1. Developmental and Cognitive Disorders
Chapter 13
Developmental and Cognitive Disorders

2. Nature of Developmental Psychopathology: An Overview
Normal vs. abnormal development
Developmental psychopathology
Study of how disorders arise and change with time
Disruption of early skills can affect later development

3. Nature of Developmental Psychopathology: An Overview
Developmental disorders
Diagnosed first in infancy, childhood, or adolescence
Attention deficit hyperactivity disorder (ADHD)
Learning disorders
Autism
Mental retardation
Technology Tip: The American Academy of Child and Adolescent Psychiatry homepage provides information for children and their families (including research, education, and treatment) on many childhood disorders.

4. Attention Deficit Hyperactivity Disorder (ADHD)
Nature of ADHD
Central features – inattention, overactivity, and impulsivity
Associated with numerous impairments
Behavioral
Cognitive
Social and academic problems
Technology Tip: Attention Deficit Disorder. This site contains a wealth of scholarly information and links related to ADHD.

5. Attention Deficit Hyperactivity Disorder (ADHD)
DSM-IV-TR symptom types
Inattentive type
Hyperactive type
Impulsive type

6. ADHD: Facts and Statistics
Prevalence
Occurs in 3% - 7% of school-aged children
Symptoms are usually present around age three or four
Children with ADHD have problems as adults
Gender differences
Boys outnumber girls 3:1
Cultural factors
Probability of ADHD diagnosis
Greatest in the United States

7. The Causes of ADHD: Biological Contributions
Genetic contributions
ADHD seems to run in families
DAT1 - gene have been implicated

8. The Causes of ADHD: Biological Contributions
Neurobiological contributions
Smaller brain volume
Inactivity of the frontal cortex and basal ganglia
Abnormal frontal lobe development and functioning

9. The Causes of ADHD: Biological Contributions (continued)
The role of toxins
No evidence that allergens and food additives are causes
Maternal smoking increases risk

10. The Causes of ADHD: Psychosocial Contributions
Psychosocial factors
Can influence the nature of ADHD
ADHD children are often viewed negatively by others
Constant negative feedback from peers and adults
Peer rejection and resulting social isolation
Such factors foster low self-esteem
Technology Tip: Attention Deficit Hyperactivity Disorder (NIMH). This NIMH web site provides a wealth of information and resources related to ADHD.

11. Biological Treatment of ADHD
Goal of biological treatments
To reduce impulsivity and hyperactivity and to improve attention
Stimulant medications
Reduce core symptoms in 70% of cases
Examples include Ritalin, Dexedrine

12. Biological Treatment of ADHD
Other medications with more limited efficacy
Imipramine and clonidine (antihypertensive)
Designer drugs
Effects of medications
Improve compliance and decrease negative behaviors
Do not affect learning and academic performance
Benefits are not lasting following discontinuation

13. Behavioral and Combined Treatment of ADHD
Behavioral treatment
Reinforcement programs
To increase appropriate behaviors
Decrease inappropriate behaviors
May also involve parent training
Combined bio-psycho-social treatments
Are highly recommended
Superior to medication or behavioral treatments alone
Technology Tip: CH.A.D.D. (Children and Adults with Attention Deficit Disorders). CH.A.D.D. is a non-profit organization devoted to educating the public about attention deficit and hyperactivity disorders. This site includes information on the symptoms of ADDHD, treatments, and as well as CH.A.D.D. chapters throughout the country.

14. Learning Disorders: An Overview
Scope of learning disorders
Academic problems in reading, mathematics, and writing
Performance substantially below expected levels
Technology Tip: Learning Disabilities Association of America. This web site provides information and news updates on learning disabilities. This site is aimed at parents, teachers, and other professionals.

15. Learning Disorders: An Overview
DSM-IV-TR reading disorder
Discrepancy between actual and expected achievement
Performance significantly below age or grade level
Cannot be caused by sensory deficits
DSM-IV-TR mathematics disorder
Achievement below expected performance
DSM-IV-TR disorder of written expression
Achievement below expected performance in writing
Technology Tip: NLDline This is a non-verbal learning disabilities website with a huge array of information about learning disabilities common in people with pervasive developmental disorders.

16. Learning Disorders: Statistics
Prevalence of learning disorders
5-10% prevalence in the United States
Highest in wealthier regions of the United States
Six million children have been diagnosed
4-10% prevalence for reading difficulties
School experience tends to be generally negative
Technology Tip: Dyslexia Online. A website maintained by Dr. Harold Levinson devoted to "resolving the traditional misconceptions of dyslexia and related attention deficit and anxiety disorders."

