2020-Abnormal Psychology(PSY3200) Lecture Notes Chapter 10 PDF

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Chapter 10: Neurodevelopmental and Neurocognitive Disorders Lecture NotesNeurodevelopmental and Neurocognitive Disorders: Attention-deficit/hyperactivity disorder Autism Spectrum Disorder Intellectual Disability Learning, Communication, and Motor Disorders Major and Mild Neurocognitive Disorders Del...

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ABNORMAL PSYCHOLOGY Chapter 10: Neurodevelopmental and Neurocognitive Disorders Lecture Notes

Neurodevelopmental and Neurocognitive Disorders: Attention-deficit/hyperactivity disorder Autism Spectrum Disorder Intellectual Disability Learning, Communication, and Motor Disorders Major and Mild Neurocognitive Disorders Delirium Disorders Arising in Childhood and Old Age Neurodevelopmental disorders

– Attention-deficit/hyperactivity disorder – Autism spectrum disorders – Intellectual disability – Learning, communication, and motor disorders Neurocognitive disorders – Major and mild neurocognitive disorders – Delirium Attention-Deficit/Hyperactivity Disorder (1) Persistent pattern of inattention and/or hyperactivity that interferes with functioning or development

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Inattention signs and symptoms—overlooks or misses details, doesn’t seem to listen when spoken to, fails to finish homework or duties, problems organizing, loses things frequently, forgetful Hyperactivity and impulsivity signs and symptoms—fidgets, leaves seat often, runs about or climbs when inappropriate, inability to play quietly, appears “driven by a motor,” excessive talking, can’t wait for turn, often interrupts or intrudes on others

Attention-Deficit/ Hyperactivity Disorder (2) Age limit for the onset of symptoms—12 years Occurs in more than one setting such as school and home Subtypes 1

ABNORMAL PSYCHOLOGY Chapter 10: Neurodevelopmental and Neurocognitive Disorders Lecture Notes

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Combined presentation—Six or more symptoms of inattention and hyperactivityimpulsivity Predominantly inattentive presentation—Six or more symptoms of inattention but less than six of hyperactivity-impulsivity Predominantly hyperactive/impulsive presentation—Six or more symptoms of hyperactivity-impulsivity less than six symptoms of inattention

Factors Contributing to ADHD Biological factors

– Cerebral cortex is smaller in volume – Less connectivity between frontal areas of the cortex and areas of the brain that influence motor behavior, memory, and attention – Abnormal functioning of catecholamine neurotransmitters – Genetic factors – Prenatal and birth complications – Diet

Psychological and social factors

– Aggressive and hostile parenting – Parents with substance abuse Treatments for ADHD • Stimulant drugs increase levels of dopamine—Ritalin, Dexedrine, and Adderall • Nonstimulant drugs affect the levels of norepinephrine—Atomoxetine, clonidine, and guanfacine • Behavioral therapies—Focus on reinforcing attentive, goal-directed, and prosocial behaviors and extinguishing impulsive and hyperactive behaviors • Combination of stimulant therapy and psychosocial therapy is best • Behavioral therapies focus on reinforcing attentive, goal-directed, and prosocial behaviors

– Extinguish impulsive and hyperactive behaviors 2

ABNORMAL PSYCHOLOGY Chapter 10: Neurodevelopmental and Neurocognitive Disorders Lecture Notes

Autism Spectrum Disorder (1) Impairment in two fundamental behavior domains

– Deficits in social interactions and communications • • •

Problems with social-emotional reciprocity Difficulty with nonverbal communication Problems developing, maintaining, and understanding relationships

– Deficits in restricted, repetitive patterns of behaviors, interests, and activities • • • •

Stereotyped or repetitive movements, use of objects or speech

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Self-stimulatory behaviors

Insistence on sameness or rigid adherence to routines Abnormal and fixated interests Hypo- or hyper-reactivity to sensory input

Autism Spectrum Disorder (2) Approximately 50 percent of those with autism show some type of intellectual disability

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IQ is best predictor of outcome Savant syndrome—having special talents or abilities—is rare Onset in early childhood is required for diagnosis Majority require ongoing support from parents in adulthood or residential care DSM-IV-TR Pervasive Developmental Disorders included autism, Asperger's disorder, Rett’s disorder, and childhood disintegrative disorder

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DSM-5 combined into autism spectrum disorder

