CHAPTER 14 NEURODEVELOPMENTAL DISORDERS  Socially, he appeared to like other people but

his interest seemed to center on their ability to

I. OVERVIEW OF NEURODEVELOPMENTAL DISORDERS
 Disorders that show themselves early in life
often persist as the person grows older, so the
term childhood disorder may be misleading.
 Neurodevelopmental disorders –
developmental disorders that are all presumed
to be neurologically based
 A number of difficulties and, indeed, distinct
disorders begin in childhood.
 In certain disorders, some children are fine
except for difficulties with talking.
 Other children have a combination of
conditions that significantly hinder their
development
get him something he wanted, such as favorite
drink and food
 If environment changed even in a minor way,
Timmy would become disruptive and violent to
the point of hurting himself
 To minimize his self-injurious behavior, the
family took care to ensure that his surroundings
stayed the same as much as possible
 No real progress was made toward eliminating
his violent behavior
 As he grew up, he became difficult to work
with; hurting his mother on several occasions
 Her mother institutionalized Timmy when he
was 17

CASE OF TIMMY: The Boy Who Looked Right Through

II. WHAT IS NORMAL? WHAT IS ABNORMAL?
You
 Developmental psychopathology – study of how
 Born with the umbilical cord wrapped around
disorders arise and how they change with time
his neck
 Childhood – considered important because the
 He had been without oxygen for an unknown
brain changes significantly for several years
period
after birth; when critical developments occur in
 Didn’t like to be picked up and cuddled as a
social, emotional, cognitive, and other
baby
important competency areas.
 2 years old – wasn’t able to talk still; doesn’t
 Changes follow a pattern:
play with other children; spent most time alone;
o Child develops one skills before
waving his hands in front of his face; and always
acquiring the next
lining up blocks in a certain order.
o Although this pattern of change is only
 Persisted his behavior at the age of 3
one aspect of development, it is an
 Neurological examinations revealed nothing
important concept at this point because
unusual but suggested, on the basis of Timmy’s
it implies that any disruption in the
delay in learning such basic skills as talking and
development of early skills will, by the
feeding himself, that he had severe intellectual
very nature of this sequential process,
disability
disrupt the development of later skills.
 By age 7 – still didn’t speak or play with other
 People with autism spectrum disorder suffer
children; developed an aggressive and self-
from a disruption in early social development,
injurious behaviors
which prevents them from developing
 Was brought to a clinic for children with severe
important social relationships, even with their
disabilities
parents
 Diagnosed as having autism
 From a developmental perspective, the absence
 Clinic specialists recommended a
of early and meaning social relationships has
comprehensive educational program of
serious consequences.
intensive behavioral intervention to help Timmy
 Children whose motivation to interact with
with language and socialization and to counter
others is disrupted may have a more difficult
his increasing tendency to engage in tantrums
time learning to communicate; that is, they may
 Continued daily for approximately 10 years
not want to learn to speak if other people are
 First three words – soda, cookie, and Mama
not important to them.
 It may be important to identify children with
attention-deficit/hyperactivity disorder, for
example, because their problems with
impulsivity may interfere with their ability to
create and maintain friendships, an important
developmental consideration.
 Identifying a disorder such as autism spectrum
disorder at an early age is important for these
children so that their social deficits can be
addressed before they affect other skill
domains, such as social communication.
 Biological and psychosocial influences
continuously interact with each other
o Even for disorders such as ADHD and
autism spectrum disorder that have
clear biological bases, the presentation
of the disorder is different for each
individual.
 However, some workers in the field may view
aspects of normal development as symptoms of
abnormality.
