1
Q
What is IQ?
A
an overall score that combines scores on measures of different aspects of cognitive functioning
it includes: verbal reasoning, nonverbal reasoning, processing speed, and some aspects of executive functions like working memory
2
Q
What IQ is considered an Intellectual Development Disorder (IDD)?
A
below a score of 70
3
Q
What are the diagnostic criteria for IDD?
A
a. deficient intellectual functioning (IQ < 70)
b. adaptive impairments
C. Onset of intellectual and adaptive deficits during the developmental period
4
Q
explain the diagnostic criteria of IDD a.) (deficient intellectual functioning (IQ < 70)) of IDD
A
IQ score lower than 70, aka the child is not performing at an average IQ standard.
Note* IQ scores must be used with care for children with less access to resources such as education, financial resources, nutrition, etc.
5
Q
explain the diagnostic criteria of IDD B.) (Adaptive impairments)
A
trouble with:
- conceptual skills (understanding of abstract ideas, EX: Money)
- receptive and expressive language
- academic functioning
- social understanding and functioning
- practical skills (i.e., dressing, toileting, self care, daily living)
6
Q
explain the diagnostic criteria of IDD C. onset of intellectual and adaptive deficits during the developmental period
A
- before age 18
- nearly always very early in development
- rules out adults with degenerative cognitive disease or traumatic brain injury
7
Q
What are some common comorbidities of IDD?
A
- depression and social withdrawl
- ADHD
- self-injurious or aggressive behaviors
- physical and health disabilities
8
Q
Explain mild idd.
A
- IQ typically around 50 - 70
- about 85% of individuals with IDD have mild IDD
- impaired abstract thinking, academic functioning
- immature social interactions and judgment, difficulty regulating behavior and emotions, difficulty understanding social cues, can be easily manipulated by others
- some support needed for daily tasks, may be able to live independently without support, potentially hold a job that doesn’t emphasize conceptual skills, need support for daily living like budget, raising a family, etc.
9
Q
explain moderate idd.
A
- IQ typically around 35 - 49
- about 10% of individuals with IDD
- substantial support is needed across cognitive domains; language and conceptual reasoning are especially weak
- marked difficulty in comparison to peers, social interactions are much less complex and much more superficial, a lot of difficulty understanding social cues; easy to manipulate, likely to require social and communicative support at work
- extensive support needed for daily tasks and activities, unlikely to live independently even with support, potentially hold a job but require extensive support, self-injurious behaviors in a small subset of individuals
10
Q
explain severe/profound idd
A
- IQ is typically less than 35
- about 5% of individuals with IDD
- attain few conceptual skills, minimal or no language, limited or no understanding of complex ideas, may use or understand simple words or simple gestures
- limited social interactions (typically only with family or caregiver), very limited understanding of social cues/gestures, comorbid sensory or physical impairments limit social activities.
- need extensive supervision at all times, dependent on others for all aspects of physical care and safety, self-injurious behaviors in a significant subset of individuals
11
Q
what are the known causes of severe IDD?
A
- chromosomal disorders
- specific genetic mutation
- enviornmental risk factors
12
Q
explain how chromosomal disorders may cause severe IDD
A
- an entire chromsome is missing or duplicated
- this is the most common cause of severe IDD
- EX: Down syndrome (extra chromsome 21), klinefelter’s syndrome (XXY), turner syndrome (single x chromosome)
13
Q
explain how specific genetic mutation may cause severe IDD
A
- fragile x: section of X chromosome vulnerable to breakage
- phenlyketonuria (if left untreated): diet can treat this
- thousands of other rare genetic syndroms
- IDD is our only clear example of a “single gene” condition in this class!
14
Q
explain how environmental risk factors may play a role in severe IDD
A
- major prental and birth complications
- severe hypoxia (oxygen deprivation) at birth = one of the strongest environmental predictors
15
Q
what are the causes of mild IDD?
A
multiple genetic and environmental factors can play a role.
- Genetic influences
- prenatal enviornment
- birth complications
- later medical complications during development
16
Q
can medication cure IDD?
A
No.
But, medication can help to address co-occuring symptoms, such as stimulants for ADHD, antidepressants for anxiety or depression, and antiseizure medications
17
Q
why are there higher autism rates now compared to the 1960s?