Contributors to Autism Spectrum Disorder Biological factors

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Polygenic disorder—evidenced by family and twin studies

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General vulnerability to several types of cognitive impairment Neurological factors 3

ABNORMAL PSYCHOLOGY Chapter 10: Neurodevelopmental and Neurocognitive Disorders Lecture Notes

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Greater brain and head size 30 percent develop seizures by adolescence Brain structure abnormalities May be caused by genetics or prenatal and birth complications Serotonin and dopamine implicated

Treatments for Autism Spectrum Disorder Drug therapy

– Selective serotonin reuptake inhibitors—Reduce repetitive behaviors and aggression – Atypical antipsychotic medications—Reduce obsessive and repetitive behaviors and improve self-control

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Stimulants—Used to improve attention Psychosocial therapies

– Behavioral techniques and structured educational services – Operant conditioning strategies are used to reduce excessive behaviors – Comprehensive behavior therapy administered by parents and at school Intellectual Disability Intellectual deficits and deficits in the ability to function in three broad domains of daily living

– Conceptual domain – Social domain – Practical domain Impairments occur across multiple settings Onset during the developmental period Classified as mild, moderate, severe, or profound Causes of Intellectual Disability Genetic contributions 4

ABNORMAL PSYCHOLOGY Chapter 10: Neurodevelopmental and Neurocognitive Disorders Lecture Notes

– Nearly 300 genes implicated – Phenylketonuria (PKU), Tay-Sachs disease, and chromosomal disorders Brain damage during gestation and early life – Fetal alcohol syndrome: Occurs when mothers abuse alcohol during pregnancy •

Children have a below average IQ of 68 and poor judgment, distractibility, and difficulty understanding social cues

– Severe head trauma – Exposure to toxic substances such as lead, mercury, and arsenic – Infectious diseases Sociocultural factors – Low socioeconomic backgrounds – Living in lower socioeconomic areas Treatments for Intellectual Disability Drug therapy

– Medication to reduce seizures, neuroleptic medications, atypical antipsychotics to reduce aggression, antidepressants to reduce depression Behavioral strategies

– Involvement of parents and caregivers, enhance positive behaviors and minimize

negative ones; teach social and vocational skills Social programs

– Early intervention, mainstreaming, institutionalization when necessary, group homes that provide comprehensive care

Learning, Communication, and Motor Disorders Deficits or abnormalities in specific skills or behaviors Not due to intellectual disability, global developmental delay, neurological disorders, or general external factors like economic disadvantage Specific Learning Disorder 5

ABNORMAL PSYCHOLOGY Chapter 10: Neurodevelopmental and Neurocognitive Disorders Lecture Notes Deficits or abnormalities in learning or using specific academic skills or behaviors

– Specify area affected: • • •

Reading Written expression Mathematics

– Must persist for at least 6 months, despite interventions that target the deficits Communication Disorders Language disorder

– Difficulties with spoken, written language, and other language modalities

Speech sound disorder

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Difficulty in producing speech Childhood-onset fluency disorder or stuttering

– Problems with speaking evenly and fluently, voicing frequent repetitions of sounds

or syllables Social communication disorder

– Deficits in using verbal and nonverbal communication for social purposes, in a manner that is appropriate for the social context

Causes of Learning and Communication Disorders Genetic factors—Abnormalities in brain structure and functioning

– Broca’s area—articulate and analyze words Environmental factors

– Lead poisoning – Birth defects – Sensory deprivation – Low socioeconomic status Treatment of Learning and Communication Disorders 6

ABNORMAL PSYCHOLOGY Chapter 10: Neurodevelopmental and Neurocognitive Disorders Lecture Notes Therapies designed to build missing skills Individualized education plan (IEP)

– Describes specific skills and deficits as determined by tests, teachers, and parents – Includes parent and teacher interventions Changing skills can change brain function

Motor Disorders Tourette’s disorder, persistent motor or vocal tic disorder (PMVTD), and stereotypic movement disorder

