Neurodevelopmental Disorders

Chapter 14

Neurodevelopmental Disorders

Chapter Overview

This chapter outlines the primary features of neurodevelopmental disorders, with a particular emphasis on attention deficit/hyperactivity disorder, specific learning disorders, autism spectrum disorders, and intellectual disability. Major features of each of these disorders are outlined within a developmental framework, including integrative coverage of biological, psychological, and sociocultural variables that cause and/or maintain them. Available biological and psychosocial treatments for the developmental disorders are described, including efforts underway to prevent such problems.

Chapter Outline

OVERVIEW OF NEURODEVELOPMENTAL DISORDERES

What Is Normal? What Is Abnormal?

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

SPECIFIC LEARNING DISORDER

AUTISM SPECTRUM DISORDER

Treatment of Autism Spectrum Disorder

INTELLECTUAL DISABILITY

Causes

PREVENTION OF NEURODEVELOPMENTAL DISORDERS

Detailed Outline

Overview of Neurodevelopmental Disorders

Developmental psychopathology is the study of how disorders arise and change with time. These changes usually follow a pattern, with the child mastering one skill before acquiring the next. This aspect of development is important because it implies that any disruption in the acquisition of early skills will, by the very nature of the developmental process, also disrupt the development of later skills.

Attention-Deficit/Hyperactivity Disorder

The primary characteristics of people with attention deficit/hyperactivity disorder are a pattern of inattention (such as not paying attention to school- or work-related tasks), impulsivity, and/or hypeactivity. These deficits can significantly disrupt academic efforts and social relationships.

 Discussion Point:

What are the possible explanations for gender differences in the diagnosis of ADHD?

Specific Learning Disorder

DSM-5 describes specific learning disorders as academic performance that is substantially below what would be expected given the person’s age, intelligence quotient (IQ) score, and education. These problems can be seen as difficulties with reading, mathematics, and/or written expression. All are defined by performance that falls short of expectations based on intelligence and school preparation.

Communication and motor disorders seem closely related to specific learning disorder. They include childhood speech fluency disorder (stuttering), a disturbance in speech fluency; language disorder, limited speech in all situations but without the types of cognitive deficits that lead to language problems in people with intellectual disability or one of the pervasive developmental disorders; and Tourette’s disorder, which includes involuntary motor movements such as head twitching and vocalizations such as grunts that occur suddenly, in rapid succession, and in idiosyncratic or stereotyped ways.

 Discussion Point:

What are the benefits of “mainstreaming” children with learning disorders versus delivering special education services? What are the drawbacks of this approach?

Autism Spectrum Disorder

People with ASD all experience trouble progressing in language, socialization, and cognition. This is not a relatively minor problem (like specific learning disorder) but is a condition that significantly affects how individuals live and interact with others.

Autistic spectrum disorder is a childhood disorder characterized by significant impairment in social communication skills and restricted, repetitive patterns of behavior, interests, or activities. This disorder does not have a single cause; instead, a number of biological conditions may contribute, and these, in combination with psychosocial influences, result in the unusual behaviors displayed by people with ASD.

Impressive advances have been made in improving outcomes for many young children with ASD using early intervention programs. Treatment for older children involves behavioral interventions focused on their social communication deficits and the restricted, repetitive patterns of behavior, interests, or activities.

Intellectual Disability

The definition of intellectual disability has three parts: significantly subaverage intellectual functioning, concurrent deficits or impairments in present adaptive functioning, and an onset before the age of 18.

 Discussion Point:

What are the possible causes of the Flynn effect?

Down syndrome is a type of intellectual disability caused by the presence of an extra 21st chromosome. It is possible to detect the presence of Down syndrome in a fetus through a process known as amniocentesis.

Two other types of intellectual disability are common: Fragile X syndrome, which is caused by a chromosomal abnormality of the tip of the X chromosome, and cultural–familial intellectual disability, a rare problem resulting from adverse environmental conditions.

Key Terms

neurodevelopmentalautism spectrum disorder

disorders, 511 (ASD), 524

attention-deficit/hyperactivityjoint attention, 525

disorder (ADHD), 512prosody, 525

copy number variants, 517naturalistic teaching

specific learning disorder, 520 strategies, 529

childhood-onset speech fluencyintellectual disability (ID), 530

disorder (stuttering), 522phenylketonuria (PKU), 534

language disorder, 522Lesch-Nyhan syndrome, 534

Tourette’s disorder, 522Down syndrome, 534

Rett’s disorder, 524amniocentesis, 535

childhood disintegrativechorionic villus sampling

disorder, 524 (CVS), 535

pervasive developmentalfragile X syndrome, 536

disorder, not otherwisecultural-familial intellectual

specified, 524disability, 536

Ideas for Instruction

1.Activity: Would You Want to Know? Genetic research raises several interesting ethical questions, particularly with regard to the disorders discussed in this chapter. Ask students to consider whether they would want to know as parents whether their unborn child would have Down syndrome or perhaps even autism (if such a test were available). Also ask students to consider the ethical implications involved if and when routine genetic testing for development disorders comes of age. Would such testing be advantageous or potentially harmful?

