1. Developmental and Cognitive Disorders
Chapter 13

2. Perspectives on Developmental Disorders
Normal vs. Abnormal Development
Childhood is associated with significant developmental changes
Disruption of early skills will likely disrupt development of later skills
Developmental Disorders
Diagnosed first in infancy, childhood, or adolescence
Attention deficit hyperactivity disorder (ADHD)
Learning disorders
Autism
Mental retardation

3. Attention Deficit Hyperactivity Disorder (ADHD): An Overview
Nature of ADHD
Central features – Inattention, overactivity, and impulsivity
Associated with behavioral, cognitive, social, and academic problems
DSM-IV and DSM-IV-TR Symptom Clusters
Cluster 1 – Symptoms of inattention
Cluster 2 – Symptoms of hyperactivity and impulsivity cluster
Either cluster 1 or 2 must be present for a diagnosis

4. ADHD: Facts and Statistics
Prevalence
Occurs in 4%-12% of children who are 6 to 12 years of age
Symptoms are usually present around age 3 or 4
68% of children with ADHD have problems as adults
Gender Differences
Boys outnumber girls 4 to 1
Cultural Factors
Probability of ADHD diagnosis is greatest in the United States

5. ADHD: Biological Contributions
Genetic Contributions
ADHD runs in families
Familial ADHD may involve deficits on chromosome 20
Neurobiological Contributions: Brain Dysfunction and Damage
Inactivity of the frontal cortex and basal ganglia
Right hemisphere malfunction
Abnormal frontal lobe development and functioning
Yet to identify a precise neurobiological mechanism for ADHD
The Role of Toxins
Allergens and food additives do not appear to cause ADHD
Maternal smoking increases risk of having a child with ADHD

6. ADHD: Psychosocial Contributions
Psychosocial Factors Can Influence the Disorder Itself
Constant negative feedback from teachers, parents, and peers
Peer rejection and resulting social isolation
Such factors foster low self-image

7. Biological Treatment of ADHD
Goal of Biological Treatments
To reduce impulsivity/hyperactivity and to improve attention
Stimulant Medications
Reduce the core symptoms of ADHD in 70% of cases
Examples include Ritalin, Dexedrine
Effects of Medications
Improve compliance and decrease negative behaviors in many children
Beneficial effects are not lasting following drug discontinuation
Negative side effects include insomnia, drowsiness, and irritability

8. Behavioral and Combined Treatment of ADHD
Behavioral Treatment
Involve reinforcement programs
Aim to increase appropriate behaviors and decrease inappropriate behaviors
May also involve parent training
Combined Bio-Psycho-Social Treatments
Are highly recommended

9. Learning Disorders
Scope of Learning Disorders
Problems related to academic performance in reading, mathematics, and writing
Performance is substantially below what would be expected
DSM-IV and DSM-IV-TR Reading Disorder
Discrepancy between actual and expected reading achievement
Reading is at a level significantly below that of a typical person of the same age
Problem cannot be caused by sensory deficits (e.g., poor vision)
DSM-IV and DSM-IV-TR Mathematics Disorder
Achievement below expected performance in mathematics
DSM-IV and DSM-IV-TR Disorder of Written Expression
Achievement below expected performance in writing

10. Learning Disorders: Some Facts and Statistics
Incidence and Prevalence of Learning Disorders
1% to 3% incidence of learning disorders in the United States
Prevalence is highest in wealthier regions of the United States
Prevalence rate is 10% to 15% among school age children
Reading difficulties are the most common of the learning disorders
About 32% of students with learning disabilities drop out of school
School experience for such persons tends to be quite negative

11. Biological and Psychosocial Causes of Learning Disorders
Genetic and Neurobiological Contributions
Reading disorder runs in families, with 100% concordance rate for identical twins
Evidence for subtle forms of brain damage is inconclusive
Overall, genetic and neurobiological contributions are unclear
Psychological and motivational factors seem to affect eventual outcome

