Developmental Disorders Chapter 13

Pervasive Developmental Disorders: An Overview Nature of Pervasive Developmental Disorders Problems occur in language, socialization, and cognition Pervasive – Means the problems span the person’s entire life Examples of Pervasive Developmental Disorders Autistic disorder Asperger’s syndrome Treatment of Autism and other PDD’s focuses upon: Acquisition of language skills Improving quality of social interactions Acquiring greatest possible functional skills

The Nature of Autistic Disorder: An Overview Autism Significant impairment in social interactions and communication Restricted patterns of behavior, interest, and activities Three Central DSM-IV and DSM-IV-TR Features of Autism Problems in socialization and social function Problems in communication – 50% never acquire useful speech Restricted patterns of behavior, interests, and activities

Autistic Disorder: Facts and Statistics Prevalence and Features of Autism Rare condition – Affecting 2 to 20 persons for every 10,000 people; but prevalence is increasing considerably Autism occurs worldwide Symptoms develop before 36 months of age Autism and Intellectual Functioning 50% have IQs in the severe-to-profound range of mental retardation 25% test in the mild-to-moderate IQ range (i.e., IQ of 50 to 70) Remaining people display abilities in the borderline-to- average IQ range Better language skills and IQ test performance predict better lifetime prognosis

Increasing Prevalence? 1966 epidemiological study (Lotter, 1966) 4-5/10,000 (.05%) 2002 review of recent studies 60 per 10,000 autism spectrum disorders (.6%) 8 to 30 per 10,000 for autistic disorder (.3%) Probably reasons for increase Identification of children with higher and lower intelligence Broadening and refining of criteria General awareness of the disorder Diagnosing disorder in children with other difficulties

Asperger’s Disorder: Part of the Autistic Spectrum The Nature of Asperger’s Disorder Such persons show significant social impairments Restricted and repetitive stereotyped behaviors May be clumsy, and are often quite verbal (i.e., pedantic or overly formal speech) Do not show severe delays in language and other cognitive skills Prevalence of Asperger’s Disorder Often under diagnosed Affects about 1 to 36 persons per 10,000 people

CAUSES OF AUTISM-SPECTRUM DISORDERS Significant genetic component Families with 1 autistic child have 3-5% risk of having a second child with autism (rate in general pop. Is %) Possible/probably neurological dysfunction High rate of MR, clumsiness, abnormal posture or gait Abnormally small cerebellum No evidence for psychosocial causes Poor parenting does not lead to autism or related disorders (no “refrigerator mothers”)

TREATMENT Specialized behavioral techniques using shaping, discrimination training, reinforcement to teach small steps Communication – speech, sign language, use of picture board Socialization – eye contact, some limited social behavior; does not usually result in “normal” relationships (e.g., friends) Intensive, early intervention shows significant and in some cases, dramatic treatment hrs/wk, beginning before age 6, 2+ years This is the most important and best treatment for the disorder Support for family

Mental Retardation (MR): An Overview Nature of Mental Retardation Below-average intellectual and adaptive functioning Range of impairment varies greatly across persons Mental Retardation and the DSM-IV and DSM-IV-TR Significantly sub-average intellectual functioning (IQ below 70) Concurrent deficits or impairments in two or more areas of adaptive functioning MR must be evident before the person is 18 years of age

DSM-IV and DSM-IV-TR Levels of Mental Retardation (MR) Mild MR (85%) Includes persons with an IQ score between 50 or 55 and 70 Moderate MR (10%) Includes persons in the IQ range of to Severe MR (3-4%) Includes people with IQs ranging from up to Profound MR (1-2%) Includes people with IQ scores below 20-25

Other Classification Systems for Mental Retardation (MR) American Association of Mental Retardation (AAMR) Defines MR based on levels of assistance required Examples of levels include intermittent, limited, extensive, or pervasive assistance Classification of MR in Educational Systems Educable mental retardation (i.e., IQ of 50 to approximately 70-75) Trainable mental retardation (i.e., IQ of 30 to 50) Severe mental retardation (i.e., IQ below 30) Implications of Different MR Classification Systems

Mental Retardation (MR): Some Facts and Statistics Prevalence About 1% to 3% of the general population 90% of MR persons are labeled with mild mental retardation Gender Differences MR occurs more often in males, male-to-female ratio of about 6:1 Course of MR Tends to be chronic, but prognosis varies greatly from person to person

BIOLOGICAL CAUSES Genetic (only about 30% cases of MR) Tuberous sclerosis (rare, but 60% have MR); PKU (restricted diet till age 7 since unable to break down phenylalanine); Lesch-Nyhan syndrome Chromosomal abnormalities Down Syndrome – trisomy 21 (extra 21 st chromosome) Fragile X syndrome

PSYCHOLOGICAL & SOCIAL CAUSES Cultural-familial retardation (70% cases of MR) – mild to moderate MR combination of biological and psychological factors? abuse, neglect, social deprivation

TREATMENT OF MR Goal of maximizing functioning Select reasonable goals for areas of functioning Self-care (dressing, feeding self) Communication Social skills Tasks of daily living (transportation, buying groceries) Cognitive skills developed as appropriate (read, write, make change) Use behavioral techniques to teach skills, shaping, repeated trials, reinforcement Individuals with MR have higher rate of other psychological disorders (depression, psychosis)