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MENTAL/PSYCHIATRIC DISORDERS IN CHILDHOOD & ADOLESCENCE (A. ADHD…
MENTAL/PSYCHIATRIC DISORDERS IN CHILDHOOD & ADOLESCENCE
A. ADHD
DIAGNOSTIC
Essential Features
Inattention
Hyperactivity (excessive motor activity)
Impulsivity
Immediate rewards/delayed gratification
Social intrusiveness
Begins in childhood - Sx before 12
In more than 1 setting
Signs can be min
Frequent rewards
Supervised
New settings
Tasks stimulating/interesting/electronic
Interacting one-on-one
Subtypes
Few Sx
Mild inattentive
Severe inattentive
Talkative-Impulsive
Mild-combined
Severe-combined
Hyperactive
Sleep disturbances
COMORBIDITY
Common comorbid
ODD
Developmental Coordination Disorder
Reading/Writing Disorder
Tic Disorder
MDD
CD (poorest outcome)
Parent/sibling often also has ADHD/affective disorder
Cont in adulthood
Complicate diagnosis
TRANSACTIONAL MODEL
Genetics
Fam
Fam environment - increase/worsen Sx
Dysfunctional interactional patterns
Temperament
Psychosocial
Poor social skills/competence
Deviant behav's etc
Diffs in w/ inattention & w/out inattention
Inattention - more w/drawn - RISK
ACADEMIC & SCHOOL ADJUSTMENT
Sig lower achievement
Related to behav & cog intellectual weaknesses
Probs in school & uni milestones
Probs in adulting
INTELLECTUAL, PERCEPTUAL, ATTENTION & MEMORY FUNCTIONING
Diffs across spectrum
Poor WM, internalised speech & development of verbal thinking
TREATMENT
Multimodal
NB consider age & developmental level
Infants/toddlers - pos parent/child relationships
Better parenting
Develop social skills
IMPLICATIONS FOR ASSESSMENT
Tasks sometimes not taxing enough to activate attentional system/executive functions
Administered interesting, supervised, time-limited
Assessment of attention & EF
Delay btwn stimulus & response
Internally represented view of task
Response inhibition
Metacog = plan, organise & evaluate learning
B. ID/INTELLECTUAL DEVELOPMENTAL DISORDER
DEF
Disability w/ sig limitations in intellectual func & adaptive behav
Onset before 18
DIAGNOSTIC
Deficits in mental ability (A)
Intellectual func
Reasoning
Planning
Abstract thinking
Judgement
Impairment in everyday adaptive func (B)
Conceptual - academic
Social - interpersonal skills
Practical - learning & self-management (adulting/living)
Onset in development period (C)
Critical components
Verbal comprehension
WM
Perceptual reasoning
Quantitative reasoning
Abstract thought
Cog efficacy
RISK FACTORS
Extrinsic (Contextual)
Fam
School
ED system
Macro level
Intrinsic (Inherent/Personal)
Genetic
Physiological
Physical
Pyschological
TEACHER SKILLS
ID & assess aids & support needs
Develop ISP
Implement & evaluate ISP
Know side effects of meds
Emotive aspects - feelings, emotions & moods
Learner-in-Context Assessment
C. AUTISM SPECTRUM DISORDER
DIAGNOSTIC
Impairments in Comm & Social Interaction (A)
Pervasive & sustained
Verbal & non-verbal decifits in social comm vary depending on factors
Lack of speech
poor comprehension
Echoed speech
Overly literal lang
If formal lang intact - use of lang for reciprocal soc comm is impaired
Soc Emo Reciprocity deficits
Little/no initiation of soc interaction
No sharing emo
Reduced/absent imitation of others behav
Lang 1 sided
Request/label rather than share/comment
Adults: responding to complex soc cues
Non-verbal (absent/reduced/atypical)
eyecontact
gestures
facial express
body orientation
speech intonation
Adults: odd, wooden body lang
Impaired joint att
Lack of pointing
Showing/bringing objects to share interest
Failure to follow eye gaze
Relationships
Lack of soc interest
Reject others
Passive/inappropriate (aggressive/disruptive)
Lack of shared soc play
Imagination
Play w/ fixed rules
Understand 1 setting not another
May desire friendship but no idea how
Restricted Repetitive Patterns of Behav, Interest/Act (B)
Stereotypes/rep behav
Simple motor seterotypes
Rep use of objects
Rep Speech
Excessive routines
Restricted patterns of behav
Resistance to change
Rigid thinking
Highly restrict/fixated interests
Ritualised patterns of V&NV behav
Hyper/Hypo reactivity to sensory input
Sx present from early childhood & limit daily func (C&D)
DEVELOPMENT & CAUSE
Recognised at 2 (severe early, subtle later)
Develop plateaus/regression
Rare in other disorder
1st Sx
Delayed lang develop
Lack of /unusual soc interest
odd play patterns
