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Disorders First Apparent in Childhood

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Title: Disorders First Apparent in Childhood Author: Jorden Cummings Last modified by: jorden Created Date: 5/5/2006 2:25:35 AM Document presentation format – PowerPoint PPT presentation

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Title: Disorders First Apparent in Childhood


1
Disorders First Apparent in Childhood
2
Why first apparent?
  • Childhood disorders may continue into adulthood
  • Childhood disorders may lead to other adult
    disorders
  • Childhood disorders may impact development

3
Disorders
  • Attention Deficit Hyperactivity Disorder
  • Learning Disorders/Communication Disorders
  • Autism Aspergers Disorder
  • Mental Retardation (Axis II)
  • Conduct Disorder Oppositional Defiant Disorder
  • Selective Mutism

4
Attention Deficit Hyperactivity Disorder (ADHD)
  • Inattention
  • lack of focus on detail careless mistakes
  • difficulty with sustained attn
  • not listening when spoken to
  • fails to follow through on tasks
  • organizational problems
  • dislikes sustained effort
  • easily distracted
  • forgetful in daily activities

5
Attention-Deficit Hyperactivity Disorder
  • Hyperactivity/Impulsivity
  • Fidgets or squirms in seat
  • Leaves seat when it is inappropriate
  • Runs or climbs excessively
  • Difficulty playing quietly
  • Is often on the go or acts as if driven by a
    motor
  • Talks excessively
  • Blurts out answers before questions are finished
  • Difficulty waiting for his/her turn
  • Disrupts or interrupts others

6
ADHD
  • Symptoms are usually evident before school-age,
    but more relevant in that setting
  • Symptoms must be present in more than one setting
  • 5 of school-age children have ADHD (drops with
    age)

7
ADHD
  • Significant social impairments
  • Academic problems
  • Comorbid with mood disorders, learning
    disorders, substance use, APD, neurological
    problems, physical accidents and injury

8
What Happens When they Grow Up?
  • Adults may self-select environments that result
    in less noticeable symptoms
  • 68 have attention problems in adulthood
  • Only 30 of children retain the diagnosis in
    adolescence, and 10 in young adulthood
  • 25 do not finish school
  • 1/5 develop APD w/ high levels of crime

9
What Causes ADHD?
  • Large genetic component
  • Subtle brain differences
  • Smaller brain volume
  • Association with maternal smoking
  • 2-3 times more likely
  • Inability to inhibit behavior
  • Executive functioning deficit (goals, planning)

10
What Causes ADHD?
  • Is the real problem our regimented modern
    classrooms?
  • Decreased time for active play
  • Change in environment penalizes students who
    would be normal under different circumstances
  • Little evidence of brain abnormalities
  • ADHD looks like extreme playfulness
  • Function well outside the classroom (no control)

11
Does Diet Affect ADHD?
  • Some argue that dietary additives affect/cause
    ADHD (e.g., food coloring)
  • Parents place children on special diets
  • Evidence indicates that NO, diet is not
    responsible for ADHD

12
How do we treat ADHD?
  • Stimulant medications
  • Increase arousal and help focus attention
  • Short half-life
  • Stimulants do affect growth hormones and can
    suppress appetite
  • Many children take only during school hours
  • Drug holidays are recommended
  • Use the lowest therapeutic dose

13
How do we treat ADHD?
  • Behavioral Therapy for Children
  • Improve socialization skills
  • Reinforce and reward improved behavior until the
    environment is rewarding alone
  • Main techniques
  • Progressive muscle relaxation
  • Contingency plans
  • Cognitive therapy to increase awareness

14
How do we treat ADHD?
  • Behavioral Therapy for Parents
  • Parents are trained in behavior management,
    contingency management
  • Reduce family stress
  • Psychoeducation can reduce family blame
  • Best treatment is meds therapy
  • Meds are often necessary for severe cases

15
Learning Disorders
  • Deficits in reading, math, or written expression
  • Childs achievement level is below what would be
    predicted based upon their ability level
  • In DE, this difference must be present in less
    than 4 of children of the same age to qualify
    for services

16
Learning Disorders
  • Diagnosis based on comparison of those tests, in
    those specific domains only
  • 5 of American students have a learning disorder
  • Reading is most common

