DEVELOPMENTAL

PSYCHOPATHOLOGY
By: Sidra Tanvir
Government College University (GCU) Lahore.
NEURODEVELOPMENTAL DISORDERS
 The neurodevelopmental disorders are a group of
conditions with onset in the developmental period.
 The disorders typically manifest early in development,
often before the child enters grade school, and are
characterized by developmental deficits that produce
impairments of personal, social, academic, or
occupational functioning.
NEURODEVELOPMENTAL DISORDERS
 The range of developmental deficits varies from very
specific limitations of learning or control of executive
functions to global impairments of social skills or
intelligence.
 The neurodevelopmental disorders frequently co-occur;
for example, individuals with autism spectrum disorder
often have intellectual disability (intellectual
developmental disorder), and many children with
attention-deficit/hyperactivity disorder (ADHD) also
have a specific learning disorder.
NEURODEVELOPMENTAL DISORDERS
 For some disorders, the clinical presentation includes
symptoms of excess as well as deficits and delays in
achieving expected milestones.
 For example, autism spectrum disorder is diagnosed only
when the characteristic deficits of social communication
are accompanied by excessively repetitive behaviors,
restricted interests, and insistence on sameness.
NEURODEVELOPMENTAL DISORDERS
 Intellectual disability
 Global developmental delay

 Communication disorders include language disorder,

speech sound disorder, social (pragmatic)
communication disorder, and childhood-onset fluency
disorder (stuttering).
 Autism spectrum disorder

 ADHD

 Neurodevelopmental motor disorders include

developmental coordination disorder, stereotypic
movement disorder, and tic disorders
INTELLECTUAL DISABILITY
(INTELLECTUAL DEVELOPMENTAL DISORDER)
 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.
 The deficits result in impairments of adaptive
functioning, such that the individual fails to meet
standards of personal independence and social
responsibility in one or more aspects of daily life,
including communication, social participation, academic
or occupational functioning, and personal independence
at home or in community settings.
DIAGNOSTIC CRITERIA
 Intellectual disability (intellectual developmental disorder) is a disorder
with onset during the developmental period that includes both
intellectual and adaptive functioning deficits in conceptual, social, and
practical domains.
 The following three criteria must be met:
A. Deficits in intellectual functions, such as reasoning, problem solving,
planning, abstract thinking, judgment, academic learning, and
learning from experience, confirmed by both clinical assessment and
individualized, standardized intelligence testing.
B. Deficits in adaptive functioning that result in failure to meet
developmental and sociocultural standards for personal independence
and social responsibility. Without ongoing support, the adaptive
deficits limit functioning in one or more activities of daily life, such as
communication, social participation, and independent living, across
multiple environments, such as home, school, work, and community.
C. Onset of intellectual and adaptive deficits during the developmental
period.
INTELLECTUAL DISABILITY
SEVERITY LEVEL
BORDER LINE CASE: (I.Q = 68-69)
 Children with I.Q between 68-69 are not retarded strictly
speaking because they are not defective but they are unable to
attain the average level of their classmates.
 Their functional level is 12-18 years old children. They have
some educational problems and some can achieve 6th -10th
class reading levels.
 They are characterized by slowness in performing their
schoolwork and have a serious difficulty in conceptualization.
As a rule they are backbenchers.
 They are only un-adopted within the academic framework.
That’s why it takes them about 2 years to spend in the same
class. Most can achieve independent social and vocational
adjustment
INTELLECTUAL DISABILITY
SEVERITY LEVEL
MILD: (1.Q =52-67)
 Children belonging to this group are formally classified as mild retarded.

 Their functional level is 8-12 years old children.

 Most of them need special class placement but some can achieve 4 th -6th class
reading levels.
 Mild retardation is often not suspected until the child enters the school. Often
shows combination of difficulty with academic subjects and behavior
problems.
 Learning problems may appear to be specific to one subject such as reading
and writing.
 Behaviour problem also might result from the frustration of scholastic or as
attempt to gain the acceptance from the other.
 The cause of most cases of mild retardation is unknown but nutrition, health-
care and environrnental stimulation appear to play an important role.
 They are slow in their social, motor and language skills from their peers. Those
who are well adjusted are capable of independent life and adjustment to a
working community.
INTELLECTUAL DISABILITY
SEVERITY LEVEL (MILD)
Conceptual Domain
 For pre-school children there may be no obvious
conceptual difference.
 For school age children and adults, there are difficulties
in learning academic skills involving reading, writing,
arithmetic, time or money with support needed in one or
more areas to meet age related expectations.
 In adults abstract thinking executive functioning,
strategization, priority setting and short term memory as
well as functional use of academic skills are impaired
INTELLECTUAL DISABILITY
SEVERITY LEVEL (MILD)
SOCIAL DOMAIN
 Compared with typically developing age mates the
individual with immature social interactions.
 Communication, conversation and language are more
concrete or immature than expected for age.
 There may be difficulties regulating emotion and
behavior in age appropriate fashion
 These difficulties are noticed by peers in social
situations.
 There is limited understanding of risk in social
situations, social judgment is immature for age and the
person is at risk of being manipulated by others.
INTELLECTUAL DISABILITY
SEVERITY LEVEL (MILD)
PRACTICAL DOMAIN
 The individual may function age appropriately in personal care.
Individuals need some support with complex daily living tasks in
comparison to peers.
 In adulthood supports typically involve grocery shopping,
transportation, home and child care organizing , banking and money
management.
 Recreational skills resemble those of age mates although judgment
related to well being and organization around recreation require
support.
 In adulthood , competitive employment is often seen in jobs that do
not emphasize conceptual skills.
 Individuals generally need support to make health care decisions and
legal decisions and to learn to perform a skilled vocation competently.
 Support is typically needed to raise a family.
INTELLECTUAL DISABILITY
SEVERITY LEVEL (MODERATE)
MODRATE RETARDATION (I.Q = 36-51)
 They are usually function in classes as trainable retarded.