unusual comm
@ 2yrs odd & rep behav & absence of typical play
Some developmental gains later in childhood
Lower impairment = better independent func
CULTURE ISSUES
Culture norms
Soc interaction
NV Comm
Relationships
Compare against norms
GENDER ISSUES
More in males
Females + ID
FUNCTIONAL CONSEQUECNES
Lack of soc & comm hamper learning
Insistence on routine/aversion to stimulus = diff w/ sleeping/eating & routine care
Adaptive skills below IQ
Diff w/ planning, organising, coping = neg impact on academic achievement
Poor adult psychosoc func
COMORBID CONDITIONS
Intellectual impairment
Structural Lang Disorder
D. SLD
GENERAL
SLD = neurodevelop disorder w/ bio origin thats basis for abnormalities at cog level that are associated w/ behav signs of the disorder
Bio origin = interaction of genetic, epigenetic & environ factors that affect brain's ability to perceive/process V/NV info
Features
Persistent diffs learning key aca skills
Reading comprehension
Reading single words
Arithmetic cal
Written expression & sp
Math reasoning
Disrupted pattern of academic skills
Dyslexia most common SLD
Individual performance on affected academic skill is well below average
Learning diff's apparent in early school yrs
Learning diffs specific
Not attributable to ID, global develop delay, hearing/vision disorders, motor/neuro disorder
Learning diif not attributed to general external factors
Not attirubuted to hearing, vision, motor, neuro disorders
Learning diff restricted to one academic skill/domain
May experience prob in more than 1 area & have diff's w/ attention, emo adjustment & behav probs
W/ reading disorder may experience diff w/ written lang
Likely to show sig prob w/ emo adjustment & soc competence
READING DISORDERS
GENERAL
Phonological core deficits
Phonological awareness = use phonemic segs of speech, incl awareness & use of sound structure in lang
Diff phonemic awareness (how sounds relate)
Prob w/ auditory discrimination
Naming & vocab deficits
Prob w/ WM for sounds & sound combos
Diff's applying alphabetic principle w/ unfamiliar words
INTELLECTUAL FUNCTIONS
Weakness on V measures
Vocab knowledge
Auditory memory
Verbal associations
Receptive vocab
Word similarities
Verbal fleuncy
Recep + express lang
Reading IQ effect
PERCEPTUAL FUNCTIONS
Diffs in phonemic processing
Deficient speech perception
MEMORY FUNCTIONS
Remembering a series of words precedes a RD - risk factor
Unable to hold letter strings in STM
Rely on word meaning to remember
ACADEMIC & SCHOOL ADJUSTMENT
Motivational problems
Dislike school
2ndary self esteem probs
SOCIAL-PSYCH ADJUSTMENT
Prone to psych issues if parents & teachers have unrealistic expectations
Internalising disorders
FAMILY & HOME FACTORS
Compensatory variables
SES
Home conditions
ED of fam
Resilience
Stable & consistent home environ
Strong emo fam bonds
Child characteristics
VISUAL/ORTHOGRAPHIC DEFICITS IN READING
Logographic Stage
Reading through visual/graphic analysis
Visual memory NB - sight word vocab
Alphabetic Stage
Phonological decoding of words using grapheme-phoneme conversions
Othrographic Stage
To be fluent
Morpheme (syllables) units used
WRITTEN LANG DISORDERS
Often overlooked
Children w/ SLD show sig diff in composition, spelling, handwriting & grammer at higher levels
Young kids - writing conventions, Older kids - composition skills
Diff's w/ writing narrative text, expository & finding ideas to write about
COGNITIVE CORRELATES
Writing needs motor & visual skills
1st copy & trace - learn to write alone
Prob solving & EF involved
Experience prob w/ selective attention - impacts planning
WM NB
ASSESSMENT
Writing samples
Std measures
Task analysis
Error pattern analysis
Dynamic assessment
SLD W/ MATH IMPAIRMENT
Sole math disorder rare - usually in NV LD
SUBTYPES
Procedural
Performance skills similar to developmental delay
Improve w/ age & gr
Careless errors
Use fingers to count
Dont understand process behind task
Semantic Memory
Cont throughout school
Prob w/ memory & retrieval
Left hemi dysfunc
Visuospatial
Prob w/ spatial representation
Prob w/ aligning columns
Understanding relationship btwn no's & quantity
Not reading disorder
DEVELOPMENT OF MATH ABILITY
Counting NB to learn math
1-1 correspondence, correct order of no's, how objects sort & cat = NB premath skills
Arithmetic skills start w/ addition (counting)