Abnormal Child Psychology

Associated characteristics of ASD intellectual deficits(ID) Specific and general cognitive deficits

*70%* of children with ASD have been estimated to have co-occuring ID. Approx 40% have severe to profound ID, 30% have mild to moderate ID. They have problems with language and imitation - can be difficult for them - using weichsler intelligence scale for children - uneven across different WISC subtests. low verbal, ok non-verbal. Despite their intellectual deficits, a small but sig number of them develop: spelling, reading, mathematics, music or drawing. As many as 25% display a *special cognitive skill* that is above average for the general population and well above their own general level of intellect. These special abilities are more strongly related to the *restricted and repetive characteristics* of children with ASD *Specific and general cognitive deficits* Great difficulty in situations that require social understanding -They don't engage in pretend play *Mentalization/theory of mind(ToM)* ToM-By age 4. "mindblindness" - they fail to develop the capacity to mindread in the normal way...-ToM deficits: May be able to learn, remember and know things about the social world - but has little understanding of their meaning. The original test to detect mental states of others was called the *Sally-Anne test*. Where will sally look for the marble? - look for her marble in her basket where she put it - even people with ID realize...A small but sig number of children with ASD(from 15%-60%) demonstrate some knowledge of ToM - mechanism other than ToM are needed to explain the cognitive deficits in autism.**general cognitive deficits* executive functions, inhibitition, sustaining task performance and self-monitoring, using feedback -they have great difficulties in generalizing previousy learned information to new situations. A general cognitive deficit hypothesized to underlie ASD is a weak drive for *Central coherence*=refers to the strong tendency of humans to interpret stimuli in a relatively global way that takes the broader context into account. Underlying impairment in *social motivation*they fail to find social stimuli intrinsically rewarding - may *fail to find eye-to-eye contact rewarding* and thus are less motivated and less likely to attend to social cues, extract meaning of other peoples emotions and so on

Associated characteristics: Conduct problems Conduct problems - Family problems

*Cognitive and verbal deficits*=most have normal intelligence, they score nearly 8 points lower on IQ tests. Lower IQ scores may be related to co-occurrence with *ADHD*. Verbal IQ is consistently lower than performance IQ in children with CD - suggesting a specific and pervasive deficit in language. *Language deficits* may contribute to conduct problems by interfering with the development of self-control, emotion regulation or the labeling of emotions in others -which may lead to a lack of emphaty(hostile family environment, rejected by peers,)deficits in executive functions(impulsive, future rewards, adapt their actions to circumstances)*ODD/CD and ADHD frequently co-occur* *Peer problems* display verbal and physical aggression toward other children as well as *poor social skills* *Peer rejection* in elementary school is a strong risk factor for adolescent conduct problems, *bullies and friends are also antisocial* The combination of early antisocial behavior and associating with deviant peers is a powerful predictor of conduct problems during adolescence*-(hostile attributional bias) -*Self-esteem defictits*=may experience high self-esteem that over time permits them to rationalize their antisocial conduct(aggressive behavior - way to avoid the lowering of self-concept) *Conduct problems - Family problems* Family problems are among the strongest and most consistent correlates of conduct problems *2 types of family disturbances:* 1)*General family disturbances*=include parental mental health problems, a family history of antisocial behavior, marital discord, family instability, limited resources and antisocial family values 2)*Specific disturbances in parenting practices and family functioning*=include excessive use of harsh discipline, lack of supervision, lack of emotional support and involvement and parental disagreement about discipline.Both are interrelated -*High levels of conflict are common in families of children with CD*. *Poor parenting practices* for example lack of involvement in child-rearing, .... -Parents may also exhibit *social-cognitive deficits*(infer hostile intent of others)Often a *lack of family cohesion* - reflected in *emotional detachment, poor communication and problem solving, low support and family disorganization*

Prenatal exposure to alcohol and teratogens/risk factors

*Fetal alcohol spectrum disorder(FASD)*=an umbrella term that covers the range of outcomes associated with all levels of prenatal alcohol exposure -Even small amounts of alcohol may have negative effects on the growth and intellectual abilities of a fetus. *Fetal alcohol syndrome(FAS)-* is the most *extreme* form of FASD. FAS is characterized by CNS dysfunction, abnormalities in facial features and growth retardation. Considered to be the leading known cause of ID because of its clear link to intellectual impairment. On average the IQ of children and youths with FAS is in the mild range of ID. Long-term difficulties that resemble ADHD, attention deficit, poor impulse control, serious behavior problems. Persist often to adulthood and carry high treatment costs*Teratogenic*=damage to fetal development.Other teratogens that increase the risk of ID because of their effect on CNS development - viral infections such as rubella, syphilis,Scarlet fever.Tuberculosis of the nervous system,Degenerative diseases of the nerves& Sometimes measles and mumps can lead to ID. ID also can be caused by x-rays, certain drugs taken by the - in essence any biochemical or infectious substance that cannot be destroyed or regulated by the mother´s immune system or regulatory system can pose a risk to fetal development and in turn ID

Causes : Communication disorders

*Genetic connection*=Have more difficulty deciphering certain speech sounds because of subtle but important differences in the way neurons fire in response to various sounds *The brain*: Language functions develop rapidly and are housed primarily in the left temporal lobe or the brain - a circular feedback-loop helps strengthen the developmental process of language reception and expression. Home environment:Parents changed the way they spoke to their children, depending on their children`s abilities-Its unlikely that comm disorders are caused by parents *Treatment* 1)Treatment to promote the child`s language competencies 2)Treatment to adjust the environment in ways that accommodate the child`s needs 3)Therapy with the child or youth to equip him with knowledge and skills to reduce behavioural and emotional symptoms Computer and teacher assisted instruction to teach early language *Childhood-onset fluency disorder*(stuttering)=the repeated and prolonged pronounciation of certain syllables that interferes with communication

Treatments ID Family-oriented strategies and inclusion movement

*Psychosocial treatments*: *Early intervention* Early educational intervention=Consists of systematic efforts to provide high-risk children with supplemental educational experiences before they enter school-the optimal timing for intervention appears to be during the pre-school years *behavioural treatments*: *language training*, language therapist - reinforced for neste bokstav I løpet av ordet. ...Eating, fork - guided by *modelling* and *graduated guidance* -*social skills training*=uses positive reinforcement strategies to teach and reward important interpersonal skills such as smiling, sharing, asking for help, attending, taking turns, following diretions and solving problems *CBT*-most effective for children with some receptive and expressive language skills - verbally describe their own actions - benefit from verbal self-regulation and behavioural inhibition training programs *Self-instructional training*=teaches children to use verbal cues, initially taught by the therapist or teacher to process information, to keep themselves on task *Family-oriented strategies and inclusion movement* Family members need support and guidance, access to necessary services, opportunities for a short caregiving break, goal oriented councelling. Short term, problem-focused behavioural therapy for the parent is one of the most successful approaches. When the child has ID the primary focus on behavior change is skill acquisition rather than reduction of behavior problems *3 critical periods:* 1)*childs infancy and toddlerhood*2)*preschool and school years* 3)*emergence into young adulthood* *Inclusion movement*=gives children with disabilities the option of being educated in regular classroom settings, regardless of the severity of the disability. Downs syndrome - a visually based approach to teach them how to read more effective *Residential care*=out-of home placement=aggressive behavior of the child, or the need for specialized language or social skills training that cannot be provided adequately in the home or regular school setting

