Neuropsychological Neuropsychological Development of ChildrenDevelopment of Children

Brooke Schauder, PhDBrooke Schauder, PhD

Erie Psychology ConsortiumErie Psychology Consortium

Phases of DevelopmentPhases of Development

Primitive Brain Structures Primitive Brain Structures (Hindbrain/Midbrain) mature within (Hindbrain/Midbrain) mature within first 3 years of life. first 3 years of life.

By age 2, brain is 80% as large as an By age 2, brain is 80% as large as an adult brain. adult brain.

Basic sensory and motor functions Basic sensory and motor functions are gained in this phase.are gained in this phase.

Frontal lobe functioning doesn’t Frontal lobe functioning doesn’t begin to occur until between 5-7. begin to occur until between 5-7.

Piaget’s Stages in Relation to Piaget’s Stages in Relation to Neurological DevelopmentNeurological Development

Sensorimotor (0-2) no language, no Sensorimotor (0-2) no language, no thought, no objective reality in thought, no objective reality in beginning of this stagebeginning of this stage

Preoperational Thinking:(2-7) Preoperational Thinking:(2-7) Egocentric thought, reason Egocentric thought, reason dominated by perception; intuitive dominated by perception; intuitive rather than logic, inability to rather than logic, inability to conserve.conserve.

Concrete OperationsConcrete Operations

(7-11) Ability to conserve; logic of (7-11) Ability to conserve; logic of categories and relationships; categories and relationships; understanding of numbers; bound to understanding of numbers; bound to concrete objects and events; concrete objects and events; development of reversibility.development of reversibility.

Formal Operations:(12-15) Generality Formal Operations:(12-15) Generality of thought; propositional thinking; of thought; propositional thinking; ability to deal with the hypothetical.ability to deal with the hypothetical.

Myelination and Teen YearsMyelination and Teen Years

MRI Imaging shows that white matter MRI Imaging shows that white matter (connection material) continues (connection material) continues throughout teen years.throughout teen years.

EXECUTIVE Functions are the EXECUTIVE Functions are the lastlast to to develop.develop.

Developmental MilestonesDevelopmental Milestones

Age 5: stands on 1 foot for 10 Age 5: stands on 1 foot for 10 seconds, draws a person with a body, seconds, draws a person with a body, speaks sentence of more than 5 speaks sentence of more than 5 words, talks about future events, words, talks about future events, counts to 10, names 4 colors, wants counts to 10, names 4 colors, wants to please friends, aware of gender, to please friends, aware of gender, differentiates obvious fantasy from differentiates obvious fantasy from reality.reality.

Childhood Neurodevelopmental Childhood Neurodevelopmental DisordersDisorders

Learning Disabilities Learning Disabilities (5-10%)(5-10%)

ADHD (7%)ADHD (7%) Tourette Syndrome Tourette Syndrome

(2%)(2%) Autism (<1%) and Autism (<1%) and

other PDDs (3%)other PDDs (3%) Turner SyndromeTurner Syndrome Fragile X Syndrome Fragile X Syndrome NeurofibromatosisNeurofibromatosis

Down SyndromeDown Syndrome Klinefelter SyndromeKlinefelter Syndrome PhenylketonuriaPhenylketonuria Rett SyndromeRett Syndrome Seizure DisordersSeizure Disorders Prader-Willi SyndromePrader-Willi Syndrome Williams SyndromeWilliams Syndrome

Learning DisabilitiesLearning Disabilities Most common neurobehavioral Most common neurobehavioral

disorder.disorder. Not a SINGLE entity or cause:Not a SINGLE entity or cause:

• Genetic (up to 35%)Genetic (up to 35%)• EnvironmentalEnvironmental

TeratogensTeratogens Brain TraumaBrain Trauma MalnutritionMalnutrition Early parent-infant relational problem, lack Early parent-infant relational problem, lack

of sensory stimulation.of sensory stimulation.

