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PSYC4080 6.0D PSYC4080 6.0D Developmental Disorders Developmental Disorders 1 Developmental Developmental Disorders Disorders Autism, Asperger’s, Autism, Asperger’s, Intellectual Disabilities Intellectual Disabilities

PSYC4080 6.0D Developmental Disorders 1 Autism, Asperger’s, Intellectual Disabilities

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Page 1: PSYC4080 6.0D Developmental Disorders 1 Autism, Asperger’s, Intellectual Disabilities

PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 11

Developmental Developmental DisordersDisorders

Autism, Asperger’s, Autism, Asperger’s,

Intellectual DisabilitiesIntellectual Disabilities

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Pervasive Developmental Pervasive Developmental Disorders: Autism and Disorders: Autism and Asperger’s SyndromeAsperger’s Syndrome

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AutismAutism

Onset before age 3. It is not a congenital Onset before age 3. It is not a congenital disorder. disorder.

Large reductions in intellectual abilityLarge reductions in intellectual ability 70% have an IQ less than 75 (low).70% have an IQ less than 75 (low).

Can learn some language, but have Can learn some language, but have particularly poor social skillsparticularly poor social skills Life of solitudeLife of solitude

Stereotyped, ritualized behavioursStereotyped, ritualized behaviours

Occasional “splinter” skills – areas of Occasional “splinter” skills – areas of great strength in comparison to intellect.great strength in comparison to intellect.

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AutismAutism

PrevalencePrevalence Rare, 2-5:10 000 persons (APA, 1994)Rare, 2-5:10 000 persons (APA, 1994) Occurs more frequently in males than Occurs more frequently in males than females (2.5-4 : 1)females (2.5-4 : 1)

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Case StudyCase Study

During the first years of life, “John” walked and talked at During the first years of life, “John” walked and talked at the expected milestones the expected milestones

The only exception was that he was very clingy to his The only exception was that he was very clingy to his mother--he was scared to venture outside alone (he mother--he was scared to venture outside alone (he would scream) and would not engage with anyone else.would scream) and would not engage with anyone else.

JJohn loved his building cups. However, he was ohn loved his building cups. However, he was disinterested in playing with his sister, preferring to placedisinterested in playing with his sister, preferring to place the the cupscups aaround the room. If they were moved, or one round the room. If they were moved, or one was lost, he was inconsolable for the whole day.was lost, he was inconsolable for the whole day.

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Case StudyCase Study

At the age of three, John hadAt the age of three, John had nnormal verbal skills and his ormal verbal skills and his memory seemed phenomenal. He could recite all the memory seemed phenomenal. He could recite all the road signs in the highway code without error. road signs in the highway code without error.

However, heHowever, he wwas extremelyas extremely wwary ofary of oother people, always ther people, always avoiding eye contact and getting increasingly difficult for avoiding eye contact and getting increasingly difficult for his mother to manage. his mother to manage.

He had tantrums which became worse as heHe had tantrums which became worse as he sstruggled to truggled to make sense of his world.make sense of his world.

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Case StudyCase Study

His mother knew there was something wrong but no-one His mother knew there was something wrong but no-one listened. listened. Others said it was aOthers said it was all her fault because ll her fault because she was too sensitive and over-protective. she was too sensitive and over-protective.

When John started school, he seemed to be When John started school, he seemed to be unteachable. He would not settle,unteachable. He would not settle, aand at last people took nd at last people took mother’s concerns mother’s concerns sseriously.eriously.

On the plus side, John was getting better developmental On the plus side, John was getting better developmental skills and could play the glockenspiel and piano if he was skills and could play the glockenspiel and piano if he was in the mood. He did it instinctively, playing any tune with in the mood. He did it instinctively, playing any tune with one hand.one hand.

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Case StudyCase Study

John was manic, always anxious, often difficult. John was manic, always anxious, often difficult.

John was a big fan of the Beatles, 60s music and the John was a big fan of the Beatles, 60s music and the pop charts. He can tell you instantly what was number pop charts. He can tell you instantly what was number one in July 1967. He would listen to music for hours. one in July 1967. He would listen to music for hours.

