Leture 11

• Sociocultural causes for Autism Spectrum Disorder

  • Some clinical theorists have proposed that a high degree of family dysfunction, social stress, and environmental stress are key factors

  • Research does not support this theory
• Psychological causes for Autism Spectrum Disorder

  • Some theorists say people with autism spectrum disorder have a central perceptual or cognitive disturbance

  • 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

  • It has been theorized that early biological problems prevent proper cognitive development
• Biological causes for Autism Spectrum Disorder


  • detailed biological explanation for autism spectrum disorder not yet developed -> BUT: promising leads have been uncovered

  • Examination of relatives keeps suggesting a genetic factor in the disorder– Prevalence rates are higher among siblings and highest among identical twins (60%)

  • Researchers have identified specific biological abnormalities that may contribute to the disorder, particularly in the cerebellum

  • MMR vaccination theory: unsupported and based on fraud
• How Do Clinicians and Educators Treat Autism Spectrum Disorder?

  • Treatment can help people with autism spectrum disorder adapt better to their environment, although no known treatment totally reverses the autistic pattern

  • Treatments of particular help are cognitive-behavioral therapy, communication training, parent training, and community integration

  • Psychotropic drugs and certain vitamins have sometimes helped when combined with other approaches
• Cognitive-behavioral therapy as treatment for Autism Spectrum Disorder


  • Behavioral approaches have been used to teach new, appropriate behaviors—including speech, social skills, classroom skills, and self-help skills—while reducing

  negative behaviors

  • Most often, therapists use modeling and operant conditioning

  • Therapies are ideally applied when they are started early in the children's lives
• Communication training as treatment for Autism Spectrum Disorder


  • Even when given intensive behavioral treatment, half of all people with autism spectrum disorder remain speechless

  • may be taught other forms of communication, e.g. sign language & simultaneous communication

  • Some may use augmentative communication systems, such as “communication boards” or computers that use pictures, symbols, or written words, to represent objects or needs

  • Such programs use child-initiated interactions to help improve communication skills
• ntellectual Disability


  • According to DSM-5, people should receive a diagnosis of intellectual disability 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, self direction, work, or safety

  • Symptoms must appear before age 18
• 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

  • Having difficulty in one or two of these subtests or areas of functioning does not necessarily reflect low intelligence

  • An individual's overall test score, or intelligence quotient (IQ), is thought to indicate general intellectual ability
• Assessing Intelligence (part 2)

  • Many theorists have questioned whether IQ tests are valid

  • IQ tests also appear to be socioculturally biased

  • If IQ tests do not always measure intelligence accurately and objectively, then the diagnosis of intellectual disability may be biased

  • Some people may receive a diagnosis partly because of test inadequacies, cultural differences, discomfort with the testing situation, or the tester’s bias
• What Are the Features of Intellectual Disability (ID)?

  • most consistent sign: person learns very slowly

  • Other areas of difficulty: attention, short term memory, planning, and language

  • Those who are institutionalized with intellectual disability are particularly likely to have these limitations

  • Traditionally four levels of intellectual development disorder have been distinguished:

  • Mild (IQ 50 to 70)

  • Moderate (IQ 35 to 49)

  • Severe (IQ 20 to 34)

  • Profound (IQ below 20)
• mild Intellectual disability


  • ~ 80 to 85% of all people with intellectual disability fall

  into the category of mild intellectual disability (IQ 50 to 70)

  • Interestingly, intellectual performance seems to improve with age

  • Research has linked mild intellectual disability mainly to sociocultural and psychological causes:

  • Poor and unstimulating environments

  • Inadequate parent–child interactions

  • Insufficient early learning experiences
• Levels of intellectual disability

  • Moderate
  • Severe
  • Profound
• Moderate intellectual disability


  • ~10% function at this level
  • IQ 35 to 49
  • Can care for themselves
  • Benefit from vocational training
  • Can work in unskilled or semiskilled jobs
• Severe intellectual disability


  • Approximately 3 to 4 percent of persons with intellectual disability
  • IQ 20 to 34
  • Usually require careful supervision
  • Only able to perform basic work tasks
  • Rarely able to live independently
• Profound intellectual disability


  • Approximately 1 to 2 percent of persons with intellectual disability
  • IQ below 20
  • With training may learn or improve basic skills
  • Need a very structured environment
• Severe and profound levels of intellectual disability often appear as part of larger syndromes that include severe physical handicaps
• What Are the Causes of Intellectual Disability?

