Neurodevelopmental Disorders

I. General Overview

A. Prevalence

About 25% of adolescents have a diagnosable mental disorder at any given time and 10% of children suffer from a mental disorder severe enough to impair development.

The most commonly diagnosed psychological disorders in children age 6 to 17 are learning disabilities (12%) and attention-deficit hyperactivity disorder (9%).

B. Risk Factors C. Cultural Factors

II. Tourette’s Disorder: a neurological condition

producing a chronic combination of motor tics and vocal tics.

A. Tic: a rapid, recurring involuntary movement or vocalization.

B. Some Common Motor Tics… 1) Eye blinking 2) Clearing the throat 3) Head twitching or shaking 4) Flailing one’s arms about

5) Copropraxia: involuntarily performing obscene or

forbidden gestures.

6) Echopraxia: the involuntary repetition or imitation of the

observed movements of another.

C. Some Common Vocal Tics…

1) Coprolalia: involuntary swearing or the involuntary

utterance of obscene words or socially inappropriate and derogatory remarks.

2) Echolalia: the automatic repetition of vocalizations made

by another person.

3) Palilalia: the repetition or echoing of one's own spoken

words.

4) Screaming / Yelling / Grunting 5) Other random bizarre noises D. Description of tics from the perspective of those with the condition

E. Comorbidity F. Demographics

It’s found all over the world among people of all ethnic / racial backgrounds.

It is 3 to 4 more times likely to show up in males.

The onset of symptoms is usually between the ages of 7-11 (middle childhood).

It occurs in less than 1% of the population.

G. Genetic Causes H. Treatment 1) Psychotherapy 2) Drug Therapy

III. Autism Spectrum Disorder: a disorder

marked by extreme unresponsiveness to other people, severe communication deficits, and highly rigid and repetitive behaviors, interests, and activities.

A. Key Features

People with ASD are diagnosed along this spectrum as being severe, moderate, or mild.

One key feature of moderate to severe ASD is the child’s aloneness.

Other features of moderate to severe ASD include cognitive deficits that lead to language and communication problems.

People with moderate to severe ASD also can engage in limited symbolic and imaginative play and have trouble thinking abstractly.

They have very repetitive and rigid behavior. This has been called a “perseveration of sameness”.

The motor movements of people with this disorder may be unusual.

The intellectual abilities, as assessed using standardized tests like an IQ test, of those who are autistic can vary widely, just as with people without ASD. Therefore, it is not considered an intellectual disability.

B. Asperger’s Syndrome: characterized by significant

difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development and functioning.

C. Prevalence

Symptoms appear early in life, before age 3.

Around 80% of all cases appear in boys.

Researchers estimate that 1% - 2% of children in the U.S. are affected by some form of Autism Spectrum Disorder.

D. General Causes

The specific cause is still unknown.

Researchers have consistently failed to find links between autism and use of childhood vaccines.

1) Abnormal brain circuitry among neural networks.

2) Structural abnormalities in cerebellum.

3) Multiple genetic factors are likely involved.

E. Treatment

1) Applied Behavior Analysis: using operant conditioning

methods, therapists and parents systematically use rewards and mild punishments to increase the child’s ability to attend to others, to play with other children, to develop academic skills, engage in self-care, and to eliminate self-harming behavior.

The most widely used behavioral treatment programs are highly intensive and structured, offering a great deal of individual, one-to-one instruction.

People with ASD are often taught other forms of communication, including sign language and communication systems, such as “communication boards” or computers that use pictures, symbols, or written words, to represent objects or needs.

F. Savant Syndrome: a condition in which a person

demonstrates profound abilities that far exceed what normal people are capable of doing.

About 50% of savants are autistic. The other 50% often have some form of central nervous system injury or disease.

Savant skills are usually found in the areas of memory, art, musical abilities, calendar calculation, mathematics, and spatial skills.

IV. Intellectual Disability: a generalized delay

or impairment in the development of intellectual and adaptive abilities (a.k.a. Intellectual Developmental Disorder “IDD”).

IDD affects 1% – 2% of the population and is roughly two times more likely to develop in males than females.

Symptoms must appear before age 18.

IDD is present when there are notable deficits in one or more of the following domains...

1) Conceptual/Academic: abilities in math, language,

reading, problem solving, memory, etc.

2) Social: awareness of others, communication, acquiring

and maintaining friends.

3) Practical: self-care, maintain job, manage money,

complete schoolwork, etc.

The severity of IDD ranges from mild (roughly 85% of all cases) to profound.

A. Down Syndrome: a condition caused by the presence of an

extra chromosome on the 21st pair and characterized by intellectual disability and various physical anomalies.

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

They have trouble with following instructions and remembering, especially information that is presented verbally.

The life expectancy is under 50 years of age.

B. Fragile X Syndrome: an inherited form of intellectual

disability caused by a mutated gene on the X chromosome.

This affects 1 out of 1,000 to 1,500 males and 1 out of 2,000 to 2,500 females.

This IDD disorder can range from mild to profound in severity.

C. Fetal Alcohol Syndrome: occurs when pregnant mothers

drink heavily, although even moderate drinking can negatively affect the brain.

Affects as many as 1 in 700 children.

These kids usually have unusually small heads and distorted facial features.

There are always brain abnormalities.

D. Hydrocephalus: occurs from the accumulation of an

abnormally large amount of cerebrospinal fluid under the skull.

