Neurodevelopmental Disorders Neurodevelopmental disorders new combination of disorder in the DSM-5

Overview of Neurodevelopmental Disorders First diagnosed = infancy, childhood, adolescence Attention deficit hyperactivity disorder (ADHD) Specific learning disorders Autism spectrum disorder Intellectual Disability

Attention Deficit/Hyperactivity Disorder (ADHD) Central features Inattentive Hyperactive Impulsivity DSM-5 differentiates two categories of symptoms Problems of inattention Problems of Hyperactivity and impulsivity

Attention Deficit/Hyperactivity Disorder (ADHD) Impairments Behavioral Cognitive Social Academic

ADHD: Statistics Prevalence 3% to 9% worldwide 11% of children in the U.S. aged 4 to 17 Onset 3 or 4 years Boys : Girls = 3:1 Possible cultural construct

ADHD: Statistics Adults with ADHD Lower level jobs 2.5 fewer years of education More likely to be divorced, have substance use problems and antisocial personality disorder High risk behaviors High comorbidity ODD Mood disorders

ADHD: Causes Genetics Familial component Copy number variants—CNVs Dopamine DRD4, DAT1, DRD5 genes and Ritalin Norepinephrine GABA Serotonin

ADHD: Causes Neurobiological contributions Smaller brain volume 3-4% The role of toxins Allergens and food additives No evidence Maternal smoking Increases risk Interacts with genetic predisposition

ADHD: Causes Psychosocial and social factors Negative responses Teachers Peers Adults Peer rejection Low self-esteem Poor self-image

Treatment of ADHD Treatment of two fronts Psychosocial intervention Improving academic performance, decreasing disruptive behavior, and improving social skills Behavioral interventions before medication Parent training Social skills training Biological intervention

Treatment of ADHD: Biological Goals Reduce impulsivity and hyperactivity Improve attention Stimulants 4 million currently treated Ritalin

Treatment of ADHD: Biological Other Medications Adderall Strattera Tenex Clonidine

Treatment of ADHD: Biological Effects of medications Improve compliance Decrease negative behaviors Do not affect learning and academic performance Possible abuse issues Side effects Psychopharmacogenetics The study of how your genetic makeup influences your response to certain drugs

Autism Spectrum Disorder Autism spectrum disorder (ASD) is a neurodevelopmental disorder that, affects how one perceives and socializes with others DSM-5 combined the following into Autism spectrum disorder (ASD) Autistic disorder Asperger’s disorder Childhood disintegrative disorder Rett disorder is now diagnosed as ASD with a qualifier

Autism Spectrum Disorder Pervasive developmental disorder “Not otherwise specified” dropped in DSM-5 Social (Pragmatic) Communication was added to the DSM-5

Autism Spectrum Disorder Two major characteristics of ASD Communication and social interaction Restricted, repetitive patterns of behavior, interests, or activities Three levels of severity Level 1— “Requiring support” Level 2— “Requiring substantial support” Level 3— “Requiring very substantial support” Described qualitatively and, as yet, has no quantitative equivalent

Autism Spectrum Disorder Impairment in social communication and social interaction Fail to develop age-appropriate social relationships Social communication and social interaction Joint attention Deficits in nonverbal communication Prosody

Autism Spectrum Disorder Impairment in social communication and social interaction 25% never acquire speech Echolalia Conversational impairments

Autism Spectrum Disorder Restricted, repetitive patterns of behavior, interests, or activities Restricted patterns Behaviors Interests Activities Maintenance of sameness Stereotyped and ritualistic behaviors

Autism Spectrum Disorder : Statistics Prevalence: 1 in every 50 births Male to female estimate being 4.4 to 1 IQ interaction 38% intellectual disabilities Occurs worldwide

Causes of Autism Spectrum Disorder : Psychological and Social Dimensions Historical views Failed parenting Perfectionistic, cold, and aloof High socioeconomic status Higher IQs Lack of self-awareness Limited self-concept Behavioral correlates Echolalia Self-injury

Causes of Autism Spectrum Disorder : Biological Significant genetic component Familial component 20% risk of second child with autism 100 fold increase in risk Numerous genes on a number of our chromosomes involved Oxytocin receptor genes Bonding and social memory Older parents increased risk

Causes of Autism Spectrum Disorder : Biological Neurobiological influences Amygdala Larger size at birth = higher anxiety, fear Elevated cortisol Neuronal damage Similar size when older Fewer neurons Oxytocin Lower levels

Causes of Autism Spectrum Disorder : Biological Neurobiological influences Vaccinations Mercury No increased risk Negative effect of not vaccinating

Treatment of Autism Spectrum Disorder Psychosocial treatments Behavioral approaches Skill building Reduce problem behaviors Communication and language training Increase socialization Naturalistic teaching strategies Early intervention is critical

Treatment of Autism Spectrum Disorder Biological treatments Medical intervention has had little positive impact Decrease agitation Tranquilizers SSRIs

Treatment of Autism Spectrum Disorder Integrated treatments Preferred model Multidimensional, comprehensive focus Children Families Schools Home Community and social support

Prevention of Neurodevelopmental Disorders Early intervention At-risk children, families Head Start Program Educational Medical Social supports Genetic screening Detection and correction Prenatal gene therapy