17
Consequences of Learning Disorders
  • Many drop out of school
  • Low employment rates (60-70)
  • Self-esteem problems

18
Causes of Learning Disorders
  • Genetic basis
  • Almost 100 concordance between identical twins
  • Neurological differences
  • E.g., in sound recognition

19
Treating Learning Disorders
  • Treatment such as distinguishing sounds
  • Children usually require educational
    interventions
  • Extra time
  • Additional practice and assistance
  • Special education
  • Earlier diagnosis better prognosis

20
Communication Disorders
  • Deficits in the ability to express or comprehend
    verbal language
  • Expressive Language Disorder
  • Phonological Disorder
  • Stuttering
  • Many are new categories to DSM-IV
  • Usually the realm of Speech Language Pathologists

21
Pervasive Developmental Disorders
  • Disruptions in social interaction communication
    skills
  • Presence of stereotyped behaviors, interests,
    and/or activities

22
Symptoms of Autism
  • Abnormal/delayed development
  • Socially
  • Communication
  • Apparent by age 3 (20 report normal 1-2 years)
  • Failure to engage (e.g., reciprocal interactions)
  • Inappropriate facial expressions, body postures,
    gestures, eye contact

23
Symptoms of Autism
  • Unable to form friendships - shared interests
  • Social/emotional reciprocity
  • Stereotypic behavior
  • Self-destructive behavior

24
Symptoms of Autism
  • Functional language deficits
  • No language at all
  • Repeat others
  • Pragmatic language deficits
  • Integrate words with gestures
  • Inability to understand irony, sarcasm, pretend
    play

25
Symptoms of Autism
  • Restricted, repetitive, stereotyped behavior,
    interests, activities
  • Abnormal in intensity/focus
  • E.g. dates, phone numbers
  • Lining up objects
  • Inflexible patterns, routines, rituals
  • Preoccupation with parts of interest

26
Associated Features and Disorders
  • Hyperactivity, short attention span, impulsivity,
    aggressiveness
  • Self-injurious behavior temper tantrums
  • Odd responses to sensory stimuli (e.g. high
    threshold for pain, sensitive to sound, touch,
    light)
  • Abnormal affect or fear reaction

27
Aspergers Disorder
  • Mild autism
  • No significant delays in early language
  • Other language may be odd and preoccupied with
    certain topics
  • No delay in cognition or self-help skills,
    adaptive behavior, curiosity about environment
  • Little concern in infancy, may seem precocious
  • Usually noticed after entrance to school

28
Prevalence Course
  • 1 in every 166 births
  • 41 boys to girls
  • Deficits sometimes noticed early
  • Some improve at school
  • Some improve during adolescence, but others
    deteriorate
  • IQ functional language predictors

29
Causes of Autism Genetic Contributions
  • Strongest genetic component
  • Early studies thought not genetic
  • But, hard to study
  • 1 in 240,000 possible twin studies (1000 in US)
  • Autistic adults unlikely to have children
  • Autistic children have less siblings

30
Twin Studies Solve the Mystery
  • Heritability index .90 (risk)
  • Genetically heterogeneous
  • Unable to isolate genes
  • Some evidence for viral infections during
    pregnancy

31
Causes of Autism Biological Abnormalities
  • 75 neurological abnormalities
  • Abnormal reflexes/muscle tone
  • Perceptual/motor coordination
  • Movement/posture problems
  • Increase of seizures
  • Reduced brain size

32
Behavioral Treatments for Autism
  • Decrease undesirable behavior shape desirable
  • Positive reinforcement extinction
  • Social punishment
  • Families are important
  • Language social skills

33
Alternative Treatments for Autism
  • Vitamins
  • Other medications
  • Diet
  • Auditory Integration Training
  • Facilitated Communication

34
What are Alternative Treatments?
  • Scientifically unverified
  • Randomized control studies
  • Replication
  • Large samples

35
Whats so bad about alternative treatments?
  • They give parents false hope
  • They can violate patient rights
  • Can allow others to control decisions made by
    patients
  • In some cases, have led to abuse allegations

36
Facilitated Communication
  • Provide assistance for communicating
  • Alphabet board, computer, typewriter, etc
  • Support hand/arm
  • May isolate fingers
  • Requires extensive training