2.Activity: The Movie Rainman. In the film Rainman, Dustin Hoffman plays the role of Raymond, a man with autism spectrum disorder. Many students will likely be familiar with the film, but what they may not know or appreciate is whether Hoffman’s character accurately depicts the condition. Most experts agree that Hoffman’s character does not accurately represent autism spectrum disorder, and the textbook similarly reinforces this point. After discussing the diagnosis, show the film and ask students to identify whether Raymond displays the three main features of autism spectrum disorder and whether the film fits the facts with regard to autistic behavior. You may also open the discussion to issues related to media depiction of persons with other neurodevelopmental developmental disabilities.

3.Activity: Guest Lecture by a Special Education Instructor. Ask a special education instructor to visit the class to talk about the intervention methods he or she uses to assist people with neurodevelopmental disorders. You may also supplement this with a speaker from your college or university student disabilities services.

Video Activity: Autism and Mainstreaming. Show the segment titled “Autism,” from Abnormal Psychology: Inside/Out. In this segment, Dr. Durand discusses the nature of autism, its characteristics, and symptoms. There is live footage of a public school in New York where the teachers and children with autism are in a mainstreamed setting with other students. Aside from the real footage, this segment highlights the ongoing controversy regarding whether such children should be mainstreamed into regular classes or placed in special education classes. You may use this segment as a springboard to discuss student reactions to the idea of mainstreaming, particularly in light of the assets and liabilities of this approach. Stress that there are no right or wrong answers.

5.Invite a guest speaker from the community to discuss the range of services offered to individuals with developmental disorders. Many of your students will have had mainstreamed students in either middle school or high school; ask them to discuss the benefits to the individuals mainstreamed, themselves, and society.

Supplementary Reading Material

Additional Readings:

Barkley, R. A. (1997). ADHD and the nature of self-control. New York: Guilford.

Christophersen, E. R., & Mortweet, S. L. (2001). Treatments that work with children. Washington, DC: American Psychological Association.

Clipson, C., & Steer, J. (1998). Case studies in abnormal psychology. Boston, MA: Houghton Mifflin Company. Chapter 14, Attention-Deficit Hyperactivity Disorder: All Wound Up and Out of Control.

Cohen, S. (1998). Targeting autism: What we know, don’t know, and can do to help young children with autism and related disorders. Berkeley, CA: University of California Press.

Fouse, B. A. (1997). Treasure chest of behavioral strategies for individuals with autism. Arlington, TX: Future Horizons.

Frith, U. (Ed.) (1991). Autism and Asperger’s syndrome. New York: Cambridge University Press.

Jordan, D. R. (1992). Attention deficit disorder: ADHD and ADD syndromes. Austin, TX: PRO-ED.

Kazdin, A. E. (1990). Psychotherapy for children and adolescents. Annual Review of Psychology, 41, 21–54.

Klin, A., Volkmar, F. R., & Sparrow, S. S. (Eds.) (2000). Asperger syndrome. New York: Guilford.

Kozloff, M. A. (1998). Reaching the autistic child: A parent training program. Cambridge, MA: Brookline Books.

Kurlan, R. (Ed.) (1993). Handbook of Tourette’s syndrome and related tic and behavioral disorders. New York: Dekker.

Meisels, S. J., & Shonkoff, J. P. (Eds.) (1990). Handbook of early childhood interventions. New York: Cambridge University Press.

Pliszka, S. R., Carlson, C. L., & Swanson, J. M. (1999). ADHD with comorbid disorders: Clinical assessment and management. New York: Guilford.

Quay, H. C., Routh, D. K., & Shapiro, S. K. (1988). Psychopathology of childhood: From description to validation. Annual Review of Psychology, 38, 491–532.

Sattler, D., Shabatay, V., & Kramer, G. (1998). Abnormal psychology in context: Voices and perspectives. Boston, MA: Houghton Mifflin Company. Chapter 12, Disorders of Childhood and Adolescence, Mental Retardation, and Eating Disorders.

Seifert, C. D. (1990). Theories of autism. Lanham, MD: University Press of America.

Shapiro, E. S. (1996). Academic skills problems. New York: Guilford.

Siegel, B. (1996). The world of the autistic child: Understanding and treating autistic spectrum disorders. Oxford: Oxford University Press.

Silverman, H. H. (1992). Stuttering and other fluency disorders. Englewood Cliffs, NJ: Prentice Hall.

Teeter, P. A. (2000). Interventions for ADHD: Treatment in developmental context. New York: Guilford.

Attention-Deficit/Hyperactivity Disorder

This site contains a wealth of scholarly information and links related to ADHD.

Autism Spectrum Disorder

This site contains a wealth of scholarly information and links related to autistic disorder.