12. Treatment of Learning Disorders
Requires Intense Educational Interventions
Remediation of basic processing problems (e.g., teaching visual skills)
Efforts to improve of cognitive skills (e.g., instruction in listening)
Targeting behavioral skills to compensate for problem areas
Data Support Behavioral Educational Interventions for Learning Disorders

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

14. Autistic Disorder
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

15. Autistic Disorder: Facts and Statistics
Prevalence and Features of Autism
Affects 2 to 20 persons for every 10,000 people
More prevalent in females with IQs below 35, and in males with higher IQs
Autism occurs worldwide
Symptoms usually 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 predicts better lifetime prognosis

16. Causes of Autism: Early and More Recent Contributions
Historical Views
Bad parenting
Unusual speech patterns
Lack of self-awareness
Echolalia
Current Understanding of Autism
Medical conditions – Not always associated with autism
Autism has a genetic component that is largely unclear
Neurobiological evidence for brain damage – Link with mental retardation
Cerebellum size – Substantially reduced in persons with autism

17. Treatment of Pervasive Developmental Disorders
Psychosocial “Behavioral” Treatments
Skill building and treatment of problem behaviors
Communication and language problems
Address socialization deficits
Early intervention is critical
Biological and Medical Treatments Are Unavailable
Integrated Treatments: The Preferred Model
Focus on children, their families, parents, schools, and the home
Build in appropriate community and social support

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

19. DSM-IV and DSM-IV-TR Levels of Mental Retardation (MR)
Mild MR
Includes persons with an IQ score between 50 or 55 and 70
Moderate MR
Includes persons in the IQ range of to 50-55
Severe MR
Includes people with IQs ranging from up to 35-40
Profound MR
Includes people with IQ scores below 20-25

20. 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)

21. 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 1.6:1
Course of MR
Tends to be chronic, but prognosis varies greatly from person to person

22. Mental Retardation (MR): Biological Contributions
Genetic Research
MR involves multiple genes, and at times single genes
Chromosomal Abnormalities and Other Forms of MR
Down syndrome – Trisomy 21
Fragile X syndrome – Abnormality on X chromosome
Maternal Age and Risk of Having a Down’s Baby
Nearly 75% of cases cannot be attributed to any known biological cause

23. Mental Retardation (MR): Psychosocial Contributions
Cultural-Familial Retardation
Believed to cause about 75% of MR cases and is the least understood
Associated with mild levels of retardation on IQ tests and good adaptive skills
Cultural-Familial Retardation: Difference vs. Developmental Views
Difference view – Mild MR is a matter of degree and kind
Developmental view – Mild MR reflects a slowing or delay of normal development

24. Treatment of Mental Retardation (MR)
Parallels Treatment of Pervasive Developmental Disorders
Teach needed skills to foster productivity and independence
Educational and behavioral management
Living and self-care skills via task analysis
Communication training – Often most challenging treatment target!
Community and supportive interventions
Persons with MR Can Benefit from Such Interventions

25. Summary of Developmental Disorders
Developmental Psychopathology and Normal and Abnormal Development
Attention Deficit Hyperactivity Disorder
Deficits in inattention, hyperactivity, or impulsivity
Disrupt academic and social functioning
Learning Disorders
All share deficits in performance below expectations for IQ and school preparation
Pervasive Developmental Disorder
All share deficits in language, socialization, and cognition
Mental Retardation
Subaverage IQ, deficits in adaptive functioning, onset before age 18
Prevention and Early Intervention Are Critical for Developmental Disorders

26. Cognitive Disorders: An Overview
Perspectives on Cognitive Disorders
Affect cognitive processes such as learning, memory, and consciousness
Most develop later in life
Three Classes of Cognitive Disorders
Delirium – Often temporary confusion and disorientation
Dementia – Degenerative condition marked by broad cognitive deterioration
Amnestic disorders – Memory dysfunctions caused by disease, drugs, or toxins
Shifting DSM Perspectives
From “organic” mental disorders to “cognitive” disorders
Broad impairments in memory, attention, perception, and thinking
Profound changes in behavior and personality