o Echolalia – involves repeating the
speech of others; though to be a sign of
autism spectrum disorder
o When we study the development of III. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
speech in children without disorders,  Primary characteristics:
however, we find that repeating what o Pattern of inattention, such as being
someone else says is an intermediate disorganized or forgetful about school
step in language development. or work-related tasks, or of
o In children with autism spectrum hyperactivity and impulsivity
disorder, therefore, echolalia is just a o These deficits can significantly disrupt
sign of relatively delayed language skills academic efforts, as well as social
and not a symptom of their disorder relationships
 Attention-deficit/hyperactivity disorder –
involves characteristics of inattention or
hyperactivity and impulsivity CASE OF DANNY: The Boy Who Couldn’t Sit Still
 Specific learning disorder – characterized by one  9 year old boy
or more difficulties in areas such as reading and  Had difficulties at school and at home
writing  Had a great deal of energy and loved playing
 Autism spectrum disorder – a more severe most sports especially baseball
disability, in which the child shows significant  Academically, his work was adequate; though
impairment in social communication and has his performance was diminishing
restricted patterns of behavior, interest, and  Spends a few minutes on a task without some
activities interruption
 Intellectual disability - involves considerable  Equally impulsive during their interactions
deficits in cognitive abilities.  At home, he was considered a handful
 Communication and motor disabilities – also  Room was in constant mess
considered neurodevelopmental disorders
  Often scolded for not carrying out some tasks
because he reasons that he forgot what he was
doing
 Sometimes being yelled “slow down!” due to
his hyperactivity
CLINICAL DESCRIPTION
 Difficulty sustaining their attention on a task or
activity
 End result: unfinished tasks and they often
seem not to be listening when someone else is
speaking
 Display motor hyperactivity
 Described as fidgety in school, unable to sit still
for more than a few minutes
 Impulsivity – acting without thinking
 DSM-5 two categories of symptoms:
o Inattention – people may appear not to
listen to others
 May lose necessary school
homeworks, books, or tools
 Not pay enough attention to
details
 Making careless mistakes
o Hyperactivity and Impulsivity
 Hyperactivity – fidgeting, having
trouble sitting for any length of
time, always being on the go
 Impulsivity – blurting out
answers before questions have
been completed and having
trouble waiting turns
o Either the first or the second/third must
be present for someone to be
diagnosed with ADHD
 Secondary problems to ADHD
o Academic performance often suffers
o Cause of this poor performance is not
known; but can be a result to
inattention and impulsivity and
concurrent learning disabilities
o Unpopular and rejected by peers
 Environmental influences can also play; hostile
home environment and gene-environment
interactions
 Genetic research on both ADHD and learning
disabilities – the may share a common
biological cause
STATISTICS
 5.2% of the child populations across all regions
of the world
 There had been debates about the validity of
ADHD as a real disorder
o Some people believe that children are
just normally active – possible
misdiagnosis
 Most likely labeled in the US
o Example, 11% of children aged 4 to 17
were labeled with ADHD b/w 2011 and
2012
 Some argue that ADHD in children is just a
cultural construct – behavior of children is
typical from a developmental perspective and it
is Western’s society intolerance (due to the loss
of extended family support, pressure to succeed
academically, and busy family life) that causes
labeling ADHD as a disorder
 Boys are 3x more likely to be diagnosed with
ADHD than girls
o Reason for gender difference is
unknown
o It may be that adults are more tolerant
of hyperactivity among girls, who tend
to be less active than boys with ADHD
o Boys tend to be more aggressive, which
will more likely result in attention by
mental health professionals
o Girls with ADHD – display more
behaviors referred to as “internalizing”
– anxiety and depression
 There has been bias on boys in terms of
research on ADHD
 Children with ADHD are first identified as
different from their peers around age 3 or 4;
their parents describe them as active,
mischievous, slow to toilet train, and
oppositional (Taylor, 2012).
 The symptoms of inattention, impulsivity, and
hyperactivity become increasingly obvious
during the school years.
 Despite the perception that children grow out
of ADHD, their problems usually continue: it is
estimated that about half of the children with
ADHD have ongoing difficulties through
adulthood
 Over time, children with ADHD seem to be less
impulsive, although inattention persists.
 During adolescence, the impulsivity manifests
itself in different areas; for example, teens with
ADHD are at greater risk for pregnancy and
contracting sexually transmitted infections.
 They are also more likely to have driving
difficulties, such as crashes; to be cited for
speeding; and to have their licenses suspended
CAUSES
 As children with ADHD become adults, there is
increased risk risk of displaying risky driving,
having a sexually transmitted disease, increased
chance of having a head injury, and more
emergency department admissions
 Several DSM-5 disorders appear to overlap with
other disorders
o Oppositional defiant disorder (ODD),
conduct disorder, and bipolar disorder
all have characteristics seen in children
with ADHD.
o ODD is a DSM-5 disorder that includes
behaviors such as “often loses temper,”
“argues with adults,” “often
deliberately annoys people,” “touchy
and easily annoyed by others,” and
“often spiteful and vindictive”
o The impulsivity and hyperactivity
observed in children with ADHD can
manifest themselves in some of these
symptoms.
