FAP5-Lecture-Ch14 - Chapter 14 Disorders of Childhood and...

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Unformatted text preview: Chapter 14 Disorders of Childhood and Adolescence Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Slides & Handouts by Karen Clay Rhines, Ph.D. 1 Disorders of Childhood and Adolescence Abnormal functioning can occur at any time in life Some patterns of abnormality, however, are more likely to emerge during particular periods Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 2 Childhood and Adolescence People often think of childhood as a carefree and happy time yet it can also be frightening and upsetting Children of all cultures typically experience at least some emotional and behavioral problems as they encounter new people and situations Surveys indicate that worry is a common experience Bedwetting, nightmares, and temper tantrums are other problems experienced by many children 3 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Childhood and Adolescence Adolescence can also be a difficult period Physical and sexual changes, social and academic pressures, personal doubts, and temptation cause many teenagers to feel anxious, confused, and depressed Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 4 Childhood and Adolescence Along with these common psychological difficulties, at least onefifth of all children and adolescents in North America also experience a diagnosable psychological disorder Boys with disorders outnumber girls with disorders, even though most of the adult psychological disorders are more common in women 5 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Childhood and Adolescence Certain disorders of children childhood anxiety disorders and childhood depression have adult counterparts In contrast, other childhood disorders conduct disorders, ADHD, and elimination disorders, for example usually disappear or radically change form by adulthood There also are disorders that begin in birth or childhood and persist in stable forms into adult life These include pervasive developmental disorders and mental retardation 6 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Oppositional Defiant Disorder and Conduct Disorder Children consistently displaying extreme hostility and defiance may qualify for a diagnosis of oppositional defiant disorder This disorder is characterized by repeated arguments with adults, loss of temper, anger, and resentment Children with this disorder ignore adult requests and rules, try to annoy people, and blame others for their mistakes and problems Approximately 8% of children qualify for this diagnosis The disorder is more common in boys than girls before puberty but equal in both sexes after puberty 7 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Oppositional Defiant Disorder and Conduct Disorder Children with conduct disorder, a more severe problem, repeatedly violate the basic rights of others They are often aggressive and may be physically cruel and violent Many steal from, threaten, or harm their victims, committing such crimes as shoplifting, vandalism, mugging, and armed robbery Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 8 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 9 Oppositional Defiant Disorder and Conduct Disorder Conduct disorder usually begins between 7 and 15 years of age Around 10% of children, threequarters of them boys, qualify for this diagnosis Children with a mild conduct disorder may improve over time, but severe cases frequently continue into adulthood These cases may turn into antisocial personality disorder or other psychological problems 10 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Oppositional Defiant Disorder and Conduct Disorder More than onethird of boys and onehalf of girls with conduct disorder also display attentiondeficit/hyperactivity disorder (ADHD) In most cases, ADHD is believed to precede and help cause the conduct disorder Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 11 Oppositional Defiant Disorder and Conduct Disorder Many clinical theorists believe that there are actually several kinds of conduct disorder One team distinguishes four patterns: Overtdestructive Overtnondestructive Covertdestructive Covertnondestructive Some individuals display only one of these patterns, while others display a combination of them It may be that the different patterns have different causes 12 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Oppositional Defiant Disorder and Conduct Disorder Other researchers distinguish yet another pattern of aggression found in certain cases of conduct disorder relational aggression in which individuals are socially isolated and primarily display social misdeeds Relational aggression is more common in girls than boys Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 13 Oppositional Defiant Disorder and Conduct Disorder Many children with conduct disorder are suspended from school, placed in foster homes, or incarcerated When children between the ages of 8 and 18 break the law, the legal system often labels them juvenile delinquents Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 14 What Are the Causes of Conduct Disorder? Cases of conduct disorder have been linked to genetic and biological factors, drug abuse, poverty, traumatic events, and exposure to violent peers or community violence They have most often been tied to troubled parentchild relationships, inadequate parenting, family conflict, marital conflict, and family hostility 15 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 How Do Clinicians Treat Conduct Disorder? Because disruptive behavior patterns become more locked in with age, treatments for conduct disorder are generally most effective with children younger than 13 A number of interventions have been developed but no one of them alone is the answer for this difficult problem Given that conduct disorder affects all spheres of a child's life, today's clinicians are increasingly combining several approaches into a wideranging treatment program 16 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 How Do Clinicians Treat Conduct