Dr van Widenfelt PSYC 307 100 FALL 2015 Agenda Developmental psychopathology continued childhood disorders ADHD ASD ADHD Attention deficit hyperactivity disorder ADHD has great difficulty concentrating for more than a few moments is inattentive impulsive and overactive Symptoms must be present before age 7 New DSM5 must be present before age 12 Note May not have all of the symptom categories Symptoms Inattention Careless Loses things Easily distrated Forgetful Doesn t listen Difficulty sustained attention Symptoms Hyperactivity Squirmy fidgety Runs climbs On the go Very chatty Symptoms Impulsivity Interrupts Can t wait turn Blurts out answers in school Boys to girls 4 1 Accounts for almost half of mental health referral Affects children in middle childhood Causes Again multiple causes Treatment what helps Behavior managment Home Classroom Pharmacological treatment What helps parents Parent training Help with how to respond Stay neutral and positive and not negative Praising and rewarding Trying to use DO statements rather than don t Help parents break that cycle of negative attention Help with how to create structure and clarity Have certain non negotiable rules Set limits Have reasonable consequences Not huge threats that are disproportional or can t be carried out Senario interrupting Gentle reminders your turn in a minute Scenario teasing sister at dinner You can But you can t touch your sister If the rule is broken there is one warning Examples of What helps kids Self talk related to stop think before act Reframe negative self talk Instead of I m so stupid I can t do this try I m not stupid but I do struggle with this But I know if I keep at it I can do it Autism Spectrum Disorders Autistic spectrum disorder ASD developmental disorders a range of disorders and severity high and low functioning Likely life long disorder Earlier diagnosis essential Symptoms Three signs of an autism spectrum disorder Under age 3 Delayed language Impaired social responses Unusual repetitive play restricted repetitive patterns of behavior interests or activities hyper or hypo reactivity to sensory input May or may not be extra sensitive ie itchy clothes pain seek or avoid lights motion touch Seek sensory input Rocking jumping When parents get concerned Parents usually start getting concerned by 15 months of age about social difficulties and speech delays Can t tell in first year Retrospectively 70 see development was never normal ie may have never liked being cuddled For 30 clear setback in 2nd or 3rd year Communication impairment 30 never acquire useful speech Delayed and sometimes not properly developed later parroting speech talking at someone rather than conversing with speech used for demanding things talk at length about current preoccupations use of strange idiosyncratic phrases Social communication Restricted and repetitive activities and interests Insists on routines and rituals Small changes results in tantrum During play ordering lining things up Usually don t see pretend play as toddlers Unusual interest in an object Sometimes have Unusual Abilities Might see already as toddlers Exceptional skills Interest in shapes letters numbers Early recognition of signs reading Good expressive vocabulary Great memory for movies books Evt knowledge of one particular subject High functioning Often viewed as having asperger syndrome Some aspects of Asperger syndrome or high functioning autism Don t see the early language delay that is apparent in other ASD Their special interest is often the sole topic of conversation Love to talk about their special interest regardless of other persons interest and reaction Deflecting might be met with annoyance Special interest more extreme than others may have unusual knowledge in certain area How do you observe young children Direct observation interactions clinical probes Pointing and directing child to look 12 15 months Calling child s name 12 months Asking Where s mommy Eye contact gaze referencing pointing evidence of joint attention Observe for unusual movements looking at things closely out of corner of eye repetitive movements sensitivities Probing questions for parents What is your child s favorite toy type of play 12 to 18 months Does your child babble Wave bye bye Raise arms to be lifted Hear your voice as well as other things in the environment 9 to 12 months Does your child have echolalia pop up words exceptional labeling 12 15 and 24 months Do you notice delays in social skills or language Rates Ratio boys to girls 4 1 Cause unknown Increase in recent years Now diagnosing 1 in 88 children Increase Likely due to Increased awareness Changes in diagnositic criteria widened Etiology UNKNOWN Initially described as a disorder of parenting refrigerator mothers Multiple causes Equifinality STRONG genetic cause May be passed down in family May be a genetic mutation in that individual that is not passed down Other factors in the developmental process Increased age of father can be risk factor Exposure to certain agents during mother s pregnancy There may be a role of other systems as well Immune Gastrointestinal GI Genetics Complex yet strong genetic factors Strongest evidence from twin studies Identical twins with aprox 70 chance Fraternal twins with aprox 30 chance Sibs aprox 20 Relatives may be affected by difficulties that are conceptually related to autistic behaviors broader autistic phenotype Vaccines Vaccines DO NOT cause autism Currently no evidence to support a relationship between vaccines and autism Theories continue to change Recent retraction of Lancet article that suggested that author lost his medical license Families still caught in the middle between research and media What is it like for the parents Treatment Special diets Medication Behavioral methods Treatment Speech Language Therapy Picture Exchange Communication System Auditory Integration Therapy Occupational Therapy Sensory Integration Behavior Management Applied Behavioral Analysis ABA evidence based Medications Target symptoms Anxiety Aggression Obsessive compulsive features ADHD features Sleep problems Seizures Mood lability Repetitive behaviors Have a great weekend Plan ahead Remember next Friday is next exam Wednesday we will do a review