o Similarly, conduct disorder can be a
precursor to antisocial personality
disorder—is also observed in many
children with ADHD
o Bipolar disorder – is one of the mood
disorders that can overlap with ADHD
 ADHD is more common in families in which one
person has the disorder (Genetics)
o Genetic deficits may contribute to the
problems experienced by individuals
with ADHD
 Environmental influences play a relatively small
role in the cause of the disorder when
compared with many other disorders
 Multiple genes are also responsible for ADHD
o Mutations occur that either create extra
copies of a gene on one chromosome or
result in the deletion of genes (Copy
number variants – CNVs)
 Neurochemicals such as dopamine,
norepinephrine, serotonin, and GABA
implicated cause of ADHD
o there is strong evidence that ADHD is
associated with the dopamine D4
receptor gene, the dopamine
transporter gene (DAT1), and the
dopamine D5 receptor gene.
o DAT1 is of particular interest because
methylphenidate (Ritalin)— one of the
most common medical treatments for
ADHD – inhibits this gene and increases
the amount of dopamine available
 Endophenotypes – basic deficits/characteristics
of ADHD
 Gene-environment interaction studies of ADHD
 o If mothers smoked during pregnancy
o Prenatal smoking seemed to interact
with this genetic predisposition to
increase the risk for hyperactive and
impulsive behavior
o Maternal stress and alcohol use
o Premarital instability and discord
 For several decades, ADHD has been thought to
involve brain damage, and this notion is
reflected in the previous use of labels such as
“minimal brain damage” or “minimal brain
dysfunction”
 Variety of toxins and food additives have been
considered as possible causes of ADHD over the
BIOLOGICAL INTERVENTIONS
years
 Psychological and social dimensions of ADHD
may further influence the disorder itself—
especially how the child fares over time.
 Negative responses by parents, teachers, and
peers to the affected child’s impulsivity and
hyperactivity may contribute to feelings of low
self-esteem, especially in children who are also
depressed
TREATMENT OF ADHD
 Psychosocial interventions – focus on
broader issues such as improving academic
performance, decreasing disruptive
behavior, and improving social skills
 Biological treatments – reduce the
children’s impulsivity and hyperactivity and
to improve their attention skills
 Use of intervention first before proceeding
to medications
PSYCHOSOCIAL INTERVENTIONS
 Help children at home and in school
 The programs set such goals as increasing
the amount of time the child remains
seated, the number of math papers
completed, or appropriate play with peers.
 Reinforcement programs reward the child
for improvements and, at times, punish
misbehavior with loss of rewards.
 Parent-education programs – teach families
how to respond constructively to their
child’s behaviors and how to structure the
child’s day to prevent difficulties
 Social skills training – includes teaching how
to interact with peers
 For adults with ADHD – cognitive-behavioral
interventions are given
o To reduce distractibility and
improve organizational skills
 Combination of approaches to target both
o Short-term management issues –
decrease in hyperactivity and
impulsivity
o Long-term concerns – preventing
and reversing academic decline and
improving social skills
 1st types of medication – stimulants
 Drugs such as methylphenidate (Ritalin,
Adderall) and several nonstimulant
medications such as atomoxetine
(Strattera), guanfacine (Tenex), and
clonidine have proved helpful in reducing
the core symptoms of hyperactivity and
impulsivity and in improving concentration
on tasks
 On some low dosages, people with or
without ADHD react the same way
 Stimulant medications reinforce the brain’s
ability to focus attention during problem-
solving tasks
 Concern for stimulant – abuse of drug use
o Ritalin and Adderall – to create
elation and reduce fatigue
 Strattera – atomoxetine; is a selective
norepinephrine-reuptake inhibitor and
therefore does not produce the same
“highs” when used in larger doses.
 All these drugs seem to improve compliance
and decrease negative behaviors in many
children, and their effects do not usually
last when the drugs are discontinued.
 Psychopharmacogenetics – study of how
your genetic makeup influences your
response to certain drugs.
o Medications can be matched for
individuals to better complement
their specific needs
 Genetic screening – identify defects or any
number of potential genetic problems
  Medications often result in unpleasant side
effects, such as insomnia, drowsiness, or
irritability
COMBINED APPROACH TO TREATMENT
 Multimodal Treatment of Attention-
Deficit/Hyperactivity Disorder (MTA) study, this
14-month study included 579 children who
were randomly assigned to one of four groups.
 Initial reports from the study suggested that the
combination of behavioral treatments and
medication, and medication alone, were
superior to behavioral treatment alone and
community intervention for ADHD symptoms.
