ADHD:

Childhood developmental disorder:

Referred – hyperactivity

Characterized by difficulties that interfere with effective task-oriented behavior in children

particularly impulsivity, excessive or exaggerated motor activity, such as aimless or haphazard
running or fidgeting, and difficulties in sustaining attention.

Often lower in intelligence – 7-15 IQ points below avg.

Tend to talk incessantly and to be socially intrusive and immature.

Have problems because of their impulsivity and over activity.

Hyperactive children usually have great difficulty in getting along with their parents because they do
not obey rules.

In general, they are not anxious even though their over activity, restlessness, and distractibility are
frequently interpreted as indications of anxiety. They usually do poorly in school and often show
specific learning disabilities such as difficulties in reading or in learning other basic school subjects.

More among preadolescent boys than among girls.

ADHD occurs with the greatest frequency before age 8 and tends to become less frequent and to
involve briefer episodes thereafter. ADHD has also been found to be comorbid with other disorders
such as oppositional defiant disorder (ODD).

ODD – oppositional defiant disorder.

 Characterized by a recurrent pattern of negativistic, defiant, disobedient, and hostile

behavior toward authority figures that persists for at least 6 months.
 ODD is grouped into three subtypes: angry/irritable mood, argumentative/defiant behavior,
and vindictiveness.
 This disorder usually begins by the age of 8 and has a lifetime prevalence of 10 percent, with
a slightly higher rate among boys (11 percent) than girls (9 percent).
 Prospective studies have found a developmental sequence from ODD to conduct disorder,
with common risk factors for both conditions. That is, virtually all cases of conduct disorder
are preceded developmentally by ODD, but not all children with ODD go on to develop
conduct disorder within a 3-year period.
 The risk factors for both include family discord, socioeconomic disadvantage, antisocial
behavior in the parents, and overlapping neural correlates

Criteria:

A. A persistent pattern of inattention and/or hyperactivity impulsivity that interferes with

functioning or development, as characterized by (1) and/or (2):

1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to
a degree that is inconsistent with developmental level and that negatively impacts directly
on social and academic/occupational activities:

a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at
work, or during other activities
b. Often has difficulty sustaining attention in tasks or play activities
c. Often does not seem to listen when spoken to directly
d. Often does not follow through on instructions and fails to finish schoolwork, chores, or
duties in the workplace
e. Often has difficulty organizing tasks and activities
f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
g. Often loses things necessary for tasks or activities
h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may
include unrelated thoughts).
i. Is often forgetful in daily activities

2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at
least 6 months to a degree that is inconsistent with developmental level and that negatively
impacts directly on social and academic/ occupational activities:

a) Often fidgets with or taps hands or feet or squirms in seat.

b) Often leaves seat in situations when remaining seated is expected
c) Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or
adults, may be limited to feeling restless.)
d) Often unable to play or engage in leisure activities quietly.
e) Is often “on the go,” acting as if “driven by a motor”
f) Often talks excessively.
g) Often blurts out an answer before a question has been completed
h) Often has difficulty waiting his or her turn
i) Often interrupts or intrudes on others

B) Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.

C) Several inattentive or hyperactive-impulsive symptoms are present in two or more settings

D) There is clear evidence that the symptoms interfere with, or reduce the quality of, social,
academic, or occupational functioning.

E) The symptoms do not occur exclusively during the course of schizophrenia or another
psychotic disorder and are not better explained by another mental disorder.

Causal factors -

 The cause or causes of ADHD in children have been much debated. It still remains unclear to
what extent he disorder results from environmental or biological factors, and recent
research points to both genetic and social environmental precursors.
Neurodevelopmental disorders:

 The neurodevelopmental disorders are a group of severely disabling conditions that are
among the most difficult to understand and treat.

 They are considered to be the result of some structural differences in the brain that are
usually evident at birth or become apparent as the child begins to develop.

 Example, autism spectrum disorder, one of the most severe and puzzling disorders occurring
in early childhood.

Autism spectrum disorder:

Other names - autism, childhood autism, and autism spectrum disorder.

involves a wide range of problematic behaviors including deficits in language and perceptual and
motor development; defective reality testing; and an inability to function in social situations.

An Absence of Speech Children with autism do not effectively learn by imitation. This dysfunction
might explain their characteristic absence or severely limited use of speech.

If speech is present, it is almost never used to communicate except in the most rudimentary fashion,
such as by saying “yes” in answer to a question or by the use of echolalia—the parrot-like repetition
of a few words.

Echolalia - meaningless repetition of words just spoken by another person, occurring as a symptom of
mental conditions.

