MENTAL RETARDATION AND DEVELOPMENTAL DISORDERS

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PSYCHOLOGICAL PROBLEMS OF CHILDHOOD:Kinds of Internalizing Disorders >>

Abnormal Psychology PSY404

Lesson 43

MENTAL RETARDATION AND DEVELOPMENTAL DISORDERS

Developmental psychopathology is the study of how disorders arise and change with time. These

changes usually follow a pattern, with child mastering one skill before acquiring the next, it implies that

any disruption in the acquisition of early skills by the very nature of the developmental process also

disrupt the development of later skills. Developmental Psychopathology approach is absolutely essential

to disorders of children, because children change rapidly during the first 20 years of life. Psychologists

become concerned only when a child's behavior deviates substantially from developmental norms,

behavior that is typical for children of a given age.

1- Attention Deficit Hyperactivity Disorder

· The primary characteristics of people with attention deficit hyperactivity disorder are the pattern

inattention (such as not paying attention to school-or work related tasks) or hyperactivity-

impulsivity, or both.

· These deficits can significantly disrupt academic efforts and social relationships.

2- Learning Disorders

DSM-IV-TR groups the learning disorders as

· reading disorder

· Mathematics disorder

· Disorder of written expression

All are defined by performance that fall far short of expectations based on intelligence and school

preparation.

3- Verbal or communication disorders

Verbal or communication disorders seem closely related to learning disorders.

· They include stuttering, stammering, disturbance in speech fluency, expression, language disorder, a

very limited speech in all situations.

· Selective mutism.

4- Pervasive Developmental Disorder

· People with pervasive developmental disorder experience trouble progressing in language,

socialization and cognition. The use of word pervasive means that these are not relatively minor

problems (like learning disabilities) but conditions that significantly affect how individuals live.

Kinds of Pervasive Developmental Disorder

(i) Autistic Disorder

(ii) Attention Deficit Hyperactivity Disorder (ADHD)

(iii) Oppositional Deficit Disorder (ODD)

(iv) Conduct Disorder

(v) Asperger's Disorder

(vi) Childhood Disintegrative Disorder

(vii) Rett's Disorder

Mental retardation and Pervasive Developmental Disorders (PDD) involve serious disruptions in

development.

Both disorders are either present at birth or begin early in life.

Both affect many areas of intellectual, social, and life functioning.

Autism is the most familiar PDD, and, in fact, professionals often use the term autistic spectrum

disorders as a synonym for PDD.

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PDD are distinguished by dramatic, severe, and unusual symptoms.

Socially, the child not only lives in a world of his own but also in a world apart.

Many children with PDD also cannot communicate.

In addition, children with PDD are preoccupied with unusual repetitive behavior, like needing to

preserve rigid routines or rocking back and forth endlessly.

All people with mental retardation have impaired intellectual abilities, but they vary widely in

academic ability, social functioning, and life skills.

Some people with profound retardation require total care and live their entire lives in institutions.

However, most people with mental retardation learn the self-care and vocational skills that allow

them to live in the community.

All people with mental retardation have impaired intellectual abilities, but they vary widely in

academic ability, social functioning, and life skills.

Some people with profound retardation require total care and live their entire lives in institutions.

However, most people with mental retardation learn the self-care and vocational skills that allow

them to live in the community.

Pervasive developmental disorders (PDDs) begin early in life and involve severe impairments in a

number of areas of functioning.

People with PDD exhibit profound disturbances in relationships, engage in unusual behaviors, and

typically have substantial communication difficulties.

1- Autistic Disorder (Autism)

· Autistic disorder (autism) is characterized by profound indifference to social relationships, odd,

stereotypical behaviors, and severely impaired or nonexistent communication skills.

· Early onset is a defining feature of autism.

· Because babies with autism look normal, the condition may not be accurately diagnosed for a few

years, as infants and toddlers fail to reach developmental milestones and social achievement.

· Communication problems range from few difficulties disorder to profound impairments in many

cases of autism.

· According to field studies conducted for DSM-IV, 54 percent of patients with autism remain mute,

as do 35 percent of patients with other PDD.

· Echolalia is a common problem.

· Those with autism or other PDD frequently repeat phrases that are spoken to them, or sometimes

repeatedly echo a phrase they heard at an earlier time.

· Another common language problem is pronoun reversal, which involves confusing the pronoun

"you" with the pronoun "I."

· The inability to relate to others is another central feature of autistic disorder.

· One view is that people with autism lack a theory of mind--that is, they fail to appreciate that other

people have a point of reference that differs from their own.

· Another defining symptom of autism is restricted, repetitive, and stereotyped patterns of behavior,

interests, and activities.

· These odd preoccupations and rituals create social complications.