17. FIGURE 13. 1 Uneven distribution
FIGURE 13.1  Uneven distribution. The highest percentages of schoolchildren diagnosed with learning disabilities are in the wealthiest states.

18. Biological and Psychosocial Causes of Learning Disorders
Genetic and neurobiological contributions
Reading disorder runs in families
Evidence for subtle forms of brain damage is mounting
Overall, contributions are unclear
Psychosocial contributions are largely unknown

19. Treatment of Learning Disorders
Requires intense educational interventions
Remediation of basic processing problems
Improvement of cognitive skills
Targeting skills to compensate for problem areas
Data support behavioral educational interventions

20. Pervasive Developmental Disorders: An Overview
Nature of pervasive developmental disorders
Problems occur in language, socialization, and cognition
Pervasive – problems span many life areas
Examples of pervasive developmental disorders
Autistic disorder
Asperger’s syndrome

21. The Nature of Autistic Disorder: An Overview
Autism – significant impairments
Social interactions and communication
Restricted patterns of behavior, interest, and activities
Technology Tip: Autistic Disorder. This site contains a wealth of scholarly information and links related to autistic disorder.

22. The Nature of Autistic Disorder: An Overview
Three central DSM-IV-TR features of autism
Qualitative impairment of social interaction
Problems in communication
50% never acquire useful speech
Restricted patterns of behavior, interests, and activities

23. Autistic Disorder: Statistics
Prevalence and features of autism – One in every 500 births
More prevalent in females with IQs below 35
More prevalent in males with higher IQs
Occurs worldwide
Symptoms usually develop before 36 months of age

24. Autistic Disorder: Statistics
Autism and intellectual functioning
45%- 60% with autism have average or above average IQs
Reliable indicators of good prognosis
Language ability and IQ

25. Causes of Autism: Early and More Recent Contributions (continued)
Current understanding of autism
Medical conditions – not always related to autism
Genetic component is largely unclear
Neurobiological evidence of brain damage
Substantially reduced cerebellum size
Psychosocial contributions are unclear
Technology Tip: Ask NOAH about Autism. This is an excellent mega site on information related to child developmental disorders and includes many useful links to teaching and scholarly resources.

26. “Autism Diagnosis in Children” 04:12

27. Asperger’s Disorder: Part of the Autistic Spectrum
The nature of Asperger’s disorder
Show significant social impairments
Restricted and repetitive stereotyped behaviors
May be clumsy
Often quite verbal
No severe language and/or cognitive delays
Technology Tip: Asperger's Disorder. This site contains a wealth of scholarly information and links related to Asperger’s disorder.

28. Asperger’s Disorder: Part of the Autistic Spectrum
Prevalence of Asperger’s disorder
Often under diagnosed
Affects about one - two persons per 10,000 people
More often in boys that girls
Causes of Asperger’s disorder are somewhat unclear

29. Treatment of Pervasive Developmental Disorders: Example of Autism
Psychosocial “behavioral” treatments
Skill building
Reduction of problem behaviors
Target communication and language problems
Address socialization deficits
Early intervention is critical
Technology Tip: Autism Center. This web page, in addition to providing links to other related sources on the web, gives information on the symptoms of autism, guidelines for families and caregivers, and relevant books and resources.

30. Treatment of Pervasive Developmental Disorders: Example of Autism
Biological and medical treatments are unavailable
Integrated treatments: The preferred model
Focus on children, their families, schools, and home
Build in appropriate community and social support

31. Intellectual disability (ID): An Overview
Nature of mental retardation
Disorder of childhood
Below-average intellectual and adaptive functioning
Range of impairment varies greatly across persons
Technology Tip: An excellent resource of historical information related to intelligence testing:

32. Intellectual disability (ID): An Overview
DSM-IV-TR criteria
Significantly sub-average intellectual functioning
Deficits or impairments in present adaptive functioning
Must be evident before the person is 18 years of age
Technology Tip: Information on intellectual disability. Provided by the US Centers for Disease Control & Prevention :

33. DSM-IV-TR Levels of Intellectual disability (ID)
Mild ID
IQ score between 50 or 55 and 70
Moderate ID
IQ range of to 50-55
Severe ID
IQs ranging from up to 35-40
Profound ID
IQ scores below 20-25

34. Other Classification Systems for Intellectual disability (ID)
American Association of Mental Retardation (AAID)
Defines ID based on levels of assistance required
Levels of assistance
Intermittent, limited, extensive, pervasive