ASD - development Genetic influences ASD

*The 2 strongest predictors of adult outcomes: * 1) *ID* 2) *Language development* The diagnosis of ASD is usually made in the preschool period or later- The period from 12 to 18 months seems to be the earliest point in development at which ASD can be reliably detected. Some show abnormal behavior soon after birth, some show seemingly normal development for the first year or longer followed by regression, while others improve sig over time -Very few adults with ASD achieve high levels of independence - most remain quite dependent on their family and other support services, with few friends and no permanent job. Further efforts to address the needs of older individuals with ASD are solely needed. 1-2%--Around 2 years, Different developmental pathwys, Most show gradual improvement of their symptoms with age Problems in early development: -Children with ASD experience more health problems prenatally, at birth or immediately following birth than do other children -*Risk factors*: maternal age, drugs, diabetes, infections during pregnancy *Genetic influences ASD* Associated with chromosomal defects and tuberous sclerosis. Heritable. "the broader autism phenotype" identical twins - 70-90%. ASD is likely to be a complex genetic disorder resulting from both rare mutations and simulatenous genetic variations in multiple genes. Epigenetics. *lack of normal connectivity across brain networks that underlie the core features of ASD**Biological findings*: *Structural abnormalities* in the cerebellum and the medial temporal lobe and related limbic system structures. Structural and functional abnormalities in the *amygdala* of those with ASD(recognizing the emotional sig of a stimuli)*Brain metabolism*: decreased blood flow in the frontal and temporal lobes*Delay in the maturation of the PFC**Default mode network*

ID--comorbidy and behaviour Downs syndrome

-*Mild ID are bright enough to learn and to attend regular schools and classrooms* - *learned helplessness* - *assistance*, *proper instruction* -less likely to urge that child to persist after failure -ID isn't necesarilly a lifelong disorder. Integrated classrooms allow children with ID despite their limited social skills to interact with typically developing peers. Many of them show *emotional disturbance*--Impulse control disorders, anxiety disorders and mood disorders are the most commonly diagnosed psychiatric diagnoses for children with ID.*Internalizing problems* ADHD related symptoms. Pica. *Self-injurious behavior*=serious and sometimes life-treathening problem that affects about 20% young children with ID - head banging,severe scratching *Stereotypies*=frequent repetition of the same posture, -- *life expectancy* approaching 60 years - most who live beyond the age of 40 demonstrate cognitive decline much like alzeimer disease due to gene damage on chromosome 21*Downs syndrome**receptive language better than expressive *form more slowly attachment - strange situation - were not picked up and held to the same extent as non-delayed children* - Mild to moderate ID show much the same development symbolic play - games, puppets, sports - they often fail to gain their peers acceptance.Down syndrome - slowing and stability hypothesis

Comorbidity(conduct problems) Prevalence, gender and course

-Substance use, Risky sex, Premature death(before age 30) - 3-4 times higher in boys with CD Accompanying disorders and symptoms=Most of children with CD suffer from one or more additional disorders, most commonly *ADHD, depression and anxiety*. More than 50% of children with CD also have ADHD. A shared predisposing vulnerability such as impulsivity, poor self-regulation or temperament may lead to both ADHD and CD. *ADHD may be a catalyst for CD*. ADHD may lead to childhood onset of CD. About 50% of youths with conduct problems also receive a diagnosis of depression or anxiety. May be ODD and not CD that best accounts for the connection - driven by the negative mood symptoms of ODD(anger, irritability). Most girls with CD develop a depressive or anxiety disorder by early adulthood and for both sexes, *increasing severity of antisocial behavior is associated with increasing severity of depression and anxiety*. Uncertain relationship between anxiety and antisocial outcomes=*Anxiety related to* shyness, inhibition and fear may protect against conduct problems..*Anxiety associated with* negative emotionality and social avoidance/withdrawal based on a lack of caring about others may increase the child`s risk for conduct problems. *Prevalence, gender and course* ODD is more prevalent than CD during childhood, but by adolescence they occur equally often. Lifetime prevalence for *ODD=12%*, *CD=8%* Gender disparity in conduct problems increases through middle childhood, narrows greatly in early adolescence - due mainly to a rise in covert nonaggressive antisocial behavior in girls and then increases again in late adolescence when boys are at the peak of their delinquent behavior *Boys*=early symptoms of CD: aggression and theft. *girls*=sexual misbehavior, develop relationships antisocial boys, then become pregnant at an earlier age and a display a wide range spectrum of later problems, including anxiety, depression and poor parenting. *Men*=more violent prone, repeated acts of physical violence -Chronic conduct problems=10:1, more transient forms of antisocial behavior: 2:-Conduct problems are one of the most *common* mental disorders in adolescent girls. *Girls*=*indirect forms of relational aggression* such as verbal insults, gossip, tatting, ostracism, - move into adolescence, the function of their aggressive behavior increasingly revolves around group acceptance and affiliation, whereas for boys, aggression remains confrontial. Early menarche - mixed gender school, sex - find rewards and opportunities for antisocial behavior in the company of boys instead of girls. Both early maturing boys and girls - risk for being exposed to peers who may draw them into delinquent behavior

ADHD - Cognitive deficits and Speech and language impairments, etc.

1)*Cognitive deficits* - Deficits in executive functions=underlie the childs capacity for self-regulation functions such as self-awareness, planning, self-monitoring and self-evaluation - include working memory, self directed speech, response inhibition, tolerating frustration. Eksekutiv functions deficits(ASD+conduct disorder)=occur in only about 50% of children with ADHD - problem lies in applying their intelligence inattention has been estimated to account for about a 2-5 points lowering - Impairments in academic functions=most of them experience severe difficulties in school, especially for those with *co-occuring disorders* - for example learning disorders=as many as 45% of children with ADHD have a specific learning disorder - (reading, spelling, math) The cognitive defitcts and intellectual may directly lead to learning problems. *Distorted self-perceptions, Positive bias*. Those who display inattentive and depressive/anxious symptoms tend to report lower self-esteem, whereas those with symptoms of hyperactivity-impulsivity and conduct problems appear to exaggerate their self-worth(self-protective function, *dunning-kruger* -Distortions in their *quality of life* - they rate their quality of life more positively than others rate it *Speech and language impairments*About 30 to 60% of children with ADHD also have impairments in their speech and language. The pragmatic aspects of speech, along with impaired verbal working memory and discourse analysis are primary difficulties *Medical and physical concerns*Health related problems, Accident prone -Demonstrating risk-taking behaviours(substance use disorder,), Asthma, poor fitness, obesity Sleep disturbances, Impulsive behavior is the most sig childhood cha that predicts reduced life expectancy 4)*Social problems* Frequently in conflict. *family problems+peer problems*=Children with ADHD are disliked and uniformly rejected by peers, have few friends and report receiving *low social support* from peers.