· Rituals such as flapping a string or spinning a top seem to serve no other function than providing

sensory feedback or self-stimulation.

· Self-injurious behavior is one of the most bizarre and dangerous difficulties that can accompany PDD.

Frequency of Autism and PDD

· Upper level estimates now suggest that as many as 60 in 10,000 children suffer from autism.

· Three to four times as many boys as girls suffer from autism, suggesting a gender-linked etiology.

· Autism also is much more common among siblings of a child with autism, suggesting possible

genetic causes.

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2- Attention-deficit/hyperactivity disorder (ADHD)

· Attention-deficit/hyperactivity disorder (ADHD) is characterized by hyperactivity, attention deficit,

and impulsivity.

· The symptoms of hyperactivity and attention deficit each have been viewed as being the core

characteristics of ADHD.

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3-Oppositional Defiant Disorder (ODD)

· Oppositional defiant disorder (ODD) is defined by a pattern of negative, hostile, and defiant

behavior.

· The rule violations in ODD typically involve minor transgressions, such as refusing to obey adult

requests, arguing, and acting angry.

· A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four

(or more) of the following are present:

o Often loses temper.

o Often argues with adults.

o Often actively defies or refuses to comply with adults' requests or rules.

o Often deliberately annoys people.

o Often blames others for his/her mistakes or misbehavior.

o Is often touchy or easily annoyed by others.

o Is often angry and resentful.

o Is often spiteful and vindictive.

· The disturbance in behavior causes clinically significant impairment in social, academic, or

occupational functioning.

· Note: Consider a criterion only if the behavior occurs more frequently than is typically observed in

individuals of comparable age and developmental level.

· Professionals have long debated whether ADHD and ODD are the same or separate disorders.

· The current consensus is that the two disorders are separate but frequently comorbid.

· Not only ADHD and ODD are highly comorbid, but about 25 percent of children with each

problem also have a learning disorder.

4-Conduct Disorder (CD)

· Conduct disorder (CD) is defined primarily by a persistent and repetitive pattern of serious rule

violations, most of which are illegal as well as antisocial--for example, assault or robbery.

· DSM-IV-TR distinguishes the age of onset in defining conduct disorders--a distinction between

adolescent-limited versus life-course patterns of antisocial behavior.

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Most of the symptoms of conduct disorder involve index offenses--crimes against people or

property that are illegal at any age.

A few diagnostic criteria are comparable to status offenses--acts that are illegal only because of the

youth's status as a minor.

However, juvenile delinquency is a legal classification, not a mental health term.

Anywhere from 5 to 15 percent of youth in the United States may have ODD and/or CD.

After the first few years of life, from two to ten times as many boys as girls have an externalizing

disorder.

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Except for the normative increase during adolescence, the prevalence of externalizing behavior

generally declines with age, although it declines at much earlier ages for girls than for boys.

Externalizing disorders are associated with various indicators of family adversity, a fact highlighted

by British psychiatrist Michael Rutter.

Rutter's Family Adversity Index includes six family predictors of behavior problems among

children:

low income,

overcrowding in the home,

maternal depression,

paternal antisocial behavior,

conflict between the parents, and

removal of the child from the home.

5- Asperger's Disorder

The new diagnosis for Asperger's disorder refers to people who show the symptoms of autism but do

not have major problems in communication and generally function higher in other areas as well.

6- Childhood Disintegrative Disorder

Childhood disintegrative disorder refers to a poorly understood and somewhat controversial condition

characterized by severe problems in social interaction and communication, in addition to stereotyped

behavior.

7- Rett's Disorder

Rett's disorder is a clearly distinct condition characterized by at least 5 months of normal development

followed by

o a deceleration in head growth,

o loss of purposeful hand movements,

o loss of social engagement,

o poor coordination, and

o a marked delay in language.

Treatment of PDD (continued)

1- A huge variety of medications have been used to treat autism, including antipsychotics,

antidepressants, amphetamines, psychedelics, and megavitamins.

Unfortunately, none of these medications is an effective treatment for autism, and few show much

promise.

2- Intensive behavior modification using operant conditioning techniques called Applied Behavior Analysis

(ABA) is the most promising approach to treating autism.

ABA therapists focus on treating the specific symptoms of autism, including communication deficits,

lack of self-care skills, and self-stimulatory or self-destructive behavior.

3- Behavior therapists have been fairly successful in teaching self-care skills and less successful in

teaching social responsiveness.

4- One of the most actively researched residential programs is Achievement Place, a group home that

operates according to highly structured behavior therapy principles.

Achievement Place homes, like many similar residential programs, are very effective in improving

aggression and noncompliance while the adolescent is living in the treatment setting.

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