35. Other Classification Systems for Intellectual disability (ID)
Classification of ID in educational systems
Educable (IQ of 50 to 70-75)
Trainable (IQ of 30 to 50)
Severe (IQ below 30)
Implications of different ID classification systems

36. Intellectual disability (ID): Some Facts and Statistics
Prevalence
About 1-3% of the general population
90% are labeled with mild intellectual disability
Course of ID
Tends to be chronic
Prognosis varies greatly from person to person
Technology Tip: Visit the American Association of Mental Retardation website for more information:

37. Causes of Intellectual disability (ID): Biological Contributions
Hundreds of known causes
Environmental – deprivation, abuse
Prenatal – exposure to disease or a drug/toxin
Perinatal – difficulties during labor
Postnatal – head injury

38. Causes of Intellectual disability (ID): Biological Contributions
Genetic research
Multiple genes, and at times single genes
Chromosomal abnormalities
Down syndrome and fragile X syndrome
PKU
Lesch-Nyhan syndrome

39. Causes of Intellectual disability (ID): Biological Contributions
Down syndrome
Maternal age and risk of having a Down’s baby
Amniocentesis
Chorionic villus sampling (CVS)

40. FIGURE 13.2  The increasing likelihood of Down syndrome with maternal age. (Based on data from Hook, E. B., Epidemiology of Down syndrome. In S. M. Pueschel & J. E. Rynders, Eds., Down syndrome: Advances in biomedicine and the behavioral sciences (pp. 11–88). Cambridge, MA: Ware Press, © 1982 Ware University Press.)

41. Cultural-familial intellectual disability
Believed to cause about 75% of ID cases
Is the least understood
Associated with
Mild levels of retardation on IQ tests
Good adaptive skills
Technology Tip: Down Syndrome Page. This page was established in 1995 and provides information on healthcare guidelines for patients, education resources, events & conferences, and Down Syndrome organizations worldwide.

42. FIGURE 13.3  The actual distribution of IQ scores for individuals with cultural–familial retardation and organic retardation. Note that the cultural–familial group represents the normal expected lower end of the continuum but the organic group is a separate and overlapping group. (Adapted, with permission, from Zigler, E., & Hodapp, R. M., Understanding mental retardation. Cambridge: Cambridge University Press, © 1986 Cambridge University Press.)

43. Treatment of Intellectual disability (ID)
Parallels treatment of pervasive developmental disorders
Teach needed skills
To foster productivity
To foster independence
Educational and behavioral management
Living and self-care skills via task analysis
Communication training – often most challenging

44. Treatment of Intellectual disability (ID)
Community and supportive interventions
Persons with ID can benefit from such interventions

45. Summary of Developmental Disorders
Developmental psychopathology
Attention deficit hyperactivity disorder
Deficits in attention, hyperactivity, or impulsivity
Learning disorders
Deficits in performance below expectations

46. Summary of Developmental Disorders
Pervasive developmental disorder
All share deficits in language, socialization, and cognition
Intellectual disability
Sub-average IQ, deficits in adaptive functioning
Onset before age 18
Prevention and early intervention are critical
Technology Tip: Information provided by the US Centers for Disease Control & Prevention :

47. Nature of Cognitive Disorders: An Overview
Perspectives on cognitive disorders
Affect learning, memory, and consciousness
Most develop later in life
Three classes of cognitive disorders
Delirium – temporary confusion and disorientation
Dementia – marked by broad cognitive deterioration
Amnestic disorders – memory dysfunctions

48. Nature of Cognitive Disorders: An Overview
Shifting DSM perspectives
From “organic” mental disorders to “cognitive” disorders
Broad impairments in cognitive functioning
Profound changes in behavior and personality

49. Delirium: An Overview Nature of delirium
Central features – impaired consciousness and cognition
Develops rapidly over several hours or days
Appear confused, disoriented, and inattentive
Marked memory and language deficits
Technology Tip: Delirium. This web page provides diagnostic and clinically-relevant research information and links about delirium.

50. Delirium: An Overview (continued)
Facts and statistics
Affects up 30% of persons in acute care facilities
Most prevalent in older adults
Those undergoing medical procedures
AIDS patients and cancer patients
Full recovery often occurs within several weeks

51. Medical Conditions Related to Delirium
Drug intoxication, poisons, withdrawal from drugs
Infections
Head injury and several forms of brain trauma
Sleep deprivation, immobility, and excessive stress

52. Medical Conditions Related to Delirium
DSM-IV-TR subtypes of delirium
Delirium due to a general medical condition
Substance-induced delirium
Delirium due to multiple etiologies
Delirium not otherwise specified

53. Treatment and Prevention of Delirium
Attention to precipitating medical problems
Psychosocial interventions include reassurance
Focus on coping strategies
Inclusion of patients in treatment decisions
Prevention
Address proper medical care for illnesses
Address proper use and adherence to therapeutic drugs

54. Dementia: An Overview Nature of dementia
Gradual deterioration of brain functioning
Deterioration in judgment and memory
Deterioration in language / advanced cognitive processes
Has many causes and may be irreversible
Technology Tip: Dementia. Web Good site with a lot of information/links on a wide variety of topics/research. Includes a support database.