Criteria for Autism:

A. Persistent deficits in social communication and social interaction across multiple contexts, as
manifested by the following, currently or by history
1. Deficits in social-emotional reciprocity, ranging
2. Deficits in nonverbal communicative behaviours used for social interaction, ranging
3. Deficits in developing, maintaining, and understanding relationships, ranging

B. Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least two

of the following, currently or by history
1. Stereotyped or repetitive motor movements, use of objects, or speech
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or
nonverbal behaviour
3. Highly restricted, fixated interests that are abnormal in intensity or focus
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the
environment

C. Symptoms must be present in the early developmental period

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas
of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental
disorder) or global developmental delay.

Remember these –
social deficit (children with autism do not show any need for affection or contact with anyone, and
they usually do not even seem to know or care who their parents are.)

intellectual ability (Compared with the performance of other groups of children on cognitive or
intellectual tasks, children with autism often show marked impairment.)

maintaining sameness (preoccupied with and form strong attachments to unusual objects such as
rocks, light switches, or keys. In some instances, the object is so large or bizarre that merely carrying
it around interferes with other activities.)

an absence of speech (“yes” echolalia)

self – stimulation (repetitive movements as head banging, spinning, and rocking, which may
continue by the hour)

Causal Factors in Autism

The precise cause or causes of autism are unknown, although most investigators agree that a
fundamental disturbance of the central nervous system is involved.
Many investigators believe that autism begins with some type of inborn defect that impairs an infant’s
perceptual-cognitive functioning—the ability to process incoming stimuli and to relate to the world.

Recent MRI research suggests that abnormalities in the brain anatomy may contribute to the brain
metabolic differences and behavioral phenotype in autism.

The defective genes or damage from radiation or other conditions during prenatal development may play a
significant role in the etiologic picture.

Nevertheless, the exact mode of genetic transmission is not yet understood, but it seems likely that
relatives may also show an increased risk for other cognitive and social deficits that are milder in form
than true autism

Medication and behaviour therapy – treatments

Specific Learning disorder:

Learning disorders are delays in cognitive development in the areas of language, speech, mathematical, or
motor skills that are not necessarily due to any demonstrable physical or neurological defect.

Of these types of problems, the best known and most widely researched are a variety of reading/writing
difficulties known collectively as dyslexia.

Dyscalculia – affect ability to understand numbers and learn math facts

Dysgraphia – difficulty in writing.

The diagnosis of learning disorders is restricted to those cases in which there is clear impairment in school
performance or (if the person is not a student) in daily living activities impairment not due to intellectual
disability or to a pervasive developmental disorder such as autism.

Skill deficits due to ADHD are coded under ADHD. Significantly more boys than girls are diagnosed as
having a learning disorder, but estimates of the extent of this gen- der discrepancy have varied widely from
study to study.

The consequences of various encounters between children with learning disabilities and rigid school
systems can be disastrous to these children’s self-esteem and general psychological well-being, and
research indicates that these effects do not necessarily dissipate after secondary schooling ends but impact
their career adjustment.

Learning disorder difficulties are no longer a significant impediment, an individual may bear, into maturity
and beyond, the scars of many painful school-related episodes of failure.

High levels of general talent and of motivation to overcome the obstacle of a learning disorder sometimes
produce a life of extraordinary achievement.

Estimates suggest that 2 to 10 percent of children have a learning disorder, most often classified as
dyslexia (80 per- cent), with about 30 percent of children with a learning dis- order also suffering from a
comorbid disorder such as ADHD, depression, or anxiety.

Causal factors:

 some sort of immaturity, deficiency, or dysregulation limited to those brain functions that
supposedly mediate, for normal children, the cognitive skills that children with learning disorders
cannot efficiently acquire.
 Specifically, there appears to be dysfunction in the left hemisphere’s reading network among
people with dyslexia.
 region for dyslexia on chromosome 6 has been reported

treatments:

 testing treatments for reading disabilities revealed that phonics instruction, which involves
teaching children letter–sound correspondence as well as how to decode and create syllables, is
associated with significant improvements in reading and spelling abilities
 suggests that efforts by educators, parents, and researchers in this area are starting to have a
positive effect
 Intellectual Disability:

Intellectual disability (intellectual developmental disorder) is characterized by deficits in general mental

abilities, such as reasoning, problem solving, planning, abstract-thinking, judgment, academic learning,
and learning from experience.

For the diagnosis to apply, these problems must begin before the age of 18.

