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NEURODEVELOPMENTAL DISORDERS (CHILDHOOD & ADOLESCENCE) - Coggle Diagram
NEURODEVELOPMENTAL DISORDERS (CHILDHOOD & ADOLESCENCE)
anxiety and depression
anxiety disorders
classified similarly to adults; often comorbid w/ depressive disorders
most common mental disorder among children and adolescents: higher rates among girls, lifetime 32%; spec phobia > social anxiety disorder > separation anxiety disorder > PTSD
separation anxiety disorder
excessive anxiety about separation from major attachment figures (mothers, familiar home surroundings)
lack self-confidence, are apprehensive in new situations, tend to be immature for their age, shy, sensitive, nervous, submissive, worried...
in many cases, a clear psychosocial stressor can be identified (death of a relative or pet)
actually separated -- preoccupation w/ morbid fears, cling helplessly onto adults, have difficulty sleeping...
for many kids it goes away on its own, but some also experience other anxiety-based disorders (phobia, OCD)
causal factos
genetic: OCD, social + cultural more important (parental behavior and family stress in minority families)
early sensitivity -- easily conditionable by aversive stimuli; modeling effect of an overanxious and protective parent; parents' failure to provide support in the face of perceived threats
treatments and outcomes
same meds, benzos or SSRIs
CBT = highly effective, exposure-based therapies = effective
depressive disorders
treatments
meds: antidepressants (most widely used), Prozac (effective, but somatic side effects and an increased risk of suicidal thoughts and behavior)
CBT = effective
causal factors
parental depression -- behavioral + mood problems in kids (more impaired, need more psych treatment, have more diagnoses, higher risk of death by suicide, earlier death)
alcohol intake by mother during pregnancy
experience of negative events + learning of maladaptive behavior (hyperreactivity of the CNS -- vulnerable to depression)
negative parental behavior or emotional states -- modeling of depressive behavior, lack of responsiveness to the child, or biological?
overview
sadness, withdrawal, crying, poor sleep and appetite, thoughts of suicide, suicide attempts = irritability (can be substituted for depressed mood)
12% lifetime; girls>boys, low during childhood and increase dramatically in adolescence
high comorbidity w/ ADHD, bipolar less frequent (3%)
disruptive, impulse-control, and conduct disorder
oppositional defiant disorder (ODD)
recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persists for at least 6 months
angry/irritable mood, argumentative/defiant behavior, vindictiveness
usually begins at age 8; 10% lifetime; boys>girls
ODD --> CD; same risk factors (family discord, socioeconomic status, antisocial behavior in parents, overlapping neural correlates)
conduct disorder (CD)
persistent, repetitive violation of rules and a disregard for the rights of others
12 years onset; 10% lifetime, boys>girls
combo of 3 of the 15 symptoms in five subtypes: rule violations, deceit/theft, aggressive behavior, severe forms of 1 and 2, combo of 1, 2, and 3 (great deal of variability in the clinical representation)
frequent comorbidity: substance abuse, depressive, increased risk for pregnancy and antisocial personality disorder (+many more)
causal factors in both
genetic predisposition --> low verbal intelligence --> mild neuropsychological problems --> difficult temperament --> insecure attachment --> deficiencies in self-control (attention, planning, self-monitoring...)