– adulthood Typically begin in childhood and increase in adolescence then decline in – Highly comorbid with obsessive-compulsive disorder – Treat with habit reversal therapy –Developmental Tourette’s and PMVTD may respond to drugs that alter the dopamine system coordination disorder – 50 percent also have ADHD – Treat with physical or occupational therapy Major Neurocognitive Disorder (NCD), also called dementia Characterized by decline in cognitive functioning severe enough to interfere with daily living Often accompanied by changes in emotional functioning and personality Insight may be poor Different types exist with different patterns of deficits and different underlying causes Mild neurocognitive disorder: milder versions that involve modest decline from previous functioning but that has not resulted in significant impairment in functioning Types of Cognitive Deficits Seen in Major Neurocognitive Disorder

– Memory – Aphasia: Deterioration of language – Echolalia: Repeating what is heard 7

ABNORMAL PSYCHOLOGY Chapter 10: Neurodevelopmental and Neurocognitive Disorders Lecture Notes

– Palilalia: Repeating sounds or words over and over – Apraxia: Impairment of the ability to execute common actions like waving – Agnosia: Failure to recognize objects or people – Loss of executive functions •

Executive functions: Brain functions that involve the ability to plan, initiate, monitor, and stop complex behaviors

Alzheimer’s Disease Type of neurocognitive disorder Clear decline in learning and memory Mild memory loss quickly progresses to profound memory loss and disorientation Two-thirds of patients show psychiatric symptoms:

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Agitation Irritability Apathy Dysphoria Hallucinations and delusions may appear in severe cases

Biology of Alzheimer’s Disease

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Neurofibrillary tangles: Made of protein called tau that impede nutrients and other essential supplies from moving through cells causing them to die Plaques: Deposits of a protein called beta-amyloid

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Neurotoxic and accumulate in the spaces between the cells of the cerebral cortex, hippocampus, and amygdala

Extensive cell death in the cortex that shrinks the cortex and enlarges the ventricles of the brain Cells lose many of their dendrites, the branches that link one cell to other cells

Causes of Alzheimer’s Disease 8

ABNORMAL PSYCHOLOGY Chapter 10: Neurodevelopmental and Neurocognitive Disorders Lecture Notes

– Genetic predisposition •

Apolipoprotein E gene ApoE

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Certain variants of ApoE lead to reduced cortex and hippocampus volume as early as childhood

Chromosome 21—Down syndrome

– Deficits in a number of neurotransmitters • • • • •

Acetylcholine Norepinephrine Serotonin Somatostatin Peptide Y

Vascular Neurocognitive Disorder Significant decline in processing speed, ability to pay attention, and executive functions as a result of a recent vascular event or cerebrovascular disease

– Severity of cognitive symptoms and functional decline make it a major or mild NCD Cerebrovascular disease: Blood supply to areas of the brain is blocked, causing brain tissue damage Stroke: Sudden damage to an area of the brain due to the blockage of blood flow or to hemorrhaging Neurocognitive Disorders Associated with Other Medical Conditions Parkinson's disease—Degenerative brain disorder Neurocognitive disorder due to Lewy body disease HIV—Can cause a mild or major NCD Huntington's disease—Rare genetic disorder that afflicts people early in life Traumatic brain injury: Penetrating injuries caused by impact to the head and/or concussive forces Gender, culture, and education have an effect on neurocognitive disorder

Treatments for and Prevention of Neurocognitive Disorder9

ABNORMAL PSYCHOLOGY Chapter 10: Neurodevelopmental and Neurocognitive Disorders Lecture Notes Cholinesterase inhibitors—Prevent the breakdown of the neurotransmitter acetylcholine Antidepressants and antianxiety drugs—Help control emotional symptoms Antipsychotic drugs—Control hallucinations, delusions, and agitation Behavior therapies help to control patients anger and emotional outbursts Physical and mental activity helps reduce the risk of NCDs Delirium Disorientation, recent memory loss, and a clouding of attention Causes

– Involves abnormalities in a number of neurotransmitters – Neurocognitive disorder—Strongest predictor – Intoxication of illicit drugs and withdrawal – Fluid and electrolyte imbalances, medication side effects, and toxic substances – Medical condition affecting level of acetylcholine in brain Treatments for Delirium Treat any underlying medical condition contributing to the delirium Discontinue drugs that contribute to delirium Antipsychotic medications—Help treat a delirium person's confusion Nursing care Secure atmosphere helps create a secure feeling and a feeling of being in control Biological vulnerability can lead to neurodevelopmental or neurocognitive disorder symptoms. Environmental and psychosocial modifiers, including epigenetic processes and environmental and social interventions, can influence this.

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