Lecture 13

• Defining line between typical and atypical development is complicated ▪ Three broad criteria:

  1. Statistical deviance: does the behavior fall outside the normal range of behavior?

  2. Maladaptiveness: does the behavior interfere with adaptation or pose a danger to self or others?

  3. Personal distress: does the behavior cause personal anguish or

  discomfort?
• Professional diagnostic criteria:


  ▪ DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)

  ▪ ICD-10 (International classification of diseases, section F) → Defining features and symptoms of mental disorders
• ▪ Cultural and developmental considerations need to be considered as well

  →Example: Major Depressive Disorder


  ▪ Culture: Asians with depression report more somatic symptoms

  ▪ Development: children are more irritable than sad
• Nature-nurture


  biological, psychological and social factors across the lifespan; impact of risk factors versus protective factors → Interdisciplinary considerations to understand atypical development needed
• Continuity-discontinuity


  development/changes of psychopathologies across the lifespan (e.g., certain life phases for certain disorders versus across the lifespan)
• How to identify typical versus atypical?

  Social norms: expectations on how to behave in a particular social

  context

  ▪ Example: Lack of normal eye contact and Autism versus in certain cultures, looking into the eyes is perceived as rude

  ▪ Remember also: Emotional display rules
• How to identify typical versus atypical? p.2

  ▪ Age norms: expectations on which behavior is appropriate or typical for various ages

  ▪ Example: temporary delinquent behavior during adolescence may be normal, not normal if it persists beyond adolescence
• Vulnerability


  predisposing genetics, physiology, set of cognitions, personality
• Differential susceptibility hypothesis (Belsky & Pluess, 2009)

  Hypothesis emphasizes that vulnerable individuals are most vulnerable in negative contexts, but can also benefit most in positive contexts! → For better AND for worse
• Autism Spectrum Disorder: Characteristics,

  ▪ Social and communication deficits:

  ▪ Difficulties to respond appropriately to social cues, sharing experiences with others, participating in social interactions

  ▪ Difficulties reading the mind of others or emotions
• Autism Spectrum Disorder: Characteristics p2


  ▪ Restricted interests and repetitive behavior:

  ▪ Seeking for sameness and repetition, becoming obsessed with specific objects or interests, repeating phrases

  ▪ Stereotyped behaviors (e.g., rocking, spinning toys); elaborated rituals and routines (e.g., specific sequence for getting dressed)

  ▪ Feeling stressed when environment changes
• ▪ Autism spectrum disorder usually begins in infancy


  ▪ Over half of children with autism from secure attachments, but higher than (normal) average number develop disorganized-disoriented attachments

  ▪ Autism spectrum disorder: big variation in degree, nature and causes of deficits (not just one)

  ▪ DSM-5: different disorders are grouped as ASD, variation from mild to

  severe
• ▪ Asperger syndrome: mild form of ASD (“little professors”)


  ▪ Normal or above average intelligence

  ▪ Good verbal skills, clear desire to establish social relationships

  ▪ Deficit in social-communication skills
• Autism Spectrum Disorder (ASD)


  • Most children show autistic characteristics from birth
  • Often diagnosis not before 4 years of age
  • By age 1 year: lack of typical interest in and responsiveness to social stimuli
  • Failure to orient to someone calling name of infant
  • Problems with eye contact or visual focus on faces in a scene (rather focus on background)
  • Often comorbidity (co-occurring) of other disorders, e.g., intellectual disability, language disorders, ADHD, epilepsy, anxiety disorders
  • Savant abilities: special talents (e.g., calculating days of the week corresponding to calendar dates)
• ASD


  As extreme end of a continuum of social responsiveness
• ▪ Increased rates – explanations autism spectrum disorder


  ▪ Increased awareness

  ▪ Broader definition (including also mild cases)

  ▪ Increased diagnosis (formerly other diagnosis like language impairments or learning disabilities)
• Brain functioning related to autism diagnosis

  • Varies
  • Not yet clear what specifically explains characteristics in individuals with ASD
• Possible explanations/hypotheses for autism

  • Early brain overgrowth
  • Later underconnectivity
• Early brain overgrowth


  • Infants with ASD show higher than usual volume of neurons and connections among them with disorganized patches of neurons within them
• Later underconnectivity


  • Slowing in neural growth and pruning not as usual → connections in key brain areas for social information processing are underdeveloped
• "Second hit" during adolescence

  1. Neural loss in regions that usually would undergo growth spurt and reorganization

  2. Difficulties in peer and romantic relationships, development of self-control and autonomy
• Genes contribute strongly as cause for autism spectrum disorder


  ▪ Almost 19% of 3-year-olds with older sibling with ASD have it, too

  ▪ Hundreds of genes on several chromosomes implied

  ▪ Most likely: inherited from parents or by mutations

  ▪ More often when parents, especially fathers, are older → genetic mutations more common
• Environmental influences: virus or chemicals as cause for autism spectrum disorder