Normally, cerebrospinal fluid flows continually from the ventricles in the brain to the thin space that surrounds the brain and spinal cord. Eventually, it exits through the blood stream and is replaced by new cerebrospinal fluid.

For some children, there is a blockage which leads to a buildup.

In congenital cases, the skull is already enlarged at birth or begins to enlarge soon thereafter.

This condition affects about one in every 1000 births.

E. Intellectual Disability Causes Occurring After Birth

After birth, particularly up to age 6, certain injuries and accidents can affect intellectual functioning.

Examples include poisoning, serious head injury, excessive exposure to x rays, and excessive use of certain chemicals, minerals, and/or drugs (e.g., lead paint).

Certain infections, such as meningitis and encephalitis, can lead to IDD if they are not diagnosed and treated in time.

F. Intervention

The services that children with intellectual disability need depend on the level of severity and type of intellectual disability.

People with intellectual disability who are capable of functioning in the community have the right to receive less-restrictive care than is provided in large institutions.

V. Learning Disorders: a deficiency in a

specific learning ability in the context of normal intelligence and typical exposure to learning opportunities.

Learning disorders are typically chronic disorders that affect development well into adulthood.

Children with learning disorders tend to perform poorly in school.

A. Problems with Reading (often referred to as Dyslexia):

characterizes children who have poorly developed skills in recognizing words and comprehending written text.

Among children diagnosed with a learning disorder, 80% have Dyslexia.

Dyslexia is estimated to affect about 4% of school-age children and is much more common in boys than in girls.

It is often inherited.

B. Problems with Writing: refers to children with grossly

deficient writing skills.

The deficiency may be characterized by errors in spelling, grammar, or punctuation, or by difficulty in composing sentences and paragraphs.

C. Problems with Arithmetic and Mathematic Reasoning

Skills: refers to children with problems in understanding basic

mathematical terms or operations, such as addition or subtraction; decoding mathematical symbols (+, =, etc.); or learning multiplication tables.

D. Problems with Executive Functions: refers to children with

problems in organizing, planning, and coordinating tasks needed to manage and complete assignments.

VI. Attention-Deficit Hyperactivity Disorder

(ADHD): characterized by persistent inattention

and distractibility, impulsivity, low tolerance for frustration, and inappropriate overactivity

.

A. Hyperactivity: an abnormal behavior pattern characterized

by difficulty in maintaining attention and extreme restlessness.

B. The ADHD Subtypes 1) a predominantly inattentive type 2) a predominantly hyperactive or impulsive type 3) a combination type characterized by high levels of both inattention and hyperactivity –impulsivity

ADHD affects about 9% of school-age children, as many as 70% of them boys.

Between 35% and 60% continue to have ADHD as adults (about 4% of the general U.S. adult population).

C. Theoretical Perspectives 1) Biological Perspectives

We know that ADHD tends to run in families. It has an 35-40% heritability rate if one parent has the disorder and a 75% - 80% concordance rate among identical twins.

Rapidly accumulating evidence from brain-imaging studies of children with ADHD shows dysfunctions in parts of the brain, especially the prefrontal cortex, that regulate attention and impulsive behavior.

2) The Sociocultural Perspective 3) The Evolutionary Perspective

D. Treatment 1) Drug Therapy

Stimulants, such as Ritalin, have often been prescribed.

2) Psychotherapy

Cognitive-Behavioral Therapy has proven successful in teaching children with ADHD methods for recognizing and resisting their impulsive urges.

VII. Conduct Disorder (CD): a repetitive,

persistent pattern of aggressive, antisocial behavior violating societal norms or the rights of others.

Conduct Disorder usually begins between 7 and 15 years of age.

About 10% of children are diagnosed with Conduct Disorder (twice as common among boys).

Children with a mild conduct disorder may improve over time, but severe cases frequently continue into adulthood and develop into Antisocial Personality Disorder.

VIII. Oppositional Defiant Disorder (ODD): a

pattern of behavior marked by negativity, hostility, and defiance toward authority figures such as teachers and parents.

As many as 10% of children qualify for this diagnosis.

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

A. Theoretical Perspectives: CD and ODD

Some theorists believe that the opposition to authority in Oppositional Defiant Disorder is an expression of an underlying temperament described as the “difficult-child” type. Many cases of Conduct Disorder have been linked to genetic and biological factors, drug abuse, poverty, traumatic events, and exposure to violent peers or community violence.

Both disorders have often been tied to troubled parent-child relationships, inadequate parenting, family conflict, marital conflict, and family hostility.

B. Treatment: CD and ODD

Treatment provides strategies for parents to develop more consistent discipline strategies, to use positive reinforcement, and to increase the frequency of positive interactions between the parent and the child.

More aggressive interventions are used when necessary such as being placed in residential treatment programs that establish explicit rules with clear rewards and mild punishments.

IX. Childhood Anxiety and Depression

A. Separation Anxiety Disorder: a condition involving

excessive, prolonged anxiety concerning separation from home or from people to whom a child is attached.

Separation anxiety disorder is displayed by about 7% of all children.

Separation anxiety disorder may further take the form of a school phobia or school refusal.

B. Childhood Depression: characterized by such symptoms as

a sense of friendlessness, inability to have fun or concentrate, fatigue, irritability, apathy, feelings of worthlessness, weight change, physical complaints, and thoughts of death or suicide.

C. Play Therapy: a therapeutic approach in which a child plays

freely while a therapist observes and occasionally comments, asks questions, or makes suggestions.