Disorder? Sociocultural Treatments Given the importance of family factors in conduct disorder, therapists often use family interventions One such approach is called parentchild interaction therapy When children reach school age, therapists often use a family intervention called parent management training These treatments often have achieved a measure of success 17 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 How Do Clinicians Treat Conduct Disorder? Sociocultural Treatments Other sociocultural approaches, such as residential treatment in the community and programs at school, have also helped some children improve One such approach is treatment foster care In contrast to these other approaches, institutionalization in "juvenile training centers" has not met with much success and may, in fact, strengthen delinquent behavior 18 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 How Do Clinicians Treat Conduct Disorder? ChildFocused Treatments Treatments that focus primarily on the child with conduct disorder, particularly cognitivebehavioral interventions, have achieved some success in recent years In problemsolving skills training, therapists combine modeling, practice, roleplaying, and systematic rewards Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 19 How Do Clinicians Treat Conduct Disorder? ChildFocused Treatments Another childfocused approach, the Anger Coping and Coping Power Program, has children participate in group sessions that teach them to manage anger more effectively Studies indicate that these approaches do reduce aggressive behaviors and prevent substance use in adolescence Recently, drug therapy also has been used 20 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 How Do Clinicians Treat Conduct Disorder? Prevention It may be that the greatest hope for reducing the problem of conduct disorder lies in prevention programs that begin in early childhood These programs try to change unfavorable social conditions before a conduct disorder is able to develop Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 21 AttentionDeficit/ Hyperactivity Disorder Children who display attention deficit/hyperactivity disorder (ADHD) have great difficulty attending to tasks or behave overactively and impulsively, or both The primary symptoms of ADHD may feed into one another, but often one of the symptoms stands out more than the other 22 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 23 AttentionDeficit/ Hyperactivity Disorder Problems common to the disorder: Learning or communication problems Poor school performance Difficulty interacting with other children Misbehavior, often serious Mood or anxiety problems Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 24 AttentionDeficit/ Hyperactivity Disorder Around 5% of schoolchildren display ADHD, as many as 90% of them boys The disorder usually persists through childhood but many children show a lessening of symptoms as they move into adolescence As many as 60% continue to have ADHD as adults Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 25 What Are the Causes of ADHD? Clinicians generally consider ADHD to have several interacting causes, including: Biological causes, particularly abnormal dopamine activity High levels of stress Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 26 What Are the Causes of ADHD? Sociocultural theorists also point out that ADHD symptoms and a diagnosis of ADHD may themselves create interpersonal problems and produce additional symptoms in the child Two other explanations have received considerable press but have not been supported: ADHD is typically caused by sugar or food additives ADHD results from environmental toxins such as 27 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 lead How Do Clinicians Assess ADHD? ADHD is a difficult disorder to assess Ideally, the child's behavior should be observed in several environmental settings because symptoms must be present across multiple settings to meet DSMIVTR's criteria It also is important to obtain reports of the child's symptoms from their parents and teachers Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 28 How Is ADHD Treated? There is heated disagreement about the most effective treatment for ADHD The most common approach has been the use of stimulant drugs such as methylphenidate (Ritalin) These drugs have a quieting effect on most children with ADHD and sometimes increase their ability to solve problems, perform in school, and control aggression However, some clinicians worry about the possible longterm effects of the drugs 29 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 How Is ADHD Treated? Behavioral therapy is also applied widely in cases of ADHD Parents and teachers learn how to apply operant conditioning techniques to change behavior These treatments have often been helpful, especially when combined with drug therapy Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 30 The Sociocultural Landscape: ADHD and Race Race seems to come into play with regard to ADHD A number of studies indicate that African American and Hispanic American children with significant attention and activity problems are less likely than white American children to be assessed for ADHD, receive an ADHD diagnosis, or undergo treatment for the disorder Those who do receive a diagnosis are less likely than white children to be treated with the interventions that seem to be of most help Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 31 The Sociocultural Landscape: ADHD and Race In part, racial differences in diagnosis and treatment are tied to economic factors A growing number of clinical theorists further believe that social bias and stereotyping may contribute to the racial differences seen in diagnosis and treatment Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 32 The Sociocultural Landscape: ADHD and Race While many of today's clinical theorists correctly alert us that ADHD may be generally overdiagnosed and overtreated, it is important that they also recognize that children from certain segments of society may, in fact, be underdiagnosed and undertreated Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 