conduct disorder, particularly child with conduct disorder, particularly cognitive-behavioral interventions, have cognitive-behavioral interventions, have achieved some success in recent yearsachieved some success in recent years In problem-solving skills training, therapists In problem-solving skills training, therapists

combine modeling, practice, role-playing, combine modeling, practice, role-playing, and systematic rewardsand systematic rewards




Child-Focused TreatmentsChild-Focused Treatments Another child-focused approach, Anger Another child-focused approach, Anger

Coping and Coping Power Program, has Coping and Coping Power Program, has children participate in group sessions that children participate in group sessions that teach them to manage anger more teach them to manage anger more effectivelyeffectively

Studies indicate that these approaches do Studies indicate that these approaches do reduce aggressive behaviors and prevent reduce aggressive behaviors and prevent substance use in adolescencesubstance use in adolescence

Recently, drug therapy also has been usedRecently, drug therapy also has been used




PreventionPrevention It may be that the greatest hope for It may be that the greatest hope for

reducing the problem of conduct reducing the problem of conduct disorder lies in prevention programs disorder lies in prevention programs that begin in early childhoodthat begin in early childhood These programs try to change unfavorable These programs try to change unfavorable

social conditions before a conduct disorder social conditions before a conduct disorder is able to developis able to develop



Attention-Deficit/Attention-Deficit/Hyperactivity DisorderHyperactivity Disorder

Children who display Children who display attention-deficit/hyperactivity disorder attention-deficit/hyperactivity disorder (ADHD) have great difficulty attending (ADHD) have great difficulty attending to tasks or behave overactively and to tasks or behave overactively and impulsively, or bothimpulsively, or both

The primary symptoms of ADHD may The primary symptoms of ADHD may feed into one another, but often one of feed into one another, but often one of the symptoms stands out more than the the symptoms stands out more than the otherother




Problems common to the disorder:Problems common to the disorder: Learning or communication problemsLearning or communication problems Poor school performancePoor school performance Difficulty interacting with other Difficulty interacting with other

childrenchildren Misbehavior, often seriousMisbehavior, often serious Mood or anxiety problemsMood or anxiety problems




Around 5% of schoolchildren display ADHD, Around 5% of schoolchildren display ADHD, as many as 90% of them boysas many as 90% of them boys

Those whose parents have had ADHD are Those whose parents have had ADHD are more likely than others to develop itmore likely than others to develop it

The disorder usually persists through The disorder usually persists through childhood but many children show a lessening childhood but many children show a lessening of symptoms as they move into adolescenceof symptoms as they move into adolescence Between 35% and 60% continue to have ADHD as Between 35% and 60% continue to have ADHD as

adultsadults



What Are the Causes of What Are the Causes of ADHD?ADHD?

Clinicians generally consider ADHD Clinicians generally consider ADHD to have several interacting causes, to have several interacting causes, including:including: Biological causes, particularly abnormal Biological causes, particularly abnormal

dopamine activitydopamine activity High levels of stressHigh levels of stress



What Are the Causes of What Are the Causes of ADHD?ADHD?

Sociocultural theorists also point out that ADHD Sociocultural theorists also point out that ADHD symptoms and a diagnosis of ADHD may symptoms and a diagnosis of ADHD may themselves create interpersonal problems and themselves create interpersonal problems and produce additional symptoms in the childproduce additional symptoms in the child

Three other explanations have received Three other explanations have received considerable press: considerable press: ADHD is typically caused by sugar or food additivesADHD is typically caused by sugar or food additives ADHD results from environmental toxins such as leadADHD results from environmental toxins such as lead Excessive exposure to television can contribute to Excessive exposure to television can contribute to

ADHDADHD



How Do Clinicians Assess How Do Clinicians Assess ADHD?ADHD?

ADHD is a difficult disorder to assessADHD is a difficult disorder to assess Ideally, the child’s behavior should be Ideally, the child’s behavior should be

observed in several environmental observed in several environmental settings because symptoms must be settings because symptoms must be present across multiple settings in order present across multiple settings in order to meet DSM-IV-TR’s criteriato meet DSM-IV-TR’s criteria

It also is important to obtain reports of It also is important to obtain reports of the child’s symptoms from their parents the child’s symptoms from their parents and teachersand teachers



How Is ADHD Treated?How Is ADHD Treated? There is heated disagreement about the There is heated disagreement about the

most effective treatment for ADHDmost effective treatment for ADHD The most common approach has been the use The most common approach has been the use

of stimulant drugs such as methylphenidate of stimulant drugs such as methylphenidate (Ritalin)(Ritalin)

These drugs have a quieting effect on as many These drugs have a quieting effect on as many as 80% of children with ADHD and sometimes as 80% of children with ADHD and sometimes increase their ability to solve problems, increase their ability to solve problems, perform in school, and control aggressionperform in school, and control aggression

However, some clinicians worry about the possible However, some clinicians worry about the possible long-term effects of the drugs long-term effects of the drugs



How Is ADHD Treated?How Is ADHD Treated?

