Developmental and

Cognitive Disorders
Chapter 13

What are developmental

disorders?
Disorders that usually first appear in

childhood or adolescence (onset)

Note: most of these conditions persist
into adulthood

IC A

d is o rd e rs

In te lle c tu a l & C o g n itv e im p a irm e n t

- a ll M R
- a ll L D

M o to r F u n c tio n im p a irm e n t
a ll m o t o r s k ills d /o
a ll t ic d /o
s t e r e o t y p ic m o v e m e n t d /o

D is r u p t iv e o r s e lf in ju r io u s b e h a v io r
a ll a d h d & d is r u p tiv e d /o
f e e d in g & e a t in g d /o
a ll e lim n a t io n d / o , s e p e ra t io n a n x ie ty

In fo rm a tio n e x c h a n g e
a ll p e r v a s iv e d /o
a l l c o m m u n i c a t io n d / o
s e le c t iv e m u t is m

ICA D/O
As you answer the questions below, you

will be better able to choose between the

four categories introduced earlier.
1. Is the predominant sx an impairment of
learning or intellectual function?
2. Is the predominant sx abnormal motor
activity?
3. Is the predominant sx socially inappropriate
or self injurious behavior?
4. Is the predominant sx an impairment in the
ability to communicate or exchange
meaningful information?

Perspectives on
Developmental Disorders
Normal vs. Abnormal Development
Developmental Psychopathology

Study of how disorders arise and

change with time

Childhood is associated with significant

developmental changes

Disruption of early skills will likely

disrupt development of later skills

Outline
Common developmental disorders

(ADHD & Learning Disorders)

Pervasive Developmental disorders
(autism)
Mental Retardation
Cognitive Disorders (dementia)

Attention Deficit Hyperactivity

Disorder (ADHD): An Overview

Nature of ADHD

Central features Inattention, overactivity, and

impulsivity

Difficulty w sustained attn (cant finish games, watch

TV)

Constant motion, fidgeting

Blurt out answers, act without thinking

Associated with behavioral, cognitive, social,

and academic problems

Attention Deficit Hyperactivity

Disorder (ADHD): An Overview
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

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

Impulsive component decreases over time

Gender Differences

Boys outnumber girls 4 to 1

ADHD: Overdiagnosis?
Cultural Factors

Probability of ADHD diagnosis is

greatest in the United States

Studies show more school-aged kids on

stimulants than prevalence of Dx

College-aged people often present for

assessment when academic problems
emerge

ADHD: Biological
Contributions
Genetic Contributions

ADHD runs in families

Some studies suggest High heritability

Familial ADHD may involve deficits on

chromosome 20

The D4 receptor gene is more common

in ADHD children (dopamine
dysregulation?)

ADHD: Biological
Contributions

Neurobiological Contributions: Brain

Dysfunction and Damage

Used to be called minimal brain

dysfunction

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

ADHD: Biological
Contributions
The Role of Toxins

Allergens and food additives do not

appear to cause ADHD

Maternal smoking increases risk of

having a child with ADHD

ADHD: Psychosocial
Contributions
Psychosocial Factors appear to

Influence (not cause) the Disorder

Constant negative feedback from

teachers, parents, and peers

Peer rejection and resulting social

isolation

Such factors foster low self-image

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, Cylert

Other Medications

Imipramine and Clonidine (antihypertensive) have

some efficacy

Biological Treatment of ADHD

Effects of Medications

Improve compliance and decrease negative

behaviors in many children

Not clear that academic performance or social

skills are improved in the long-term

Beneficial effects are not lasting following

drug discontinuation

Negative side effects include insomnia,

drowsiness, and irritability

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 - it appears however

that long-term psychosocial Tx is necessary to
maintain gains

Learning Disorders

Scope of Learning Disorders

Problems related to academic performance in

reading, mathematics, and writing

Performance is substantially below what would

be expected (IQ - Ach discrepancy)

DSM-IV and DSM-IV-TR Reading,

Mathematics, Written Expression Disorders

Performance 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)

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

School experience for such persons tends to be quite negative

About 32% of students with learning disabilities drop out of

school

Half of school children classified as

disabled have learning disabilities.
Twenty years ago the proportion was
50% lower

Figur
e 13.1

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

Treatment of Learning
Disorders
Medications not typically used

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

Pervasive Developmental
Disorders

PDD is an umbrella term

severe and pervasive impairments in
several areas of development: reciprocal
social interaction skills, communication
skills, presence of stereotyped behavior,
interests, and activities
Symptoms are on a continuum
5 PDDs: autistic disorder, Aspergers
disorder, Retts disorder, Childhood
Disintegrative Disorder, PDD/NOS
(distinctions among these not particularly clear)

Autistic Disorder
Approximately 10 cases per 10,000

individuals
More common in males (4-5:1)
Impairment in Social Interactions
Impairment in Communication
Restricted, Repetitive and
Stereotyped Behaviors, Interests,
and Activities
Onset of delays prior to age 3 years

Autistic Disorder (cont.)