HHe was also becoming a very handsome young man e was also becoming a very handsome young man who was starting to attract female attention but he was who was starting to attract female attention but he was totally disinterested. Sexuality was never a part of his totally disinterested. Sexuality was never a part of his world.world.

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Case StudyCase Study

When his mother died at the age of 47 of cancer, John When his mother died at the age of 47 of cancer, John did notdid not aattend the funeral. He matter-of-factly said his ttend the funeral. He matter-of-factly said his sister had taken his mother’s place now. There was no sister had taken his mother’s place now. There was no other emotion.other emotion.

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DSM-IV criteriaDSM-IV criteria

Complicated diagnosisComplicated diagnosis

A. Total of six (or more) items from (1), A. Total of six (or more) items from (1), (2), and (3), with at least two from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):and one each from (2) and (3):

1.1. qualitative impairment in social qualitative impairment in social interaction.interaction.

2.2. qualitative impairments in communication.qualitative impairments in communication.

3.3. restricted, repetitive, and stereotyped restricted, repetitive, and stereotyped patterns of behavior, interests, and patterns of behavior, interests, and activities.activities.

LINK: http://www.psych.yorku.ca/mirabella/4080/documents/PDDDSMCriteria.pdf

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DSM-IV criteriaDSM-IV criteria

B. Delays or abnormal functioning with B. Delays or abnormal functioning with onset prior to age 3 years: onset prior to age 3 years:

(1)(1) social interaction, social interaction,

(2)(2) language as used in social language as used in social communication, or communication, or

(3)(3) symbolic or imaginative play.symbolic or imaginative play.

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DSM-IV criteriaDSM-IV criteria

C. The disturbance is not better C. The disturbance is not better accounted for by accounted for by Rett's disorderRett's disorder or or childhood disintegrative disorderchildhood disintegrative disorder..

Rett’s: Only in girls who develop Rett’s: Only in girls who develop normally until 6 months of age and normally until 6 months of age and regress. regress. • Associated with microcephaly (small Associated with microcephaly (small head). head).

• Genetic causeGenetic cause CDD: Later onset, more severe effects CDD: Later onset, more severe effects on motor behaviour, adaptive skills on motor behaviour, adaptive skills (loss of bowel control)(loss of bowel control)

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Asperger’s DisorderAsperger’s Disorder

Also called Also called high functioning autismhigh functioning autism Children tend to have a higher verbal IQ Children tend to have a higher verbal IQ than those with autism.than those with autism. Low, but normal language skills.Low, but normal language skills.

May appear normal with many behaviours May appear normal with many behaviours that are considered socially odd.that are considered socially odd. Low, but normal social skills.Low, but normal social skills.

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DSM-IV criteriaDSM-IV criteria

A. Qualitative impairment in social A. Qualitative impairment in social interactioninteraction

B. Restricted, repetitive, and stereotyped B. Restricted, repetitive, and stereotyped patterns of behavior, interests, and patterns of behavior, interests, and activitiesactivities

C. The disturbance causes clinically C. The disturbance causes clinically significant impairment in social, significant impairment in social, occupational, or other important areas of occupational, or other important areas of functioning.functioning.

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DSM-IV criteriaDSM-IV criteria

D. There is no clinically significant general D. There is no clinically significant general delay in language (e.g., single words used by age delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 2 years, communicative phrases used by age 3 years).years).

E. There is no clinically significant delay in E. There is no clinically significant delay in cognitive development or in the development of cognitive development or in the development of age-appropriate self-help skills, adaptive age-appropriate self-help skills, adaptive behavior (other than in social interaction), and behavior (other than in social interaction), and curiosity about the environment in childhood.curiosity about the environment in childhood.

F. Criteria are not met for another specific F. Criteria are not met for another specific pervasive developmental disorderpervasive developmental disorder or or schizophreniaschizophrenia..