33 Elimination Disorders Children with elimination disorders repeatedly urinate or pass feces in their clothes, in bed, or on the floor They have already reached an age at which they are expected to control these bodily functions These symptoms are not caused by physical illness 34 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Enuresis Enuresis is repeated involuntary (or in some cases intentional) bedwetting or wetting of one's clothes It typically occurs at night during sleep but may also occur during the day The problem may be triggered by a stressful event Children must be at least 5 years of age to receive this diagnosis Prevalence of enuresis decreases with age 35 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Enuresis Research has not favored one explanation for the disorder over others Psychodynamic theorists explain it as a symptom of broader anxiety and underlying conflicts Family theorists point to disturbed family interactions Behaviorists often view it as the result of improper toilet training Biological theorists suspect that the physical structure of the urinary system develops more slowly in some children 36 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Enuresis Most cases of enuresis correct themselves without treatment Therapy, particularly behavioral therapy, can speed up the process Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 37 Encopresis Encopresis repeatedly defecating in one's clothing is less common than enuresis and less well researched The problem: Is usually involuntary Seldom occurs during sleep Starts after the age of 4 Is more common in boys than girls 38 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Encopresis Encopresis causes intense social problems, shame, and embarrassment Cases may stem from stress, constipation, improper toilet training, or a combination of all three The most common treatments are behavioral and medical approaches, or combinations of the two Family therapy has also been helpful Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 39 LongTerm Disorders That Begin in Childhood Two of the disorders that emerge during childhood are likely to continue unchanged throughout a person's life: Pervasive developmental disorders Mental retardation Clinicians have developed a range of treatment approaches that can make a major difference in the lives of people with these problems 40 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Pervasive Developmental Disorders Pervasive developmental disorders are a group of disorders marked by impaired social interactions, unusual communications, and inappropriate responses to stimuli in the environment The group includes autistic disorder, Asperger's disorder, Rett's disorder, and childhood disintegrative disorder Because autistic disorder initially received so much more attention than the others, these disorders are often referred to as autisticspectrum disorders 41 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Autistic Disorders Autistic disorder, or autism, was first identified in 1943 Children with this disorder are extremely unresponsive to others, uncommunicative, repetitive, and rigid Symptoms appear early in life, before age 3 There has been a steady increase in the number of children diagnosed and it appears that at least one in 600 and maybe as many as one in 200 children display the disorder Around 80% of all cases appear in boys 42 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 43 Autistic Disorders As many as 90% of children with autism remain severely disabled into adulthood and are unable to lead independent lives Even the highestfunctioning adults with autism typically have problems in social interactions and communication and have restricted interests and activities Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 44 What Are the Features of Autism? The central feature of autism is the individual's lack of responsiveness, including extreme aloofness and lack of interest in people Language and communication problems take various forms One common speech peculiarity is echolalia, the exact echoing of phrases spoken by others Another is pronominal reversal, or confusion of pronouns 45 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 What Are the Features of Autism? Autism is also marked by limited imaginative play and very repetitive and rigid behavior This has been called a "perseveration of sameness" Many sufferers become strongly attached to particular objects plastic lids, rubber bands, buttons, water and may collect, carry, or play with them constantly 46 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 What Are the Features of Autism? The motor movements of people with autism may be unusual Often called "selfstimulatory" behaviors; may include jumping, arm flapping, and making faces Children with autism may engage in selfinjurious behaviors Children may at times seem overstimulated and/or understimulated by their environments 47 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Asperger's Disorder Those with Asperger's disorder (or syndrome) experience the kinds of social deficits, impairments in expressiveness, idiosyncratic interests, and restricted and repetitive behaviors that characterize individuals with autism, but at the same time they often have normal intellectual, adaptive, and language skills 48 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Asperger's Disorder Clinical research suggests that there may be several subtypes of Asperger's disorder, each having a particular set of symptoms Asperger's disorder appears to be more prevalent than autism Approximately 1 in 250 individuals displays this pattern, with 80% of them boys It is important to diagnose and treat the disorder early in life so that the individual has a better chance of success in life 49 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 What Are the Causes of Pervasive Developmental Disorders? Much more research has been conducted on autism than on Asperger's disorder or other pervasive developmental disorders Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 50 What Are