Interrelated theories of ADHD Causes - genetic influence

1)*Cognitive functioning deficits* 2)*Reward-motivation deficits* Display an abnormal sensitivity to rewards(higher reward threshold) and usually a heightened sensitivity or an aversion to delay - as a result they have difficulty motivating themselves and performing well when rewards are unavaible or delayed - some research has connected ADHD with disruptions in the *dopamine-reward pathways* of the brain 3)*Arousal level deficits* -Have an abnormal level of arousal - either too high or more commonly too low. Hyperactivity-impulsivity=reflects an underaroused childs effort to maintain an *optimal level of arousal* by excessive self-stimulation - this theory has received some support 4)*Self-regulation deficits*=They have a higher-order deficit in their ability to self-regulate -to use though and language to direct their behavior. *Deficiencies in self-regulation leads to impulsivity*, poor maintenance of effort, poor modulation of arousal level, emotion dysregulation and attraction to immediate rewards - *self-regulatory theories* examine the interplay among cognitive, arousal and reward/motivational processes to understand. No single theory can explain the many difficulties associated with ADHD Current research strongly suggests that ADHD is a neurodevelopmental disorder for which genetic and neurobiological factors plays a central role - however, biological and environmental risk factors together shape the development of behavioural and emotional regulation and the expression of ADHD symptoms over time- complex and chronic disorder *Causes - genetic influence*ADHD runs in families - *60%* among the most heritable of the childhood disorders. *Specific gene studies*:Reduced dopaminergic activity may be related to the behavioural symptoms of ADHD*Multiple genes interacting* *Neurobiological factors*: diff in *skin-condutance, heart-rate, brain activity during vigilance tests*.. differences in *blood flow to the prefrontal regions of the brain* *Pregnancy birth*: maternal stress, alcohol, teratogens....*Brain abnormalities*: Abnormalities primarily in the "frontostriatal circuitry of the brain" - this region consists of the *PFC - basal ganglia - areas associated with attention, executive functions*Effective medication for ADHD - selective deficiency in the avaibility of both dopamine and norepinephrine*Goodness of fit*=the match between the childs early temperament and the parents style of interaction

DSM-5 and ID

1)*Deficits in intellectual function*(confirmed by both clinical assessment and standardized intelligence testing) (reasoning, problem solving, learning from experience - DSM-5 doesn't provide specific IQ cutoff limits) 2)*Deficits in adaptive functioning*(conceptual, social and practical domains) 3)*Onset of intellectual and adaptive deficits during the developmental period*(generally considered to be before age 18) *mild - moderate - severe or profound severity* -*Defined on the basis of adaptive functioning in 3 primary domains: conceptual, social and practicaL*. -Doesn't provide specific IQ cut-off to allow greater focus on adaptive functioning and levels of support that may be required -However, *they generally have an IQ score 2 standard deviations or more below the population mean (70 points or below)* --*The majority of people diagnosed with intellectual disability fall into the mild range* *Prevalence=1%*. More men with mild ID. More prevalent among children of lower SES and children from minority groups.Chromosome abnormalities are the single most common cause of moderate to severe ID. As many as *85%* have the mild form of the disorder. Strategies and services are developed to optimize individual functioning.

Causes conduct problems

1)*Difficult temperament*=first year of life - expressed as fussiness, irritability, irregular sleeping and eating patterns, or fearfulness in response to novel events *Boys*=fussiness *Girls*=fearfulness stronger predictor. Difficult temperament=increase in hyperactivity and impulsivity with growing mobility, weak emotion-regulation skills and a heightened risk for simple forms of oppositional and aggressive behaviors that peak during the preschool years if accompanied by harsh parenting and high levels of stress *Peer rejection* leads to social-cognitive deficits and aggression&Social-cognitive deficits lead to peer rejection and aggression&Aggression leads to peer rejection. Conversely, *better social-cognitive skills* may increase peer acceptance and lower aggressiveness - *Delinquent behaviors*: peak around 17 years, followed by an equally dramatic drop in late adolescence and young adulthood. About 50% of children with early conduct problems do improve - *those who improve*: tend to display less extreme level of early conduct problems, have higher intelligence and SES, fewer delinquent friends, mothers who weren't teenagers when they gave birth and parents with more social skills and fewer mental health problems *Causes conduct problems* *Genetic factors*: Difficult temperament, lack of response to distress in others, impulsivity, a tendency to seek rewards or an insensitivity to punishment that combine to create an antisocial propensity/personality. (GxE)*-MAOA enzyme. Maltreated children with a low-active MAOA genotype are much more likely to develop antisocial behavior than maltreated children who don't have this genotype *Prenatal factors and birth complications*;Low birth weight & Malnutrition during pregnancy*Neurobiological factors:* *Gray: BIS,BAS* *Antisocial patterns Overactive BAS and an under active BIS* - a pattern determined primarily by *genetic predisposition*Children with CD show a *heightened sensitivity to reward - they also fail to respond to punishment(under active BIS)*. Variations in stress-regulating mechanisms, including the *HPA axis*, Autonomic nervous system, Seretonergic functioning, *Structural and functional deficits in PFC* Childen with early onset of aggressive symptoms: *Low cortical arousal* *Low reactivity of the ANS(lower resting heart-rate)* *Social-cognitive abilities*responding to cues etc. *Family factors*: Genetic risk - positive parenting may reduce the influence of the child`s genotype on later antisocial behavior.Family difficulties are related to the development of both ODD and CD*Physical abuse is a strong risk factor* *Shared genetic predisposition* that leads parent and child to display similar behavior patterns. Interventions directed at changing ineffective parenting behaviors are among the most effective methods for reducing children`s conduct problems *Coercion theory*: 4 step, avoid demands. learned noxious behavior.

Different types of ID

1)*Down syndrome 2)*Fragile x-syndrome* 3)*Prader-willi* 4)*Angelman syndromes 5)*Single-gene conditions* Fragile-X syndrome=the most common cause of inherited ID.The gene for fragile x-syndrome known as the FMR-1 gene is located on the X chromosome. Close to 50% meet the criteria for autism Prader-willi syndrome=complex genetic disorder that includes short stature, ID or learning disabilities, incomplete sexual development, low muscle tone and an involuntary urge to eat constantly. Rare. -Angelman syndrome=associated with ID that is usually moderate to severe - behavior characterized by ataxia, jerky movements, hand flapping, seizures and the absence of speech Distinctive features include a large jaw and an open-mouthed expression -Prader-willi and angelman syndromes=Associated with an abnormality of chromosome 15, but they are not considered inherited conditions (these syndromes are believed to be spontaneous genetic birth defects that occur at or near the time of conception) -Single gene conditions=PKU. The cause of PKU is a recessive gene transmitted by typical mendelian mechanisms. Children receive the gene from both parents. Immediately placed on a restricted diet. Inborn errors of metabolism account for 3% to 7% of cases of severe intellectual disability.Pregnancy and delivery are times of greatest susceptibility to trauma, infections, or other complications and account for about 10% of ID

Common co-occuring disorders: .(ADHD)

1)*Oppositional and conduct disorder* 2)*Anxiety disorders* 3)*Mood disorders* 4)*Motor coordination and tic disorders*. *Learning disorders + substance use disorder*are also quite common. Some also display symptoms of *ASD*. About half of them meet criteria for oppositional defiant disorder(ODD) by age 7 or later. Children with ODD overact by lashing out at adults and other kids. They are stubborn, short-tempered, argumentative and defiant. Symptoms: 2 types: 1)*Irritability*=tantrums, crankiness 2)*Defiance*=talking back., argumentativenes. About *30 to 50%* of children with ADHD eventually develop *conduct disorder*(CD) which is more severe than ODD..CD=violate societal rules, associated: illegal drugs - substance use disorder. *ADHD leads to ODD and CD rather than vice versa*. Variations in a specific gene - the *COMT-gene*ADHD is also a risk factor for the later development of antisocial PF. About 25% or more of children with ADHD experience *excessive anxiety* and *depression* 30-50% of children with ADHD display motor coordination difficulties, such as clumsiness, poor performance in sports, or poor handwriting - especially when they attempt to execute complex motor sequences. About 20% of them also have *tic-disorder*= sudden, repetive, nonrhytmic motor movements or sounds such as eye blinking, facial grimacing, throat clearing and grunting