Qualitative Impairment in Social Interaction

(needs at least 2)
marked impairment in the use of nonverbal
behaviors
Failure to develop peer relationships
appropriate to developmental level
A lack of spontaneous seeking to share
enjoyment, interests, or achievements
lack of social or emotional reciprocity

Autistic Disorder (cont.)

Qualitative impairment in Communication (needs a

lest one)
delay or total lack of development of spoken
language (no compensation)
marked impairment in the ability to initiate or sustain
a conversation with others in individuals that can
speak
stereotyped and repetitive use of language or
idiosyncratic language
lack of carried , spontaneous make-believe play or
social imitative play appropriate to developmental
level.

Autistic Disorder (cont.)

Restricted, Repetitive and Stereotyped

Behaviors, Interests, and Activities (needs at
least one)
encompassing preoccupation with one or more
stereotyped and restricted patterns of interest
that is abnormal either in intensity or focus
apparently inflexible adherence to specific,
nonfunctional routines or rituals
stereotyped mannerisms
persistent preoccupation with parts of objects

Other issues related to autism

Sensory issues (e.g., high threshold

for pain, oversensitivity to sounds,

fascination with touch or smell)
Abnormalities in mood and affect
Feeding issues (limited diet, pica)
Behavior difficulties (SIB, Tantrums,
short attention span, hyperactivity,
sleep problems)

Phenomenology of Autism
20/20 Video
What is it like to be autistic?

Autism and Intellectual

Functioning

75% of individuals have mental retardation

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

Etiology of Autism

Psychosocial Contributions Are Unclear

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

Aspergers Disorder
Qualitative impairment in social

interaction
Restrictive Repetitive and
stereotyped patterns of behavior,
interest, and activities
Disturbance causes clinically
significant impairment
no clinically significant general delay
in language
no clinically significant delay in
cognitive or adaptive functioning

Retts
Disorder

Only reported in females

Apparent normal pre and perinatal
development
Normal head circumference at birth
Deceleration of head growth between 5 and
48 months
Loss of hand skills between 5 and 30 months
with development of stereotyped hand
movement, loss of social engagement, poorly
coordinated gait or trunk movements,
severely impaired expressive and receptive
language development with severe
psychomotor retardation
Severe or Profound MR

Applied Behavior Analysis

Breaks down autism into separate behavioral
problems and attempts to treat as many of
these problems as possible.
By far the most well documented treatment
approach with hundreds of studies on
behavioral treatment for children with autism.
Goal is remediation (recovery) from the
disorder to the point that children are
indistinguishable from their peers.

UCLA Young Autism Project (Lovaas)

Intensive one-on-one training for app. 40 hours a

week.
Training prg carried out in homes, school, community
commences at age no older than 46 months
1st phase, focuses on teaching compliance, simple
imitation, appropriate play, suppress self-stimulation
and non-compliant behavior
2nd phase teaching expressive skills, early abstract
language, social play with peers
Third phase teaching expression of emotions,
functional academics and more complex cognitive
abilities (e.g., cause-to-effect relationships)

UCLA Young Autism Project - study design

Initial 2 year treatment

N = 59 children
3 groups:
(a) Experimental group (N=19) - 40 hours a week
of treatment for 2 years
Control group # 1 (N=19) - 10 hours of treatment
for 2 years on average
Control group #2 (N=21) - No treatment provided
by UCLA

Blind Evaluations pre & post treatment

UCLA Young Autism Project

pre-treatment
Exp Group
Treatment:

40 hrs/week

Pre Treatment Measures:

Age at Dx
32 months
Age @ Beg. trt
35 months
IQ
53

Control Group # 1
10 hrs/week

34 months
40 months
46

UCLA Young Autism Project

pre-treatment
Exp Gr
Control Group # 1
(N=19)
(N=19)
Mute 58% 47%
Reject Adults
63% 42%
Not Toilet Trained 68% 63%
Gross Inattention 89% 74%
Tantrums
89% 79%
Absent Toy Play
53% 63%
Self Stimulation 95% 89%
Absent Peer Play 100% 100%

