Neurodevelopmental Disorders: Chapter 3

• Chapter 3 is concerned with Neurodevelopmental Disorders

Developmental Psychopathy

• Examines how disorders arise, change, and persist during development.
• Aims to pinpoint the specific processes behind behavior patterns causing distress or impaired function.

Neurodevelopmental Disorders

• Neurological in nature.
• Cause deficits in general mental abilities like problem-solving and abstract thought.
• Cause deficits in specific learning areas like math and spelling.
• Cause deficits in Communication, including producing or understanding speech.
• Cause deficits in social communication, interaction and motor skills like motor or vocal tics.
• DSM-5 categorizes these disorders into 7 groups, distinguished by the nature of impairment.

Intellectual Disability (ID) or Intellectual Developmental Disorder

• Involves intellectual and adaptive functioning below the developmental age.
• Must be apparent before age 18.
• Includes deficits in 3 domains:
  • Conceptual skills like problem-solving and abstract thought.
  • Social skills like developing relationships.
  • Practical skills like fulfilling daily responsibilities.
• Severity is categorized based on adaptive functioning level: mild, moderate, severe, or profound.

Communication Disorders

• Deficits in speech, language, and communication.
• Language Disorder is defined as the limited use of speech compared to what an individual should understand.
• Communication Disorder is defined as struggles with the social aspects or rules of communication.
• Childhood-Onset Fluency Disorder is stuttering.

Autism Spectrum Disorder (ASD)

• Involves impairments in social communication, interaction, and restricted, repetitive behaviors or interests.
• DSM-5 requires noting the severity level of the impairment.
• Severity is defined in relation to the level of support the individual requires: support, substantial support, or very substantial support.
• This system replaces earlier categories of Asperger’s Disorder which is defined by relatively low levels of impairment, and Pervasive Developmental Disorder defined by associated significant impairments.
• Asperger's Disorder and Pervasive Developmental Disorder are no longer included in the DSM categorical system.
• Three criteria are required for to to diagnose under DSM-5
  • Deficits in social emotional reciprocity, failure to respond to social interactions for example.
  • Impaired non-verbal communication with abnormalities in eye contact for example.
  • Impaired ability to develop and maintain relationships with absence of interest in peers e.g..
• A deficit in joint attention is noted, which involves the ability to share interest in an object by pointing or looking.
• A broad range of intellectual functioning can be found.

Specific Learning Disorders

• Characterized by below-average performance in reading, writing/expression, and math.
• Deficits are usually evident in early school years.
• Early diagnosis is important for predicting school drop-out.
• Assessment uses intelligence and achievement tests.
• Diagnosis happens if there's a significant difference between overall intelligence and specific achievement test scores.
• Intelligence scores of people with the disorders are usually average or above.

Motor Disorders

• Impairments in the development and performance of coordinated motor skills.
• Can lead to uncoordinated movements that disrupt daily life.
• Tic disorders include sudden, recurrent, rapid vocalizations or movements.
• Tourette's Disorder involves both motor and vocal tics that begin before age 18 and last for over a year.

Incidence of Autism Spectrum Disorder

• Autism has increased by 600% in the last 20 years according to some sources.
• In Canada, 1 in 200 children are diagnosed, compared to 1 in 10,000, 10 years ago.
• An estimated 190,000 Canadian children have ASD.
• The reason for the increase is difficult to determine, and can be attributed to factors,
  • may be an actual rise in the condition
  • Broadening of definition
  • Increased public awareness
  • Improved symptom recognition and diagnosis
  • Improved survey methodology
  • Greater exposure to environmental toxins affecting genetic mutations.

Explaining Neurodevelopmental Disorders: Biological Paradigm

• Strongest evidence on disorders is biological.
• Largely determined by genetics and brain damage.
• Genetics is a predisposing factor in ASD, but specific genes and their influence are not yet fully understood.

