Lecture 7 - Atypical Neurodevelopment.pdf

Lecture 7 - Atypical Neurodevelopment Overview Neurodevelopmental disorders ADHD Disruptive Behaviour Disorders Autism Neurogenetic Neurodiversity Neurodevelopmental Disorders What are Neurodevelopmental Disorders Differs from typical Multiple explanations of description Genetics, neurone, brain ne...

Lecture 7 - Atypical Neurodevelopment Overview Neurodevelopmental disorders ADHD Disruptive Behaviour Disorders Autism Neurogenetic Neurodiversity Neurodevelopmental Disorders What are Neurodevelopmental Disorders Differs from typical Multiple explanations of description Genetics, neurone, brain networks, areas, cognitive processes and social/ cultural/ interpersonal behaviours and functioning Disorders that influence how the brain functions and alters neurological development, causing difficulties in social, cognitive and emotional functioning Diagnosed during early childhood Causes functional impairment ADHD Inattenton and hyperactivity Criteria One Inattention Falling to attend details/ careless mistakes Seeming not to listen when spoken to Frequent loss of belongings Hyperactivity/ Impulsivity Frequent fidgeting Excessive tal,ing Difficulties waiting Behaviours present before age 12 Behaviours present across 2+ settings Cause functional impairment Cannot be explained by other mental disorders Reasons for ADHD Genetics- Family history Is this due to the environment set up? environmental factors Parental smoking? Actually more associated with parental ADHD than smoking Brain damage- lead poisoning, dietary agents Rule out PTSD Sleep disorder Other neurological condition - head injury Mechanisms Sex (X chromosome), more prevalent in boys Attetion Reward processing Concept of sluggish cognitive tempo Sense of time Executive functioning Cognitive inhibition Cognitive organisation Working memory Cognitive Disengagement Syndrome Barkley-sluggish Cognitive Tempo Associated with inattentive symptoms Distinct disorder 40% of people with ADHD have symptoms of CDS Characterised Excessive daydreaming Slowed behaviours Treatments Medication - stimulants are very effective - 80% side effects Behavioural management Planning and organisation Organisationql skills training - Richard gallagher Cognitive behavioural therapy for adults - Mary Solano Cognitive rehabilitation/ remediation Organisational Skills Management Cognitions that defeat organisation Externalised the disorder Materials Management Teach how to organise a backpack Create a folder for papers management How to pack for a trip Time management and Task Planning Time detective tools Time estimation Problems with organizational tools Introduce Daily Assignment Record Introduce Planning Break tasks down into pieces Introduce Calendars Teach children how to plan tasks and schedule with their calendars ADHD Compensatory Mechanisms Organisation strategies Perfectionism Sensory strategies Listening to music Internalising symptoms may mask symptoms in girls Disruptive Behaviour Disorders Oppositional Defiant Disorder Conduct Disorder Oppositional Defiant Disorder Criteria At least 4 of the following symptoms that has lasted for over six months Must negatively impact functioning ** Angry/irritable mood: Often loses their temper, is often angry or resentful, is often touchy or ** easily annoyed ** Argumentative/defiant behavior: Often argues with authority figures or adults, actively defies ** or refuses to comply with requests from authority figures or with rules, often deliberately annoys others, often blames others for his or her mistakes ** Vindictiveness: Has been spiteful or vindictive at least twice within the past six months ** Causes Biology -Parents with substance problems, poor nutrition, parent with mood disorder, exposure to toxins or smoking during pregnancy, impairment to brain involved in planning/judgement Psychology -Neglectful relationships with parents or poor relationship, difficulties forming social relationships Social -Abuse/neglect, ACES, chaotic environment, lack of parentally involvement, family instability, poverty, lack of supervision Treatments Behavioural Management Behavioural plans and contingencies Use of time out Mentalisation based family therapy = identify attachment disruptions that lead to problem behaviours Parent Child iNteraction Therapy Incorporates: social learning theory, attachment theory, developmental theory, behavioral principles, and traditional play therapy Use of one way mirror and bug in the ear Child Directed Interaction phase Parent directed interaction phase Conduct Disorder Symptoms At least four of the following Aggressive behavior toward others and animals. Frequent physical altercations with others. Use of a weapon to harm others. Deliberately physically cruel to other people. Deliberately physically cruel to animals. Involvement in confrontational economic order crime- e.g., mugging. Has perpetrated a forcible sex act on another. Property destruction by arson. Property destruction by other means. Has engaged in non-confrontational economic order crime- e.g., breaking and entering. Has engaged in non-confrontational retail theft, e.g., shoplifting. Disregarded parent's curfew prior to age 13. Has run away from home at least two times. Has been truant before age 13. • §Functional Impairment §Diagnosed before 18 §Qualifiers: -Child, Adolescent or Unspecified -Limited prosocial emotions, lack of guilt/ remorse, lack of empathy, callousness, unconcerned about performance, shallow or deficient affect -Mild, moderate or severe levels of severity Prevalance §Precursor to antisocial personality disorder §2%-10% prevalence; median of 4% §More common in boys than girls due to boys tendency to act