27. Delirium
Nature of Delirium
Central features – Impaired consciousness and cognition
Impairments develop rapidly over several hours or days
Examples include confusion, disorientation, attention, memory, and language deficits
Facts and Statistics
Affects 10% to 30% of persons in acute care facilities
Most prevalent in older adults, AIDS patients, and medical patients
Full recovery often occurs within several weeks

28. 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
DSM-IV and DSM-IV Subtypes of Delirium
Delirium due to a general medical condition
Substance-induced delirium
Delirium due to multiple etiologies
Delirium not otherwise specified

29. Treatment and Prevention of Delirium
Attention to precipitating medical problems
Psychosocial interventions include reassurance, coping strategies
Prevention
Address proper medical care for illnesses
Address proper use and adherence to therapeutic drugs

30. Dementia Nature of Dementia Gradual deterioration of brain functioning
Affects judgment, memory, language, and advanced cognitive processes
Dementia has many causes and may be reversible or irreversible
Progression of Dementia: Initial Stages
Memory impairment, visuospatial skills deficits
Agnosia – Inability to recognize and name objects (most common symptom)
Facial agnosia – Inability to recognize familiar faces
Other symptoms – Delusions, depression, agitation, aggression, and apathy
Progression of Dementia: Later Stages
Cognitive functioning continues to deteriorate
Person requires almost total support to carry out day-to-day activities
Death results from inactivity combined with onset of other illnesses

31. Dementia: Facts and Statistics
Onset and Prevalence
Can occur at any age, but most common in the elderly
Affects 1% of those between years of age
Affects over 10% of persons 85 years and older
47% of adults over the age of 85 have dementia of the Alzheimer’s type
Incidence of Dementia
Affects 2.3% of those years of age and 8.5% of persons 85 and older
Rates of new cases appear to double with every 5 years of age
Gender and Sociocultural Factors
Dementia occurs equally in men and women
Dementia occurs equally across educational level and social class

32. DSM-IV and 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

33. Dementia of the Alzheimer’s Type
DSM-IV-TR Criteria and Clinical Features
Multiple cognitive deficits that develop gradually and steadily
Predominant impairment in memory, orientation, judgment, and reasoning
Can include agitation, confusion, depression, anxiety, or combativeness
Symptoms are usually more pronounced at the end of the day
Range of Cognitive Deficits
Aphasia – Difficulty with language
Apraxia – Impaired motor functioning
Agnosia – Failure to recognize objects
Difficulties with planning, organizing, sequencing, or abstracting information
Impairments have a marked negative impact on social and occupational functioning
An Autopsy Is Required for a Definitive Diagnosis

34. Alzheimer’s Disease: Some Facts and Statistics
Nature and Progression of the Disease
Deterioration is slow during the early and later stages, but rapid during middle stages
Average survival time is about 8 years
Onset usually occurs in the 60s or 70s, but may occur earlier
Prevalence of Alzheimer’s Disease
Affects about 4 million Americans and many more worldwide
Prevalence is greater in poorly educated persons and women
Prevalence rates are low in some ethnic groups (e.g., Japanese, Nigerian, Amish)

35. Vascular Dementia
Nature of Vascular Dementia
Progressive brain disorder 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, and most require formal care in later stages
DSM-IV and DSM-IV Criteria and Incidence
Cognitive disturbances are identical to dementia
Unlike Alzheimer’s, obvious neurological signs of brain tissue damage occur
Incidence is believed to be about 4.7% or men and 3.8% of women

36. Dementia Due to HIV Disease
Overview and Clinical Features
HIV causes neurological impairments and dementia
Cognitive slowness, impaired attention, forgetfulness, and clumsiness
Repetitive movements (e.g., tremors/leg weakness), apathy, and social withdrawal
Progression of HIV-Related Cognitive Impairments
Tend to occur during the later stages of HIV infection
Impairments are observed in 29% to 87% of people with AIDS
Subcortical dementia – Refers to deficits that affect inner brain regions
Aphasia is uncommon in subcortical dementia, but anxiety and depression occur