the Causes of Pervasive Developmental Disorders? A variety of explanations for autism have been offered Sociocultural explanations are now seen as having been overemphasized Recent work in the psychological and biological spheres has persuaded clinical theorists that cognitive limitations and brain abnormalities are the primary causes of the disorder 51 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 What Are the Causes of Pervasive Developmental Disorders? Sociocultural causes Theorists initially thought that family dysfunction and social stress were the primary causes of autism Kanner argued that particular personality characteristics of parents created an unfavorable climate for development -- "refrigerator parents" These claims had enormous influence on the public and the self image of parents, but research totally failed to support this model Some clinicians have proposed a high degree of social and environmental stress as a factor, a theory also unsupported by research 52 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 What Are the Causes of Pervasive Developmental Disorders? Psychological causes According to some theorists, people with autism have a central perceptual or cognitive disturbance One theory holds that individuals fail to develop a theory of mind an awareness that other people base their behaviors on their own beliefs, intentions, and other mental states, not on information they have no way of knowing Repeated studies have shown that people with autism have this kind of "mindblindness" It has been theorized that early biological problems prevented proper cognitive development 53 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 What Are the Causes of Pervasive Developmental Disorders? Biological causes While a clear biological explanation for autism has not yet been developed, promising leads have been uncovered Family studies suggest a genetic factor in the disorder Prevalence rates are higher among siblings and highest among identical twins Chromosomal abnormalities have been discovered in 10% to 12% of people with the disorder Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 54 What Are the Causes of Pervasive Developmental Disorders? Biological causes Some studies have linked autism to prenatal difficulties or birth complications Some theorists have proposed that a postnatal event the MMR vaccine might produce autism in some children, although subsequent research has found no link Researchers have also identified specific biological abnormalities that may contribute to the disorder 55 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 What Are the Causes of Pervasive Developmental Disorders? Biological causes Many researchers believe that autism may have multiple biological causes Perhaps all relevant biological factors lead to a common problem in the brain a "final common pathway" that produces the features of the disorder Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 56 How Do Clinicians and Educators Treat Pervasive Developmental Disorders? Treatment can help people with autism adapt better to their environment, although no known treatment totally reverses the autistic pattern Treatments of particular help are behavioral therapy, communication training, parent training, and community integration In addition, psychotropic drugs and certain vitamins have sometimes helped when combined with other approaches 57 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 How Do Clinicians and Educators Treat Pervasive Developmental Disorders? Behavioral therapy Behavioral approaches have been used in cases of autism to teach new, appropriate behaviors, including speech, social skills, classroom skills, and selfhelp skills, while reducing negative ones Most often, therapists use modeling and operant conditioning Therapies are ideally applied when people with autism are young 58 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 How Do Clinicians and Educators Treat Pervasive Developmental Disorders? Communication training Even when given intensive behavioral treatment, half of the people with autism remain speechless Many therapists include sign language and simultaneous communication a method of combining sign language and speech into therapy They may also use augmentative communication systems, such as "communication boards" or computers that use pictures, symbols, or written words to represent objects or needs Such programs now use childinitiated interactions to help improve communication skills 59 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 How Do Clinicians and Educators Treat Pervasive Developmental Disorders? Parent training Today's treatment programs involve parents in a variety of ways For example, behavioral programs train parents so they can apply behavioral techniques at home In addition, individual therapy and support groups are becoming more available to help parents deal with their own emotions and needs 60 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 How Do Clinicians and Educators Treat Pervasive Developmental Disorders? Community integration Many of today's schoolbased and homebased programs for autism teach selfhelp, self management, and living skills In addition, greater numbers of group homes and sheltered workshops are available for teens and young adults with autism These programs help individuals become a part of their community and also reduce the concerns of aging parents 61 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Mental Retardation The term "mental retardation" has been applied to a varied population In recent years, the less stigmatizing term "developmental disability" has become synonymous with mental retardation in many clinical settings Approximately three of every 100 persons meets the criteria for this disorder Around threefifths of them are male and the vast majority are considered mildly retarded 62 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Mental Retardation According to the DSMIVTR, people should receive a diagnosis of mental retardation when they display general intellectual functioning that is well below average, in combination with