Abnormal Brain Structures in Abnormal Brain Structures in Reading Disorder (Dyslexia)Reading Disorder (Dyslexia)

Left Parietal AbnormalitiesLeft Parietal Abnormalities Thin Corpus CallosumThin Corpus Callosum General Left Sided cell abnormalities General Left Sided cell abnormalities Inferior frontal, superior temporal, Inferior frontal, superior temporal,

parietal regions affected (not parietal regions affected (not occipital or orbitofrontal)occipital or orbitofrontal)

Abnormal Brain Structures in Non-Abnormal Brain Structures in Non-Verbal Learning Disorder (NLD)Verbal Learning Disorder (NLD)

Mathematics DisorderMathematics Disorder Learning Disorder, NOSLearning Disorder, NOS Social Skills problems & Social Skills problems &

disorganization.disorganization. Right-sided brain abnormalities – Right-sided brain abnormalities –

parietal lobe (however, left side may parietal lobe (however, left side may be involved as well)be involved as well)

Treatment of Children with Treatment of Children with Learning DisordersLearning Disorders

(30-40%)have ADHD type symptoms: (30-40%)have ADHD type symptoms: impulsivity, distractibility.impulsivity, distractibility.

Conduct Disorder (Parental Intervention – Conduct Disorder (Parental Intervention – basic behavioral principles)basic behavioral principles)

Anxiety disorder/Depression: CBT, Anxiety disorder/Depression: CBT, relaxation, positive self-talk, relaxation, positive self-talk, desensitization, self-esteem building. desensitization, self-esteem building.

Social Skills Deficits: Identifying and Social Skills Deficits: Identifying and responding to emotions, conversation responding to emotions, conversation skills, Social Role Playing.skills, Social Role Playing.

4 Personality Patterns Found in LD 4 Personality Patterns Found in LD Children (Wirt, Lachar, Klinedinst, & Children (Wirt, Lachar, Klinedinst, &

Seat, 1977)Seat, 1977) 44% displayed Balanced, well-adjusted 44% displayed Balanced, well-adjusted

social emotional functioning.social emotional functioning. 26% exhibited internalizing psychological 26% exhibited internalizing psychological

disturbances (depression, anxiety, low disturbances (depression, anxiety, low social skills).social skills).

13% displayed normal personality fxn, but 13% displayed normal personality fxn, but somatic concerns.somatic concerns.

17% behavioral disturbance, ODD, conduct 17% behavioral disturbance, ODD, conduct problems.problems.

Attention Deficit Hyperactivity Attention Deficit Hyperactivity Disorder (ADHD)Disorder (ADHD)

A “biopsychosocial” problem; A “biopsychosocial” problem; interaction of interaction of biological/tempermental traits with biological/tempermental traits with environment.environment.

It is a “cluster” of deficits, rather It is a “cluster” of deficits, rather than a single disorder with a single than a single disorder with a single etiology.etiology.

Genetics and Brain StructureGenetics and Brain Structure

Dopamine transporter and receptor Dopamine transporter and receptor genes.genes.

Frontal lobe impairment (executive Frontal lobe impairment (executive functions of attention, motor functions of attention, motor planning, mental flexibility, planning, mental flexibility, sustaining mental effort, and sustaining mental effort, and abstract reasoning.abstract reasoning.

Reduction in Basal Ganglia: Reduction in Basal Ganglia: subcortical structure involved in subcortical structure involved in movement and basic sensory movement and basic sensory regulation.regulation.

TreatmentTreatment

Most effective: combination of medical, Most effective: combination of medical, behavioral, and environmental.behavioral, and environmental.

Classroom: Classroom: • Organized and structured environment Organized and structured environment • Rewards are consistent and immediateRewards are consistent and immediate• Response Cost program should be Response Cost program should be

implementedimplemented• Constant feedback from instructorsConstant feedback from instructors• Transition times should be monitored closelyTransition times should be monitored closely• Consistent Parent- teacher communicationConsistent Parent- teacher communication

ADHD Parenting SkillsADHD Parenting Skills

Have the parents read “123 Magic” and/or Have the parents read “123 Magic” and/or “The Explosive Child” for basic behavior “The Explosive Child” for basic behavior mod. Strategiesmod. Strategies

Parents must distinguish incompetence Parents must distinguish incompetence from noncompliancefrom noncompliance

Parents must give Parents must give clear, operationalclear, operational commands. commands.