A
Because in the 1960s, only children with severe autism received a diagnosis. Now, the criteria include milder symptoms of autism.
18
Q
What criteria must a person meet for Autism Spectrum Disorder (ASD)? (hint, there are 4)
A
A. Persistent difficulty in social communication and social interaction.
B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following currently or by history
C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
D. Symptoms together limit and impair everyday functioning
19
Q
What are some psychological interventions for IDD?
A
- family interventions
- early (behavioral) interventions
- school-based interventions and accommodations
- adult residential care
*none of these are a cure, but lead to improved outcomes
20
Q
Explain Criteria A. Persistent difficulty in social communication and social interaction
A
- Deficits in social-emotional reciprocity
- Deficits in nonverbal communication behaviors used for social interaction
- Deficits in developing, maintaining, and understanding relationships
21
Q
Explain Criteria B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following currently or by history;
A
- Stereotyped or repetitive speech, motor movements, or use of objects
- Insistence on sameness, inflexible adherence to routines, rigid thinking patterns, excessive resistance to change
- highly restricted, fixated interests that are atypical/unusual in intensity or focus
- hyper or hypo reactivity to sensory input for unusual interest in sensory aspects of the environment
22
Q
What does high functioning autism in kids typically look like?
A
- tend to be rule followers
- concerned with fairness/justice
- may be socially naive/extremely kind
- difficulty with social conflict
- interest in technology/video games
- meticulous/perfectionistic
- strong vocab/difficulty with abstract reasoning
- strong recall of facts
- “absent minded professor”
- strong visual spatial skills
- nonverbal communication difficulties
- history of difficulties that may no longer get in the way
- may overlap with kids with anxiety/ADHD
23
Q
What are some hypotheses for the increase in the number of ASD cases?
A
- public/professional awareness
- diagnostic changes/substitution
- availability of services
- changes in referral patterns
- broader spectrum
- environmental aspects
- medication during pregnancy?
- hypertension
- autoimmune disorders
- nutritional factors
- time between pregnancies
24
Q
What are common co-occuring disorders of ASD?
A
- anxiety
- adhd/executive functioning
- sensory integration needs
- speech/language disorders
- specific learning disorders
- mood disorders/depression
25
How do you treat ASD?
- strong behavioral support
-push toward more naturalist and sensitive programming
- medication can be helpful for treating associative needs
- social skills group or social communication work
- practicing social skills in the world
26
What is the DSM-5 definition of a communication disorder?
- deficits in language, speech, ,and communication
27
language disorder
effects 7% of school-age children
- difficulty in acquisition and use of language
- reduced vocabulary, difficulty with written or verbal expression
28
speech-sound disorder
3% of preschool children
- specific deficit in articulation/production of speech
- usually, kids will have language difficulty and difficulty with speech
29
child-hood onset fluency disorder
- 1% of school-aged children
- commonly called stuttering
- atypical fluency and time of patterning of speech
-repetitions, pauses, word substitutions
30
what are the causes of communication disorders?
- most communication disorders have a significant genetic risk (50-70%)
- environment can also have an impact: birth complications, low language at home
31
What is the DSM-5 definition of Specific Learning Disorder?
a. persistent difficulty learning and using academic skills
b. unexpected: skills are substantially below the expectation for the child's age
c. difficulties begin during school-age years (even if not diagnosed until later)
d. learning difficulties are not better explained by low intellectual ability, uncorrected visual or hearing impairment, or inadequate instruction.
32
What is the impairment that occurs in specific learning disorders?
academic functioning (grades, retainment, lower eventual academic outcomes, may take lower-paying jobs to avoid reading, writing, or math duties)
social difficulties (affected, but not as bad as the book implies. most pronounced in math)
33
Comorbidity of specific learning disorders?