 Their functional level is 4-7 years old children.

 Some of the brighter ones can be taught to read and write and some
manage to achieve a fair command of spoken language.
 They can learn some self help skills such as self dressing, self
washing, self feeding, cleanliness, and other aspects of life like
purchasing and simple food preparation etc.
 They suffer from body deformities and motor coordination.

 Some of them are hostile and aggressive with early diagnostic

parental help and adequate opportunities for training..
 Most of them can achieve partial independent behavior. They may
be able to function independently in supervised living and sheltered
workshops.
INTELLECTUAL DISABILITY
SEVERITY LEVEL (MODERATE)
Conceptual domain
 The individual’s conceptual skills lag markedly behind those of
peers.
 For preschoolers, language and pre-academic skills develop
slowly.
 For school age children progress in reading, writing,
mathematics, and understanding of time and money occurs
slowly across the school years and is marked with limited
compared with that of peers.
 For adults, academic skills can be developed up till elementary
level. However, they require support to use all academic skills
in work and personal life.
 Ongoing assistance on daily basis is needed to complete
conceptual tasks and fulfill responsibilities.
INTELLECTUAL DISABILITY
SEVERITY LEVEL (MODERATE)
Social Domain
 Individual show marked differences from peers in social and
communicative behavior across development.
 Spoken language is typically a primary tool for social communication but is
much less complex than that of peers.
 Capacity for relationships is evident in ties o family and friends.

 They may have some successful friendships across life and sometime
romantic relations in adulthood.
 Individual may not perceive r interpret social cues accurately.

 Social judgment and decision making abilities are limited.

 Caretakers must assist the person with life decisions.

 Friendships with typically developing peers are often affected by

communication or social limitations.
 Significant social and communicative support is needed in work setting for
success.
INTELLECTUAL DISABILITY
SEVERITY LEVEL (MODERATE)
Practical Domain
 Individual can care for personal needs involving eating,
dressing, elimination, hygiene.
 Although an extended period of teaching and time is needed
for individual to become independent..
 Likewise participation in all household activities can be
achieved by adulthood.
 Independent employment require limited conceptual and
communication skills
 A variety of recreational skills can be developed in these
individuals.
 However, maladaptive behavior is present in a significant
minority and causes social problems.
INTELLECTUAL DISABILITY
SEVERITY LEVEL (SEVERE)
SEVERE RETARDATION (I.Q = 20-35)
 Children belonging to this group can learn minimum self care
skills.
 These children do not usually profit from academic training
programs design to improve the speech and to teach some
help, self skills such as toilet training, feeding, dressing and
cleanliness have been successful.
 Task analysis is used to break down each task down in to small
steps. Each step is then trained separately using reward as
incentive for appropriate response.
 Among these individuals motor and speech development is
severely retarded and sensory defect is genes usually leading
to the presence of negative traits in off-springs and can cause
retardation.
INTELLECTUAL DISABILITY
SEVERITY LEVEL (SEVERE)
Conceptual Domain
 Attainment of conceptual skills are limited.

 The individual generally has little understanding of

written language or of concepts involving money.
 Caretakers provide extensive support for problem
solving throughout life.
INTELLECTUAL DISABILITY
SEVERITY LEVEL (SEVERE)
Social Domain
 Spoken language is quite limited in terms of vocabulary and
grammar.
 Speech may be single words or phrases and might be
supplemented through augmentative means.
 Speech and communication are focused on the here and now
within everyday events.
 Language is used for social communication more than for
explication.
 Individuals understand simple speech and gestural
communications.
 Relationships with family members and familiar others are
source of pleasure and help
INTELLECTUAL DISABILITY
SEVERITY LEVEL (SEVERE)
Practical Domain
 Individual require support and supervisions for all
activities of daily living all the time.
 They can’t making responsible decisions regarding well
being of self and others.
 In adulthood, they require on going assistance .