Behavioral therapy is also applied Behavioral therapy is also applied widely in cases of ADHDwidely in cases of ADHD Parents and teachers learn how to apply Parents and teachers learn how to apply

operant conditioning techniques to operant conditioning techniques to change behaviorchange behavior

These treatments have often been These treatments have often been helpful, especially when combined with helpful, especially when combined with drug therapydrug therapy



How Is ADHD Treated?How Is ADHD Treated?

Because children with ADHD often Because children with ADHD often display other (comorbid) display other (comorbid) psychological disorders as well, psychological disorders as well, researchers have further tried to researchers have further tried to determine which treatments work determine which treatments work best for different combinations of best for different combinations of disordersdisorders



The Sociocultural The Sociocultural Landscape: ADHD and Landscape: ADHD and

RaceRace Race seems to come into play with regard Race seems to come into play with regard

to ADHDto ADHD A number of studies indicate that African A number of studies indicate that African

American and Hispanic American children with American and Hispanic American children with significant attention and activity problems are significant attention and activity problems are less likely than white American children to be less likely than white American children to be assessed for ADHD, receive an ADHD diagnosis, assessed for ADHD, receive an ADHD diagnosis, or undergo treatment for the disorderor undergo treatment for the disorder

Those who do receive a diagnosis are less likely than Those who do receive a diagnosis are less likely than white children to be treated with the interventions that white children to be treated with the interventions that seem to be of most helpseem to be of most help




RaceRace In part, racial differences in In part, racial differences in

diagnosis and treatment are tied to diagnosis and treatment are tied to economic factorseconomic factors

A growing number of clinical A growing number of clinical theorists further believe that social theorists further believe that social bias and stereotyping may bias and stereotyping may contribute to the racial differences contribute to the racial differences seen in diagnosis and treatmentseen in diagnosis and treatment




RaceRace While many of today’s clinical While many of today’s clinical

theorists correctly alert us that theorists correctly alert us that ADHD may be generally ADHD may be generally overdiagnosed and overtreated, it is overdiagnosed and overtreated, it is important that they also recognize important that they also recognize that children from certain segments that children from certain segments of society may, in fact, be of society may, in fact, be underdiagnosed and undertreatedunderdiagnosed and undertreated



Elimination DisordersElimination Disorders

Children with elimination disorders Children with elimination disorders repeatedly urinate or pass feces in repeatedly urinate or pass feces in their clothes, in bed, or on the floortheir clothes, in bed, or on the floor

They have already reached an age at They have already reached an age at which they are expected to control which they are expected to control these bodily functionsthese bodily functions These symptoms are not caused by These symptoms are not caused by

physical illnessphysical illness



EnuresisEnuresis Enuresis is repeated involuntary (or in some Enuresis is repeated involuntary (or in some

cases intentional) bedwetting or wetting of cases intentional) bedwetting or wetting of one’s clothesone’s clothes

It typically occurs at night during sleep but It typically occurs at night during sleep but may also occur during the daymay also occur during the day The problem may be triggered by a stressful eventThe problem may be triggered by a stressful event

Children must be at least 5 years of age to Children must be at least 5 years of age to receive this diagnosisreceive this diagnosis

Prevalence of enuresis decreases with agePrevalence of enuresis decreases with age



EnuresisEnuresis Research has not favored one explanation for Research has not favored one explanation for

the disorder over othersthe disorder over others Psychodynamic theorists explain it as a symptom of Psychodynamic theorists explain it as a symptom of

broader anxiety and underlying conflictsbroader anxiety and underlying conflicts Family theorists point to disturbed family Family theorists point to disturbed family

interactionsinteractions Behaviorists often view it as the result of improper Behaviorists often view it as the result of improper

toilet trainingtoilet training Biological theorists suspect that the physical Biological theorists suspect that the physical

structure of the urinary system develops more slowly structure of the urinary system develops more slowly in some childrenin some children



EnuresisEnuresis

Most cases of enuresis correct Most cases of enuresis correct themselves without treatmentthemselves without treatment Therapy, particularly behavioral Therapy, particularly behavioral

therapy, can speed up the processtherapy, can speed up the process



EncopresisEncopresis Encopresis Encopresis – – repeatedly defecating in repeatedly defecating in

one’s clothing one’s clothing –– is less common than is less common than enuresis and less well researchedenuresis and less well researched

The problem:The problem: Is usually involuntaryIs usually involuntary Seldom occurs during sleepSeldom occurs during sleep Starts after the age of 4Starts after the age of 4 Is more common in boys than girlsIs more common in boys than girls