Autism Center

This webpage, in addition to providing links to other related sources on the Web, gives information on the symptoms of autism, guidelines for families and caregivers, and relevant books and resources.

CH.A.D.D. (Children and Adults with Attention-Deficit/Hyperactivity Disorder)

CH.A.D.D. is a non-profit organization devoted to educating the public about attention deficit and hyperactivity disorders. This site includes information on the symptoms of ADHD, treatments, and as well as CH.A.D.D. chapters throughout the country.

The Division for Early Childhood

This website provides links related to early intervention information for developmental disorders.

Learning Disabilities Association of America

This website provides information and news updates on learning disabilities. This site is aimed at parents, teachers, and other professionals.

Center for Autism and Related Disabilities

http://www.albany.edu/psy/autism/autism.html

This site provides a wealth of information related to research and treatment of autism.

NLDline

This is a non-verbal learning disabilities website with a huge array of information about learning disabilities common in people with pervasive developmental disorders.

WARNING SIGNS OF

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

 Often fidgeting with hands or feet, or squirming while seated

 Difficulty remaining seated when required to do so

 Easily distracted by extraneous stimuli

 Difficulty awaiting turn in games or group activities

 Often blurting out answers before questions are completed

 Difficulty in following instructions

 Difficulty sustaining attention in tasks or play activities

 Often shifting from one uncompleted task to another

 Difficulty playing quietly

 Often talking excessively

 Often interrupting or intruding on others

 Often not listening to what is being said

 Often forgetting things necessary for tasks or activities

 Often engaging in physically dangerous activities without considering possible consequences

WARNING SIGNS OF

SPECIFIC LEARNING DISABILITY (PRESCHOOL)

Does the child have trouble with or delayed development in the following?

 Learning the alphabet

 Rhyming words

 Connecting sounds and letters

 Counting and learning numbers

 Being understood when he or she speaks to a stranger

 Using scissors, crayons, and paints

 Reacting too much or too little to touch

 Using words or, later, stringing words together into phrases

 Pronouncing words

 Walking forward or up and down stairs

 Remembering the names of colors

 Dressing self without assistance

WARNING SIGNS OF

SPECIFIC LEARNING DISABILITY (ELEMENTARY SCHOOL)

Does the child have trouble with the following?

 Learning new vocabulary

 Speaking in full sentences

 Understanding the rules of conversation

 Retelling stories

 Remembering newly learned information

 Playing with peers

 Moving from one activity to another

 Expressing thoughts orally or in writing

 Holding a pencil

 Handwriting

 Computing math problems at his or her grade level

 Following directions

 Self-esteem

 Remembering routines

 Learning new skills

 Understanding what he or she reads

 Succeeding in one or more subject areas

 Drawing or copying shapes

 Understanding what information presented in class is important

 Modulating voice (may speak too loudly or in a monotone)

 Keeping notebook neat and assignments organized

 Remembering and sticking to deadlines

 Understanding how to play age-appropriate board games

WARNING SIGNS OF

SPECIFIC LEARNING DISABILITY (ADULTHOOD)

Does the adult have trouble with the following?

 Remembering newly learned information

 Staying organized

 Understanding what he or she reads

 Getting along with peers or coworkers

 Finding or keeping a job

 Sense of direction

 Understanding jokes that are subtle or sarcastic

 Making appropriate remarks

 Expressing thoughts orally or in writing

 Following directions

 Basic skills (such as reading, writing, spelling, and math)

 Self-esteem

 Using proper grammar in spoken or written communication

 Remembering and sticking to deadlines

WARNING SIGNS OF AUTISM SPECTRUM DISORDER

 Difficulty interacting with other children

 Insistence on sameness; resists changes in routine

 Inappropriate laughing and giggling

 No real fear of dangers

 Little or no eye contact

 Sustained odd play

 Apparent insensitivity to pain

 Echolalia (repeating words or phrases in place of normal language)

 Prefers to be alone; aloof manner

 May not want cuddling or act cuddly

 Spins objects

 Not responsive to verbal cues; acts as though deaf

 Inappropriate attachment to objects

 Difficulty in expressing needs; uses gestures or pointing instead of words

 Noticeable physical overactivity or extreme underactivity

 Tantrums; displays extreme distress for no apparent reason

 Unresponsive to normal teaching methods

 Uneven gross/fine motor skills (e.g., may not want to kick ball but can stack blocks)

“EARLY” WARNING SIGNS OF

AUTISM SPECTRUM DISORDER

If your child displays any of these signs, bring it to the attention of your doctor:

 No babbling by 12 months

 No pointing, waving, and other gesturing by 12 months

 No single words by 16 months

 No two-word spontaneous (not echoed) phrases by 24 months

 Any loss of language or social skills at any age

 Inability to make or hold eye contact

 Inability to respond to the child’s name being called

 Inability to look where you point

 Lack of interest in pretend play by 18 months

 Arches back to avoid touch

 Rocks or bangs head

 Makes little attempt to communicate