 Maladaptive behavior including self injury is present in a

significant minority.
INTELLECTUAL DISABILITY
SEVERITY LEVEL (PROFOUND)
PROFOUND RETARDATION (I.Q= BELOW 20)
 Children belonging to this group are referred to as dependent retarded
and very minimum self-help skills are possible for them but functioning
below that of the severely retarded is still capable of a wide range of
behavior.
 Some of them may be able to communicate through primitive speech,
signs or gestures, recognize familiar faces, response to simple commands
and achieve some self-help skills such as toilet training, feeding, dressing
etc, other may be bedridden, unaware and irresponsive to environment.
 Among these individuals severe physical deformities, central nervous
system pathology and deafness are common.
 These children have highest mortality rate.

 Those who survive in to adulthood are still very dependent upon the care
of others.
 Their life span is very short.
INTELLECTUAL DISABILITY
SEVERITY LEVEL (PROFOUND)
Conceptual Domain
 Conceptual skills involve the physical world rather than
symbolic processes.
 The individual may use objects in goal directed fashion
for self care, work and recreation.
 Certain visuo-spatial skills such as matching and sorting
based on physical characteristics may be acquired.
 However, co-occurring motor and sensory impairments
may prevent functional use of objects.
INTELLECTUAL DISABILITY
SEVERITY LEVEL (PROFOUND)
Social Domain
 Individual has very limited understanding of symbolic
communication in speech or gestures.
 They may understand some simple instructions or
gestures.
 They can express their desires and emotions mainly
through non-verbal communication.
 They enjoy relations with family members, caretakers
and initiate and respond to social interactions through
gestures or emotional cues.
 Co-occurring sensory and physical impairments may
prevent many social activities.
INTELLECTUAL DISABILITY
SEVERITY LEVEL (PROFOUND)
Practical Domain
 Individual depend on others in all aspects of life.

 Recreational activities may involve enjoyment in

listening music, watching movies or going out for walk.
 Maladaptive behavior is present in a significant minority.
DIFFERENTIAL DIAGNOSIS
Major and mild neuro-cognitive disorders.
 Intellectual disability is categorized as a
neurodevelopmental disorder and is distinct from the
neuro-cognitive disorders, which are characterized by a
loss of cognitive functioning.
 Major neuro-cognitive disorder may cooccur with
intellectual disability (e.g., an individual with Down
syndrome who develops Alzheimer's disease, or an
individual with intellectual disability who loses further
cognitive capacity following a head injury).
 In such cases, the diagnoses of intellectual disability and
neurocognitive disorder may both be given.
DIFFERENTIAL DIAGNOSIS
Communication disorders and specific learning
disorder
 These neurodevelopmental disorders are specific to the
communication and learning domains and do not show
deficits in intellectual and adaptive behavior.
 They may co-occur with intellectual disability.

 Both diagnoses are made if full criteria are met for

intellectual disability and a communication disorder or
specific learning disorder.
DIFFERENTIAL DIAGNOSIS
Autism spectrum disorder
 Intellectual disability is common among individuals
with autism spectrum disorder.
 Assessment of intellectual ability may be complicated by
social- communication and behavior deficits inherent to
autism spectrum disorder, which may interfere with
understanding and complying with test procedures.
 Appropriate assessment of intellectual functioning in
autism spectrum disorder is essential, with reassessment
across the developmental period, because IQ scores in
autism spectrum disorder may be unstable, particularly
in early childhood.
CAUSES OF INTELLECTUAL DISABILITY
GENETIC CAUSES
 CHROMOSOMAL ABBREVATION:
 It means variation in either the number or location of genetic material
on the chromo0some.
 DOWN’S SYNDROME:
 It is common genetic disorder in which a person is born with 47 rather
than 46 chromosomes resulting in developmental delays, mental
retardation, low muscle tone and other effects.
 INTER MARRIAGES:
 There are two types of genes in a human body. Dominant and
Recessive
 Dominant genes carry better survival chances while recessive genes
are negative traits. In the case of inter marriages the repeated cousin
marriages lead to the emergence of recessive genes usually leading to
the presence of negative traits in off-springs and can cause retardation.
CAUSES OF INTELLECTUAL DISABILITY
BIOLOGICAL CAUSES:
 PRENATAL:
 Medication (unnecessary during pregnancy), maternal
diabetes, maternal hypertension, maternal mal-nutrition,
maternal chest disease, X-ray, mother age 35 years and above
etc, are some causes of mental retardation.
 PERINATAL:
 Anoxia (oxygen deficiency), complication of pre-maturity,
birth trauma or other illness of the child.
 POST NATAL:
 Jaundice, high fever, typhoid, head injury, epilepsy etc.
CAUSES OF INTELLECTUAL DISABILITY
ENVIRONMENTAL CAUSES:
 EARLY STIMULATION:
 Stimulation means giving the child a variety of opportunities
to experience, explore and play with the things around. It
involve body movement and the use of all senses.
 LOW SOCIO-ECONOMIC STATUS:
 low income
 less education

 PARENTS WITH POOR HEALTH

 FAMILY OR PARENTAL CONFLICTS