 For problems that went beyond the specific
symptoms of ADHD, such as social skills,
academics, parent–child relations, oppositional
behavior, and anxiety or depression, results
suggested slight advantages of combination
over single treatments (medication
management, behavioral treatment) and
community care.
 Behavioral intervention was faded over time
IV. SPECIFIC LEARNING DISORDER
 Characterized by performance that is
substantially below what would be expected
given the person’s age, intelligence quotient
(IQ) score, and education.
CASE OF ALICE: Taking a Learning Disorder to College
 20 years old college student
 Reported to enjoy school and has been a good
student until about sixth grade where her
grades suffered
 She wasn’t working up to her potential
 Managed to graduate from high school and
enrolled in the local community and found
herself struggling with work
 Learned several tricks that seemed to help in
her study and at least get passing grades
 When she reads silently, she could barely
remember any of the details just minutes later
 During sophomore year, she transferred to a
university
 Scores from an IQ test placed her slightly above
average, but she was assessed to have
significant difficulties with reading.
 Her comprehension was poor, and she could
not remember most of the content of what she
read.
CLINICAL DESCRIPTION
 DSM-5 definition - a significant discrepancy
between a person’s academic achievement and
what would be expected for someone of the
same age—referred to by some as “unexpected
underachievement”
 Person perform academically at a level
significantly below that of a typical person of
the same age, cognitive ability (as measured on
an IQ test), and educational background.
 Not caused by a sensory difficulty or poor and
absent instruction
 Disorders in reading, math, or written
expression – high-light specific problems for
remediation
 Clinicians also rate the disorder on levels of
severity
 Historical definition - discrepancy of more than
2 standard deviations between achievement
and IQ.
 Response to intervention – alternative
approach used by clinicians
o involves identifying a child as having a
specific learning disorder when the
response to a known effective
intervention (for example, an early
reading program) is significantly inferior
to the performance by peers
o provides an early warning system and
focuses on providing effective
instruction
STATISTICS
 6.5 M students between 3 – 31 (2009 – 2010)
 Increase in wealthier regions
 Economic status and not ethnic background
 Mathematics disorder – 1% of the population
 Boys are more likely to have reading disorders
(according to research)
 Students with SLD are most likely to drop out
from school, unemployed, and have suicidal
thoughts/have attempted suicide
 Communication disorders – closely related to
SLD
o Includes childhood-onset fluency
disorder (stuttering) and language
 disorder (combines DSM-IV-TR
expressive and mixed receptive-
expressive language disorders)
CAUSES
 Genetic, neurobiological, and environmental
factors
 Genetics
o Run in families, sophisticated families,
and twin studies
 Reading disorders are sometimes broken into
problems with;
o Word Recognition (Dyslexia) - difficulty
decoding single words
o Fluency – problems being able to read
words and sentences smoothly and
automatically
o Comprehension – difficulty getting
meaning from what is read
 Environmental influences:
o home reading habits of families
 Subtle brain impairment
o three areas of the left hemisphere
appear to be involved in problems with
dyslexia (word recognition)—
 Broca’s area (which affects
articulation and word analysis),
 an area in the left
parietotemporal area (which
affects word analysis),
 and an area in the left
occipitotemporal are (which
affects recognizing word form)
o A different area in the left hemisphere
—the intraparietal sulcus—seems to be
critical for the development of a sense
of numbers and is implicated in
mathematics disorder
o No current evidence for specific deficits
responsible for disorders of written
expression
 Disorders of reading – diagnosed most often in
English-speaking countries
TREATMENT OF LEARNING DISORDERS
 Educational Intervention
o Categories: (1) specific skills instruction
- including instruction on vocabulary,
finding the main idea, and finding facts
in readings
o (2) strategy instruction - which includes
efforts to improve cognitive skills
through decision making and critical
thinking
 Biological (drug) treatment is restricted to
people with comorbid ADHD (involves
impulsivity and inability to sustain attention and
can be helped with certain stimulant
medications such as methylphenidate)
 Approaches
o Direct Instruction - includes several
components; among them are
systematic instruction (using highly
scripted lesson plans that place
students together in small groups based
on their progress) and teaching for
mastery
 One study used functional magnetic resonance
imaging scanning (fMRI) to compare how
children with and without reading disorders
processed simple tasks
o exposed to 8 weeks of intensive training
on a computer program that helped
them work on their auditory and
language-processing skills.
o Not only did the children improve their
reading skills but also their brains
started functioning in a way similar to
the brains of their peers who were good
readers.