Parents should learn to use “start” and not Parents should learn to use “start” and not “stop” commands.“stop” commands.

Must use consistent and frequent Must use consistent and frequent reinforcement. reinforcement.

Tourette SyndromeTourette Syndrome

Usually begins at age 7.Usually begins at age 7. Motor tics preceed vocal tics.Motor tics preceed vocal tics. Etiology is genetic AND familial Etiology is genetic AND familial

(learned).(learned). Abnormalities of basal ganglia Abnormalities of basal ganglia

(movement)(movement) Orbitofrontal Cortex: Decision Orbitofrontal Cortex: Decision

Making, obsession, compulsion, Making, obsession, compulsion, attention.attention.

Basal GangliaBasal Ganglia

Orbitotrontal CortexOrbitotrontal Cortex

Treatment of Tourette DisorderTreatment of Tourette Disorder

Awareness/Self-MonitoringAwareness/Self-Monitoring: record : record each incidence of the habit or tic for each incidence of the habit or tic for a specified amount of time each day a specified amount of time each day (30 minutes). (30 minutes).

-have the child verbally describe the -have the child verbally describe the details of the habit or tic to the details of the habit or tic to the therapist. therapist.

- Have the child become cognizant of - Have the child become cognizant of where the tic/habit happens most where the tic/habit happens most frequently.frequently.

Tourette Treatment Tourette Treatment

Competing-Response Training: Competing-Response Training: Have the person engage in a Have the person engage in a response that is incompatible with response that is incompatible with the tic. Must be 1) incompatible 2) the tic. Must be 1) incompatible 2) capable of being maintained for capable of being maintained for several minutes 3) able to strengthen several minutes 3) able to strengthen the muscles antagonistic to those the muscles antagonistic to those used when engaging in the tic used when engaging in the tic behavior.behavior.

Tourette TreatmentTourette Treatment

Relaxation Training: Progressive Relaxation Training: Progressive muscle relaxation, deep breathing, muscle relaxation, deep breathing, visual imagery, self-statements of visual imagery, self-statements of relaxation.relaxation.

Contingency Management: Work Contingency Management: Work with parents to set up rewards for with parents to set up rewards for decreased tic behavior.decreased tic behavior.

Pervasive Developmental Pervasive Developmental DisordersDisorders

Characterized by severe deficits in Characterized by severe deficits in multiple areas, including social multiple areas, including social interaction, communication, and interaction, communication, and behavioral stereotypes.behavioral stereotypes.• Autistic DisorderAutistic Disorder• Rett’s DisorderRett’s Disorder• Childhood Disintegrative DisorderChildhood Disintegrative Disorder• PDD NOSPDD NOS

Rett’s DisorderRett’s Disorder

Onset of problems AFTER normal 5 Onset of problems AFTER normal 5 months of development.months of development.• Deceleration of head growth (between 5 Deceleration of head growth (between 5

and 48 months)and 48 months)• Loss of motor skillsLoss of motor skills• Loss of social engagementLoss of social engagement• Poorly coordinated trunk movementsPoorly coordinated trunk movements• Severely impaired expressive and Severely impaired expressive and

receptive language developmentreceptive language development

Childhood Disintegrative DisorderChildhood Disintegrative Disorder Normal development for 2 years Normal development for 2 years

(verbal and non-verbal, social skills, (verbal and non-verbal, social skills, play, etc.)play, etc.)• Loss of previous skills before age 10 in 2 Loss of previous skills before age 10 in 2

of:of: LanguageLanguage -social skills-social skills Bowel or bladderBowel or bladder -play-play Motor skillsMotor skills

AND 2 of:AND 2 of:• Social interaction problemsSocial interaction problems• Communication problemsCommunication problems• Behavioral stereotypes or restricted interestsBehavioral stereotypes or restricted interests