developing CD at an earlier age is a risk factor for developing psychopathy or ASPD; link also stronger for lower-SES kids
psychosocial factors: rejected by peers (at highest risk or adolescent delinquency), anger from parents and teachers, harsh and rejective family setting (+ neglect)
treatments
cohesive family model (interaction between the child and the parents)
standard talk therapies not really effective
parent management training successful
prevention programs
specific learning disorders
overview
delays in cognitive development in the areas of speech, language, mathematical, or motor skills that are not necessarily due to any demonstrable physical or neurological defect"
clear impairment in school performance or in daily living activities (not due to intellectual disability or a pervasive developmental disorder)
boys>girls; dyslexia as an example
they have everything liked with at least average achievement in school, no obvious crippling emotional problems, deficits in motivation -- yet they still fail with a stubborn persistence
bad for the kid's self-esteem and general psychological well-being, it continues to impact their career adjustments too
causal factors
CNS impairment (immaturity, deficiency, or dysregulation); deficiency in the activation of the cerebellum
genetic (gene 6 = dyslexia)
treatments
phonics instruction (letter-sound correspondence, decoding and creating syllables) = significant improvement in reading and spelling
elimination disorders
involve a single outstanding symptom rather than a pervasive maladaptive pattern
enuresis
habitual involuntary discharge of urine, usually at night, after age 5
bed-wetting that is not organically caused
primary: never been continent, secondary: continent for at least a year, but have regressed
biological conditions: genetic, disturbed cerebral control of the bladder, excessive production of urine during the night
psychological conditions: failure to learn how to inhibit reflexive bladder emptying, psych immaturity (emotional problems), disturbed family interactions (sustained anxiety), stressful events...
conditioning treatments (bell-and-pad procedure), meds (antidepressant drug imipramine - lessening the deepest stage of sleep, intranasal desmopressin -- decreases urine volume) have a frequent relapse when discontinued
best approach: biobehavioral
encopresis
kids who have not learned appropriate toileting for bowel movement after age 4
less common than enuresis; onset age 7, boys>girls
often when under stress, suffer from constipation
conditioning procedures = moderate success; best if medical and psych
neurodevelopmental disorders
overview
disruptions to normal brain development
must have their onset during childhood (diff from anxiety and depression); persist into adulthood (diff from ODD and CD)
ADHD
overview
persistent pattern of difficulties sustaining attention and/or impulsiveness and excessive or exaggerated motor activity
score lower on IQ tests (related to poor academic functioning, difficulties in reading or learning), behavioral problems (suspension, repeating a grade, being viewed negatively by peers, not getting along w/ parents...)
the most diagnosed disorder by mental health professionals, boys>girls, comorbid w/ ODD and CD
beyond adolescence
1/2 meets criteria in adulthood (most are male, divorced, and unemployed)
inattention > hyperactivity
causal factors
genetic + environmental (prenatal alcohol exposure)
smaller total brain volumes, brains mature more slowly (prefrontal regions)
treatments
meds (Ritalin, increased dramatically in recent years; stimulant = decreases overactivity, lowers aggressiveness; side effects) (Pemoline, less side effects) Strattera, non-stimulant, jaundice and liver damage) (Adderall, no advantage over others)
psych (positive effects, teaching organizational and planning skills, decreasing distractibility and procrastination, parenting techniques for reinforcement)
autism spectrum disorder
treatments
Lovaas: intensive behavioral intervention (1:1 meetings, 40 hrs/wk, reinforcement and punishment)
Dawson: Early Start Denver Model (improvements in IQ, language, and adaptive behavior, decreased symptoms, 20 hrs/wk, child and parents)
causal factors
very strong heritable component (hundreds of genes, same ones linked to ADHD, schizo, bipolar disorder, and depression)
de novo (mutations in the egg or in the sperm) mutations or inherited risk from one of the parents (older father age)
clinical picture
social deficit
not showing a need for affection or contact, do not express emotion (but do not lack emotional reactions), a lack of social understanding
decreased activity in the medial prefrontal cortex, increased in ventral occipitotemporal regions
aversion to auditory stimuli, not always consistent
absence of speech
absent or severely limited use of speech; rudimentary fashion
echolalia = parrot-like repetition of a few words