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Other InformationOther Information

Autism is not a homogenous disorder Autism is not a homogenous disorder More of an umbrella term for disorders with More of an umbrella term for disorders with multiple possible causes and outcomesmultiple possible causes and outcomes

Specific type of mental retardationSpecific type of mental retardation Gross brain damageGross brain damage

Behaviour is thought of as eccentric, and Behaviour is thought of as eccentric, and may get in the way of having good may get in the way of having good relationships with others.relationships with others.

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EtiologyEtiology

1.1. Birth traumaBirth trauma• forceps delivery forceps delivery • viral infections (immunization) viral infections (immunization) • metabolic problems, hormonal imbalancesmetabolic problems, hormonal imbalances

2. Genetic causes?2. Genetic causes?• No definitive research No definitive research • High concordance in monozygotic twins High concordance in monozygotic twins

(over 90%)(over 90%)• Does run in families (usually through Does run in families (usually through

father)father)

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EtiologyEtiology

3. 3. Comorbid with other developmental Comorbid with other developmental abnormalities: abnormalities:

• Trisomy 21 (Down’s), phenylketonuria Trisomy 21 (Down’s), phenylketonuria • Asperger’s may be related to neuronal Asperger’s may be related to neuronal

migration disorders migration disorders (Berthier, Starkstein, & (Berthier, Starkstein, & Leiguarda, 1990)Leiguarda, 1990)

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NeuropathologyNeuropathology

1. High (15-30%) incidence of seizures occur in 1. High (15-30%) incidence of seizures occur in autism (Smalley, Levitt, & Bauman, 1998)autism (Smalley, Levitt, & Bauman, 1998)

2. Numerous neurological abnormalities:2. Numerous neurological abnormalities: IncreasedIncreased brain volume (Deb & Thompson, 1998; brain volume (Deb & Thompson, 1998;

Rapin & Katzman, 1998)Rapin & Katzman, 1998) Decreased number of cells in limbic system and Decreased number of cells in limbic system and

cerebellar cortex (Rapin & Katzman, 1998) cerebellar cortex (Rapin & Katzman, 1998) Diminished corpus callosum (Piven et al., 1997)Diminished corpus callosum (Piven et al., 1997) 25-30% of adults with autism have elevated serum 25-30% of adults with autism have elevated serum

serotonin levels (Cummings & Mega, 2003)serotonin levels (Cummings & Mega, 2003)

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Intellectual Intellectual DisabilityDisability

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Information and PrevalenceInformation and Prevalence

An umbrella term for a number of diseases An umbrella term for a number of diseases and injuries in infants and children that and injuries in infants and children that result in severely reduced intellectual result in severely reduced intellectual functioningfunctioning

High prevalence: 1-3% of the population.High prevalence: 1-3% of the population. Also occurs in many infants with in utero Also occurs in many infants with in utero abnormalitiesabnormalities

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DSM-IV system criteriaDSM-IV system criteria

1. Low IQ based on standardized IQ 1. Low IQ based on standardized IQ teststests

• Mild ID – 55-70 IQMild ID – 55-70 IQ• Moderate ID – 40-55 IQModerate ID – 40-55 IQ• Severe ID – 25-40 IQSevere ID – 25-40 IQ• Profound ID – below 25 IQProfound ID – below 25 IQ

2. Identification before age 182. Identification before age 18

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American Association on American Association on Intellectual Intellectual

Disability(1992)Disability(1992) Subaverage intellectual functioning (DSM-Subaverage intellectual functioning (DSM-IV).IV).