2 common pathways: (CD) Risk factors for antisocial behaviors

1)*The life course persistent(LCP)* path=manifest, latent, 2)*The adolescent limited (AL)* path=less extreme antisocial behavior, less likely to drop out of school and have stronger family ties - their delinquent activity is often related to temporary situational factors, especially peer influences, -model antisocial peers - when access to adult privileges become avaible. Persistence in early adulthood is often the result of snares, or outcomes of antisocial behavior that close the door to getting a good job, pursuing higher education or attracting a supportive partner. (unplanned parenthood, dropping out of school, addiction to drugs/alcohol)Adult antisocial behavior is almost always preceded by antisocial behavior during childhood and adolescence Males are at a higher risk for criminal behavior, work problems and substance abuse, whereas females are more likely to experience depression, suicidual behavior and health problems *Risk factors for antisocial behaviors* 50% heritable - general liability. aggressive +childhood onset...callous-unemotional traits(CU traits) *Child: Genetic risk*, Prenatal and birth complications, Exposure to lead or other toxins, Low arousal and reactivity, PFC, reduced amygdala activity, Blunted emotional and cortisol reactivity(CU-type), insensitivity to stress, fearlessless/low anxiety, *Difficult temperament* , *emotional dysregulation*, *ADHD,* *Insecure/disorganized attachment*, Social-cognitive deficits(hostile attributional bias), Lowered verbal intelligence and verbal deficits *Family*=Antisocial family values, parental antisocial or criminal behavior, maternal depression, parental substance abuse, teen motherhood, single parenthood, family stress, conflict, low SES, low education of mother, Inneffective parenting, Poor supervison and monitoring, Harsh discipline, Inconsistent discipline, Poor comm + problem, low parental involvement, Parental neglect, low parental warmth, parental hostile attributional bias *Peers*=Early peer aggression,, rejection by,,, association with deviant sibblings, peers, bullying *School*Poor academic performance, low aspirations, low motivation *Neigbourhood and community*=Disadvantage and poverty, gang membership, weapon,, *Sociocultural*=Media portrayal of violence, cultural attitudes encourgaging aggression, socialising

Preventive interventions

1)Children who come from mostly middle-class healthy families and who have mild conduct problems are likely to benefit from individual, parent, family and school-based interventions 2)Those who come from highly dysfunctional homes and poor neigbourhoods and who display severe and persistent problems are likely to benefit very little - unless early much more intensive and long-term interventions are used. *Intensive intervention*=good short-term, we don't know long-term. Need for intensive home and school-based interventions. Interactive videotape=Teaching *child-management skills* the program also addresses the associated individual, family and school difficulties that accompany conduct problems. Parents are taught personal self-control strategies for managing anger,depression and blame - ways to strengthen social support. Teachers are taught ways to strengthen positive relationships with students, effective classroom discipline, teaching social skills, anger management, problem solving.........how to increase collaboration with parents. *Programme- high risk children* *Fast track* 5 integrated treatment components: 1)PMT 2)Home visiting/case management 3)Social-cognitive skills training 4)Academic tutoring 5)Teacher-based classroom intervention Fast track interventions were implemented with close collaboration among parents, teachers and project staff --Had significant impact - reducing conduct problems, enhancing the child`s social competence and family relations.Findings supports the efficacy for children at highest intial risk for conduct problems Risk and protective factors

Causes of ID

A genetic or environmental cause is known for almost 2/3 of individuals with moderate to profound ID, wheras the causes are known for only about ¼ of the individuals with mild ID 1)*Organic* group=clear biological basis - usually associated with severe and profound ID2) *Cultural-familial* group=no clear organic basis and are usually associated with mild ID The prime suspects are environmental and situational factors such as *poverty, inadequate child care, poor nutrition and parental psychopathology* Both genetic and environmental factors are implicated in milder forms of ID but in a manner yet to be determined..*4 risk factors - ID* 1)*Biomedical*=chromosomal disorders, single-gene disorders, syndromes, metabolic disorders, cerebral dysgenesis, maternal illness, parental age(all this prenatal) *perinatal*: prematurity, birth-injury, neonatal disorders. *postnatal*: traumatic brain injury, seizure disorders, degenerative disorders 2)*Social*=poverty, maternal malnutrition, domestic violence(prenatal) perinatal: lack of access to prenatal care. postnatal: impaired child-caregiver interaction, lack of adequate stimulation 3)*Behavioural*=parental drug abuse, alcohol use, smoking, immaturity(prenatal) perinatal: parental rejection of caretaking. postnatal: child abuse 4)*Educational*=parental cognitive disability without supports, lack of preparation for parenthood(prenatal) postnatal=delayed diagnosis, impaired parenting --They all interact across time and even across generations.Social and psychological dimensions account for about 15 to 20% of ID - Parental neglect and deviance..A child`s overall adjustment is a function of parental participation, family resources and social supports(environmental side), combined with his level of intellectual functioning, basic temperament and other specific deficits(individual side)its not necessary to focus attention primarily on what the child lacks..... build on the childs existing resources and strengths.....*Drug treatment* *prenatal education* and *screening*-Promotion of proper childcare, especially during the childs first 2 years

Attention-Deficit/Hyperactivity Disorder(ADHD)

ADHD is a neurodevelopmental disorder, because it has an early onset and persistent course , is associated with lasting alterations in neural development, and is often accompanied by subtle delays and problems in language, motor and social development that overlaps with other neurodevelopmental disorders such as autism spectrum disorder and specific learning disorder. *ADHD*=describes children who display persistent age innapropriate symptoms of inattention, hyperactivity and impulsivity that are sufficient to cause impairment in major life activities.They are usually already trying hard- thwarted by their limited self-control. The 2 dimensions are highly correlated but they do predict different behavioural and cognitive impairments and likely have different neural correlates Symptoms of *Inattention* tend to predict academic problems and peer neglect, whereas those of *hyperactivity-impulsivity* tend to predict aggressive behavior and peer-rejection, among other problems. The 2 are closely connected developmentally - attention helps the child regulate behavior, emotions and impulses *Inattention*refers to an inability to sustain attention or stick to tasks or play activities, to remember and follow through on instructions or rules, and to resist distractions - also involves difficulties in planning and organization and in timeliness and problems in staying alert. *Distractability* indicate a deficit in selective attention(children with ADHD are much more likely to be distracted by stimuli that are highly *Salient and appealing* Deficits in *sustained attention* are one of the core features of ADHD. Diff in*Alerting* *Hyperactivity-impulsivity*=involves the *undercontrol* of motor behavior, poor sustained inhibition of behavior, the inability to delay a response or defer gratification, or an inability to inhibit dominant responses in relation to ongoing situational demands. They are conceptually distinct, but usually co-occur*Cognitive impulsivity*=reflected in disorganization, hurried thinking and the need for supervision - valuing the immediate rewards*Behavioural impulsivity* includes impulsively calling out in class or act without considering the cons.Cognitive and behavioural impulsivity (and inattention) predict problems with academic achievement, particularly in reading. Only behavioural impulsivity predicts rule-breaking behavior - conduct problems. Emotional impulsivity=demonstrated by impatience, low frustration tolerance, hot temper, quickness to anger and irratiblity.*..