V. AUTISM SPECTRUM DISORDER
 is a neurodevelopmental disorder that, at its
core, affects how one perceives and socializes
with others
 DSM-5 combined most of the disorders
previously included under the umbrella term
“pervasive developmental disorders” (e.g.,
autistic disorder, Asperger’s disorder, and
childhood disintegrative disorder) and included
them into this one category
 Rett disorder - genetic condition that affects
mostly females, is diagnosed as ASD with the
qualifier “associated with Rett syndrome” or
“associated with MeCP2 mutation” (the gene
involved in Rett syndrome).
 Social (Pragmatic) Communication Disorder -
difficulties in social communication seen in ASD,
 but without restricted, repetitive patterns of
behavior.
o These individuals do not easily learn the
social rules when communicating with
others (e.g., interrupting, talking too
loud, not listening to others)
CLINICAL DESCRIPTION
 Two major characteristics
o 1) impairments in social communication
and social interaction
 present in early childhood and
that they limit daily functioning
o 2) restricted, repetitive patterns of
behavior, interests, or activities
 Degree of impairment makes the distinctions
with people with ASD, Asperger’s disorder, and
pervasive developmental disorder-not
otherwise specified
 Levels of severity
o Level 1— “Requiring support”
o Level 2— “Requiring substantial
support”
o Level 3 — “Requiring very substantial
support”
 Each level of support – described qualitatively
not quantitatively
CASE OF AMY: In Her Own World
 3 years old
 Spends much of her day picking up pieces of lint
 Hasn’t spoken yet and can’t feed or dress
herself
 Screams so loud often
 Doesn’t seem to be interested in her mother’s
love and affection
 Likes to eat butter – became the tool for
conditioning Amy to behave
IMPAIRMENT IN SOCIAL COMMUNICATION AND SOCIAL
INTERACTION
 Three aspects (which all must be present to be
diagnosed with ASD)
o Problems with social reciprocity - a
failure to engage in back-and-forth
social interactions
 Severe symptoms – Inability to
engage in Joint Attention
o nonverbal communication
o Initiating and maintaining social
relationships—all three of which must
be present to be diagnosed with ASD.
 Combination of nonverbal
communication and social
reciprocity
o Deficits in nonverbal communication
can involve problems with a range of
actions in persons with severe forms of
ASD (e.g., not pointing to things you
want) and among those with milder
forms of ASD (e.g., standing too close to
someone).
o Prosody – lack of appropriate facial
expression or tone of voice when
speaking or just give the appearance of
general nonverbal awkwardness
o Echolalia – repeating the speech of
others; a sign of delayed speech
development
 Intonation is also repeated
o People with ASD have one-sided
conversations about the topics they
want to discuss
RESTRICTED, REPETITIVE PATTERNS OF BEHAVIOR,
INTERESTS, OR ACTIVITIES
 Maintenance of sameness – intense preference
for the status quo
 People with ASD spend countless hours in
stereotyped and ritualistic behavior - making
such stereotyped movements as spinning
around in circles, waving their hands in front of
their eyes with their heads cocked to one side,
or biting their hands
STATISTICS
 Average of 1 in 50 school-aged children in the
US are under the category of ASD
 Reasons are complex and other environmental
factors (prenatal exposure to toxins) cannot yet
be ruled out as partially contributing t the rise
in rates
 Males are more likely to be diagnosed with ASD
 They have ranged of IQ scores
CAUSES: PSYCHOLOGICAL AND SOCIAL DIMENSIONS
 Historically – ASD was seen as the result of
failed parenting
  Other theories of the cause – based on the
unusual speech patterns of some individuals
o Tendency to avoid first person
pronouns such as I and me and to use
he and she instead
o Theorists wonder whether ASD involves
a lack of self-awareness
 Self-concept may be lacking when people with
ASD also have cognitive disabilities or delays,
not because of the disorder itself.