EncopresisEncopresis Encopresis causes intense social Encopresis causes intense social

problems, shame, and embarrassmentproblems, shame, and embarrassment Cases may stem from stress, constipation, Cases may stem from stress, constipation,

improper toilet training, or a combination improper toilet training, or a combination of all threeof all three

The most common treatments are The most common treatments are behavioral and medical approaches, or behavioral and medical approaches, or combinations of the twocombinations of the two Family therapy has also been helpfulFamily therapy has also been helpful



Long-Term Disorders Long-Term Disorders That Begin in ChildhoodThat Begin in Childhood

Two of the disorders that emerge Two of the disorders that emerge during childhood are likely to continue during childhood are likely to continue unchanged throughout a person’s life:unchanged throughout a person’s life: Pervasive developmental disordersPervasive developmental disorders Mental retardationMental retardation

Clinicians have developed a range of Clinicians have developed a range of treatment approaches that can make a treatment approaches that can make a major difference in the lives of people major difference in the lives of people with these problemswith these problems



Pervasive Developmental Pervasive Developmental DisordersDisorders

Pervasive developmental disorders are a Pervasive developmental disorders are a group of disorders marked by impaired social group of disorders marked by impaired social interactions, unusual communications, and interactions, unusual communications, and inappropriate responses to stimuli in the inappropriate responses to stimuli in the environmentenvironment

The group includes autistic disorder, The group includes autistic disorder, Asperger’s disorder, Rett’s disorder, and Asperger’s disorder, Rett’s disorder, and childhood disintegrative disorderchildhood disintegrative disorder Because autistic disorder initially received so much Because autistic disorder initially received so much

more attention than the others, these disorders are more attention than the others, these disorders are often referred to as autistic-spectrum disordersoften referred to as autistic-spectrum disorders



Autistic DisordersAutistic Disorders Autistic disorder, or autism, was first identified in Autistic disorder, or autism, was first identified in

19431943 Children with this disorder are extremely Children with this disorder are extremely

unresponsive to others, uncommunicative, unresponsive to others, uncommunicative, repetitive, and rigidrepetitive, and rigid

Symptoms appear early in life, before age 3Symptoms appear early in life, before age 3 There has been a steady increase in the number There has been a steady increase in the number

of children diagnosed and it appears that at least of children diagnosed and it appears that at least one in 600 and maybe as many as one in 200 one in 600 and maybe as many as one in 200 children display the disorderchildren display the disorder

Around 80% of all cases appear in boysAround 80% of all cases appear in boys



Autistic DisordersAutistic Disorders

As many as 90% of children with As many as 90% of children with autism remain severely disabled into autism remain severely disabled into adulthood and are unable to lead adulthood and are unable to lead independent livesindependent lives Even the highest-functioning adults Even the highest-functioning adults

with autism typically have problems in with autism typically have problems in social interactions and communication social interactions and communication and have restricted interests and and have restricted interests and activitiesactivities



What Are the Features of What Are the Features of Autism? Autism?

The central feature of autism is the The central feature of autism is the individual’s lack of responsiveness, individual’s lack of responsiveness, including extreme aloofness and lack of including extreme aloofness and lack of interest in peopleinterest in people

Language and communication problems Language and communication problems take various formstake various forms One common speech peculiarity is echolalia, One common speech peculiarity is echolalia,

the exact echoing of phrases spoken by othersthe exact echoing of phrases spoken by others Another is pronominal reversal, or confusion Another is pronominal reversal, or confusion

of pronounsof pronouns



What Are the Features of What Are the Features of Autism?Autism?

Autism is also marked by limited Autism is also marked by limited imaginative play and very repetitive and imaginative play and very repetitive and rigid behaviorrigid behavior This has been called a “perseveration of This has been called a “perseveration of

sameness”sameness” Many sufferers become strongly attached Many sufferers become strongly attached

to particular objects – plastic lids, rubber to particular objects – plastic lids, rubber bands, buttons, water – and may collect, bands, buttons, water – and may collect, carry, or play with them constantly carry, or play with them constantly



What Are the Features of What Are the Features of Autism?Autism?

The motor movements of people with autism The motor movements of people with autism may be unusualmay be unusual Often called “self-stimulatory” behaviors; may Often called “self-stimulatory” behaviors; may

include jumping, arm flapping, and making facesinclude jumping, arm flapping, and making faces Children with autism may engage in self-Children with autism may engage in self-

injurious behaviorsinjurious behaviors Children may at times seem overstimulated Children may at times seem overstimulated

and/or understimulated by their and/or understimulated by their environments environments



Asperger’s DisorderAsperger’s Disorder

Those with Asperger’s disorder (or Those with Asperger’s disorder (or syndrome) experience the kinds of syndrome) experience the kinds of social deficits, impairments in social deficits, impairments in expressiveness, idiosyncratic interests, expressiveness, idiosyncratic interests, and restricted and repetitive behaviors and restricted and repetitive behaviors that characterize individuals with that characterize individuals with autism, but at the same time they often autism, but at the same time they often have normal intellectual, adaptive, and have normal intellectual, adaptive, and language skills language skills