under-connectivity within imitation regions --> greater symptoms
self-stimulation
repetitive movements (head banging, spinning, rocking...) may last hours at a time
maintaining sameness
preoccupation w/ unusual objects
violent temper tantrum when familiarity in the environment is disrupted even slightly until it is restored
overview
wide range of problematic behaviors including deficits in language and perceptual and motor development; defective reality testing; impairments in social communication
lifetime 2.4%; boys>girls
usually identified before 30 months w/ high diagnostic stability, early signs seen in first 6 months (decline in focus on the eyes of others, more on inanimate objects)
tic disorders
persistent, intermittent muscle twitch or spasm, usually limited to a localized muscle group
8-14 age of onset, male>female
many are not aware they have it until someone brings it to their attention
Tourette's disorder
an extreme tic disorder involving multiple motor and vocal patterns
tics are preceded by an urge that seems to be relieved by the execution of the tic
coprolalia: complex vocal tic that involves the uttering of obscenities
strong biological basis + psych causes (slef-consciousness, tension in social situations)
behavioral treatments (habit reversal training HRT, school psych),meds (antipsychotic and noradrenergic)
intellectual disability
overview
deficits in general mental abilities, such as reasoning, problem solving, planning, abstract thinking, judgement, academic learning, and learning from experience
intelligence + performance; must be present before 18 (dementia after 17); 5-6 onset, peak at 15, then sharply drop off
levels of disability
mild
IQ = 100, sd = 15
the largest number of those w/ this condition
educable, comparable to those 8-11 y/o, adolescent social adjustment (lack imagination, inventivenes, and judgement)
require some supervision bc they lack to see consequences of their actions
can become self-supporting citizens
moderate
IQ = 35-40, 50-55; 4-7 y/o
reading, writing, little language; slow and limited learning
can achieve self-care, acceptable behvavior, cooking, minor janitorial work...
severe
IQ = 25, 35-40
impaired speech development, sensory defects, motor handicaps
limited levels of personal hygiene and self-help skills; still always dependent on others for care
simple occupational tasks under supervision
profound
IQ = below 20-25
unable to master the simplest tasks, if speech develops it is rudimentary, severe physical deformities, CNS pathology, retarded growth; convulsive seizures, mutism, deafness...
must remain in custodial care all their lives; shorter life expectancy
causal factors
genetic-chormosomal
fragile X syndrome <-- FMR-1 gene (genetic aberrations --> metabolic alterations)
infections and toxic agents
viral encephalitis, genital herpes, syphilis ,HIV-1. german measles
carbon monoxide, drugs, alcohol, incompatibility in blood types between mother and fetus
trauma (physical injury)
physical injury at birth (delivery or after)
bleeding of the brain, hypoxia (lack of oxygen)
ionizing radiation
act directly on the fertilized ovum or produce gene mutations in sex cells of both parents
high-energy x-rays, nuclear weapons, leakages at nuclear power plants...
malnutrition and other biological factors
no clear link between maternal nutritional status and offspring cognitive functioning
organic intellectual disability syndromes
Down syndrome
moderate and severe intellectual disability
limitations on intellectual achievement, managing life tasks, and survivability
trisomy on the 21st chromosome (47 total); probably related to cognitive deficit and to parental age at conception
accelerated aging process and a decline in cognitive abilities
able to learn self-help skills, social behavior, routine manual skills (lower family stress, cheerful personality style)
extremely high risk for Alzheimer's
phenylketonuria
a baby appears normal but lacks a liver enzyme needed to break down phenylalanine (amino acid in many foods)
significant quantities of phenylalanine --> intellectual disability --> brain damage
elimination of such foods, early detection, treatment
cranial abnormalities
macrocephaly
increase in size and weight of the brain
visual impairment, convulsions, neurological symotoms
microcephaly
head size 3 sds below average
primary: decreased growth during pregnancy; secondary: infancy
moderate, severe, and profound categories
50% genetic, 45% in utero brain damage, 3% brain damage in infancy
hydrocephaly
accumulation of an abnormal amount of cerebrospinal fluid within the cranium; blockage of the cerebrospinal pathways and an accumulation of fluid in certain brain areas
serious brain damage --> intellectual impairment, convulsions, loss of sight / hearing
can be "cured" w/ early treatment, may minimize disability
treatments
special eduction (emphasis on reading, budgeting, development of occupational skills); mainstreaming
institution