 Savant skills – seen in Dustin Hoffman’s Rain
Man movie
o exceptional skills appear to be the
result of possessing superior working
memory and highly focused attention
o Does not occur in all individuals with
ASD
CAUSES: BIOLOGICAL DIMENSIONS
 Deficits in such skills as social communication
and the characteristic restricted and repetitive
behaviors and interests
GENETIC INFLUENCES
 Numerous genes on a number of our
chromosomes have already been implicated in
some way in the presentation of ASD
 Families that have one child with ASD have
about a 20% chance of having another child
with the disorder
 Preliminary work identifies an association
between ASD and an oxytocin receptor gene
(have a role in how we bond with others and in
our social memory)
 There appears to be an increased risk of having
a child with ASD among older parents
o De novo mutations – mutations that
occur in the sperms of fathers and eggs
of mothers which can influence the
development of ASD
NEUROBIOLOGICAL INFLUENCES
 Research on the amygdala – area of the brain
responsible for anxiety and fear
o Researchers studying the brains of
people with ASD after they died note
that adults with and without the
disorder have amygdalae of about the
same size but that those with ASD have
fewer neurons in this structure
o amygdala in children with ASD is
enlarged early in life—causing excessive
anxiety and fear (perhaps contributing
to their social withdrawal)
 Neuropeptide oxytocin - an important social
neurochemical that influences bonding and is
found to increase trust and reduce fear
o research on children with ASD found
lower levels of oxytocin in their blood
and giving oxytocin to people with ASD
improved their ability to remember and
process information with emotion
content (such as remembering happy
faces), a problem that is symptomatic of
ASD
 Mercury - the mercury previously used as a
preservative in childhood vaccines (thimerosal)
is responsible for the increases seen in ASD
o This theory was not proven
TREATMENT OF AUTISM SPECTRUM DISORDER
 No completely effective treatment exists
 most efforts at treating people with ASD focus
on enhancing their communication and daily
living skills and on reducing problem behaviors,
such as tantrums and self-injury
PSYCHOSOCIAL TREATMENTS
 Greater success has been achieved with
behavioral approaches that focus on skill
building and behavioral treatment of problem
behaviors
 Ivar Lovaas and his colleagues - used the basic
behavioral procedures of shaping and
discrimination training to teach these
nonspeaking children to imitate others verbally
o The first skill the researchers taught the
children was to imitate other people’s
speech.
o They began by reinforcing a child with
food and praise for making any sound
while watching the teacher.
o After the child mastered that step, they
reinforced the child only if she made a
sound after the teacher made a request
—such as the phrase, “Say ‘ball’” (a
procedure known as discrimination
training).
o Once the child reliably made some
sound after the teacher’s request, the
 teacher used shaping to reinforce only  As children with ASD grow older, intervention
approximations of the requested sound, focuses on efforts to integrate them into the
such as the sound of the letter “b.” community, often with supported living
o Sometimes the teacher helped the child arrangements and work settings.
with physical prompting—in this case,
VI. INTELLECTUAL DISABILITY (INTELLECTUAL
by gently holding the lips together to
DEVELOPMENTAL DISORDER)
help the child make the sound of “b.”
 is a disorder evident in childhood as
o Once the child responded successfully,
significantly below-average intellectual and
a second word was introduced—such as
adaptive functioning
“mama”—and the procedure was
 DSM-5 identifies difficulties in three
repeated.
domains:
o This continued until the child could
 conceptual (e.g., skill deficits in areas such
correctly respond to multiple requests,
as language, reasoning, knowledge, and
demonstrating imitation by copying the
memory)
words or phrases made by the teacher.
 Social (e.g., problems with social judgment
o Once the children could imitate, speech
and the ability to make and retain
was easier, and progress was made in
friendships)
teaching some of them to use labels,
 Practical (e.g., difficulties managing
plurals, sentences, and other more
personal care or job responsibilities)
complex forms of language
 DSM-IV-TR previously used the term
 Naturalistic teaching strategies – more child
“mental retardation,” but this was changed
directed versus adult directed techniques
in DSM-5 to “intellectual disability” (or
o include arranging the environment so
intellectual developmental disorder)
that the child initiates an interest
 People with ASD have unusual reactions to
CLINICAL DESCRIPTION
other people
 People with ID display a broad range of abilities
o APPROACHES: teach social skills (for
and personalities.
example, how to carry on a
 Those with more severe impairments may need
conversation and ask questions of other
help to eat, bathe, and dress themselves,
people), including the use of peers who
although with proper training and support they
do not have ASD as trainers, and there
can achieve a degree of independence.
is evidence that those with ASD can
 Language and communication skills are often
improve their socialization skills
the most obvious kinds of impairments.
BIOLOGICAL TREATMENTS  was previously included on Axis II of DSM-IV-TR.