DSM-5, ASD

ASD=a complex neurodevelopmental disorder characterized *by abnormalities in social communication and unusual behaviours and interests*.Childhood-onset schizophrenia(COS) and ASD may be linked Leo Kanner: objects>people.Preservation of samenes.*Asperger`s disorder*=milder form of autism. Intense interests and lengthy description.The core features of ASD are represented by 2 symptoms domains: 1)*Social communication and social interaction*. 1) *3 symptoms which are all required* a)*Deficits in social-emotional reciprocity*b)*Deficits in non-verbal communication behaviours used for social interaction*c)*Deficits in developing maintaining and understanding relationships* 2)*Restricted, repetive patterns of behavior, interests or activities*. Those who display only deficits in social communication and interaction but not restricted and repetive behaviours would receive a diagnosis of social(pragmatic) communication disorder - type of language disorder *3 critical factors contribute to differences*: 1)*Level of intellectual ability* - ranges from profound disability to above average intelligence 2)*Severity of their language problems* 3)*Behavior changes with age* - some children make little progress, whereas others develop speech or become more outgoing - when sig gains usually done by average/above average intelligence - and acquired speech as a young age

Medical conditions and physical characteristics: Comorbidity ASD

About 10% of children with ASD have a coexisiting medical condition that may play a causal role in their disorder - includes motor and sensory impairments, seizures, immunological and metabolic abnormalities, sleep problems and gastrointensinal symptoms.About 25% experience seizures. Seizure onset usually occurs either in early childhood or more often in late adolescence or early adulthood - with early-onset seizures typically associated with greater ID and poorer outcomes. Sleep disturbance is common - associated with a wide range variety of behavior problems. As many as 90% have a head-size that is above average - around 20% of them top 3%this characteristic is more common in higher-functioning n and distinguishes them from n with ID, language disorder and ADHD Cause of the rapid head growth during first year of life?*Comorbidity ASD*The disorders that most often accompany ASD are ID and epilepsy ADHD, conduct problems, anxieties and fears and mood-problems. Potensially life-threatening self-injurious behaviours 1) head banging, 2)hand or arm biting, 3)excessive scratching and rubbing - head injury, gain attention, self-stimulation-ID, atypical sensory processing, need for sameness, repetive behaviours and impulsitivity are among the strongest risk factors for SIB. ASD=between 1 and 2%. Found in all social classes and has been identified world-wide. 4 to 5 times more common in boys than girls. Among children with ASD and profound ID the number of boys and girls are similar. Girls less likely to be diagnosed-It has been found that girls with ASD engage in more pretend play than do boys(pretense) - brain difference?

Restricted and repetive behaviours and interests. Autistic savants

Characterized by their high frequency, repetition in a fixed manner and desire for sameness in the environment-a common type of repetive speech in children with ASD is echolalia, which is the childs parrot like repetition of words and word combinations that he has heard.perseverative speech=incessant talking about one topic and incessant questioning *2 dimensions of restricted repetive behaviours* 1) *Repetive sensory and motor behaviours* 2) *Insistence on sameness behaviours* *self-stimulatory behaviours*=stereotyped as well as repetive body movements or movements of objects. Hand-flapping or pencil spinning are examples. *Sensory overresponsitivity*=involves a negative(hug) response to or avoidance of sensory stimuli, affective processing - very common that they have abnormalities in sensory - may display deficits such as 1)*sensory dominance*=the tendency to focus on certain types of sensory input over others, for example preference for sight over sounds 2)*stimulus overselectivity*=tendency to focus on one feature of an object/event in the environment while ignoring other equally important features - tunnel vision/tunnel hearing. *Autistic savants* - *about 5%* of children with ASD develop an isolated and often remarkable talent that far exceeds normally developing children of the same age - these children, referred to autistic savants=*display supernormal abilities in calculation, memory, jigsaw puzzles, music or drawing*Superior performance has been seen as a side-effect of abnormal brain functioning, rather than as a reflection of genuine intelligence *segment* information into parts rather than looking at the whole, which leads to exceptional performance in certain domains. In most cases unfortunately the skills aren't used constructively to enhance everyday living

Core deficits ASD - social interaction deficits

Children with ASD experience profound difficulties in relating to other people even when they have average or above-average intelligence -May also display difficulties in make-believe play. Their lack of understanding of people as social partners may lead to their treating people as objects-Children with ASD display atypical processing of faces and facial expressions. Deficits in recognizing facial expressions of emotions, particularly in detecting fear - they don't look at the eyes as others .....less generalized or narrower face detection system, which may also contribute to their reduced social interest. Children with ASD displays impairments in *Joint attention* which is the ability to coordinate attention to a social partner and an object/event of mutual interest.When lower rates of secure *attachment* are found, its usually in children with lower intellectual ability and greater ASD severity The quality of infant-mother attachment in young children with ASD contributes substantially to the development of the childs play behavior, which is important for the development of social skills *Social communication deficits*As many as half of all children with ASD don't develop useful language. Almost all show delays in their language development -lack of sponatenity, rhytm and intonation of their speech is often unusual - their lack of social chatter - their failure to use language for social communication. These children display profound impairments in *pragmatics* which is the appropriate use of language in social and communitive contexts. It has been suggested that the common element underlying all the communication deficits in ASD is a general failure to understand that language can be used to inform and influence other people...

Conduct problems 2 dimensions of antisocial behavior:

Conduct problem(s) and antisocial behavior(s) are terms used to describe a wide range of age-innapropriate actions and attitudes of a child that violate family expectations, societal norms and the personal or property rights of others. *They experience problems in controlling their emotions and behaviors*. Children with severe conduct problems frequently grow up in *extremely unfortunate family and neighbourhood circumstances*, where they experience *physical abuse, neglect, poverty or exposure to criminal activity* - thus in many cases, aggressive behaviors are an adaption to home and neighbourhood violence and neglect. *Antisocial behaviours appear and then decline during normal development--vary in severity*, from minor disobedience to fighting, more common in boys than in girls during childhood, but this difference narrows in adolescence.*Children who are the most physically aggressive in early childhood maintain their relative standing over time* *externalizing dimension* itself consist of 2 related but independent subdimensions: 1. "rule breaking behavior"=setting fires, stealing 2. "aggressive behavior" =fighting, destructiveness, disobedience, threatemimg others, *2 dimensions of antisocial behavior:* 1)*overt-covert* 2)*destructive-nondestructive*. Covert=hidden acts such as lying or stealing. Overt=fighting. Those displaying *covert* antisocial behavior are less social, more anxious and more suspicious of others and come from homes that provide little family support. Children who display *overt* antisocial behavior=irritable, negative, resentful in their reactions to hostile situations and to experience higher levels of family conflict. Most children with *conduct problems* display both covert and overt behaviors. *Destructive*=cruelty to animals or physical assault. *Nondestructive*=arguing or irritability.Crossing the 2 dimensions: 4 categories of conduct problems A)*Covert-destructive*, or property violations B)*Overt-destructive*, or aggression C)*Covert-nondestructive*, or status violations D)*Overt-nondestructive*, or oppositional behavior. Children who display overt-destructive behaviours, particularly persistent physical fighting are at especially high risk for later psychiatric problems and impairment in functioning *Disruptive behavior disorders*=Oppositional defiant disorder(ODD)+Conduct disorder(CD)

intellectual disability - ID

Generalized neurodevelopmental disorder characterized by sig impaired intellectual and adaptive functioning. It is defined by an IQ score under 70 in addition to deficits in two or more adaptive behaviors that affect everyday, general living. *The 3 essential elements defining this condition*: 1)*Intellectual limitations* 2)*Deficits in adaptive skills* 3)*Early onset* ..Adaptive functioning/behavior=Refers to how effectively individuals cope with ordinary life demands, and how capable they are of living independently and abiding by community standards- *3 major categories of adaptive behavior* - conceptual, social and practical adaptive skills) 1)*Conceptual skills*=receptive and expressive language, reading and writing, money concepts, self-directions 2)*Social skills*: interpersonal, responsibility, self-esteem, gullibility, naivete, 3)*Practical skills*: personal activities of daily living such as eating, dressing, mobility 4)Occupational skills=maintaining a safe environment-adaptive behavior assessment system

