N8

							Development disorders.
  Mental retardation.
 Personality disorders.
Pervasive Development Disorders
• is a group of conditions that involve
  delays in the development of many
  basic skills, most notably the ability
  to socialize with others, to
  communicate and to use
  imagination. Children with these
  conditions often are confused in their
  thinking and generally have
  problems understanding the world
  around them.
Types of pervasive development
  disorders:
• Autism
• Asperger’s syndrome
• Childhood disintegrative disorder
• Rett’s syndrome
• Pervasive development disorder not
  otherwise specified
• Autism: Children with autism have
  problems with social interaction,
  pretend play and communication.
  They also have a limited range of
  activities and interests. Many (nearly
  75%) of children with autism also
  have some degree of mental
  retardation.
      The symptoms of autism

• 1. impairment in social interaction,
• 2. impairment in communication
• 3. impairment in behavior.
• Impairment in social interaction
- fail to develop normal personal
  interactions in virtually every setting.
- affected behaviors can include eye
  contact, facial expressions, and body
  postures.
- inability to develop normal peer and
  sibling relationships, the child seems
  isolated.
- little or no joy or interest in normal age-
  appropriate activities. Affected children or
  adults do not seek out peers for play or
  other social interactions
Communication
• What the individual understands
  (receptive language) as well as what
  is actually spoken by the individual
  (expressive language) is significantly
  delayed or nonexistent.
• Deficits in language comprehension
  (inability to understand simple
  directions, questions, or commands)
• Absence of dramatic or pretend play
• Repetitive, abnormal behaviors.
• hypersensitivity to sensory input
  through vision, hearing, or touch.
• hyposensitivity to the same type of
  stimulation.
• The causes of autism
• tuberous sclerosis (an inherited disorder),
  the fragile X syndrome, cerebral
  dysgenesis etc.
• Genetic factors – heritability is 90%. Many
  of the non-autistic co-twins had learning
  or social disabilities.
• Prenatal factors (maternal infection,
  gestational diabetes, influence of
  teratogens, maternal stress, ultrasound
  etc.), perinatal and postnatal factors
  (poisoning with mercury, side-effects of
  vaccines, autoimmune disease, use of
  paracetamole, vitamin D deficiency, viral
  infection etc.).
• Treatment of autism
• educational or vocational program that is
  suited to the developmental level of the
  child or adult, respectively.
A fundamental behavior such as putting
  hands on the tabletop, for example, must
  be mastered before the child is required to
  perform any other tasks, or before more
  information is presented.
• No medication has consistently proven to
  be of benefit in closely controlled clinical
  trials.
• Asperger's syndrome: children have
  difficulty with social interaction and
  communication, and have a narrow range
  of interests. However, children with
  Asperger's have average or above
  average intelligence, and develop normally
  in the areas of language and cognition.
  They have difficulty concentrating and may
  have poor coordination.
• Asperger syndrome
• limited interests or an unusual preoccupation
  with a particular subject to the exclusion of other
  activities
• repetitive routines or rituals
• peculiarities in speech and language, such as
  speaking in an overly formal manner or in a
  monotone, or taking figures of speech literally
• socially and emotionally inappropriate behavior
  and the inability to interact successfully with
  peers
• problems with non-verbal communication,
  including the restricted use of gestures, limited or
  inappropriate facial expressions, or a stiff gaze
• clumsy and uncoordinated motor movements
A treatment program includes:
• social skills training, a form of group therapy that
  teaches children the skills they need to interact
  more successfully with other children
• cognitive behavioral therapy, a type of 'talk'
  therapy that can help the more explosive or
  anxious children to manage their emotions better
  and cut back on obsessive interests and repetitive
  routines
• medication for co-existing conditions such as
  depression and anxiety
• occupational or physical therapy for children with
  sensory integration problems or poor motor
  coordination
• specialized speech/language therapy to help
  children who have trouble with normal conversation
• parent training and support, to teach parents
  behavioral techniques to use at home
• Childhood disintegrative disorder:
  Children with this rare condition begin their
  development normally in all areas,
  physical and mental. At some point,
  usually between 2 and 10 years of age, a
  child with this illness loses many of the
  skills he or she has developed.
• Childhood disintegrative disorder
• Language skills
• Receptive language skills
• Social skills & self-care skills
• Control over bowel and bladder
• Play skills
• Motor skills
• The exact causes of childhood disintegrative
  disorder are still unknown. Sometimes it occurs
  within days or weeks, while in other cases it
  develops over a longer period of time.
• CDD has also been associated with certain other
  conditions, particularly the following:
• Lipid storage diseases is a toxic buildup of
  excess fats (lipids) in the brain and nervous
  system.
• Subacute sclerosing panencephalitis: Chronic
  infection of the brain by a form of the measles
  virus causes subacute sclerosing panencephalitis.
  This condition leads to brain inflammation and
  the death of nerve cells.
• Tuberous sclerosis is a genetic disorder when
  tumors may grow in the brain and other vital
  organs like kidneys, heart, eyes, lungs, and skin.
  In this condition, noncancerous (benign) tumors,
  hamartomas, grow in the brain
• Rett's syndrome: children generally suffer
  the loss of many motor or movement,
  skills—such as walking and use of their
  hands—and develop poor coordination.
• linked to a defect on the X chromosome,
  so it almost always affects girls.
Mental retardation
• is a condition diagnosed before age
  18 that includes below-average
  general intellectual function, and a
  lack of the skills necessary for daily
  living.
• Mental retardation affects about 1 -
  3% of the population.
       Causes of mental retardation:
• Infections (present at birth or
  occurring after birth)
  – Congenital CMV
  – Congenital rubella
  – Congenital toxoplasmosis
  – Encephalitis
  – HIV infection
  – Listeriosis
  – Meningitis
• Chromosomal abnormalities
  – Chromosome deletions (cri du chat
    syndrome)
  – Chromosomal translocations
  – Defects in the chromosome or
    chromosomal inheritance (for example,
    fragile X syndrome, Angelman
    syndrome, Prader-Willi syndrome)
  – Errors of chromosome numbers (such
    as Down syndrome)
• Environmental
  – Deprivation syndrome
• Genetic abnormalities and inherited
  metabolic disorders
  –   Adrenoleukodystrophy
  –   Galactosemia
  –   Hunter syndrome
  –   Hurler syndrome
  –   Lesch-Nyhan syndrome
  –   Phenylketonuria
  –   Rett syndrome
  –   Tay-Sachs disease
  – Tuberous sclerosis
• Metabolic
  –   Congenital hypothyroid
  –   Hypoglycemia (poorly regulated diabetes)
  –   Reye syndrome
  –   Hyperbilirubinemia

