Child Psychopathology Mental Retardation Autism Diagnosis and description Etiology and treatment Childhood Schizophrenia

Social Quiz Why do we have “unleaded” gasoline? How did plumbing bring down the Roman Empire? Why was the “Mad Hatter” mad? Why is it frowned upon to consume large quantities of alcohol when pregnant? What color do we want newborn babies to be and why? Why does the dentist put an apron over your body when X-raying your teeth?

History of assessment Binet & Simon hired to develop a test to determine if individuals could be educated Concept of “mental age” developed, which when expressed as a ratio MA/CA = IQ Test became widely used, revised at Stanford University, became “Stanford- Binet” Intelligence Test IQ designed to predict success in school

DSM-IV Criteria Significantly subaverage IQ (less than 70) Concurrent deficits or impairments in adaptive functioning Characteristics evident prior to age 18 Ranges (and Educational Classifications): –Mild: 50/55 to 70 (“Educable”) –Moderate: 35/40 to 50/55 (“Trainable”) –Severe: 20/25 to 35/40 (“Severe”)

Prevalence 1-3% of population, depending on cutoff used those with mild mental retardation are 85% of population, majority have idiopathic origin (cultural-familial) Those with organic MR are more likely to have genetic causes Slightly more males than females Low SES and minority groups at higher risk

Other characteristics Cultural-familial MR has global delays Organic MR has less sequential organized delays, medical problems such as heart malformation Mild MR may be associated with failure, lowering goals, and minimal success (learned helplessness) Comorbid developmental disabilities including epilepsy, speech, language, behavior, sensory attachments develop, but signals, proximity seeking, and even distress may be lower 10-40% have emotional or behavior problems (e.g., pica)

Social and psychological causes Deprived physical care Poor emotional care Poor social stimulation Victor D’Avyron (feral child) was MR by environmental causes These interact with biology, e.g., poor housing may have paint chips, chips may have leaded paint, children may eat paint chips as they do not have toys to play with

Interventions for mental retardation Medications rarely, if ever, used Prenatal & postnatal education & screening –Vitamins, alcohol, PKU Community-based placements/ living situations: What are you aware of? Answers: Residential, Community-based, supported work environment, mainstreaming Variety of psychosocial interventions

Psychosocial interventions infant stimulation, developmental surveillance behavioral approaches include shaping, modeling, graduated guidance, both +/- beh. Self-regulation and metacognitive training Camp, other special programs (e.g., SMILE) family support: coping with parenting demands, stress

Diagnostic criteria for Autism Impairments in social interaction –deficits in social imitation, joint attention, eye contact, unusual play, orienting to social stimuli Qualitative impairments in communication –pronoun reversals, echolalia, speech restrictions Restricted, repetitive, and stereotyped patterns of behavior, interests and activities –perseveration, sameness, self-stimulatory behaviors, flapping Onset prior to age 3

Associated characteristics Intellectual strengths and deficits –80% are mentally retarded, esp. VIQ –25% have “splinter skills”, 5% “savant” Sensory and perceptual impairments, stimulus overselectivity Cognitive deficits, Theory of Mind Physical characteristics, 25% epilepsy Family stress is high: What came first?

Other Pervasive Developmental Disorders Asperger’s Syndrome Later age of onset Higher verbal mental age Less language delay Less social deficit Poor gross motor coordination Rett’s Disorder Girls only Deceleration of head growth Loss of hand skills Severe language deficit Loss of social engagement

Genetic Contributions About 10% have an identifiable medical condition including Fragile X Tuberous sclerosis is associated 3-9% of the time Family and twin studies show strong relationship There are likely several genetic influences in autism

Neuro- and psychobiology Structural abnormalities in cerebellum, medial temporal, limbic, and frontal lobes –Demonstrated through blood flow analyses Megalencephaly and increased brain volume in some children Epilepsy, EEG abnormalities in 50% Elevated serotonin in 1/3 of individuals Reticular Activating System and overselectivity

Summary of interventions for autism Low functioning children need behavioral interventions –SIB, self-help skills, social compliance, basic social-emotional behaviors such as eye contact High functioning children need language, social skills; preschool period Most effective treatments are highly structured and skills-oriented –Include family support and early intervention

Communication skills What is appropriate social behavior? What basic skills are important? Eye contact, introducing yourself, expressing affection, turn-taking in conversations Reduction of behaviors inconsistent with communication, e.g., flapping Operant speech training: Imitation, receptive labelling, sign language for some children

Case of Joey What is the most appropriate diagnosis and why? What treatments goals would you suggest? What priorities would you set and why?

Case Summary: Joey Appropriate Diagnosis –Autism; Not Retts or Aspergers; Query MR Treatment Options –SIB; Communication; Positive reading; Special(?) School; Parent support/ coping Priorities –1. SIB; 2. Parent-child relationship; 3. Support

Childhood-Onset Schizophrenia Compared to autism: –onset is later, intelligence is less impaired, social deficits are less severe, language deficits less severe –hallucinations and delusions are present, there are periods of remission and relapse Compared to adult schizophrenia: –onset more insidious, child not distressed by symptoms, outcome poorer Diagnosis: –hallucinations, esp. auditory hallucinations –delusions, disorganized speech, disorganized or catatonic behavior –Comorbid with depression and conduct/oppositional disorder

Associated characteristics Extremely rare in children under age 12, some prevalence in adolescence Boy:Girl ration = 2:1, earlier onset in boys Causes: –Diathesis-Stress model –Genetic vulnerability and stressful environment –Low expressed emotion in families, trauma Treatment is pharmacological, e.g., neuroleptics such as chloropromazine