Treatment conduct problems

Group treatments that bring together antisocial youth may only make the problem worse -The more progessed the antisocial behavior, the greater is the need for intensive interventions - and the poorer is the prognosis. If early onset antisocial behavior is not changed by the end of grade 3, it might be best treated as a chronic condition, which cannot be cured but can be managed or contained through ongoing interventions and supports. High costs, growing emphatis on early intervention and prevention 1)*Early intervention/prevention programs for young children at risk for or just starting to display problem behavior* 2)*Ongoing interventions to help older youths and their families cope with the many associated social, emotional and academic problems* *Effective treatments for children with conduct problems* 1)*Parent-management training(PMT)*=Teaches parents to change their childs behavior in the home and in other settings using contingency management techniques. The focus is on improving parent-child interactions and enhancing other parenting skills(parent-child communication, monitoring and supervision) 2)*Problem-solving skills training(PSST)*=identifies the childs cognitive deficiencies and distortions in social situations and provides instruction, practice and feedback to teach new ways of handling social situations. The child learns to appraise the situation, change his attributions about other childrens motivations, be more sensitive to how other children feel, and generate alternative and more appropriate solutions 3)*Multisystemic therapy(MST)*=an intensive approach that draws on other techniques such as PMT, PSST and marital therapy, as well as specialized interventions such as special education, and referral to substance abuse treatment programs or legal services.

Multisystemic therapy(MST)

MST is an intensive empirically supported family and community-based treatment for adolescents with severe conduct problems that make out-of-home placement highly likely. *Interconnected system* - transactions between the systems - Bronfenbrenner. Treatment is carried out with all family members, school personnel, peers, juvenile justice staff and other individuals in the childs life. Attempts to address the many determinants of severe antisocial behavior -Has been found to reduce long-term rates of criminal behavior, Cost-effective Possible that parts of its success may be in helping youths on the adolescent-limited path *The 9 principles on multisystemic therapy(MST):* 1)*Finding the fit* 2)*Positive and strength focused* 3)*Increasing responsibility* 4)*Present-focused, action-oriented and well-defined* 5)*Targeting sequences* 6)*Developmentally appropriate* 7)*Continuous effort(require daily/weekly effort by family members)* 8)*Evaluation and accountability* 9)*Generalization(long-term maintenance)*

Causes and treatments for COS:

Neurodevelopmental model of schizophrenia=In which a *genetic vulnerability* and *early neurodevelopmental insults* result in impaired connections between many brain regions, including the cerebral cortex, white matter, hippocampus, cerebellum and parts of the limbic system *Biological factors*:Heritability estimated around 80%- COS is best represented by a continuum of risk involving *many GxE interactions* -Its possible that most affected n with COS have a unique genetic cause. Brain scan studies: enlarged ventricles and a shrinkage in brain gray matter that spreads across the brain during adolescence *Communication deviance* *Treatment* COS is a *chronic disorder* with a *poor long-term outcome* for most sufferers, although some youngsters may display more positive outcomes. Current treatments emphatize the use of *antipsychotic medications*(clozapine) combined with *psychotherapeutic and social and educational support programs* The majority of them will spend much of their life on some medication. Medications help control psychotic symptoms in children with schizophrenia by *blocking dopamine transmission at the D2 dopamine receptor* - side effects -There is also a need for psychosocial treatments, such as family intervention, social skills training and CBT *Prevention framework*-interventions for high-risk younger individuals well before the onset of psychotic symptoms - can be effective in reducing the risk of transition to full-blown psychosis over the short term but over the long term may only delay transition to psychosis....

Treatment of ASD

No known cure.*GOAL*=minimize the core problems of ASD, maximize the child`s independence, quality of life and help the child and family cope more effectively. *Developmentally oriented*, early behavioural interventions that involve parents, special educational methods*. Gains in language, communication and measured IQ. Educational interventions and speech and *language therapy* are commonly used. For some children *antipsychotic* medications may help to decrease physical aggression and repetive behaviours(side effects.):Building rapport and teaching the child learning-readiness skills. *Discrete trial training*(stimuli - response) *incidential training*(naturally occuring).Reducing disruptive behavior: tantrums -ignoring the behavior and mild forms of punishment a)Teaching appropriate social behavior:Taught ways to express affection through smiling, hugging etc - return the affection they receive from others -Teaching *social pretend play* and specific social skills such as intiating and maintaining interactions - teaching normal or mildly handicapped peers to interact with them *b)*Teaching appropriate communication skills:*Operant speech training* =step by step approach. teaching the child to use language more spontaneously and more functionally in everyday life situations. C) Executive function intervention: CB strategies to reduce insistence on sameness and to teach flexible goal setting and planning. Early intervention= plasticity. Whenever possible intensive interventions for children with ASD begin *before the age of 3.**Effective intervention ASD The UCLA young autism project* *Early and intensive*=active engagement of the child* at least 25 hours a week, 12 months a year in systematically planned, developmentally appropriate educational activities with specific objectives*Low student-teacher ratio*, *High structure, Family inclusion, Peer interactions* -*Generalization*=teach child to apply learned skills in new settings and situations and to maintain the use of these skills ---Ongoing assessment UCLA-Evidence-based treatment for ASDUses *rewards and punishment(applied behavior analysis)**Parents are taught to act as the primary therapists for their children*Claims have been made that some children with ASD can achieve normal functioning if given intensive intervention *before age 3* uncertain.Medications benefits are limited

ODD Different types of conduct disorder.

ODD=display an age-innapropriate recurrent pattern of stubborn, hostile, disobedient and defiant behaviors. ODD usually appears by *age 8* Can have extemelly negative affect on *parent-child interactions*Children with ODD are also at considerable risk for developing later impulse control, substance-use and mood and anxiety disorders. Social : difficult peer relationships and romantic relations. ODD can be grouped into 3 dimensions* 1)*Negative affect*(angry/irritable mood) 2)*Defiance*(defiant/head strong behavior) 3)*Hurtful behavior*(vindictiveness) Which differently predict later emotional and behavioral disorders One study*Negative affectivity*=predicted depression*Defiance*=behavior disorders -*Vindictiveness*=callous and unemotional *All 3 dimensions of ODD are highly correlated* - *The hurtful behavior dimension* may be more related to the severe conduct problems of CD than to ODD.---Most clinic refered children with ODD have moderate-severe dimension of it *Conduct disorder(CD) + different types* Children with CD display a repetive and persistent pattern of severely aggressive and antisocial acts that involve inflicting pain on others or interfering with the rights of others through physical and verbal aggression, stealing or vandalism *4 dimensions* 1)*Aggression to people and animals* 2)*Destruction of property* 3)*Deceitfulness or theft* 4)*Serious violations of rules*. Children with CD often have co-occuring problems such as ADHD, academic deficiencies and poor relations with peers.Their families often use child-rearing practices such as harsh punishment, that contribute to the problem and often have their own problem and stresses (psychiatric problems, unemployment).Their parents feel these children are out of control and they feel helpless to do anything about it.. 1)*Childhood-onset conduct disorder*=display at least one symptom of the disorder before age 10. More likely to be boys, show more aggressive symptoms+++ PERSIST in their antisocial behavior over time 2)*Adolescent-onset conduct disorder*=they don't. just as likely to be girls, do not display the severity of the childhood ... less likely to persist in their antisocial behavior... Age at onset does make a difference.