  Nutritional
  – Malnutrition
• Toxic
  – Intrauterine exposure to alcohol, cocaine,
    amphetamines, and other drugs
  – Lead poisoning
  – Methylmercury poisoning
• Trauma (before and after birth)
  – Intracranial hemorrhage before or after birth
  – Lack of oxygen to the brain before, during, or after birth
  – Severe head injury
Symptoms of mental retardation
• Continued infant-like behavior
• Decreased learning ability
• Failure to meet the markers of
  intellectual development
• Inability to meet educational
  demands at school
• Lack of curiosity
• Behavioral disturbances
  – aggression, self-injury, inattention,
    hyperactivity, anxiety, depression, sleep
    disturbances, and stereotypic behaviors.
  – have difficult temperaments,
    noncompliance, hyperactivity, poor
    social skills, and delays in play skills.
• Language delay
  – delayed expressive language
    development
  – Many infants are thought to be deaf at
    presentation owing to lack of expressive
    language and environmental inattention.
• Fine motor/adaptive delay
  – Significant delays in self-feeding, toileting,
    and play skills
  – Prolonged and messy finger feeding often is
    accompanied by oral-motor incoordination.
  – lack of interest in age-appropriate toys and
    delays in imaginative play and reciprocal play
    with age-matched peers. Odd, repetitive
    behaviors often replace imaginative play with
    symbolic toys.
• Gross motor delay
  – Delays in gross motor development

   Neurologic and physical abnormalities
  – seizure disorders, microcephaly,
    macrocephaly, history of intrauterine or
    postnatal growth retardation,
    prematurity, and congenital anomalies.
• Comorbid psychiatric conditions
 - Schizophrenia may have a prevalence of 3% in
  individuals with MR, compared to 0.8% in the
  general population.
   – Bipolar disorder has a 2- to 3-fold greater
     prevalence in the cognitively impaired than in
     the general population.
   – Attention deficit/hyperactivity disorder (ADHD)
     is diagnosed in 8-15% of children and 17-52%
     of adults with MR.
   – Self-injurious behaviors require treatment in 3-
     15%, particularly in the severe range of MR.
   – Major depression, autistic spectrum disorders,
     obsessive-compulsive disorder, anxiety
     disorders, conduct disorder, tic disorders, and
     other stereotypic behaviors are diagnosed
     more commonly in the cognitively impaired.
• Mortality/Morbidity
• Neurologic dysfunction resulting in
  immobility, significant oral motor
  incoordination, dysphagia, and aspiration
  confers a greater risk of premature death.
  When significant neurologic dysfunction is
  associated with other organ system
  anomalies, an individual's life expectancy
  is shortened further.
• Respiratory disease is the most prevalent
  cause of death among individuals with
  profound mental retardation.
• Personality disorders
Personality disorders are
  pervasive chronic psychological
  disorders, which can greatly
  affect a person's life.
• Paranoid Personality Disorder is a
  pervasive distrust and suspiciousness
  of others such that their motives are
  interpreted as malvolent, beginning by
  early adulthood