- other Learning Disabilitiies (30% have others)
- ADHD
- Anxiety
- Depression
- Conduct disorder, but may be limited to subgroup with ADHD
34
at what age do you need to start treatment if there is ongoing communication difficulty?
age 4
35
Genetic and environmental risk factors of specific learning disorders?
molecular genetics of reading disorder and math disorder (writing is still unknown)
- many genes involved, each has a small effect
- some shared genetic risk for RD, MD, and WD leading to commorbidity
- shared genes also contribute to commorbidity with ADHD and anxiety
prenatal environment
- maternal smoking (fairly strong association)
- birth complications (especially hypoxia)
later enviormental risks
- socioecnomic status (less access to resources)
- low parent education (lower environmental enrichment)
- RD specifically---lower levels of language and reading at home
36
What is the neuropsychology behind reading disabilities (dyslexia)?
- weak phonological awareness (i.e., frog = 4 phonemes, f, r, o, g) (someone without phonological awareness difficulty can move these phonemes around relatively easily (i.e., remove the r from frog and you get fog)
- slow cognitive processing speed
- executive functions (working memory)
37
what is the neuropsychology of math-disorders (dyscalculia)?
weak "number-sense" (i.e., a poor conceptual understanding of how numbers work, approximation/estimation, which numerical operation should be used)---this is their largest weakness (explains about 20% of the risk)
processing speed (slower at math but also more generally
executive funcitons (working memory)
38
what is the neuropsychology of writing disorders (dysgraphia)?
-fine motor difficulties because of handwriting (though there is a weaker association in adolescents and adults)
vocabulary and complex language skills weakness (this is the most prominent weakness, approx. 20% of the risk)
processing speed (written responses and more general items)
executive functions
39
what are the two tested "categories" of ADHD?
inattention and hyperactivity/impulsivity
40
what is a key issue for ADHD?
explaining if ADHD is valid in the first place
41
Explain the inattention diagnostic criteria of ADHD.
diagnostic cutfoff: at least 6 of these 9 symptoms:
- careless mistakes
- difficulty sustaining attention
- does not listen
- does not finish work
- difficulty organizing tasks
- avoids tasks that require mental effort
- loses things necessary for tasks
- easily distracted
- forgetful
(around %5 of individuals have these at significant levels)
42
Explain the hyperactivity/impulsivity diagnostic criteria of ADHD
diagnostic cutoff: at least 6 of 9
- fidgets
- leave seat
- runs or climbs excessively
- difficulty playing quietly
- "on the go" or "driven by motor"
- talks excessively
- blurts out answers before question is completed
- difficulty waiting turn
- interrupts or intrudes on others
43
How can we tell if a child has ADHD, or if they are just a kid?
symptoms of inattention or hyperactivity/impulsivity are inconsistent with the typical developmental level
- statistically extreme compared to peers (6 out of 9)
- observed in multiple settings
- reported by multiple people
44
Explain the DSM-5 Criteria of ADHD
- symptoms of inattention or hyperactivity/impulsivity that are inconsistent with developmental level
- onset of symptoms in early childhood, though many people don't get diagnosed until late adolescence or adulthood
- there must be clinically significant impairment in academic, social, or occupational functioning as a result of these symptoms
symptoms occur: most days for a long period, across settings, based on multiple reports
45
explain the academic impairment that occurs in kids/adolescents with ADHD
- learning diabilities and underachievement
- much slwoer work even when it is eventually correct
- more likely to be expelled/drop out of school
46
explain the social/emotional impairment that occurs in kids/adolescents with ADHD
- more likley to be ignored and actively disliked
- fewer friends (from a young age)
- low self esteem
- associations with delinquent peer groups in adolesence
47
explain the adaptive/overall impairment that occurs in kids/adolescents with ADHD
- trouble managing daily responsibilities
- family stress, including higher rates of divorce amongst parents (correlation only)
- acidental injuries that end up in the ER (often due to risk taking)
48
Explain academic impairment that occurs in adults with ADHD
- lower GPA and final academic outcomes
- more likely to drop out of school
49
explain the social/emotional impairment that occurs in adults with ADHD
- fewer friends, higher (slightly) rates of divorce
- elevations of depression and social isolation
50
explain the occupational impairment that occurs in adults with ADHD
`- more likely to be fired
- more frequent job changes
51
explain the adaptive impairment that occurs in adults with ADHD
- less likely to exercise, less healthy diet
- more traffic tickets and car accidents
- shorter life span on average (small but meaningful effect)
52
is ADHD valid?
yes, ADHD is a reliable, valid diagnosis that impairs functioning for many individuals
but, the fact that ADHD is a valid diagnosis does not mean that it is always diagnosed validly
ADHD is both overdiagnosed and underdiagnosed
53
comorbidity and ADHD?