  ▪ Infections during pregnancy, prenatal exposure to rubella, alcohol

  ▪ Maternal bleeding or complications during pregnancy
• Autism Spectrum Disorder: Treatment


  ▪ Small minority outgrow symptoms

  ▪ Improvement in functioning with age but remaining to show autistic traits to some extent for life

  ▪ Positive outcomes are most likely for individuals with IQ above 70 and

  good communication skills by age 5

  ▪ Treatment focusses on intensive and highly structured behavioral and educational programming

  ▪ Additional training of social skills, e.g., pointing, joint attention, imitation
• Depression infants


  ▪ Infants can exhibit some of the behavioral and somatic symptoms

  of depression

  →Loss of interest in activities, psychomotor slowing, weight loss

  ▪ It is still debated whether a true depression can occur in infancy, but symptoms are possible
• ▪ Reasons and risk factors for later depression:

  ▪ Experience of abuse or neglect

  ▪ Depressed caregivers → adopting of depressed interaction style from caregivers

  ▪ Disorganized attachment
• Externalizing problems (Acting out) children

  ▪ Lack of self-control, acting out in ways that disturb other people, violation of social expectations

  ▪ Being aggressive, disobedient, difficult to control, disruptive

  ▪ Conduct disorder, aggressive behavior

  ▪ More common in families with lower SES than in families with higher SES, in Western societies compared to Asian cultures

  ▪ Internalizing of negative emotions, bottling

  up of emotions
• Internalizing problems (Bottling up) children

  ▪ Anxiety disorders, phobias, severe shyness, depression

  ▪ Between 4 to 18 years: increase

  ▪ More common in Asian cultures compared to Western societies
• Attention Deficit Hyperactivity Disorder (ADHD), ▪ Either one of the two sets of symptoms or combination of both:

  ▪ Inattention

  ▪ Does not seem to listen, easily distracted, makes careless errors, troubles following instructions, misses details, is distractible, forgetful, unorganized, does not finish tasks

  ▪ Hyperactivity and Impulsivity

  ▪ Being restless, finger tapping, chatting, troubles to remain seated, acting impulsively before thinking, interrupts others
• Attention Deficit Hyperactivity Disorder (ADHD) in infancy


  children with ADHD are typically very active, have difficult temperaments, show irregular feeding and sleeping patterns
• Attention Deficit Hyperactivity Disorder (ADHD) in preschool children


  always in motion, quickly switching between activities → Evaluation in relation to developmental norms
• Attention Deficit Hyperactivity Disorder (ADHD) in adults


  still disorganization, lapses of concentration, procrastination, impulsive decisions
• Attention Deficit Hyperactivity Disorder (ADHD) possible causes


  ▪ Frontal cortex and problems in executive functions (especially inhibition)

  ▪ Lower levels of dopamine + norepinephrine are involved in EF impairment

  ▪ Frontal cortex matures slower
• Attention Deficit Hyperactivity Disorder (ADHD) - Treatment, Pharmaceuticals: stimulant drugs (e.g., Ritalin, Adderall)


  ▪ Brains in ADHD are under-aroused → drugs increase neurotransmitter levels to normal levels

  ▪ Controversial: too often prescribed, side effects like appetite loss, headaches, long-term effects?
• Attention Deficit Hyperactivity Disorder (ADHD) - Treatment, behavioral therapy


  ▪ E.g., teaching to stay focused on tasks, to control impulsiveness, to interact socially
• Attention Deficit Hyperactivity Disorder (ADHD) - Treatment, Comparing different treatments:


  ▪ Medication alone seems more effective than behavioral treatment alone

  ▪ Combination of both is most effective for reducing symptoms and improving academic performance, social adjustment, parent-child relations

  ▪ However, achieving long-term effects is difficult
• Treatment in children: depression


  ▪ Cognitive behavioral therapy

  ▪ Parent-child interaction therapy for emotional development: building more effective parenting skills

  ▪ Parents learn to help child recognize and express positive and negative emotions

  ▪ Antidepressant drugs to correct for levels of neurotransmitter

  ▪ Not as effective as in adults; may increase suicidality; prescribed in severe cases
• Mental disorders in adolescence Environmental explanations:

  ▪ Developing autonomy, identity formation, peer acceptance and first romantic partners
• Mental disorders in adolescence, Biological explanations :


  ▪ Heightened risk taking as result of stronger reward-seeking and weaker cognitive control
• Eating Disorders


  Anorexia nervosa

  ▪ Underweight (< 85%, of < 17 BMI)

  ▪ Fear of becoming overweight; tendency to feel fat despite being emaciated

  Bulimia nervosa

  ▪ Binge-purge syndrome

  ▪ Recurrent episodes of consuming huge quantities of food, followed by purging activities (e.g., vomiting, use of laxatives, fasting, obsessive exercising)

  Binge eating disorder

  ▪ Recurrent out-of-control eating (binge eating)