- suspects, without sufficient basis, that
  others are exploiting, harming, or
  deceiving him or her;
- is preoccupied with unjustified doubts
  about the loyalty or trustworthiness of
  friends or associates;
Paranoid Personality Disorder
• is reluctant to confide in others because of
  unwarranted fear that the information will
  be used maliciously against him or her;
• reads hidden demeaning or threatening
  meanings into benign remarks or events;
Paranoid Personality Disorder
• persistently bears grudges, i.e., is
  unforgiving of insults , injuries, or slights
  perceives attacks on his or her character
  or reputation that are not apparent to
  others and is quick to react angrily or to
  counterattack;
• has recurrent suspicions, without
  justification, regarding fidelity of spouse or
  sexual partner
• Schizoid Personality Disorder

is a pervasive pattern of detachment from
  social relationships and a restricted range
  of expression of emotions in interpersonal
  settings, beginning by early adulthood

• neither desires nor enjoys close
  relationships, including being part of a
  family
• almost always chooses solitary activities
      Schizoid Personality
           Disorder
• has little, if any, interest in having sexual
  experiences with another person
• takes pleasure in few, if any, activities
• lacks close friends or confidants other
  than first-degree relatives
• appears indifferent to the praise or
  criticism of others
• shows emotional coldness, detachment, or
  flattened affectivity
• Schizotypal Personality Disorder
   is a pervasive pattern of social and interpersonal
  deficits marked by acute discomfort with, and
  reduced capacity for, close relationships as well
  as by cognitive or perceptual distortions and
  eccentricities of behavior, beginning by early
  adulthood

• ideas of reference (excluding delusions of
  reference)
• odd beliefs or magical thinking that influences
  behavior and is inconsistent with subcultural
  norms (e.g., superstitiousness, belief in
  clairvoyance, telepathy, or "sixth sense"; in
  children and adolescents, bizarre fantasies or
  preoccupations)
• unusual perceptual experiences, including bodily
  illusions
Schizotypal Personality Disorder
• odd thinking and speech (e.g., vague,
  circumstantial, metaphorical,
  overelaborate, or stereotyped)
• suspiciousness or paranoid ideation
• inappropriate affect
• behavior or appearance that is odd or
  eccentric
• lack of close friends or confidants other
  than first-degree relatives
• excessive social anxiety that does not
  diminish with familiarity and tends to be
  associated with paranoid fears rather than
  negative judgments about self
• Antisocial Personality Disorder is
  characterized by a long-standing pattern
  of a disregard for other people's rights,
  often crossing the line and violating those
  rights.