  primary causes for moderate, severe & profound: 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 related to unfavorable conditions that occur before, during, or after birth
• Chromosomal causes for Intellectual Disability

  • Down syndrome: The most common chromosomal disorder leading to intellectual disability

  • Fewer than 1 of every 1000 live births results in Down syndrome, but this rate increases greatly when the mother's age is greater than 35

  • Several types of chromosomal abnormalities may cause Down syndrome, but the most common is trisomy 21

  • Fragile X syndrome: The second most common chromosomal cause of intellectual disability
• Metabolic causes for Intellectual Disability

  • 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:

  • Phenylketonuria (PKU)

  • Tay-Sachs disease
• Prenatal and birth-related causes for Intellectual Disability

  • Major physical problems in the pregnant mother can threaten her fetus’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 intellectual disability

  • Birth complications, such as a prolonged period without oxygen (anoxia), can lead to intellectual disability
• Childhood problems as cause for Intellectual Disability

  • After birth, particularly up to age 6, certain injuries and accidents can affect intellectual functioning

  • Poisoning

  • Serious head injury

  • Excessive exposure to X rays

  • Excessive use of certain chemicals, minerals, and/or drugs (e.g., lead paint)

  • Certain infections, such as meningitis and encephalitis, can lead to intellectual disability if they are not diagnosed and treated in time
• Interventions for People with Intellectual Disability

  • quality of life largely dependant on sociocultural factors
  • intervention programs: try to provide comfortable and stimulating residences, social and economic opportunities, and a proper education
• Which Educational Programs Work Best?


  • early intervention-> great promise, educational programs for individuals with intellectual disability may begin during the earliest years

  issue: special education versus mainstream classrooms

  • In special education, children with intellectual disability are grouped together in a separate, specially designed educational program

  • Mainstreaming places them in regular classes

  • Neither approach seems consistently superior

  • Teacher preparedness is a factor that plays into decisions about mainstreaming
• When Is Therapy Needed for ID?


  • People with intellectual disability sometimes experience emotional and behavioral problems

  • 30 percent or more have a diagnosable psychological disorder other than intellectual disability

  • Some suffer from low self-esteem, interpersonal problems, and adjustment difficulties

  • These problems are helped to some degree by individual or group therapy

  • Psychotropic medication is sometimes (over)prescribed
• Old age


  usually defined in our society as the years past age 65
• The psychological problems of elderly persons may be divided into two groups:


  • Disorders that may be common in people of all ages but are connected to the process of aging, e.g. Depressive, anxiety, and substance use disorders

  • Disorders of cognition that result from brain abnormalities, e.g. Delirium, mild neurocognitive disorders, and major neurocognitive disorders
• Cognitive "mishaps"

  e.g., leaving without keys, forgetting someone's name
• Cognitive "mishaps"

  • Common & quite normal feature of stress or aging
• As people move through middle age

  Memory difficulties & lapses of attention increase and may occur regularly by age 60 or 70
• Sometimes, people experience memory and other cognitive changes that are far more extensive and problematic
• Cognitive problems


  Can occur without biological causes (in the form of dissociative disorders), more often have organic roots, particularly when they appear in later life
• Leading cognitive disorders among elderly

  • Delirium

  • Major neurocognitive disorder

  • Mild neurocognitive disorder
• Delirium


  A clouding of consciousness
• Delirium


  • As a person's awareness of the environment becomes less clear, the individual has great difficulty concentrating, focusing attention, and thinking sequentially
  • This leads to misinterpretations, illusions, and, on occasion, hallucinations
• State of massive confusion

  Typically short time period (hours/ days)
• Delirium


  • May occur in any age group, including children, but is most common in elderly persons
  • Affects fewer than 0.5% of the nonelderly population, 1% of people > 55, and 14% > 85
• Causes of delirium


  • Fever
  • Certain diseases and infections
  • Poor nutrition
  • Head injuries
  • Strokes
  • Stress (including the trauma of surgery)
  • Intoxication by certain substances
• People with neurocognitive disorder...


  ...experience a significant decline in at least one (often more than one) area of cognitive functioning, such as memory, attention, visual perception, planning and decision making, language ability, or social awareness

  • People may also experience changes in personality and behavior
• Major neurocognitive disorder


  A neurocognitive disorder in which the decline in cognitive functioning is substantial and interferes with a person’s ability to be independent
• Mild neurocognitive disorder


  A neurocognitive disorder in which the decline in cognitive functioning is modest and does not interfere with a person’s ability to be independent