poor adaptive behavior IQ must be 70 or lower The person must have difficulty in such areas as communication, home living, selfdirection, work, or safety Symptoms must appear before age 18 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 63 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 64 Assessing Intelligence Educators and clinicians administer intelligence tests to measure intellectual functioning These tests consist of a variety of questions and tasks that rely on different aspects of intelligence An individual's overall test score, or intelligence quotient (IQ), is thought to indicate general intellectual ability Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 65 Assessing Intelligence Many theorists have questioned whether IQ tests are indeed valid Intelligence tests also appear to be socioculturally biased If IQ tests do not always measure intelligence accurately and objectively, then the diagnosis of mental retardation may also be biased That is, some people may receive the diagnosis partly because of test inadequacies, cultural differences, discomfort with the testing situation, or the bias of the tester 66 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Assessing Adaptive Functioning Diagnosticians cannot rely solely on a cutoff IQ score of 70 to determine whether a person suffers from mental retardation Several scales have been developed to assess adaptive behavior For proper diagnosis, clinicians should observe the functioning of each individual in his or her everyday environment, taking both the person's background and the community standards into account 67 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 What Are the Characteristics of Mental Retardation? The most consistent sign of mental retardation is that the person learns very slowly Other areas of difficulty are attention, short term memory, planning, and language Those who are institutionalized with mental retardation are particularly likely to have these limitations Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 68 What Are the Characteristics of Mental Retardation? The DSMIVTR describes four levels of mental retardation: Mild (IQ 5070) Moderate (IQ 3549) Severe (IQ 2034) Profound (IQ below 20) Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 69 Mild Retardation Approximately 80%85% of all people with mental retardation fall into the category of mild retardation (IQ 5070) They are sometimes called "educably retarded" because they can benefit from schooling People with mild retardation typically need assistance but can work in unskilled or semiskilled jobs 70 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Mild Retardation Research has linked mild mental retardation mainly to sociocultural and psychological causes, particularly: Poor and unstimulating environments Inadequate parentchild interactions Insufficient early learning experiences Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 71 Mild Retardation Although these factors seem to be the leading causes of mild mental retardation, at least some biological factors may also be operating Studies have linked mothers' moderate drinking, drug use, or malnutrition during pregnancy to cases of mild retardation Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 72 Moderate, Severe, and Profound Retardation Approximately 10% of persons with mental retardation function at a level of moderate retardation (IQ 3549) They can care for themselves and benefit from vocational training Approximately 3%4% of persons with mental retardation display severe retardation (IQ 20 34) Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 They usually require careful supervision and can perform only basic work tasks 73 Moderate, Severe, and Profound Retardation About 1%2% of persons with mental retardation fall into the category of profound retardation (IQ below 20) With training they may learn or improve basic skills but they need a very structured environment Severe and profound levels of mental retardation often appear as part of larger syndromes that include severe physical handicaps 74 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 What Are the Causes of Mental Retardation? The primary causes of moderate, severe, and profound retardation are biological, although people who function at these levels are also greatly affected by their family and social environment Sometimes genetic factors are at the root of these biological problems Other biological causes come from unfavorable conditions that occur before, during, or after birth 75 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 What Are the Causes of Mental Retardation? Chromosomal causes The most common chromosomal disorder leading to mental retardation is Down syndrome Fewer than 1 of every 1000 live births result in Down syndrome, but this rate increases greatly when the mother's age is over 35 Several types of chromosomal abnormalities may cause Down syndrome, but the most common is trisomy 21 Fragile X syndrome is the second most common chromosomal cause of mental retardation 76 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 What Are the Causes of Mental Retardation? Metabolic causes In metabolic disorders, the body's breakdown or production of chemicals is disturbed The metabolic disorders that affect intelligence and development are typically caused by the pairing of two defective recessive genes, one from each parent Examples include: Phenylketonuria (PKU) TaySachs disease 77 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 What Are the Causes of Mental Retardation? Prenatal and birthrelated causes As a fetus develops, major physical problems in the pregnant mother can threaten the child's healthy development Low iodine may lead to cretinism Alcohol use may lead to fetal alcohol syndrome (FAS) Certain maternal infections during pregnancy (e.g., rubella, syphilis) may cause childhood problems including mental retardation Birth complications, such as a prolonged period without oxygen (anoxia), can also lead to mental retardation 78 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 What Are the Causes of Mental Retardation? Childhood