Autistic DisorderAutistic Disorder 6 of:6 of:

• Impairment in social interaction as:Impairment in social interaction as: Impairment of non-verbal behaviorImpairment of non-verbal behavior Failure to develop peer relationshipsFailure to develop peer relationships Lack of spontaneous seeking to interactLack of spontaneous seeking to interact Lack of social/emotional reciprocityLack of social/emotional reciprocity

• Impairment of CommunicationImpairment of Communication Delay in spoken languageDelay in spoken language Inablity to sustain conversationInablity to sustain conversation Stereotyped languageStereotyped language Lack of make-believe or imitative playLack of make-believe or imitative play

(DSM Autistic Disorder Continued)(DSM Autistic Disorder Continued)

Stereotyped behavior or interests:Stereotyped behavior or interests:• Preoccupation with interestsPreoccupation with interests• Inflexible adherence to routineInflexible adherence to routine• Repetitive motor mannerismsRepetitive motor mannerisms• Preoccupation with parts of objectsPreoccupation with parts of objects

Delays in at least 1 area manifest Delays in at least 1 area manifest BEFORE age 3.BEFORE age 3.

Asperger’s DisorderAsperger’s Disorder

Impairment in social interaction (as Impairment in social interaction (as in autism)in autism)

Stereotyped behavior or interests (as Stereotyped behavior or interests (as in Autism)in Autism)

NO clinically significant delay in NO clinically significant delay in language.language.

NO impairment of cognitive NO impairment of cognitive development.development.

Neuroanatomical FeatureNeuroanatomical Feature

MRI Studies and Total Brain volumeMRI Studies and Total Brain volume(occipital, parietal, and temporal)(occipital, parietal, and temporal)

- Temporal is critical region.Temporal is critical region.

- Limbic Regions.Limbic Regions.

- Decreased Purkinje cells.Decreased Purkinje cells.

Normal Purkinje CellNormal Purkinje Cell Autistic Purkinje CellAutistic Purkinje Cell

Neurological/Heritable Neurological/Heritable AbnormalitiesAbnormalities

Endocrine AbnormalitiesEndocrine Abnormalities

Gastrointestinal dysfunction.Gastrointestinal dysfunction. Gene HOXA1Gene HOXA1

22 (40%) had one copy of the 22 (40%) had one copy of the variantvariant

UnderconnectivityUnderconnectivityActivation and time synchronization between Activation and time synchronization between

cortical areas was lower in autistic groupcortical areas was lower in autistic group

Treatment of ASDsTreatment of ASDs

BEHAVIORAL TREATMENTBEHAVIORAL TREATMENT• Reinforcement is KEYReinforcement is KEY• RepetitionRepetition• ShapingShaping• Visual Works BestVisual Works Best

Communication: initiating Communication: initiating spontaneous questions and spontaneous questions and commentscomments• Basic Conversation SkillsBasic Conversation Skills• Organizing thoughts into wordsOrganizing thoughts into words

ASD Communication TreatmentASD Communication Treatment

Eye ContactEye Contact Non-verbal body language Non-verbal body language

(identifying)(identifying) Prosody and Intonation of SpeechProsody and Intonation of Speech Social StoriesSocial Stories

ASD TreatmentASD Treatment

PlayPlay• How to pretend How to pretend • How to initiate play with othersHow to initiate play with others• SharingSharing

Idendifying EmotionsIdendifying Emotions• Recognizing own emotionsRecognizing own emotions• Recognizing and making facial Recognizing and making facial

expressionsexpressions

Treatment of ASDsTreatment of ASDs

Use of ScheduleUse of Schedule Theory of MindTheory of Mind Time out / Quiet PlaceTime out / Quiet Place Decrease Self Injurious BehaviorsDecrease Self Injurious Behaviors

Teach Me Language (Freeman, PhD)Teach Me Language (Freeman, PhD) Asperger’s…What does it mean to Asperger’s…What does it mean to

me? (Faherty)me? (Faherty)