Asperger’s DisorderAsperger’s Disorder Clinical research suggests that there may Clinical research suggests that there may

be several subtypes of Asperger’s disorder, be several subtypes of Asperger’s disorder, each having a particular set of symptomseach having a particular set of symptoms

Asperger’s disorder appears to be more Asperger’s disorder appears to be more prevalent than autismprevalent than autism Approximately 1 in 250 individuals displays this Approximately 1 in 250 individuals displays this

pattern, with 80% of them boys pattern, with 80% of them boys It is important to diagnose and treat the It is important to diagnose and treat the

disorder early in life so that the individual disorder early in life so that the individual has a better chance of success in life has a better chance of success in life



What Are the Causes of What Are the Causes of Pervasive Developmental Pervasive Developmental

Disorders?Disorders? Much more research has been Much more research has been

conducted on autism than on conducted on autism than on Asperger’s disorder or other pervasive Asperger’s disorder or other pervasive developmental disordersdevelopmental disorders

Currently, many clinicians and Currently, many clinicians and researchers believe that the other researchers believe that the other disorders are caused by factors disorders are caused by factors similar to those responsible for autismsimilar to those responsible for autism




Disorders?Disorders? A variety of explanations for autism A variety of explanations for autism

have been offeredhave been offered Sociocultural explanations are now seen Sociocultural explanations are now seen

as having been overemphasizedas having been overemphasized Recent work in the psychological and Recent work in the psychological and

biological spheres has persuaded biological spheres has persuaded clinical theorists that cognitive clinical theorists that cognitive limitations and brain abnormalities are limitations and brain abnormalities are the primary causes of the disorderthe primary causes of the disorder




Disorders?Disorders? Sociocultural causesSociocultural causes

Theorists initially thought that family dysfunction Theorists initially thought that family dysfunction and social stress were the primary causes of and social stress were the primary causes of autismautism

Kanner argued that particular personality characteristics Kanner argued that particular personality characteristics of parents created an unfavorable climate for of parents created an unfavorable climate for development - “refrigerator parents”development - “refrigerator parents”

These claims had enormous influence on the public and These claims had enormous influence on the public and the self-image of parents, but research totally failed to the self-image of parents, but research totally failed to support this modelsupport this model

Some clinicians have proposed a high degree of Some clinicians have proposed a high degree of social and environmental stress as a factor, a social and environmental stress as a factor, a theory also unsupported by research theory also unsupported by research




Disorders?Disorders? Psychological causesPsychological causes

According to some theorists, people with autism According to some theorists, people with autism have a central perceptual or cognitive disturbancehave a central perceptual or cognitive disturbance

One theory holds that individuals fail to develop a theory One theory holds that individuals fail to develop a theory of mind – an awareness that other people base their of mind – an awareness that other people base their behaviors on their own beliefs, intentions, and other behaviors on their own beliefs, intentions, and other mental states, not on information they have no way of mental states, not on information they have no way of knowingknowing

Repeated studies have shown that people with autism have Repeated studies have shown that people with autism have this kind of “mindblindness”this kind of “mindblindness”

It has been theorized that early biological problems It has been theorized that early biological problems prevented proper cognitive developmentprevented proper cognitive development




Disorders?Disorders? Biological causesBiological causes

While a clear biological explanation for While a clear biological explanation for autism has not yet been developed, autism has not yet been developed, promising leads have been uncoveredpromising leads have been uncovered

Family studies suggest a genetic factor in the Family studies suggest a genetic factor in the disorderdisorder

Prevalence rates are higher among siblings and Prevalence rates are higher among siblings and highest among identical twinshighest among identical twins

Chromosomal abnormalities have been discovered Chromosomal abnormalities have been discovered in 10% to 12% of people with the disorderin 10% to 12% of people with the disorder




Disorders?Disorders? Biological causesBiological causes

Some studies have linked autism to Some studies have linked autism to prenatal difficulties or birth complicationsprenatal difficulties or birth complications Some theorists have proposed that a postnatal Some theorists have proposed that a postnatal

event – the MMR vaccine – might produce event – the MMR vaccine – might produce autism in some children, although subsequent autism in some children, although subsequent research has found no linkresearch has found no link

Researchers have also identified specific Researchers have also identified specific biological abnormalities that may biological abnormalities that may contribute to the disordercontribute to the disorder




Disorders?Disorders? Biological causes Biological causes

Many researchers believe that autism Many researchers believe that autism may have multiple biological causesmay have multiple biological causes Perhaps all relevant biological factors lead Perhaps all relevant biological factors lead

to a common problem in the brain – a “final to a common problem in the brain – a “final common pathway” – that produces the common pathway” – that produces the features of the disorderfeatures of the disorder



How Do Clinicians and How Do Clinicians and Educators Treat Pervasive Educators Treat Pervasive Developmental Disorders?Developmental Disorders?