By definition, any functional equivalent of Intellectual disability that has its onset after age 17 must be
considered a dementia rather than intellectual disability.

Initial diagnoses of intellectual disability occur very frequently at ages 5 to 6 (around the time that
schooling begins for most children), peak at age 15, and drop off sharply after that. For the most part, these
patterns in age of first diagnosis reflect changes in life demands.

When adequate facilities are available for their education, children in this group can usually master
essential school skills and achieve a satisfactory level of socially adaptive behavior. Following the school
years, they usually make a more or less acceptable adjustment in the community and thus lose the identity
of being mentally retarded.

Classification/ degree Range of IQ Adaptive Limitations Percentage of

of development delay scores developmentally
delayed population

+ Can reach sixth – grade skill level. (8 – 11 year old

children)

+ They are considered educatable.

+ tend to lack normal adolescents’ imagination,

Mild 55 – 70 inventiveness, and judgment. 90%

+ Often, they require some measure of supervision.

+ Capable with training of living independently and

being self – supporting. (with the help of parents and
special educational programs)

+ Can reach second – grade skill level. (4 -7years)

+ They are considered trainable.

+ Can master certain routine skills such as cooking or

cleaning.

+ some can be taught to read and write a little and

manage fair spoken languages.
Moderate 40 – 55 6%
+ usually appear clumsy and ungainly, and they suffer
from bodily deformities and poor motor coordination.

+ Can work and live-in sheltered environments with

supervision.

+ Can achieve partial independence in daily self- care,

acceptance behaviour, and economic sustenance.

Severe 25 – 40 + Can learn to talk and perform basic self – care but 3%
needs constant supervision.

+ Motor and speech development are severely retarded

 and sensory defects and motor handicaps are common.

+ develop limited levels of personal hygiene and self

help skills.

+ Very limited ability to learn, may only be able to learn

very simple tasks.

+ Poor language and limited self – care.

+ Severe physical deformities, central nervous system

pathology, and retarded growth are typical; convulsive
Profound Below 25 seizures, mutism, deafness, and other physical anomalies 1%
are also common.

+ Individuals must remain in custodial care all their

lives.

+ They have poor health and low resistance to disease

and thus a short life expectancy.

Severe and profound cases of intellectual disability can usually be readily diagnosed in infancy because of
the presence of obvious physical malformations, grossly delayed development (e.g., in taking solid food),
and other obvious symptoms of abnormality. These individuals show a marked impairment of overall

intellectual functioning.

Causal Factors in Intellectual Disability:

Cause of Intellectual disabilities:

Genetic conditions: These can include Down syndrome, Williams syndrome and fragile X syndrome.
Problems during pregnancy: Problems that interfere with fetal brain development include alcohol or
drug use, malnutrition, infections or Preeclampsia (Pregnant women have high blood pressure, protein
in urine, and swelling in their legs, feel, and hands)
Infections and Toxic Agents: Intellectual disability may be associated with a wide range of
conditions due to infection such as viral encephalitis or genital herpes. If a pregnant woman is
infected with syphilis or HIV-1 or if she gets German measles, her child may suffer brain damage. A
number of toxic agents such as carbon monoxide and lead may cause brain damage during fetal
development or after birth
Problems during childbirth: Intellectual disability may result if a baby is deprived of oxygen during
childbirth or born extremely premature.
Illness or injury: Infections like meningitis, whooping cough, or the measles can lead to intellectual
disability. Severe head injury, near – drowning, extreme malnutrition, infections in the brain, and
exposure to toxic substances.
Ionizing Radiation: In recent decades, a good deal of scientific attention has been focused on the
damaging effects of ionizing radiation on sex cells and other bodily cells and tissues. Radiation may
act directly on the fertilized ovum or may produce gene mutations in the sex cells of either or both
parents, which may lead to defective offspring.
Malnutrition and Other Biological Factors: It was long thought that dietary deficiencies in protein
and other essential nutrients during early development of the fetus could do irreversible physical and
mental damage.
In two – thirds of all children who have intellectual disability, the cause is unknown.
Treatment of Intellectual disabilities:
Ideally, children at risk of intellectual disabilities receive comprehensive interventions from the first
days of life.
Intensive individualized interventions: Enhance individual’s development of basic skills.
Drug therapies: Reduce aggression and self – destructive behaviours.
Social programs: Ensures that the environment is optimal for child’s development.
Behavioural interventions: Help to learn new skills. Reduce self – injurious and other maladaptive
behaviours.
Medications: Used to reduce seizures, antisocial behaviour, and self – harm.
Comprehensive interventions: combine all the above strategies.