 Medical intervention has had little positive o The rationale for placing these
impact on the core symptoms of social and disorders on a separate axis was that
language difficulties they tend to be more chronic and less
 A variety of pharmacological treatments are amenable to treatment, and second, it
used to decrease agitation, with the major was to remind clinicians to consider
tranquilizers and serotonin-specific reuptake whether these disorders, if present,
inhibitors being most helpful were affecting an Axis I disorder.
o People could be diagnosed on both Axis
INTEGRATING TREATMENTS
I (for example, generalized anxiety
 For children, most therapy consists of school
disorder) and Axis II (for example, mild
education with special psychological supports
intellectual disability).
for problems with communication and
o DSM-5 no longer has a separate axis for
socialization.
these disorders.
 Pharmacological treatments can help some of
them temporarily.
 The DSM-5 criteria for ID no longer include
numeric cutoffs for IQ scores, which were
present in previous versions.
 1st Criterion: significantly subaverage
intellectual functioning
o a determination made with one of
several IQ tests with a cutoff score set
by DSM-5 of approximately 70.
 The American Association on Intellectual and
Developmental Disabilities (AAIDD), which has
its own, similar definition of intellectual
disability, has a cutoff score of approximately 70
to 75
 2nd Criterion: Concurrent deficits or
impairments in adaptive functioning
o a person must also have significant
difficulty in areas such as
communication, self-care, home living,
social and interpersonal skills, use of
community resources, self-direction,
functional academic skills, work, leisure,
health, and safety.
 rd
3 criterion: age of onset
o Characteristic below-average
intellectual and adaptive abilities must
be evident before the person is 18
o age criterion rules out the diagnosis of
ID for adults who suffer from brain
trauma or forms of dementia that
impair their abilities
o Age of 18 is somewhat arbitrary, but it
is the age at which most children leave
school, when our society considers a
person an adult.
 Intellectual disability is defined by society
 People with ID differ significantly in their degree
of disability.
 Four levels of ID
o Mild – IQ score is between 50-55 and 70
o Moderate – range of 35 – 40 to 50-55
o Severe – IQ score is 20 – 25 to 35-40
o Profound – IQ scores below 20-25
 A person with severe or profound ID tends to
have extremely limited formal communication
skills (no spoken speech or only one or two
words) and may require great or even total
assistance in dressing, bathing, and eating.
 AAIDD definition of ID levels of this disorders
o Intermittent
o Limited
o Extensive
o Pervasive
 AAIDD system identifies the role of “needed
supports” in determining level of functioning
and focuses on specific areas of assistance a
person needs that can then be translated into
training goals
 DSM-5 implies that the ability of the person is
the sole determining factor.
STATISTICS
 90% - fall under the label of mild ID
 Course of ID – chronic; people don’t go through
periods of remission, such as with substance
use disorders or anxiety disorders
 Prognosis varies
 People with less severe forms of ID – can
relatively live independent given appropriate
training and support
 People with severe ID – require more assistance
 Flynn effect
o IQ scores have risen
o As these scores rise, those who make
up IQ tests adjust the assessments
every decade or two to keep the
average score around 100.
CAUSES
 Environmental: For example, deprivation,
abuse, and neglect
 Prenatal: For instance, exposure to disease or
drugs while still in the womb
 Perinatal: Such as difficulties during labor and
delivery
 Postnatal: For example, infections and head
injury
 Fetal alcohol syndrome – resulted from heavy
use of alcohol among pregnant women; can
lead to severe learning disabilities
 Other prenatal factors – pregnant woman’s
exposure to disease and chemicals and poor
nutrition
o Lack of oxygen (anoxia) – during birth
o Malnutrition
o Head injuries
BIOLOGICAL DIMENSIONS
 Most research focuses on biological influences
 o women with this gene are carriers and
GENETIC INFLUENCES don’t show any of the symptoms
 Multiple genetic influences appear to
CHROMOSOMAL INFLUENCES
contribute to ID
 Down Syndrome
o Chromosomal disorders
o People with down syndrome had an
o Single-gene disorders
additional small chromosome
o Mitochondrial disorders – defects in
o Identified by Langdon Down - tried to
mitochondria
develop a classification system for
o Multiple genetic mutations
people with ID based on their
 A portion of the people with more severe ID
resemblance to people of other races;
have identifiable single-gene disorders,
he described individuals with this
involving a dominant gene (which expresses
particular disorder as “mongoloid”
itself when paired with a normal gene), a
because they resembled people from
recessive gene (which expresses itself only
Mongolia
when paired with another copy of itself), or an
o Mongoloidism – used sometime for the
X-linked gene (present on the X or sex
term Down Syndrome
chromosome).