55. Dementia: Initial and Later Stages
Initial stages
Memory and visuospatial skills impairments
Agnosia – inability to recognize and name objects
Facial agnosia – inability to recognize familiar faces
Other symptoms
Delusions, apathy, depression, agitation, aggression

56. Dementia: Initial and Later Stages
Cognitive functioning continues to deteriorate
Total support is needed to carry out day-to-day activities
Death due to inactivity and onset of other illnesses

57. DSM-IV-TR Classes of Dementia
Dementia of the Alzheimer’s type
Vascular dementia
Dementia due to other general medical conditions
Substance-induced persisting dementia
Dementia due to multiple etiologies
Dementia not otherwise specified

58. Dementia of the Alzheimer’s Type: An Overview
DSM-IV-TR criteria and clinical features
Multiple cognitive deficits
Develop gradually and steadily
Memory, orientation, judgment, and reasoning deficits
Additional symptoms may include
Agitation, confusion, or combativeness
Depression and/or anxiety
“Sundowner syndrome”
Technology Tip: Alzheimer's Association. The Alzheimer's Association web site contains information on local chapters, coping strategies for caregivers, and scientific progress towards effective treatment and understanding of this disorder.

59. Dementia of the Alzheimer’s Type: Extent of Deficits
Range of cognitive deficits
Aphasia – difficulty with language
Apraxia – impaired motor functioning
Agnosia – failure to recognize objects
Difficulties with
Planning
Organizing
Sequencing
Abstracting information
Negative impact on social and occupational functioning

60. Dementia of the Alzheimer’s Type: Extent of Deficits
Until recently an autopsy is required for a definitive diagnosis

61. Alzheimer’s Disease: Some Facts and Statistics
Nature and progression of the disease
Deterioration is slow during the early and later stages
Deterioration is rapid during middle stages
Average survival time is about eight years
Onset usually occurs in the 60s or 70s

62. Alzheimer’s Disease: Some Facts and Statistics
Prevalence of Alzheimer’s disease
Prevalence greater in
Poorly educated persons
Prevalence rates are low in some ethnic groups

63. Vascular Dementia: An Overview
Nature of vascular dementia
Caused by blockage or damage to blood vessels
Second leading cause of dementia next to Alzheimer’s
Onset is often sudden (e.g., stroke)
Patterns of impairment are variable
Most require formal care in later stages
Technology Tip: For more information, visit the UCSF site on vascular dementia:

64. Vascular Dementia: An Overview
DSM-IV-TR criteria and incidence
Cognitive disturbances – identical to dementia
Obvious neurological signs of brain tissue damage
Prevalence 1.5% in people 70 and 15% for people over 80
Risk slightly higher in men

65. Other Causes of Dementia: Head Trauma
Head trauma – accidents are leading cause
Memory loss is the most common symptom
Technology Tip: Dementia. This web page provides diagnostic and clinically-relevant research information and links about dementia.
Technology Tip: For more information on traumatic brain injury, visit the following sites:

66. Other Causes of Dementia: HIV-1
Causes neurological impairments and dementia
Cognitive slowness, impaired attention, and forgetfulness
Apathy and social withdrawal
Technology Tip: For more information on AIDS dementia, visit the following sites:

67. Other Causes of Dementia: Parkinson’s Disease
Parkinson’s disease – degenerative brain disorder
Affects about one out of 1,000 people worldwide
Motor problems – central feature of this disorder
Caused by damage to dopamine pathways
75% survival rate for 10 years
Technology Tip: For more information on Parkinson’s disease visit the following site:

68. Other Causes of Dementia: Huntington’s
Huntington’s disease
Genetic autosomal dominant disorder
Manifests initially as chorea, usually later in life
About 20-80% display dementia
Dementia follows a subcortical pattern
Technology Tip: For more information on Huntington’s Disease, visit the following sites:

69. Other Causes of Dementia: Pick’s Disease
Rare neurological condition
Produces a cortical dementia like Alzheimer’s
Also occurs later in life (around 40s or 50s)
Little is known about what causes this disease
Technology Tip: For more information on Pick’s disease and frontotemporal dementia, visit the following sites:

70. Other Dementias: Creutzfeldt-Jakob Disease
Affects one out of 1,000,000 persons
Linked to mad cow disease
Technology Tip: For more information on Creutzfeldt-Jakob Disease, visit the following sites:

71. Other Dementias: Substance-Induced Dementia
Substance-induced persisting dementia
Results from drug use in combination with poor diet
Several drugs can lead to symptoms of dementia
Resulting brain damage may be permanent
Dementia is similar to that of Alzheimer’s
Deficits may include
Aphasia, apraxia, agnosia
Disturbed executive functioning
Technology Tip: For more information on Substance-Induced Persisting Dementia, visit the following sites: neurology.health-cares.net/alcohol-related-dementia.php

72. Causes of Dementia: The Example of Alzheimer’s Disease
Early and largely unsupported views
Implicated smoking, negative correlation

73. Causes of Dementia: The Example of Alzheimer’s Disease
Current neurobiological findings
Neurofibrillary tangles
Amyloid plaques
The role of deterministic genes
Beta-amyloid precursor gene
Presenilin-1 and Presenilin-2 genes
The role of susceptibility genes - ApoE4 gene
Brains of Alzheimer’s patients tend to atrophy
Technology Tip: For more information on the genetics of Alzheimer’s disease, visit the following sites: ghr.nlm.nih.gov/condition=alzheimerdisease

74. Causes of Dementia: The Example of Alzheimer’s Disease
Current neurobiological findings
Multiple genes are involved in Alzheimer’s disease
Chromosomes 21, 19, 14, 12,
Chromosome 14
Associated with early onset Alzheimer’s
Chromosome 19
Associated with late onset Alzheimer’s

75. The Contributions of Psychosocial Factors in Dementia
Do not cause dementia directly
May influence onset and course
Lifestyle factors – drug use, diet, exercise, stress
Cultural factors
Risk for certain conditions vary by ethnicity and class
Educational attainment, coping skills, social support

76. Medical and Psychosocial Treatment of Dementia
Medical treatment: Best if enacted early
Few exist for most types of dementias
Most attempt to slow progression of deterioration
Do not stop progression of dementia
Caregiver can be negatively impacted

77. Medical and Psychosocial Treatment of Dementia
Psychosocial treatments – aims
To enhance lives of patients and their families
To teach compensatory skills
To use memory enhancement devices, if needed
Psychosocial interventions appear to focus on caregivers
Technology Tip: For more information on behavioral treatments of AD, visit the following site:

78. Prevention of Dementia
Reducing risk of dementia in older adults
Estrogen-replacement therapy
Proper treatment of cardiovascular diseases
Use of anti-inflammatory medications
Control blood pressure and lead an active social life
Other targets of prevention efforts
Increasing safety behaviors to reduce head trauma
Reducing exposure to neurotoxins and use of drugs

79. Amnestic Disorder: An Overview
Nature of amnestic disorder
Circumscribed loss of memory
Inability to transfer information into long-term memory
No loss of other high-level cognitive functions

80. Amnestic Disorder: An Overview
Causes may include
Medical conditions, head trauma, or long-term drug use
DSM-IV-TR criteria
Inability to
Learn new information or recall learned information
Significant impairment in functioning

81. Amnestic Disorder: An Overview
The example of Wernicke-Korsakoff syndrome
Damage to the thalamus
Thiamine (vitamin B-1) deficiency
Resulting from stroke or chronic heavy alcohol use
Prevention
Use of thiamine supplements with heavy drinkers
Research on amnestic disorders is scant
Technology Tip: For more information on Wernicke-Korsakoff Syndrome, visit the following sites: ww.ninds.nih.gov/disorders/wernicke_korsakoff/wernicke-korsakoff.htm

82. Summary of Cognitive Disorders
Cognitive disorders span a range of deficits
Affect attention, memory, language, and motor behavior
Causes include
Medical conditions
Drug use
Environmental factors

83. Summary of Cognitive Disorders
Most result in progressive deterioration of functioning
Few treatments exist to reverse damage and deficits

84. Dementia: Statistics Onset and prevalence Incidence of dementia
Can occur at any age, but most common in the elderly
Affects over 10% of persons 85 years and older
Incidence of dementia
Affects 8.5% of those 85 and older
Rates seem to double with every five years of age

85. Dementia: Facts and Statistics
Gender and sociocultural factors
Occurs equally in men and women
Occurs equally across educational level and social class