37
Claims
  • Produces (frees) unexpected literacy
  • Shows normal/superior intelligence
  • Provides a means to communicate (for those who
    have no means, but otherwise would)

38
What does the research say?
  • Facilitators unintentionally influence
  • May even actively influence
  • Many well-designed studies
  • Single- and double-blind
  • Repeated measures
  • Participant as control

39
Auditory Integration Training
  1. Conduct detailed audiogram, determining which
    frequencies sensitive to
  2. Modify music by computer to remove those
    frequencies
  3. Listen to music 10 hours/day, at least twice a
    day, for 10-12 days

40
Auditory Integration Training
  • Berard, France, 1960s (US in 1991)
  • 1991 -gt published book cured 10 hours
  • Autistic children (and other patients) are
    hypersensitive to certain frequencies
  • Claims 76.2 of 1850 children very positive
    results

41
Claims
  • Improved attention
  • Improved auditory processing
  • Decreased irritability
  • Reduced lethargy
  • Improved expressive language
  • Improved auditory comprehension

42
The Critics
  • No scientific evidence for hearing impairments in
    autism
  • Inconsistent with medical knowledge re structure
    mechanism of ear
  • No measurement is valid enough to discriminate
    peaks of hypersensitivity
  • Weak, irrelevant, insignificant evidence
  • Sound levels are unsafe

43
The Best Type of Treatment
  • Structured educational programs geared to the
    persons developmental level of functioning
  • It is, however, important to be open-minded
  • Majority of other treatments not scientifically
    proven
  • Be educated
  • Consider the individual child
  • Do a thorough assessment and reevaluate

44
Mental Retardation
  • Sufficiently low cognitive ability (IQ)
  • Significant social/functional impairment

45
Assessing Cognitive Ability
  • Intelligence - a collection of adaptive skills
  • You can be good at one, but not another
  • Intelligence effects our functioning
  • IQ is normally distributed. Mean 100, SD 10
  • Scores below 70 diagnostic of retardation
  • 2-3 of the population falls below this cut-off

46
Assessing Social/Functional Deficits
  • Deficits must be present in 2 areas
  • Communication
  • Self-care
  • Home living
  • Interpersonal Skills
  • Use of Community Resources
  • Self-direction
  • Functional academic skills
  • Work
  • Leisure
  • Health Safety

47
Levels of Mental Retardation
  • Mild (IQ 50-55)
  • Benefit from education (intense)
  • Learn to read/write and do basic math
  • Difficulties usually apparent after begin
    schooling
  • May need supervision/guidance, but can live alone
    with support
  • Profound (IQ below 20-25)
  • Usually physical disorder accounts for problems
  • Inability to manage even basic self-care tasks

48
What Causes Mental Retardation?
  • Chromosomal abnormalities (e.g., Downs syndrome
    Fragile-X syndrome)
  • Downs syndrome leading cause of organic MR
  • Moderate to severe
  • Females with fragile x mild to moderate males
    moderate to severe

49
What Causes Mental Retardation?
  • Genetic Problems
  • PKU - lack of enzyme to break down phenylalanine
    build-up causes brain damage
  • Normal at birth - diagnosis results in food
    changes

50
What Causes Mental Retardation?
  • Pregnancy and Birth Complications
  • Fetal alcohol syndrome (detectable only in
    infants exposed to large amounts)
  • Exposure to other drugs
  • Therapeutic drugs (e.g., for seizures, bipolar,
    Accutane for acne)
  • Radiation (e.g., for cancer)
  • Infections, such as rubella
  • Physical damage to head, blood supply during birth

51
What Causes Mental Retardation?
  • Cultural-Familial MR
  • Low end of IQ due to development or environment
  • Heritability index for IQ .60-.80
  • Genes predominantly cause MR, environment has
    less of an impact (But is important!)
  • Appropriate stimulation during certain periods is
    necessary
  • E.g. child requires stimulation of certain brain
    areas as they develop

52
Behavior Disorders - Conduct Disorder
  • A pervasive pattern of disrespect for rights of
    others violation of rules/norms
  • Bullies, threatens, intimidates others
  • Initiates physical fights, uses weapons
  • Physically cruel to people and/or animals
  • Stolen while confronting a victim
  • Forced sexual activity