out violently; girls act out in interpersonal relationships §Callous and Unemotional Traits §Risk Factors: -Undercontrolled temperament, low verbal IQ, parental rejection and neglect (attachment trauma), other trauma and inconsistent parenting -Parental ADHD/conduct disorder, parental drug/alcohol abuse, parental overindulgence Treatments PCIT Trauma treatment Behavioural management Social and empathy training Mentalisation based family therapy Autism Spectrum Disorder Diagnostic Criteria §Persistent deficits in social communication and social interaction across contexts -Abnormal social approach and failure of back and forth conversations, reduced sharing of interests, emotions or affect, failure to initiate or respond to social interactions -Deficits in non-verbal communicative behaviour for social interaction, integrated verbal and non verbal, abnormal eye contact, poor use of gestures and lack of facial expressions -Deficits in developing, maintaining and understanding relationships, ranging to problems adjusting behaviour to social contexts, difficulties sharing imaginative plan/making friends and no interests in peers •Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history •Stereotyped or repetitive motor movements •Insistence on sameness, inflexible adherence to routines, ritualized patters or non-verbal behaviour, distress with small changes, need to take the same route, rigid thinking behaviours and eat the same food every day •Highly restricted fixed interests •Hyper or hypo-reactivity to sensory input or unusual interests in sensory aspects of environment •Symptoms must be present in the early developmental period •Functional Impairment •Disturbance not explained by intellectual ability Causes and Prevalence Rate 1 in 100 children More common in boys than girls Abilities greatly differ; some can live independently but others have severe disability and require life-long care and support Vaccines do not increase risk of autism Many genetic and environmental factors- disorders are heterogeneious Key Difficulties Difficulties with sensory processing – interoception Problems with emotion processing- alexithymia Difficulties with empathy Difficulties with executive functioning, namely set shifting/cognitive flexibility, global processing (visual), and planning/organization Treatments ** ** Highly effective treatments are available ** Behavioural management- Behavioural analysts ** -Provide behavioural contingencies for behaviours that increase flexibility, compliance with demands and for skills development reinforcement -Examine antecedents, behaviours and consequences High Functioning Autism -Rank priorities for each patient, provide antescedent management, teach new behaviours/skills and work with parents on behavioural rewards -Skills include organizational, flexibility, emotion processing, empathy, social skills (taking terns in conversation ect) and providing replacements for problematic behaviors -Skills and behaviours are generalized to varying contexts Neurogenetic Disorders Examination of disorders that defined genetically provides rich information about how genes link to psychiatric disorders/symptoms Knock out mice like phenomenon Allows for the examination of hormones ** Syndromes: ** -Prader-Willi -Turner syndrome -Klinefelter syndrome -Fragile X -Williams Syndrome -22q11 Trader Willi Syndrome Prevalence of 1 in every 20,000 to 1 in every 30,000 births At birth: floppiness, failure to thrive and difficulties feeding Older age: disturbed growth, excessive appetite (obesity), skin picking behaviours, disruptive behaviour (often food related), high pain tolerance Turner Syndrome §1 in every 2000 or 2500 §Associated with stunted growth, heart problems, no natural menses (needs hormones to grow and have period), normal IQ, good verbal abilities, poor math skills, poor working memory, poor visual/spatial abilities, disturbed social processing, anxiety, slowed processing speed, executive functioning difficulties and increased incidence of ADHD and Autism §Degree of problems directly maps onto degree chromosome is missing Klienfelter Syndrome §Impacts 1 in 650 males §Physical symptoms -Infertility and small testes -Greater height, weaker muscles -Poor motor coordination -Less body hair -Breast growth -Less interest in sex §Intelligence average-difficulties with reading and speech §Attention problems §Social difficulties Fragile X §1 in 7,000 males and 1 in 11,000 females §Leads to problems with making FMRP, which leads to problems with brain development §Developmental Delays §Learning disabilities §Social and behavioural problems -Strongly adverse to eye contact, trouble paying attention, hand flapping, speaking without thinking and being very active -Intellectual disability- math learning difficulties -Common overlap with autism Williams Syndrome Impacts 1 in 18,000 people Mild to moderate intellectual disability Poor visual spatial skills Friendly, outgoing personality Increased risk of supravalvular aortic stenosis Phenotypic facial features Growth problems and short stature Other musculoskeletal, neurological and endocrine anomalies ** What do neurogenetic disorders tell us about behaviour, brain and other neurogenetic disorders? ** Neurodiversity §Pros -Help become more empathetic and jobs/schools to become adaptive towards people who have neurodevelopmental and learning disorders §Cons -Can under emphasize how well treatments can be effective -May not emphasize how severe some symptoms are of people with neurodiversity, urging the need for support rather than normalizing of the disorder in common society -People may self diagnose, which may not be accurate and this could be harmful for the person #PS406