Parent management training (PMT) Educational intervention - summer treatment programs

PMT focuses on teaching both effective parenting practices and strategies for coping with the challenges of parenting a child with ADHD. It provides parents with a variety of skills to help them: Manage their childs oppositional and noncompliant behaviours, cope with the emotional demands of raising a child with ADHD, contain the problem so that it doesn't worsen*, keep the problem from adversely affecting other family members*. *First: Taught about the disorder*Given a set of *guiding principles. Using more immediate, frequent and powerful cons, striving for consistency, planning ahead. Not personalizing the childs problems, *Practicing forgiveness* *Next* they are though behavior management principles and techniques. *identify behaviours* they wish to encourage or discourage. using rewards and sanctions, *establish home-token program* ,noticing what their child does well and *prasing* their child`s strengths and accomplishments. *disruptive behaviours* - penalties such as loss of privileges., sharing enjoyable activity with their child. In PMT parents also learn to reduce their own level of arousal through relaxation, meditations or excersise. - reduced arousal or anger allows parents to *respond more calmly to their child`s behavior* *Stimulants versus PMT*. The effects of stimulants appear to be as strong/stronger than PMT in treating the primary symptoms of ADHD - may provide additional therapeutic effects by treating associated problem. PMT has focused mainly on teaching parents to manage the overt disruptive behaviours that ... rather than on changing the defictis underlying the childs ADHD. *Educational interventions- capitalize on strengts, managing iinattentive + hyper that interfere with learning. Techniques for managing classroom behaviours; the teacher and the child set *realistic goals and objectives* - set up *mutually agreed upon reward system*, *carefully monitor performance*, and *reward the child for meeting goals**Disruptive or off-task classroombehaviours* may be punished with response-cost procedures that involve the loss of privileges, activiites, points tokens. *Summer treatment programs:* 1)*Maximizes opportunities* to build effective peer relations in normal settings 2)*provides continuity to academic work* to ensure that gains aren't lost. These programs are coordinated with stimulant medication trials, parent management training, social skills training and educational interventions *The MTA study*=*stimulant medications was superior to behavioural treatment(PMT+intensive 8 week summer-treatment program)* *Combined treatment*: behavioural treatment+medication was best - the effects of both medication and behavioural treatments either decline or cease entirely, when the treatment stops. These treatments continue to be provided in a comprehensive, carefully monitored and ongoing fashion *Uncomplicated ADHD*=medication management*Complicated ADHD*=combining medication and behavioral treatment may be the best option*Family counceling and support groups:*

Parent management training(PMT) Problem-solving skills training(PSST)

PMT teaches parents to change their child`s behavior at home and in other settings. Its underlying assumption is that maladaptive parent-child interactions are at least partly responsible for producing and sustaining the child`s antisocial behavior - changing the way parents interact with their child will lead to improvements in the child`s behavior. The goal of PMT is to learn them new skills:Teaching them how to monitor their children`s behavior, to present clear commands and rules, and to systematically provide rewards and minor forms of punishment such as time out from positive reinforcement-Many forms of PMT(group/individual, videotaped training material). Demonstrated short-term effectiveness in producing changes in parent and child behavior - associated with reduced stress and depression in parents + reductions in the problem behaviors of siblings - its long-term effects is less clear. -PMT has been most effective with parents of children *younger than 12 years* and less so with adolescence. PMT makes numerous demands on parents to master and implement procedures in the home, attend meetings and maintain phone contact with the therapist. - few resources and stress, families.Increase engagement in low-income families=smart phone versions of PMT - skills videos, brief daily surveys... Parents of children with conduct problems frequently believe they use good parenting practices but their child fails to respond - challenge these beliefs *Problem-solving skills training(PSST)* PSST is a form of CBT that focuses on the cognitive deficiencies and distortions displayed by children... in interpersonal situations. Is used both alone and in combination with PMT. During PSST the therapist uses instruction, practice and feedback to help the child discover different ways to handle social situations Cognitive problem solving steps: Problem situation: Step1: what am I supposed to do? Step2: I have to look at all my possibilities 3: concentrate and focus 4:need to make a choice 5: I did a good job or I made a mistake --Research supports the emphatis on the relationship between maladaptive cognitions and aggressive behavior on which PSST is based *3 social-cognitive processes: * 1)*Reducing hostile attributional bias* 2)*Increasing competent response generation to social problems* 3)*Devaluing aggression*

Prevalence and facts Possible developmental pathway for ADHD

Prevalence:; around *5%* Occurs more frequently in *boys*Affects children from all classes - low family income is associated with increased likelihood of ADHD. Varying cultural norms. Some children with ADHD either outgrow their disorder or learn to cope with it, particularly those with mild ADHD and without conduct or oppositional problems(less severe, good care, supervision, support from parents and teachers, educational, access)Unfortunately most children with ADHD will continue to experience problems, leading to a lifelong pattern of suffering and disappointment. Adults with ADHD are restless, easily bored and constantly seeking novelty and excitement: may experience work difficulties, impaired social relations and suffer from depression, low self-concept, substance abuse and personality disorder. *Possible developmental pathway for ADHD* 1)Genetic risk for ADHD 2)Prenatal alcohol or tobacco exposure, pregnancy complications 3)Disturbances in dopamine transmission - abnormalities in the frontal lobes and basal ganglia 4)Failure to adequately suppress innapropriate responses 5)Cognitive deficits in working memory, self-regulation, self-directed speech 6)Behavioural symptoms of inattention, hyperactivity, impulsivity 7)Impairments in social and academic development 8)Disruptions in parenting 9)Oppositonal and conduct disorder symptoms

Variations in ID and IQ

Proper environmental circumstances will help children reach their fullest potensial - Infancy through early childhood-because of the young childs rapid brain development and responses to environmental stimulation -For some IQ can and does change by 10 to 20 points between childhood and adolescence - healthy environments, reach their full potensial *ID* encompass perhaps the widest variation in cognitive and behavioural abilities of any childhood disorder. With proper assistance, children with mild intellectual impairments can carry out their daily routines much like other children - they can attend a regular classroom, adjust to the demands of physical and intellectual challenges and develop meaningful and lasting relationships with peers and adults. Others who have more severe impairments will require greater daily supervision and care throughout their childhood and sometimes into early adulthood. Most obvious difficulties are learning to communicate effectively, due to their limited speech and language skills.Problems developing friendships with other children. Many cognitive abilities such as language and problem solving are affected, therefore most children with ID have difficulty with some aspects of learning -Persons with *moderate* intellectual disability constitute about 10% of individuals with ID - usually identified during the preschool years , when they show delays in reaching early developmental milestones - many people with *downs* function at the moderate level of impairment - because their social judgement and descision-making abilities are limited they often require supportive services to function on a daily basis..Those with severe ID around 4%. Most of these n suffer one or more *organic* causes of impairment, such as genetic defects and require some special assistance throughout their lives. Profound ID around 2% - marked delays in development and assymetrical facial features, require lifelong care and assistance

Childhood-onset schizophrenia(COS)