Treatment can help people with autism Treatment can help people with autism adapt better to their environment, although adapt better to their environment, although no known treatment totally reverses the no known treatment totally reverses the autistic patternautistic pattern

Treatments of particular help are behavioral Treatments of particular help are behavioral therapy, communication training, parent therapy, communication training, parent training, and community integrationtraining, and community integration In addition, psychotropic drugs and certain In addition, psychotropic drugs and certain

vitamins have sometimes helped when combined vitamins have sometimes helped when combined with other approacheswith other approaches




Behavioral therapyBehavioral therapy Behavioral approaches have been used in Behavioral approaches have been used in

cases of autism to teach new, appropriate cases of autism to teach new, appropriate behaviors, including speech, social skills, behaviors, including speech, social skills, classroom skills, and self-help skills, while classroom skills, and self-help skills, while reducing negative onesreducing negative ones Most often, therapists use modeling and operant Most often, therapists use modeling and operant

conditioningconditioning Therapies are ideally applied when people Therapies are ideally applied when people

with autism are youngwith autism are young




Communication trainingCommunication training Even when given intensive behavioral treatment, Even when given intensive behavioral treatment,

half of the people with autism remain speechlesshalf of the people with autism remain speechless Many therapists include sign language and Many therapists include sign language and

simultaneous communication – a method of simultaneous communication – a method of combining sign language and speech – into therapycombining sign language and speech – into therapy

They may also use augmentative communication systems, They may also use augmentative communication systems, such as “communication boards” or computers that use such as “communication boards” or computers that use pictures, symbols, or written words to represent objects pictures, symbols, or written words to represent objects or needsor needs

Such programs now use child-initiated interactions Such programs now use child-initiated interactions to help improve communication skillsto help improve communication skills




Parent trainingParent training Today’s treatment programs involve Today’s treatment programs involve

parents in a variety of waysparents in a variety of ways For example, behavioral programs train parents For example, behavioral programs train parents

so they can apply behavioral techniques at homeso they can apply behavioral techniques at home In addition, individual therapy and support In addition, individual therapy and support

groups are becoming more available to help groups are becoming more available to help parents deal with their own emotions and parents deal with their own emotions and needsneeds




Community integrationCommunity integration Many of today’s school-based and home-Many of today’s school-based and home-

based programs for autism teach self-help, based programs for autism teach self-help, selfself management, and living skillsmanagement, and living skills

In addition, greater numbers of group In addition, greater numbers of group homes and sheltered workshops are homes and sheltered workshops are available for teens and young adults with available for teens and young adults with autismautism These programs help individuals become a part These programs help individuals become a part

of their community and also reduce the concerns of their community and also reduce the concerns of aging parentsof aging parents



Mental RetardationMental Retardation The term “mental retardation” has been The term “mental retardation” has been

applied to a varied populationapplied to a varied population In recent years, the less stigmatizing term In recent years, the less stigmatizing term

“developmental disability” has become “developmental disability” has become synonymous with mental retardation in many synonymous with mental retardation in many clinical settingsclinical settings

Approximately three of every 100 persons Approximately three of every 100 persons meets the criteria for this disordermeets the criteria for this disorder Around three-fifths of them are male and the vast Around three-fifths of them are male and the vast

majority are considered majority are considered mildlymildly retarded retarded



Mental RetardationMental Retardation According to the DSM-IV-TR, people should According to the DSM-IV-TR, people should

receive a diagnosis of mental retardation receive a diagnosis of mental retardation when they display general intellectual when they display general intellectual functioning that is well below average, in functioning that is well below average, in combination with poor adaptive behaviorcombination with poor adaptive behavior IQ must be 70 or lowerIQ must be 70 or lower The person must have difficulty in such areas as The person must have difficulty in such areas as

communication, home living, self-direction, work, communication, home living, self-direction, work, or safetyor safety

Symptoms must appear before age 18Symptoms must appear before age 18



Assessing IntelligenceAssessing Intelligence Educators and clinicians administer Educators and clinicians administer

intelligence tests to measure intellectual intelligence tests to measure intellectual functioningfunctioning These tests consist of a variety of questions and These tests consist of a variety of questions and

tasks that rely on different aspects of intelligencetasks that rely on different aspects of intelligence Having difficulty in one or two of these subtests or areas Having difficulty in one or two of these subtests or areas

of functioning does not necessarily reflect low of functioning does not necessarily reflect low intelligenceintelligence

An individual’s overall test score, or intelligence An individual’s overall test score, or intelligence quotient (IQ), is thought to indicate general intellectual quotient (IQ), is thought to indicate general intellectual abilityability



