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PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 11
Developmental Developmental DisordersDisorders
Autism, Asperger’s, Autism, Asperger’s,
Intellectual DisabilitiesIntellectual Disabilities
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 22
Pervasive Developmental Pervasive Developmental Disorders: Autism and Disorders: Autism and Asperger’s SyndromeAsperger’s Syndrome
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 33
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.
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 44
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)
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 55
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.
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 66
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.
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 77
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.
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 88
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.
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 99
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.
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 1010
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
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 1111
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.
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 1212
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)
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 1313
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.
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 1414
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.
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 1515
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..
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 1616
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.
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 1717
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)
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 1818
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)
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 1919
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)
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 2020
Intellectual Intellectual DisabilityDisability
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 2121
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
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 2222
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
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 2323
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
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 2424
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
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 2525
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.
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 2626
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.
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 2727
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.
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 2828
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.
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 2929
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
PSYC4080 6.0DPSYC4080 6.0D Developmental DisordersDevelopmental Disorders 3030
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.