UCLA Young Autism Project- Results

Blind evaluation: pre treatment & 2 years later (Age 6-7)

Experimental Group Results:

** Average IQ Gain = 20 points
** 9/19 (47%) Completed first grade in regular class
** IQ Gain for these 9 subjects = 37 points
8/19 (42%) Continued in a learning disabled class
2/19 (11%) Severe MR / autistic classroom

Control Group Results:

Group # 1
Group # 2
IQ
no significant changes
Completed first grade in regular class:
0/19 ( 0%)
1/21 (5%)
Continued in a learning disabled class: 8/19 (42%)
10/21 (48%)
Continued in a Severe MR Class:
11/19 (58%)
10/21 (48%)

UCLA Young Autism Project- Results

1993 Follow Up Study Results

Blind Evaluations of the 9 children in the Best

Outcome Group
Age at follow up evaluation - 13 years old.
IQ gains remained.
Normal functioning on tests of:
emotional functioning;
social functioning;
intellectual functioning.
8/9 (88%) Remained in typical classrooms.
1/9 was in an LD classroom.

Autism - Pharmacotherapy
No known effective medications

Mental Retardation

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 - about 2-3% of the population)

Concurrent deficits or impairments two or more areas of

adaptive functioning

MR must be evident before the person is 18 years of age

Levels of MR

Mild MR

Moderate MR

Includes persons in the IQ range of 35-40 to 50-55

Severe MR

Includes persons with an IQ score between 50 or

55 and 70 (often can lead independent lives)

Includes people with IQs ranging from 20-25 up to

35-40

Profound MR

Includes people with IQ scores below 20-25

(typically require complete assistance)

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

Not that widely adopted

Classification of MR in Educational Systems

Based on whether person is Educable

Stigmatizing system

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

Mental Retardation (MR):

Psychosocial Contributions

Cultural-Familial Retardation

Believed to cause about 75% of MR cases and is

the least understood

Believed to result from combination of biological

(low IQ) and social factors

Neglect, abuse, poor nutrition

Associated with mild levels of retardation on IQ

tests and good adaptive skills

Lower end of distribution but probably distinct

etiology from those w clear organic causes

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 Downs Baby

Nearly 75% of cases cannot be attributed to any

known biological cause

Specific genetic syndromes

associated with MR
Down Syndrome
Fragile X syndrome

Down Syndrome

Down Syndrome

Most common chromosomal form of MR

Prevalence: about 1 out of every 700 live
births
As many of 75% of trisomy 21 result in
miscarriages or stillbirths.
The older the mother, the higher the (p)
of DS (e.g., Maternal age of 20 = 1 in
2000; 35 = 1 in 500; 45 = 1 in 18)
Theory - ova (eggs) produced in youth
are exposed to toxins, radiation damaged

Down Syndrome (cont.)

Health issues: Congenital heart defects

(50), hearing loss (66-89), ophthalmic
conditions (60), endocrine conditions
(e.g., hypothyroidism) (50-90), obesity
(50-60), dental problems (60-100),
seizure disorders (6-13), high risk of
Alzheimer's disease.

Down Syndrome (cont.)

Adaptive behavior: In general

children with DS show higher AB

levels than intelligence
Personality: Sociable and pleasant.
Dual DX: Less often and less
severe maladaptive behavior and
psychopathology

Fragile X Syndrome

Fragile X syndrome
Most common known inherited form

of MR
Prevalence = 1 in 4000 males and at
least half that in females.
The marker was an X chromosome
with a small, pinched-off piece of
genetic material
Mothers often have learning
disabilities

Fragile X syndrome (cont.)

Physical features: 80% of post pubertal

boys and men with this disorder have
enlarged testicules (about twice the size).
Other physical features: long narrow face
and prominent ears, flat feet, hyper
extensible finger joints, soft skin
Features become more pronounced with
age and are subtle in childhood
Few significant medical problems are
associated with fragile X (seizures in
about 20%)

Fragile X syndrome (cont.)

IQ levels vary from moderate levels of MR

to the average range of functioning (varies
with genetic status, gender, and age)
In general, females are less impaired than
males
Many males seem to show declines in their
IQ scores over time.

Treatment of MR

For mild MR, tx is similar to that for learning

disabilities
For more severe MR, treatment is similar to
that for PDD
Goals include communication, social
development, independent living and job
skills
People with MR often Benefit from Such
Interventions