53
Conduct Disorder
  • Deliberately sets fires w/ intention of doing
    damage or destroys property in other ways
  • Broken into someones house/building/car
  • Lies to obtain goods or avoid responsibility
  • Stolen costly items without confronting victim
  • Stays out at night before age 13
  • Has run away, overnight, gt2 times
  • Is truant from school prior to age 13

54
Conduct Disorder
  • Children also have poor interpersonal skills
  • Often experience peer rejection
  • Seem to have problem-solving deficits
  • Do not generate as many options as non-CD
    children
  • Inability to take anothers perspective
  • Interpret ambiguous gestures as hostile
  • Prevalence 3-6 (boys 21)

55
Oppositional Defiant Disorder
  • Pattern of negative, hostile, defiant behaviors
  • Arguing for the sake of arguing, hostility toward
    parents/teachers
  • Usually begins at home (which can impede
    diagnosis)
  • May develop into later conduct disorder
  • Typically emerge by age 8, est. 5-10 prevalence

56
What Causes Conduct Disorders?
  • Neurological differences
  • Poor coordination, fine motor skills
  • Usually have significantly lower IQ than peers
  • Temperament
  • Easily distressed, reactive to change, react to
    intense stimuli (more likely behavior problems)
  • Family Links
  • Parent with APD increases chances of CD
  • Criminal and/or alcoholic parents
  • Family history of aggression

57
What Causes Conduct Disorders?
  • Family Links cont..
  • Poor maternal mental health, prenatal health
  • Poor supervision
  • Spousal aggression
  • Lax, erratic and inconsistent parenting/discipline
  • Less acceptance, warmth, affection, support
  • Reinforce CD behavior, ignore/reward other
    (coercive process)
  • Child-parent interactions are also bidirectional

58
The Coercive Process
  • Jimmys parents tell him to go to bed
  • Jimmy refuses I want to play 1 more video
    game!
  • Parent says No! Its late and you have school.
  • Jimmy gets upset, hitting table, screaming Just
    one more game. Youre mean - you never let me
    have fun!
  • Parent feels guilty at having spent little time
    together, and is too tired after work to argue -
    says Okay, 1 more game
  • Jimmy stops screaming and plays his game
  • Parent, relieved fight is over, goes to kitchen.
    Does not monitor or play with child

59
The Coercive Process
  • What happens as a result of this process?
  • Jimmy is rewarded for screaming
  • Reward for screaming increased probability of
    screaming in future
  • Parent is rewarded for giving in
  • Parents likelihood of giving in is increased
  • If this pattern is typical, it is a risk
    factor. It also tends to escalate over time

60
Conduct Disorder APD
  • A minority of CD children develop Antisocial
    Personality Disorder
  • Treatment for conduct disorder is of interest, as
    preventing APD would reduce associated financial
    and criminal costs to society
  • Remember, APD is untreatable!

61
Treating CD and ODD
  1. Problem-Solving Skills
  2. Parent Management Training
  3. Family Therapy
  4. School Community Based Treatments

62
Problem-Solving Skills
  • Children tend to have poor problem-solving
    interpret intentions/actions as hostile
  • Combines modeling, role-playing, and
    reinforcement contingencies to increase
    problem-solving and prosocial behavior

63
Parent Training Family Therapy
  • Break cycle of coercive process
  • Promote prosocial behavior in child
  • Apply proper discipline techniques by parent
  • Increase reciprocity positive reinforcement
    between family members

64
Parent Training and Family Therapy
  • Outcomes look good (reduce arrest, increase
    school performance, family relationships)
  • Most families may be unwilling/able to participate

65
School Community Based Treatments
  • Target children at school (easier)
  • Often has more attendance than individual therapy
  • Available to all children (universal
    intervention)
  • Increased likelihood of reaching those who need
    it
  • Minimizes stigma
  • Offers opportunity to interact with other children

66
Selective Mutism
  • Selective Mutism
  • Consistent failure to speak in specific social
    situations (where these is an expectation for
    speaking) despite speaking in other situations
  • Not due to a lack of knowledge or comfort with
    spoken language
  • An anxiety disorder
  • Is not merely a child refusing to speak in a
    situation
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