o Extra 21st chromosome – Trisomy 21
 Most cases of ID have no identified etiology
o Characteristics:
 Study in Germany and Switzerland
 Facial features: folds in the
o De novo disorders were present in
corners of their upwardly
those children with ID of unknown
slanting eyes,
origin
 a flat nose
 Mutations in genetic material can occur at
 a small mouth with a flat roof
various points in development and this helps
that makes the tongue protrude
explain the causes of previously puzzling cases
somewhat.
of ID
o Tend to have congenital heart
 Someone who carries a dominant gene that
malformations
results in ID is less likely to have children and
o increased risk of dementia of the
thus less likely to pass the gene to offspring
Alzheimer’s type, a degenerative brain
 People with milk ID – may have children that
disorder that causes impairments in
acquired their genes
memory and other cognitive disorders
 Tuberous sclerosis – dominant gene disorder;
o can be tied to maternal age
relatively rare; 1 in every 30,000 births;
 as age of mother increases, so
seizures; bumps on the skin that during their
does her chance having a child
adolescence resemble acne
with this disorder
 Phenylketonuria (PKU) – affect every 1 of every
 A woman’s ova (eggs) are all
10000 newborns; inability to break down a
produced in youth, the older
chemical in our diets called phenylalanine
ones have been exposed to
 Untreated maternal PKU can harm the
toxins, radiation, and other
developing fetus
harmful substances over longer
 Lesch-Nyhan syndrome – x-linked disorder;
periods
o ID
 Causes error in cell
o signs of cerebral palsy (spasticity or
division
tightening of the muscles)
o Amniocentesis – detects the presence
o self-injurious behavior – lip and finger
of Down syndrome
biting
 procedure that involves
o only males are affect – due to recessive
removing and testing a sample
gene
 of the fluid that surrounds the
fetus in the amniotic sac
o Chorionic Villus Sampling (CVS) - a small
piece of placenta tissue is removed and
tested
o These types of test are not always
desirable because it is an invasive
procedure (inserting a needle that could
cause unwanted damage to the
developing fetus).
 Fragile X syndrome
o caused by an abnormality on the X
chromosome, a mutation that makes
the tip of the chromosome look as
though it were hanging from a thread,
giving it the appearance of fragility
o affects most males because they don’t
have the second X chromosome
 have higher rates of
hyperactivity, short attention
PREVENTION OF NEURODEVELOPMENTAL DISORDERS
spans, gaze avoidance, and
perseverative speech (repeating
the same words again and
again)
o Women who carry fragile X syndrome
commonly display mild to severe
learning disabilities
PSYCHOLOGICAL AND SOCIAL DIMENSION
 Cultural influences – abuse, neglect, and social
deprivation
 Cultural –familial intellectual disability - have
cognitive impairments that result from a
combination of psychosocial and biological
influences, although the specific mechanisms
that lead to this type of intellectual disability
are not yet understood.
 Cases are rare today due to better child care
and early identification of potential family
difficulties
TREATMENT OF INTELLECTUAL DISABILITY
 Biological treatment is not a viable option
 For Mild ID, intervention is given similar to
those with learning disabilities
 Specific learning deficits are identified and
addressed
 Level of assistance is given
 Advances in electronic and educational
technologies have made it possible for these
people to have jobs and participate in the
community
 Task analysis – skill is broken into its component
parts
o People are taught each part in
succession until they can do it on their
own
 Communication training – to make their needs
and wants known
 For individuals with the most severe disabilities
– communication training can be difficult
 Augmentative communication strategies – use
picture books, teaching the person to make a
request by pointing a picture
 Variety of computer-assisted devices including
tablet computer
 “Supported employment” - involves helping an
individual find and participate satisfactorily in a
competitive job
 Early intervention – described for ASD
o Can target and assist children, who,
because of inadequate environment
o Head Start Program – combines
educational, medical, and social
supports for these children and their
families
o Advances in genetic screening and
technology – makes it possible to detect
possible neurodevelopmental disorders
o Advances in biomedical technology
o Behavioral intervention for safety
training (for example, involving lead-
based paints in older homes),
substance-use treatment and
prevention, and behavioral medicine
(for example, “wellness” efforts) are
examples of crucial roles played by
psychologists in helping to prevent
certain forms of developmental
disorders.