Schizophrenia is a neurodevelopmental disorder of the brain that is expressed in abnormal mental functions and disturbed behavior. Its characterized by*severe psychotic symptoms, bizarre delusions(false beliefs), halluciantions(falce perceptions), though disturbance, grossly disorganized behavior, catatonic behavior(motor dysfunctions ranging from wild agitation to immobility), extremely innapropriate/flat affect, significant detoration or impairment in functioning* *COS* is a progressive neurodevelopmental disorder that causes sig distress and disability. COS is a rare and possibly more severe form of schizophrenia* that has an onset prior to age 18 and worse long-term outcomes. Some overlap in symptoms, susceptibility genes and social-cogntitive patterns in children with ASD and those with COS. Clinically those with COS have a later age at onset of their problems, less intellectual impairment, less severe social and language deficits, less ritualistic and repetive behaviors, hallucinations and delusions as the child gets older and periods of remission and relapse....COS has a gradual rather than a sudden onset in childhood. When the disorder is present in childhood, the symptoms likely will persist into adolescence and adulthood.- COS has a profound negative impact on the child`s developing social and academic competence....Sometimes difficult to dinstinguish between pathological symptoms, such as delusions and the rich imaginative fantasies typical of many children - may not see their psychotic symptoms as distressing or disorganizing. 2 categories: 1)*Positive symptoms*: psychotic or active symptoms - involve excesses or disturbances in normal functioning, such as delusions or hallucinations 2)*Negative symptoms*: involve a loss in normal functioning, for example, disturbances in sleep patterns........ The most common presenting symptom for children with COS is *auditory hallucinations*onset prior 11 years: 80%. About 50% also experience visual hallucinations. Negative symptoms: may include slowed thinking, speech and movement, emotional apathy, lack of drive. One study found that COS is preceded by ASD in 30 to 50% of cases.Both displays deficits in ToM and mirror-neuron impairmentPrevalence: COS=1/10.000 - SCHIZO occus at least 100 times more often in adultsCOS has an earlier age of onset in boys than in girls - this sex difference disappears in adolescence.For adults the rates of sh... are higher in lower SES

Specific learning disorder

Substantially below=at least 1.5 sd below average for their age and sex - below the 7 percentile. (reading, writing, spelling, math). A single gap in the brains functioning can disrupt many types of cognitive activity. Secondary problems can emerge(temper outburst, withdrawal from social situations - frustration and lack of success) Intellectually capable of learning key academic concepts of reading, writing and math, but seems unable to do so(not due to ID or global developmental delay) Borderline-to-low-average range*Emotional problems* are often seen in children who are bright enough to recognize that their performance is below that of others - and are frustrated with their poor performance at school. Can affect every aspect of their formal education as well as their interpersonal abilities*SLD* with *impairment in reading,spelling and math*. *Parents important-positive feedback *Phonological skills* - the most common underlying feature of a reading disorder is an inability to dinstinguish or to separate the sounds in spoken words*Dyslexia*=the core deficits stem from problems in decoding - breaking a word into parts rapidly enough to read the whole word - coupled with difficulty reading single small words. 2)Impairment in written expression: Spelling errors or poor handwriting that don't sig interfere with daily activities or academic pursuit...3)impairment in mathematics: Estimates of SLD across all 3 domains range from 5% to 15% among school-aged children Mathematics and writing disorders overlap considerably with reading disorders. Although SLD overlaps with behavioural disorders, they are distinct problems. Impairments are considered lifelong, although the course varies based on severity and avaible supports.SLD is associated withlower academic achievement, higher school-drop out rates, poor overall mental health and well being and lower employment and income..SLD are more likely to show internalizing problems such as anxiety and mood disorders : 2 types of children with reading disorders1)Persistently poor readers 2)Accuracy improved readers(compensate, cognitive ability)Heritability accounts for 60% of the variance in reading disorders - more likely what is inherited is a subtle brain dysfunction that in turn can lead to a learning disorder. Training children in *phonological awareness* activities at an early age may prevent subsequent reading problems among children at risk - games of listening, rhyming, identifying sentences and words. *The inclusion movement*, direct behavioural instruction, simple and gradual approach, CBT:self control, self-monitoring, self-assessment, self-management of reinforcement (Computer assisted learning)

The ODD and the CD connection + CU + Antisocial

Symptoms of ODD typically emerge *2-3 years before* CD symptoms, at about 6 years of age for ODD and 9 years for CD. *Possible that ODD is a presecutor for CD* but nearly 50% of all children with CD have no prior ODD-diagnosis and most children who display ODD don't progress to more severe CD. ODD is a *strong risk factor* for CD, but they appear to be distinguishable yet highly correlated aspects of child psychopathology. *Persistent aggressive behavior* and *CD* in childhood may be a precursor of adult antisocial personality disorder*(APD)*=a pervasive pattern of disregard for, and violation of the rights of others, including repeated illegal behaviors, deceitfulness, failure to plan ahead, repeated physical fights or assaults, reckless disregard for the safety of self or others, repeated failure to sustain work behavior or honor financial obligations and a lack of remorse. *40% of children with CD develop APD as young adults* Adolescent with APD may also display psychopathic features - which are defined as pattern of callous, manipulative, deceitful and remorseless behavior*Callous and unemotional (CU)* interpersonal style=characterized by an absence of guilt, lack of empathy, uncaring attitudes, shallow or deficient emotional responses and related traits of narcissism and impulsivity. CU traits in childhood and early adolescence are likely precursors of adult forms of psychopathy. *Limited prosocial emotions*(callous-unemotional)A subgroup if children with CD display psychopathic features including callous-unemotional (CU) traits

ADHD - Treatment Early detection+drugs

The primary treatment approach combines stimulant medication, parent management training and educational intervention *Primary treatments* 1)*Stimulant medication*=managing ADHD symptoms at school and home 2)*Parent management training*=managing disruptive child behavior at home, reducing parent-child conflict and promoting prosocial and self-regulating behaviours 3)*Educational intervention*=managaging disruptive classroom behavior, improving academic performance, teaching prosocial and self-regulating behaviours Intensive treatment = Summer treatment programs=enhancing present adjustment at home and future success at school by combining many of the primary and additional treatments in an intensive summer treatment program *Additional treatments*: 1)*Family counceling*=coping with individual and family stresses associated with ADHD, including mood disturbance and marital strain 2)*Support groups*=connecting adults with other parents of children with ADHD, sharing information and experiences about common concerns, and providing emotional support 3)*Individual counceling*=providing a supportive relationship in which the youth can discuss personal concerns and feelings *Early detection+drugs (ADHD)*Focused intervention for specific ADHD core deficits - working memory, inattention, self control and so on* *Stimulant drug - Ritalin*=a *stimulant altering activity in the frontostriatal region of the brain by affecting neurotransmitters(dopamine) important to this region*For about *80%* of children with ADHD stimulants produce dramatic increases in: sustained attention, impulse control, persistence of work effort, decreases in task-irrelevant activity and noisy and disruptive behaviours. Stimulants may also improve *academic productivity, cooperation and social interactions* Side effects, temporary effects.

Communication and Learning Disorders

These disorders usually affect only certain limited aspects of learning and rarely are they severe enough to impair the pursuit of a normal life, but they can be very stressful. *Communication disorders*=diagnosed primarily in early childhood. *Learning disorders*=identified most often during early school years- They have *interconnected features and underlying causes*. Preschoolers with communication disorders are more likely to develop a learning disability by middle childhood or early adolescence. Learning disability(LD) is still commonly used as a general term for learning problems that occur in the absence of other obvious conditions, such as ID or brain damage LD affects how n with normal/above average intelligence take in, retain or express information. The main characteristic all children with LD share is failing to perform at their expected level in school, otherwise symptoms vary tremendously. Learning disability is a lay term(not a diagnostic term) that refers to significant problems in mastering one or more of the following skills: listening, speaking, reading, writing, reasoning or mathematics *Specific learning disorder* =diagnostic term that refers to specific problems in learning and using academic skills. Unexpected discrepancy=between measured ability and actual performance