Assessing IntelligenceAssessing Intelligence Many theorists have questioned whether IQ Many theorists have questioned whether IQ

tests are indeed validtests are indeed valid Intelligence tests also appear to be Intelligence tests also appear to be

socioculturally biasedsocioculturally biased If IQ tests do not always measure intelligence If IQ tests do not always measure intelligence

accurately and objectively, then the diagnosis accurately and objectively, then the diagnosis of mental retardation may also be biasedof mental retardation may also be biased That is, some people may receive the diagnosis That is, some people may receive the diagnosis

partly because of test inadequacies, cultural partly because of test inadequacies, cultural difference, discomfort with the testing situation, difference, discomfort with the testing situation, or the bias of the testeror the bias of the tester



Assessing Adaptive Assessing Adaptive FunctioningFunctioning

Diagnosticians cannot rely solely on a Diagnosticians cannot rely solely on a cutoff IQ score of 70 to determine whether cutoff IQ score of 70 to determine whether a person suffers from mental retardationa person suffers from mental retardation

Several scales, such as the Vineland and Several scales, such as the Vineland and AAMR adaptive behavior scales, have been AAMR adaptive behavior scales, have been developed to assess adaptive behaviordeveloped to assess adaptive behavior For proper diagnosis, clinicians should observe For proper diagnosis, clinicians should observe

the functioning of each individual in his or her the functioning of each individual in his or her everyday environment, taking both the person’s everyday environment, taking both the person’s background and the community standards into background and the community standards into accountaccount



What Are the What Are the Characteristics of Mental Characteristics of Mental

Retardation?Retardation? The most consistent sign of mental The most consistent sign of mental

retardation is that the person learns retardation is that the person learns very slowlyvery slowly

Other areas of difficulty are attention, Other areas of difficulty are attention, shortshort term memory, planning, and term memory, planning, and languagelanguage Those who are institutionalized with mental Those who are institutionalized with mental

retardation are particularly likely to have retardation are particularly likely to have these limitationsthese limitations



What Are the What Are the Characteristics of Mental Characteristics of Mental

Retardation?Retardation? The DSM-IV-TR describes four levels The DSM-IV-TR describes four levels

of mental retardation:of mental retardation: Mild (IQ 50–70)Mild (IQ 50–70) Moderate (IQ 35–49)Moderate (IQ 35–49) Severe (IQ 20–34)Severe (IQ 20–34) Profound (IQ below 20)Profound (IQ below 20)



Mild RetardationMild Retardation Approximately 80%-85% of all people with Approximately 80%-85% of all people with

mental retardation fall into the category of mental retardation fall into the category of mild retardation (IQ 50–70)mild retardation (IQ 50–70) They are sometimes called “educably retarded” They are sometimes called “educably retarded”

because they can benefit from schoolingbecause they can benefit from schooling People with mild retardation typically need People with mild retardation typically need

assistance but can work in unskilled or assistance but can work in unskilled or semiskilled jobssemiskilled jobs Intellectual performance seems to improve with Intellectual performance seems to improve with

ageage



Mild RetardationMild Retardation

Research has linked mild mental Research has linked mild mental retardation mainly to sociocultural retardation mainly to sociocultural and psychological causes, and psychological causes, particularly:particularly: Poor and unstimulating environmentsPoor and unstimulating environments Inadequate parent-child interactionsInadequate parent-child interactions Insufficient early learning experiences Insufficient early learning experiences



Mild RetardationMild Retardation

Although these factors seem to be Although these factors seem to be the leading causes of mild mental the leading causes of mild mental retardation, at least some biological retardation, at least some biological factors may also be operatingfactors may also be operating Studies have linked mothers’ moderate Studies have linked mothers’ moderate

drinking, drug use, or malnutrition drinking, drug use, or malnutrition during pregnancy to cases of mild during pregnancy to cases of mild retardationretardation



Moderate, Severe, and Moderate, Severe, and Profound RetardationProfound Retardation

Approximately 10% of persons with Approximately 10% of persons with mental retardation function at a level of mental retardation function at a level of moderate retardation (IQ 35–49)moderate retardation (IQ 35–49) They can care for themselves and benefit They can care for themselves and benefit

from vocational trainingfrom vocational training Approximately 3%-4% of persons with Approximately 3%-4% of persons with

mental retardation display severe mental retardation display severe retardation (IQ 20–34)retardation (IQ 20–34) They usually require careful supervision and They usually require careful supervision and

can perform only basic work taskscan perform only basic work tasks



Moderate, Severe, and Moderate, Severe, and Profound RetardationProfound Retardation

About 1%-2% of persons with mental About 1%-2% of persons with mental retardation fall into the category of retardation fall into the category of profound retardation (IQ below 20)profound retardation (IQ below 20) With training they may learn or improve With training they may learn or improve

basic skills but they need a very structured basic skills but they need a very structured environmentenvironment

Severe and profound levels of mental Severe and profound levels of mental retardation often appear as part of retardation often appear as part of larger syndromes that include severe larger syndromes that include severe physical handicapsphysical handicaps



What Are the Causes What Are the Causes of Mental Retardation?of Mental Retardation?