AndAnd limitations in at least two of the limitations in at least two of the following:following:• CommunicationCommunication• Self care skillsSelf care skills• Home livingHome living• Social skillsSocial skills• Community useCommunity use• Self-directionSelf-direction• Health and safetyHealth and safety• Functional academicsFunctional academics• LeisureLeisure• WorkWork

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American Association on American Association on Intellectual Intellectual

Disability(1992)Disability(1992) Takes into account supports, emotional Takes into account supports, emotional development, physical health and development, physical health and environmental considerationsenvironmental considerations

Emphasis on adaptive functioning.Emphasis on adaptive functioning. Not widely used in CanadaNot widely used in Canada

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EtiologyEtiology

1.1. Down’s syndrome, other genetic disordersDown’s syndrome, other genetic disorders• Trisomy 21Trisomy 21 Occurs 1-1.5 times per 1000 live birthsOccurs 1-1.5 times per 1000 live births Occurs more often in mothers over 40 Occurs more often in mothers over 40

years of age (years of age (18 in 100018 in 1000)) Intelligence can range from severely Intelligence can range from severely

impaired to normalimpaired to normal Many metabolic diseases as well: Many metabolic diseases as well:

Phenylketonuria, Maple syrup urine Phenylketonuria, Maple syrup urine disease, Galactosemia, etc.disease, Galactosemia, etc.

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EtiologyEtiology

2. X-chromosome abnormalities (1:1500-2500)2. X-chromosome abnormalities (1:1500-2500) Fragile X syndrome: defective X chromosome Fragile X syndrome: defective X chromosome – more common in males– more common in males

Turner’s syndrome (XO): in females, short Turner’s syndrome (XO): in females, short stature and lack of sexual development at stature and lack of sexual development at pubertypuberty

Klinefelter’s syndrome (XXY): in males, Klinefelter’s syndrome (XXY): in males, incomplete sexual development, infertilityincomplete sexual development, infertility

mild to moderate ID is associated with mild to moderate ID is associated with these diseases.these diseases.

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EtiologyEtiology

3. Premature Birth3. Premature Birth Infants born 35 weeks gestation or soonerInfants born 35 weeks gestation or sooner Usually low birthweightUsually low birthweight 1 in 20 births (5%)1 in 20 births (5%) Many organs have not developed Many organs have not developed sufficiently, especially brain and lungs.sufficiently, especially brain and lungs.

Most common in mothers < 15 years and > 40 Most common in mothers < 15 years and > 40 years.years.

Maternal nutrition is a factor: anemia, Maternal nutrition is a factor: anemia, thyroid deficiency, diabetes.thyroid deficiency, diabetes.

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EtiologyEtiology

4. Other maternal factors4. Other maternal factors First trimester insult to fetus – this is First trimester insult to fetus – this is when the nervous system undergoes its when the nervous system undergoes its fastest development. fastest development.

Infections : German measles, syphilis, Infections : German measles, syphilis, toxoplasmosis (comes from eating toxoplasmosis (comes from eating undercooked pork) are most common and undercooked pork) are most common and serious.serious.

Chemicals, drugs, smoking, alcohol, and Chemicals, drugs, smoking, alcohol, and radiation during pregnancy may also be radiation during pregnancy may also be related to intellectual disability.related to intellectual disability.

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EtiologyEtiology

5. Malformations of the cerebral hemispheres 5. Malformations of the cerebral hemispheres (1:2000 births)(1:2000 births)

Spina Bifida and Cranium Bifidum: Failure Spina Bifida and Cranium Bifidum: Failure of closure of the neural tube during the of closure of the neural tube during the first few weeks of gestation (day 27-28)first few weeks of gestation (day 27-28)

A complication of these diseases is A complication of these diseases is Hydrocephalus: accumulation of CSFHydrocephalus: accumulation of CSF• Enlarged headEnlarged head• Brain atrophyBrain atrophy

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Interventions and IDInterventions and ID

• It is difficult to say whether all children with It is difficult to say whether all children with intellectual disability need intervention.intellectual disability need intervention.

Some are perfectly happy the way they are.Some are perfectly happy the way they are. Others may have emotional or behavioural Others may have emotional or behavioural

difficulties.difficulties. Some parents may have more or less support in Some parents may have more or less support in

coping with these children.coping with these children. The less support there is, the more likely they The less support there is, the more likely they

are to seek help.are to seek help. Typical interventions are aimed at educating the Typical interventions are aimed at educating the

child and remediating any language deficitschild and remediating any language deficits There is no treatment, only supportive education There is no treatment, only supportive education

or counseling.or counseling.