- comorbidity is extremley common!
up to 90% of others have at least one other diagnosis
54
explain the NEUROIMAGING findings of ADHD
- smaller and less active prefrontal cortex (especially dorsolateral cortex)
- less "connectivity" between multiple brain regions (lower efficency)
55
explain the NEUROPSYCHOLOGY findings of ADHD
- executive function deficits, especially "inhibition" of inappropriate or less optimal responses (and also working memory)
- difficulty in delaying gratification
- cognitive inefficency/slow "processing speed"
56
explain the NEUROTRANSMITTER findings of ADHD
- lower dopamine in prefrontal cortex (this is the symptom that meds most impact)
- serotonin and norepinephrine is also involved
- this is really important for treatment!
57
what is the treatment for ADHD?
stimulant medication (i.e., adderall, methyphenidate, dextroamphetamine)
- 70% of people with ADHD respond to first stimulant
- 90% of people respond to the first three stimulants they have tried
stimulants are thought of as the "frontline treatment" for adhd
it's not a paradoxical effect! it increases activation in prefrontal cortex and related structures and acts as a dopamine reuptake inhibitor, which increeases the dopamine available
58
how do you define antisocial behaviors?
behaviors that violate...
- overall societal norms
- specific cultural norms
- family expectations
- personal or property rights of others
- many may be criminal behaviors
- rates of some antisocial behaviors are increasing in adolescents (though overall arrests are declining)
- this is one of the most costly issues we will discuss in this class!
59
What is the DSM-5 definition of Conduct Disorder?
a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months.
Criteria include categories of:
- aggression to people and animals
- destruction of property
- deceitfulness/thet
- serious violation of rules
60
what does a mild conduct disorder entail
3-5 symptoms
relativley minor harm to others (lying, truancy, staying out late without permission)
61
what does a moderate conduct disorder entail?
- 6 - 10 symptoms
- symptoms and behavior impact others, but typically not direct confrontation (stealing without confronting anyone, vandalism)
62
what does a severe conduct disorder entail?
- 11 - 15 symptoms
- all symptoms tend to be severe (i.e., seemingly nonstop lying)
- most severe symptoms cause significant harm to others, and often violate laws through direct confrontation (forced sexual activity, physical cruelty, use of weapons, stealing by directly confronting)
63
what does a childhood onset of a conduct disorder entail?
symptoms occur prior to age 10
- symptoms appear very early in development and are very chronic
- poor functioning/outcome on nearly all measures
- stable antisocial behavior in adulthood
- strong relationship with substance use disorders, adult criminal behavior, abusive behaviors
- want to intervene as soon as possible
- higher rates of offenses in childhood onset group
64
what does an adolescent onset of a conduct disorder entail?
no symptoms prior to age 10
- symptoms first appear in adolesence and decline by early adulthood
- much better outcomes than child-onset (but still some milder but still important problems in mid-20s)
- can be "snared" during adolesence by criminal conviction, addiction, school drop-out, etc.
65
what is the psychopathy of conduct disorder?
- they do not care if they have to harm people to get what they want. They won't go out of their way to do it, and don't get a thrill from it, but they aren't bothered if they have to hurt other people to accomplish their goal
prioritize their needs abovve all else
emotionally flat, but reactive/explosive if challenged
have "cognitive empathy": retain ability to understand (cognitively) what another person is thinking
impaired "emotional empathy": weak ability to emotionally experience what another person is feeling
66
explain the DSM-5 definition of a conduct disorder with "limited prosocial emotions"
consistently display at least two of the characteristics below:
- lack of remorse or guilt
- callous = lack of emotional empathy
- unconcerned about poor performance
- manipulative with shallow/deficient emotional expression
67
how is the conduct disorder with "limited prosocial emotions" psychopathy different?
- increased severity
- more long term problems
- higher heritability than CD symptoms
- specific neural signature ( very low or absent amygdala response to punishment or distress shown by others, extremely low physiological arousal)
Developmental Psychopathology
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