The primary causes of moderate, The primary causes of moderate, severe, and profound retardation are severe, and profound retardation are biological, although people who function biological, although people who function at these levels are also greatly affected at these levels are also greatly affected by their family and social environmentby their family and social environment Sometimes genetic factors are at the root of Sometimes genetic factors are at the root of

these biological problemsthese biological problems Other biological causes come from unfavorable Other biological causes come from unfavorable

conditions that occur before, during, or after conditions that occur before, during, or after birthbirth




Chromosomal causesChromosomal causes The most common chromosomal disorder The most common chromosomal disorder

leading to mental retardation is Down leading to mental retardation is Down syndromesyndrome

Fewer than 1 of every 1000 live births result in Fewer than 1 of every 1000 live births result in Down syndrome, but this rate increases greatly Down syndrome, but this rate increases greatly when the mother’s age is over 35when the mother’s age is over 35

Several types of chromosomal abnormalities may Several types of chromosomal abnormalities may cause Down syndrome, but the most common is cause Down syndrome, but the most common is trisomy 21trisomy 21

Fragile X syndrome is the second most common Fragile X syndrome is the second most common chromosomal cause of mental retardationchromosomal cause of mental retardation




Metabolic causesMetabolic causes In metabolic disorders, the body’s breakdown In metabolic disorders, the body’s breakdown

or production of chemicals is disturbedor production of chemicals is disturbed The metabolic disorders that affect The metabolic disorders that affect

intelligence and development are typically intelligence and development are typically caused by the pairing of two defective caused by the pairing of two defective recessive genes, one from each parentrecessive genes, one from each parent

Examples include:Examples include: Phenylketonuria (PKU)Phenylketonuria (PKU) Tay-Sachs diseaseTay-Sachs disease




Prenatal and birth-related causesPrenatal and birth-related causes As a fetus develops, major physical problems in As a fetus develops, major physical problems in

the pregnant mother can threaten the child’s the pregnant mother can threaten the child’s healthy developmenthealthy development

Low iodine may lead to cretinismLow iodine may lead to cretinism Alcohol use may lead to fetal alcohol syndrome (FAS)Alcohol use may lead to fetal alcohol syndrome (FAS) Certain maternal infections during pregnancy (e.g., Certain maternal infections during pregnancy (e.g.,

rubella, syphilis) may cause childhood problems rubella, syphilis) may cause childhood problems including mental retardationincluding mental retardation

Birth complications, such as a prolonged period Birth complications, such as a prolonged period without oxygen (anoxia), can also lead to mental without oxygen (anoxia), can also lead to mental retardationretardation




Childhood problemsChildhood problems After birth, particularly up to age 6, After birth, particularly up to age 6,

certain injuries and accidents can affect certain injuries and accidents can affect intellectual functioningintellectual functioning Examples include poisoning, serious head Examples include poisoning, serious head

injury, excessive exposure to x-rays, and injury, excessive exposure to x-rays, and excessive use of certain chemicals, minerals, excessive use of certain chemicals, minerals, and/or drugsand/or drugs

Certain infections, such as meningitis and Certain infections, such as meningitis and encephalitis, can lead to mental retardation if encephalitis, can lead to mental retardation if they are not diagnosed and treated in timethey are not diagnosed and treated in time



Interventions for People Interventions for People with Mental Retardationwith Mental Retardation

The quality of life achieved by The quality of life achieved by people with mental retardation people with mental retardation depends largely on sociocultural depends largely on sociocultural factorsfactors Thus, intervention programs try to Thus, intervention programs try to

provide comfortable and stimulating provide comfortable and stimulating residences, social and economic residences, social and economic opportunities, and a proper educationopportunities, and a proper education




What is the proper residence?What is the proper residence? Until recently, parents of children with Until recently, parents of children with

mental retardation would send them to mental retardation would send them to live in public institutions – state schools live in public institutions – state schools – as early as possible– as early as possible These overcrowded institutions provided These overcrowded institutions provided

basic care, but residents were neglected, basic care, but residents were neglected, often abused, and isolated from societyoften abused, and isolated from society




What is the proper residence?What is the proper residence? During the 1960s and 1970s, the public During the 1960s and 1970s, the public

became more aware of these sorry became more aware of these sorry conditions, and, as part of the broader conditions, and, as part of the broader deinstitutionalization movement, deinstitutionalization movement, demanded that many people be released demanded that many people be released from these schoolsfrom these schools

People with mental retardation faced similar People with mental retardation faced similar challenges by deinstitutionalization as people challenges by deinstitutionalization as people with schizophreniawith schizophrenia