problems After birth, particularly up to age 6, certain injuries and accidents can affect intellectual functioning Examples include poisoning, serious head injury, excessive exposure to xrays, and excessive use of certain chemicals, minerals, and/or drugs Certain infections, such as meningitis and encephalitis, can lead to mental retardation if they are not diagnosed and treated in time Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 79 Interventions for People with Mental Retardation The quality of life achieved by people with mental retardation depends largely on sociocultural factors Thus, intervention programs try to provide comfortable and stimulating residences, social and economic opportunities, and a proper education Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 80 Interventions for People with Mental Retardation What is the proper residence? Until recently, parents of children with mental retardation would send them to live in public institutions state schools as early as possible These overcrowded institutions provided basic care, but residents were neglected, often abused, and isolated from society Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 81 Interventions for People with Mental Retardation What is the proper residence? During the 1960s and 1970s, the public became more aware of these sorry conditions, and, as part of the broader deinstitutionalization movement, demanded that many people be released from these schools People with mental retardation faced similar challenges by deinstitutionalization as did people with schizophrenia 82 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Interventions for People with Mental Retardation What is the proper residence? Since deinstitutionalization, reforms have led to the creation of small institutions and other community residences that teach selfsufficiency, devote more time to patient care, and offer education and medical services Residences include group homes, halfway houses, local branches of larger institutions, and independent residences These programs follow the principle of normalization they try to provide living conditions similar to those enjoyed by the rest of society Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 83 Interventions for People with Mental Retardation What is the proper residence? Today the vast majority of children with mental retardation live at home rather than in an institution Most people with mental retardation, including almost all with mild mental retardation, now spend their adult lives either in the family home or in a community residence 84 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Interventions for People with Mental Retardation Which educational programs work best? Because early intervention seems to offer such great promise, educational programs for individuals with mental retardation may begin during the earliest years At issue are special education versus mainstream classrooms In special education, children with mental retardation are grouped together in a separate, specially designed educational program Mainstreaming places them in regular classes with nonretarded students Neither approach seems consistently superior 85 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Interventions for People with Mental Retardation Which educational programs work best? Many teachers use operant conditioning principles to improve the selfhelp, communication, social, and academic skills of individuals with mental retardation Many schools also employ token economy programs Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 86 Interventions for People with Mental Retardation When is therapy needed? People with mental retardation sometimes experience emotional and behavioral problems As many as 25% have a diagnosable psychological disorder other than mental retardation Some suffer from low selfesteem, interpersonal problems, and adjustment difficulties These problems are helped to some degree by individual or group therapy Medication is sometimes prescribed 87 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Interventions for People with Mental Retardation How can opportunities for personal, social, and occupational growth be increased? People need to feel effective and competent to move forward in life Those with mental retardation are most likely to achieve these feelings if their communities allow them to grow and make many of their own choices Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 88 Interventions for People with Mental Retardation How can opportunities for personal, social, and occupational growth be increased? Socializing, sex, and marriage are difficult issues for people with mental retardation and their families With proper training and practice, individuals with mental retardation can learn to use contraceptives and carry out responsible family planning The National Association for Retarded Citizens offers guidance in these matters Some clinicians have developed dating skills programs 89 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 Interventions for People with Mental Retardation How can opportunities for personal, social, and occupational growth be increased? Some states restrict marriage for people with mental retardation These laws are rarely enforced Between onequarter and onehalf of all people with mild mental retardation eventually marry Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 90 Interventions for People with Mental Retardation How can opportunities for personal, social, and occupational growth be increased? Adults with mental retardation need the financial security and personal satisfaction that comes from holding a job Many can work in sheltered workshops, but there are too few training programs available Additional programs are needed so that more people with mental retardation may achieve their full potential, as workers and as human beings 91 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 14 ...
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FAP5-Lecture-Ch14 - Chapter 14 Disorders of Childhood and...

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