• failure to conform to social norms with
  respect to lawful behaviors as indicated by
  repeatedly performing acts that are
  grounds for arrest
• deceitfulness, as indicated by repeated
  lying, use of aliases, or conning others for
  personal profit or pleasure
 Antisocial Personality Disorder
• impulsivity or failure to plan ahead
• irritability and aggressiveness, as
  indicated by repeated physical fights or
  assaults
• reckless disregard for safety of self or
  others
• consistent irresponsibility, as indicated
  by repeated failure to sustain consistent
  work behavior or honor financial
  obligations
• lack of remorse, as indicated by being
  indifferent to or rationalizing having hurt,
  mistreated, or stolen from another
• Borderline Personality Disorder
labile interpersonal relationships
  characterized by instability, frantic
  efforts to avoid real or imagined
  abandonment.
• a pattern of unstable and intense
  interpersonal relationships
  characterized by alternating
  between extremes of idealization
  and devaluation
• identity disturbance: markedly and
  persistently unstable self-image or
  sense of self
Borderline Personality Disorder
• impulsivity in at least two areas that
  are potentially self-damaging (e.g.,
  spending, sex, substance abuse,
  reckless driving, binge eating)
• recurrent suicidal behavior, gestures, or
  threats, or self-mutilating behavior
• affective instability due to a marked
  reactivity of mood (e.g., intense
  episodic dysphoria, irritability, or
  anxiety usually lasting a few hours and
  only rarely more than a few days)
    Borderline Personality
     Disorder Symptoms
• chronic feelings of emptiness
• inappropriate, intense anger or
  difficulty controlling anger (e.g.,
  frequent displays of temper, constant
  anger, recurrent physical fights)
• transient, stress-related paranoid
  ideation or severe dissociative
  symptoms
Histrionic Personality Disorder is a
  pervasive pattern of excessive
  emotionality and attention seeking,
  beginning by early adulthood
is uncomfortable in situations in which he or
  she is not the center of attention;
• interaction with others is often
  characterized by inappropriate sexually
  seductive or provocative behavior;
• displays rapidly shifting and shallow
  expression of emotions;
  Histrionic Personality Disorder
• consistently uses physical appearance to
  draw attention to self;
• has a style of speech that is excessively
  impressionistic and lacking in detail;
• shows self-dramatization, theatricality,
  and exaggerated expression of emotion;
• is suggestible, i.e., easily influenced by
  others or circumstances;
• considers relationships to be more
  intimate than they actually are.
Narcissistic Personality Disorder:
is pervasive pattern of grandiosity (in fantasy or
   behavior), need for admiration, and lack of
   empathy, beginning by early adulthood
- has a grandiose sense of self-importance
   (e.g., exaggerates achievements and talents,
   expects to be recognized as superior without
   commensurate achievements)
- is preoccupied with fantasies of unlimited
   success, power, brilliance, beauty, or ideal
   love
- believes that he or she is "special" and unique
   and can only be understood by, or should
   associate with, other special or high-status
   people (or institutions)
 Narcissistic Personality Disorder:
• requires excessive admiration
• has unreasonable expectations of
  especially favorable treatment or
  automatic compliance with his or her
  expectations
• is interpersonally exploitative, i.e.,
  takes advantage of others to achieve
  his or her own ends
• lacks empathy: is unwilling to recognize
  or identify with the feelings and needs
  of others
• is often envious of others or believes
  that others are envious of him or her
Avoidant Personality Disorder is a
  long-standing and complex pattern
  of feelings of inadequacy, extreme
  sensitivity to what other people think
  about them, and social inhibition.
• avoids occupational activities
  that involve significant interpersonal
  contact, because of fears of criticism,
  disapproval, or rejection
• is unwilling to get involved with
  people unless certain of being liked
   Avoidant Personality Disorder
• shows restraint within intimate
  relationships because of the fear of being
  shamed or ridiculed
• is preoccupied with being criticized or
  rejected in social situations
• is inhibited in new interpersonal
  situations because of feelings of
  inadequacy
• views self as socially inept, personally
  unappealing, or inferior to others
• is unusually reluctant to take personal
  risks or to engage in any new activities
  because they may prove embarrassing
Dependent Personality Disorder is a long-
   standing need for the person to be taken care of
   and a fear of being abandoned or separated
   from important individuals in his or her life.
- has difficulty making everyday decisions
   without an excessive amount of advice and
   reassurance from others
• needs others to assume responsibility for most
   major areas of his or her life
• has difficulty expressing disagreement with
   others because of fear of loss of support or
   approval.
      Dependent Personality Disorder
• has difficulty initiating projects or doing
  things on his or her own (because of a
  lack of self-confidence in judgment or
  abilities rather than a lack of motivation or
  energy)
• goes to excessive lengths to obtain
  nurturance and support from others, to the
  point of volunteering to do things that are
  unpleasant
      Dependent Personality Disorder
• feels uncomfortable or helpless when
  alone because of exaggerated fears of
  being unable to care for himself or herself
• urgently seeks another relationship as
  a source of care and support when a close
  relationship ends
• is unrealistically preoccupied with fears
  of being left to take care of himself or
  herself
Obsessive-Compulsive Personality Disorder
   is a pervasive pattern of preoccupation
   with orderliness, perfectionism, and
   mental and interpersonal control, at the
   expense of flexibility, openness, and
   efficiency, beginning by early adulthood
- is preoccupied with details, rules, lists,
   order, organization, or schedules to the
   extent that the major point of the activity
   is lost
• shows perfectionism that interferes with
   task completion (e.g., is unable to
   complete a project because his or her own
   overly strict standards are not met)
Obsessive-Compulsive Personality Disorder
• is excessively devoted to work and
  productivity to the exclusion of leisure
  activities and friendships (not accounted
  for by obvious economic necessity)
• is overconscious, scrupulous, and
  inflexible about matters of morality,
  ethics, or values (not accounted for by
  cultural or religious identification)
• is unable to discard worn-out or worthless
  objects even when they have no
  sentimental value
 Obsessive-Compulsive Personality
                 Disorder
- is reluctant to delegate tasks or to
   work with others unless they submit
   to exactly his or her way of doing
   things
• adopts a miserly spending style
   toward both self and others; money
   is viewed as something to be
   hoarded for future catastrophes
• shows rigidity and stubbornness