What is the proper residence?What is the proper residence? Since deinstitutionalization, reforms have led to Since deinstitutionalization, reforms have led to

the creation of small institutions and other the creation of small institutions and other community residences that teach self-sufficiency, community residences that teach self-sufficiency, devote more time to patient care, and offer devote more time to patient care, and offer education and medical serviceseducation and medical services

Residences include group homes, halfway houses, local Residences include group homes, halfway houses, local branches of larger institutions, and independent branches of larger institutions, and independent residencesresidences

These programs follow the principle of normalization – These programs follow the principle of normalization – they try to provide living conditions similar to those they try to provide living conditions similar to those enjoyed by the rest of society enjoyed by the rest of society




What is the proper residence?What is the proper residence? Today the vast majority of children with Today the vast majority of children with

mental retardation live at home rather mental retardation live at home rather than in an institutionthan in an institution

Most people with mental retardation, Most people with mental retardation, including almost all with mild mental including almost all with mild mental retardation, now spend their adult lives retardation, now spend their adult lives either in the family home or in a either in the family home or in a community residencecommunity residence




Which educational programs work best?Which educational programs work best? Because early intervention seems to offer such great Because early intervention seems to offer such great

promise, educational programs for individuals with promise, educational programs for individuals with mental retardation may begin during the earliest mental retardation may begin during the earliest yearsyears

At issue are special education versus mainstream At issue are special education versus mainstream classroomsclassrooms

In special education, children with mental retardation are In special education, children with mental retardation are grouped together in a separate, specially designed grouped together in a separate, specially designed educational programeducational program

Mainstreaming places them in regular classes with Mainstreaming places them in regular classes with nonretarded studentsnonretarded students

Neither approach seems consistently superiorNeither approach seems consistently superior




Which educational programs work Which educational programs work best?best? Many teachers use operant conditioning Many teachers use operant conditioning

principles to improve the self-help, principles to improve the self-help, communication, social, and academic communication, social, and academic skills of individuals with mental skills of individuals with mental retardationretardation

Many schools also employ token Many schools also employ token economy programseconomy programs




When is therapy needed?When is therapy needed? People with mental retardation sometimes People with mental retardation sometimes

experience emotional and behavioral problemsexperience emotional and behavioral problems As many as 25% have a diagnosable psychological As many as 25% have a diagnosable psychological

disorder other than mental retardationdisorder other than mental retardation Some suffer from low self-esteem, interpersonal Some suffer from low self-esteem, interpersonal

problems, and adjustment difficultiesproblems, and adjustment difficulties These problems are helped to some degree by These problems are helped to some degree by

individual or group therapyindividual or group therapy Medication is sometimes prescribedMedication is sometimes prescribed




How can opportunities for personal, How can opportunities for personal, social, and occupational growth be social, and occupational growth be increased?increased? People need to feel effective and People need to feel effective and

competent in order to move forward in lifecompetent in order to move forward in life Those with mental retardation are most Those with mental retardation are most

likely to achieve these feelings if their likely to achieve these feelings if their communities allow them to grow and communities allow them to grow and make many of their own choicesmake many of their own choices




How can opportunities for personal, social, How can opportunities for personal, social, and occupational growth be increased?and occupational growth be increased? Socializing, sex, and marriage are difficult issues Socializing, sex, and marriage are difficult issues

for people with mental retardation and their for people with mental retardation and their familiesfamilies

With proper training and practice, individuals with With proper training and practice, individuals with mental retardation can learn to use contraceptives mental retardation can learn to use contraceptives and carry out responsible family planningand carry out responsible family planning

The National Association for Retarded Citizens offers The National Association for Retarded Citizens offers guidance in these mattersguidance in these matters

Some clinicians have developed dating skills programsSome clinicians have developed dating skills programs




How can opportunities for personal, How can opportunities for personal, social, and occupational growth be social, and occupational growth be increased?increased? Some states restrict marriage for people Some states restrict marriage for people

with mental retardationwith mental retardation These laws are rarely enforcedThese laws are rarely enforced Between one-quarter and one-half of all Between one-quarter and one-half of all

people with mild mental retardation people with mild mental retardation eventually marryeventually marry




How can opportunities for personal, How can opportunities for personal, social, and occupational growth be social, and occupational growth be increased?increased? Adults with mental retardation need the Adults with mental retardation need the

financial security and personal satisfaction financial security and personal satisfaction that comes from holding a jobthat comes from holding a job

Many can work in sheltered workshops, but Many can work in sheltered workshops, but there are too few training programs availablethere are too few training programs available

Additional programs are needed so that more Additional programs are needed so that more people with mental retardation may achieve their people with mental retardation may achieve their full potential, as workers and as human beingsfull potential, as workers and as human beings

Documents

Comer, Abnormal Psychology, 6e – Chapter 17 1 Chapter 17 Disorders of Childhood and Adolescence Slides & Handouts by Karen Clay Rhines, Ph.D. Seton Hall