PSYC 1st Edition Lecture 24 Outline of Last Lecture I. Antioxidant and redox regulation of gene transcription Outline of Current Lecture I. Nature of Developmental PsychopathologyII. Disorders Usually Diagnosed in Infancy, Childhood, and Adolescencea. Attention deficit hyperactivity disorder (ADHD)b. Learning disordersc. AutismIII. Pervasive Developmental Disorders: An Overviewa. Autistic disorderb. Asperger’s syndromeIV. Nature of Cognitive Disorders V. DeliriumCurrent LectureDevelopmental DisordersNature of Developmental Psychopathology: An Overview– Study of how disorders arise and change with time– Originate in childhood and persist.– Become lifelong problems– Some affect only one area of the child’s life (like speech); others have pervasive effectsDoes it matter when the disorder starts?• Disruption of early skills can affect later– The baby’s brain still developing for several year after birth.These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.– There are critical social, emotional, and cognitive skills being acquired at this time.– Skills develop in a sequence, so if one skill is disrupted earlier, the later, more complex development will be affected too.Example• Children with autism have disruptions in early social development, and this may prevent them from developing social relationships, even with their parents.• If their motivation to interact with others is disrupted early, they may not want to learn to speak to others if other people are not important to them.Understanding development• Understanding the disorder is easier if we understand what processes are disrupted.• Also this leads to better interventions. We can try to intervene early with autistic children in the area of social skills which may prevent continued disruption of communication and language.• Autism is a biologically-based disorder• -Changes at the psychosocial level can change the developmental trajectory.• -Therefore, important to understand normal development• Example: we used to believe echolalia was a sign of autism, but now it is known that echolalia is an intermediate step in language development.Disorders Usually Diagnosed in Infancy, Childhood, and Adolescence– Attention deficit hyperactivity disorder (ADHD)– Learning disorders– AutismAttention Deficit Hyperactivity Disorder (ADHD): An Overview• Nature of ADHD– Central features – inattention, overactivity, and impulsivity– Associated with numerous impairments• Behavioral• Cognitive• Social and academic problemsSymptomsClinical Picture:• Start many tasks without finishing one.• Flit from activity to activity• Have trouble concentrating• Problems sustaining attention in school or work• Don’t pay attention to others when they speak• Motor hyperactivity• Impulsive, act without thinkingADHD DSM-IV-TR symptom typesInattentive type Don’t listen, lose assignments, no attention to detailHyperactive type Can’t sit for long, fidgety, always on the goImpulsive type having trouble waiting for a turn, blurting out answersADHD: Facts and Statistics• Prevalence– Occurs in 3-7% of school-aged children in US– Symptoms are usually present around age 3 or 4• Gender differences – Boys 3 x more likely to be dx’d.– Girls may show less obvious sx (internalizing more than externalizing)• Historically, more dx’d in US than anywhere else.• In U.S. we are intolerant of the behaviors. Are they just normal, and we have no patience?• Are these cases misdiagnosed?• However, as diagnostic screening improves, other countries are catching up.Course of ADHD• At first, identified as active, mischievous, and slow to toilet train.• 80% have other difficulties (anxiety, depression, impulse control)• Over time, inattention persists, inactivity wanes.• In adolescence impulsivity manifests itself in an increased risk for STDs, car accidents, and license suspensions• About half the children have ongoing difficulties in adulthoodADHD• Overlapping diagnoses:– Oppositional defiant disorder• Argumentative, annoying, loses temper, vindictive– Conduct disorder– Bipolar disorder– Half of ADHD could be dx’d with ODDThe Causes of ADHD: Biological Contributions• Genetic contributions– ADHD seems to run in families– Their families seem to have an increase in psychopathology overall– DRD4, DAT1, and DRD5 (dopamine-related) genes have been implicated (polygenic).Ritalin inhibits the DAT1 gene-researchers looking for endophenotypes– Smaller brain volume– Kids with DAT1 more likely to get it if mom smoked prenatally– No evidence for food or additive allergyThe Causes of ADHD: Psychosocial Contributions• Psychosocial factors– Can influence the nature of ADHD– ADHD children are often viewed negatively by others– Constant negative feedback from peers and adults– Peer rejection and resulting social isolation– Such factors foster low self-esteemBiological Treatment of ADHD• Goal of biological treatments– To reduce impulsivity and hyperactivity and to improve attention• Stimulant medications– Reduce core symptoms in 70% of cases– Examples include Ritalin, Dexedrine– Adderal similar, but longer-actingAction of stimulants• Children and adults with or without ADHD react the same way.• Stimulants reinforce the brain’s ability to focus attention during problem-solving tasks.• Although it’s controversial, most M.D.s prescribe them at first.Why controversial?• Potential for abuse– Create elation– Reduce fatigue• Kids then at risk later for substance abuse• A newer drug, Strattera, appears effective, but doesn’t produce the same “high”,• Also antidepressants may be used.Behavioral and Combined Treatment of ADHD• Behavioral treatment: to improve academic performance– Reinforcement programs • To increase appropriate behaviors (sit longer)• Decrease inappropriate behaviors (increase appropriate play)– May also involve parent training in RF and constructive responses to child’s behaviorAdult ADD• Characterized by difficulties w/executive functions:– Attention– Planning– Concentration– Time management– Maintaining focus– Thoughtful decision-makingAdults w/ ADHD• Cognitive/behavioral intervention for distractibility and organizational skills• Education about the disorder•