Explaining Neurodevelopmental Disorders: Brain Structures

• Brain changes can negatively influence intellectual development.
• Prenatal factors like alcohol use during pregnancy.
• Oxygen deprivation at birth
• Head injuries during early development can cause damage.
• ASD cases, the amygdala which processes basic emotions shows abnormalities.

Explaining Neurodevelopmental Disorders: Neurotransmitters

• Research on oxytocin links it to social interaction and communication deficits.
• Oxytocin enhances positive feelings.
• Links between ASD and genes influence how oxytocin affects the brain.

Explaining Neurodevelopmental Disorders: Psychological and Social Factors

• Not causes, but influence development and functioning level.

Autism Spectrum Disorder: Theory of Mind

• TOM is the ability to understand that others have differing mental states, beliefs, intents, desires, pretending, or knowledge.
• An absence of TOM is at the root of most communication and social interaction difficulties of people with autism
• A lack of central drive for coherence prevents the ability to intellectualize, imagine what a person is thinking or feeling, and prevents the ability to emotionally recognize what to do in response
• Executive functioning is a higher-order thought process that is necessary for behavioral guidance, planning, memory, and flexibility.
• A deficit explains why minor details distract while failing to see the big picture.

Strength-Based Relational CYC Practice

• Core value in Child and Youth Care is respecting and advocating for the dignity and rights regardless of race, gender, class, etc.

Strength-Based Relational CYC Practice: CYCPs must know

• Ableism.
• the belief that normal is physically and mentally able people and abnormal is developmentally disabled people
• This leads to discrimination or prejudice against those with disability
• Neurotypical individuals do not have ASD
• The Role of CYC combats ableism by recognizing disrespectful language and challenging the use of that language.
• The Role of CYC combats ableism by embracing inclusiveness, advocating for the young people with disabilites.

Inclusiveness in Education

• A fundamental right is children and youth with ASD
• Other Options are not be the best outcome every single time which means individual needs may not always be the priority.
• Specialized Education may not occur where needed.
• Teachers' or CYCP's may lack training or experience.
• Bullying occurs in mainstream classrooms.

Assessment

• Recognize Indicators.
• Review Symptoms and impact on functioning.
• Internal thoughts and feelings can be internalized or externalized.
• Consider environmental triggers, and a child's sensory difficulties.

Sensory Difficulties

• Sensory processing (integration) refers to receiving messages from the senses with appropriate motor and behavioral responses.
• Sensory signals don't get organized properly in Sensor Processing Disorder (Sensory Integration Dysfunction).
• Only One sense or Multiple senses are affected.
• Children with autism can be both oversensitive or under sensitive.
• 40% are extremely sensitive to normal levels of sounds and touching with low levels of pain.

Autism Spectrum Disorder: Treatment

• Medical Interventions do not address core symptoms.
• Medications may reduce agitation and anxiety.
• Psychological intervention includes behavioral reinforcement strategies, family education, and social communication skills training.
• Applied Behavioral Analysis (ABA) which applies learning theory to improve social behaviors
• JASPER intervention focusing on Joint Attention, Symbolic Play, and Engagement Regulation.
• Psychoeducation is provided.
• Sensory integration therapy applies pressure, weight, and movement to sensory alteration.
• Family supports are provided.

Intervention Concerns: Holding Therapy

• Forced contact to stop resisting, and continued while looking carer's into the eyes.
• There is no empirical support, and the authors disagree.
• This may be associated to harm physically and psychologically to the child.

Relational CYC Practice

• Gentle teaching means safe interactions and relationships.
• Trust must occur between caregiver and child.
• Maintain control, in the face of aggression
• Intervention guidelines align with CYC principles.

Relational CYC Practice Guidelines

• Gentle teaching is used as a gentle intervention.
• Use a quiet, and calming tone.
• Use a low word count when providing directions.
• Gentle responses will be needed.
• Manage personal emotions.
• Reinforce positive actions while avoiding reinforcing inappropriate actions.