Attention Deficit Attention Deficit Hyperactivity Disorder Hyperactivity Disorder FeaturesFeatures ClassificationClassification

Predominantly InattentivePredominantly InattentivePredominantly Hyperactive-ImpulsivePredominantly Hyperactive-ImpulsiveCombinedCombined

ADHDADHD

Gender Differences Gender Differences Boys outnumber girls 4 to 1Boys outnumber girls 4 to 1

Cultural Factors Cultural Factors Probability of diagnosis is greatest in the United Probability of diagnosis is greatest in the United

States States Toxins as Cause?Toxins as Cause?

Allergens and food additives NOT relatedAllergens and food additives NOT related Maternal smoking increases riskMaternal smoking increases risk

ADHD: Biological Factors

Genetic Factors ADHD seems to run in families Three specific genes have been implicated

Neurobiological Factors Smaller brain volume Inactivity of the frontal cortex and basal ganglia Abnormal frontal lobe development and functioning

Biological Treatment of ADHDBiological Treatment of ADHD

Stimulant MedicationsStimulant MedicationsRitalin, Dexedrine, Adderall, othersRitalin, Dexedrine, Adderall, othersParadoxical EffectParadoxical EffectReduce the core symptoms of ADHD in 70% of Reduce the core symptoms of ADHD in 70% of

casescases Improve compliance and decrease negative Improve compliance and decrease negative

behaviors behaviors Do not affect learning and academic performanceDo not affect learning and academic performanceRelapse following discontinuation Relapse following discontinuation

Behavioral Treatment of ADHDBehavioral Treatment of ADHD

Behavioral TreatmentBehavioral Treatment Increase appropriate behaviors and decrease Increase appropriate behaviors and decrease

inappropriate behaviorsinappropriate behaviorsMay also involve parent trainingMay also involve parent training

Combined Biopsychosocial TreatmentsCombined Biopsychosocial TreatmentsHighly recommendedHighly recommendedGenerally superior to either tx alone Generally superior to either tx alone

Other Disruptive Behavior Other Disruptive Behavior DisordersDisorders Conduct DisorderConduct Disorder Oppositional Defiant DisorderOppositional Defiant Disorder

Learning DisordersLearning Disorders

Academic Performance Lower than IQ Academic Performance Lower than IQ PredictsPredictsReading DisorderReading DisorderArithmetic DisorderArithmetic DisorderDisorder of Written ExpressionDisorder of Written Expression

Disorder vs. Disability?Disorder vs. Disability?

Autism Spectrum DisordersAutism Spectrum Disorders

Autistic DisorderAutistic DisorderSocial and Communication ImpairmentSocial and Communication ImpairmentRestricted BehaviorRestricted Behavior

Asperger’s DisorderAsperger’s DisorderSimilar to Austism without Communication Similar to Austism without Communication

ImpairmentImpairment

Additional Pervasive Additional Pervasive Developmental DisordersDevelopmental Disorders Rett’s DisorderRett’s Disorder

Initial Normal DevelopmentInitial Normal Development Increasing Mental RetardationIncreasing Mental Retardation

Childhood Disintegrative DisorderChildhood Disintegrative DisorderRegression in language and motor skills at 2 Regression in language and motor skills at 2

to 4 yearsto 4 years

Treatment of Autism Spectrum Disorders

Biological and medical treatments are unavailable Behavioral treatments

Skill building Reduction of problem behaviors Target communication and language problems Address socialization deficits Early intervention is critical

Integrated treatments: The preferred model Focus on children, their families, schools, and home

Mental RetardationMental Retardation

MildMild IQ from 50-55 to 70IQ from 50-55 to 70 ~85%~85%

ModerateModerate IQ from 35-40 to 50-55IQ from 35-40 to 50-55 ~10%~10%

SevereSevere IQ from 20-25 to 35-40IQ from 20-25 to 35-40 ~3-4%~3-4%

ProfoundProfound IQ below 20-25IQ below 20-25 ~1-2%~1-2%

Other Classification Systems

American Association of Mental Retardation Levels of assistance required

Intermittent, limited, extensive, pervasive

Classification of MR in educational systems Educable (IQ of 50 to 70-75) Trainable (IQ of 30 to 50) Severe (IQ below 30)

Mental RetardationMental Retardation

Biological FactorsBiological Factors ChromosomalChromosomal

Down Syndrome, Fragile X SyndromeDown Syndrome, Fragile X Syndrome Neurological InjuryNeurological Injury

Prenatal – exposure to disease or a drug/toxin Perinatal – difficulties during labor Postnatal – head injury

Cultural-FamilialCultural-Familial Environmental Deprivation, AbuseEnvironmental Deprivation, Abuse Considered to be about 75% of CasesConsidered to be about 75% of Cases

Treatment of Mental Retardation Parallels treatment of pervasive developmental

disorders Teach needed skills

To foster productivity and independence Educational and behavioral management Living and self-care skills via task analysis Communication training

Community and supportive interventions

Other Childhood DisordersOther Childhood Disorders

Tic DisordersTic DisordersTourette’s SyndromeTourette’s Syndrome

Elimination DisordersElimination Disorders Separation AnxietySeparation Anxiety Selective MutismSelective Mutism OthersOthers

Cognitive DisordersNature of Cognitive Disorders

Broad impairments in memory, attention, perception, and thinking

Profound changes in behavior and personalityThree Classes

DeliriumDementia Amnesia

DementiaGradual deterioration of brain functioningAffects judgment, memory, language, and

advanced cognitive processesDementia has many causes and may be

reversible or irreversible Impairments have a marked negative impact

on social and occupational functioning

DSM-IV Classes of Dementia Dementia of the Alzheimer’s type Vascular Dementia Dementia Due to Other General Medical Conditions

Parkinson’s DiseaseHuntington’s DiseasePick’s DiseaseCreutzfeldt-Jakob Disease

Substance-Induced Persisting Dementia Dementia Due to Multiple Etiologies Dementia Not Otherwise Specified

Range of Cognitive Deficits Aphasia

Speech and word usage deficits

ApraxiaTask and coordination deficits

Agnosia/Facial AgnosiaRecognition deficits

Executive FunctionDeficits in planning, organizing, sequencing, or abstracting

information

Treatment of Dementia Medical Treatment: Best If Enacted Early

Few medical treatments exist for most types of dementia Attempt to slow deterioration

Do not actually stop progression of dementia

Psychosocial Treatments Focus on enhancing the lives of dementia patients and their

families/caregivers Teach adaptive skills Use memory enhancement devices (e.g., memory notebook) Main emphasis of psychosocial interventions is on the caregivers

(help caregivers cope and help them help the patient)