37. Other Causes of Dementia: Head Trauma and Parkinson’s Disease
Accidents are leading causes of such cognitive impairments
Memory loss is the most common symptom
Parkinson’s Disease
Degenerative brain disorder
Affects about 1 out of 1,000 people worldwide
Motor problems are characteristic of this disorder
Damage to dopamine pathways is believed to cause motor problems
Pattern of impairments are similar to subcortical dementia

38. Other Causes of Dementia: Huntington’s and Pick’s Disease
Huntington’s Disease
Genetic autosomal dominant disorder (i.e., chromosome 4)
Manifests initially as chorea, usually later in life (around 40s or 50s)
About 20% to 80% of persons go on to display dementia of the subcortical pattern
Pick’s Disease
Rare neurological condition that produces a cortical dementia like Alzheimer’s
Also occurs later in life (around 40s or 50s)
Little is known about what causes this disease

39. Other Dementias: Creutzfeldt-Jakob Disease and Substance-Induced Dementia
Affects 1 out of 1,000,000 persons
Linked to mad cow disease
Substance-Induced Persisting Dementia
Results from drug use in combination with poor diet
Examples include alcohol, inhalants, and sedative, hypnotic, and anxiolytic drugs
Resulting brain damage may be permanent
Dementia is similar to that of Alzheimer’s
Deficits may include aphasia, apraxia, agnosia, or disturbed executive functioning

40. Causes of Dementia: The Example of Alzheimer’s Disease
Early and Largely Unsupported Views: The Example of Smoking
Current Neurobiological Findings
Neurofibrillary tangles – Occur in all brains of Alzheimer’s patients
Amyloid plaques – Accumulate excessively in brains of Alzheimer’s patients
Brains of Alzheimer’s patients tend to atrophy
Multiple genes are involved in Alzheimer’s disease (chromosomes 21, 19, 14, 12, 1)
Chromosome 14 – Associated with early onset Alzheimer’s
Chromosome 19 – Associated with a late onset Alzheimer’s

41. The Contributions of Psychosocial Factors in Dementia
Do not cause dementia directly, but may influence onset and course
Lifestyle factors – Drug use, diet, exercise, stress
Cultural factors – Risk for certain diseases and accidents vary by ethnicity and class
Psychosocial factors – Educational attainment, coping skills, social support

42. Medical and Psychosocial Treatment of Dementia
Medical Treatment: Best if Enacted Early
Few medical treatments exist for most types of dementia
Most medical treatments attempt to slow progression of deterioration
Examples include glial cell-derived neurotrophic factor, Cognex, vitamin E, aspirin
Medical treatments do not stop progression of dementia
Psychosocial Treatments
Focus on enhancing the lives of dementia patients and their families/caregivers
Teach adaptive skills
Use memory enhancement prosthetic devices (e.g., memory wallet)
Main emphasis of psychosocial interventions appears to be on the caregivers

43. Prevention of Dementia
Reducing Risk of Dementia in Older Adults Via
Estrogen-replacement therapy – Reduces risk of Alzheimer’s dementia in women
Proper treatment of cardiovascular diseases
Use of anti-inflammatory medications
Other Targets of Prevention Efforts
Increasing safety behaviors to reduce head trauma
Reducing exposure to neurotoxins and use of drugs

44. Amnestic Disorder
Nature of Amnestic Disorder
Inability to transfer information from short-term memory into long- term memory
Often results from medical conditions, head trauma, or long-term drug use
DSM-IV and DSM-IV-TR Criteria for Amnestic Disorder
Cover the inability to learn new information
Inability to recall previously learned information
Memory disturbance causes significant impairment in functioning
The Example of Wernicke-Korsakoff Syndrome
Caused by thalamic damage resulting from stroke or chronic heavy alcohol use
Attempt to restore thiamine deficiency in the case of chronic alcohol abuse
Research on Amnestic Disorders Is Scant