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1.6 Normal or Abnormal? summary
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- Erasmus Universiteit Rotterdam (EUR)
1.6 normal or abnormal literature notes
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1.6 Clinical Psychology1. Young, fast and wild
➔ DSM (Diagnostic and Statistical Manual of Mental Disorders):
◆ contains information about psychiatric disorders and its criteria for diagnosis
◆ Disorders grouped together
◆ Published by the APA (American Psychiatric Association)
◆ First published in 1952
◆ Latest version DSM-5 in 2013
➔ Autism spectrum disorder (ASD):
◆ A spectrum of developmental impairments including intellectual disabilities,
social and emotional disturbances, language and communication deficits, and
self-injurious behavior patterns
◆ DSM-5 combined different diagnoses under a single umbrella term, because
there was no evidence that the disorders included were independent and they
shared a lot of commonalities
◆ The symptoms may be exhibited from early on in infancy
◆ The severity level of the diagnosis can be determined by the clinician
◆ Is often comorbid with other problems such as ADHD or epilepsy
◆ High-functioning autism can be hard to diagnose
◆ More common in boys, same among races and socioeconomic groups
◆ Prevalence has been increasing during the last decades
➔ Characteristics of ASD:
(the first 3 are known as the triad of impairments)
◆ Social interaction:
● One of the most marked and sustained features
● Inability to use the nonverbal cues of communication: eye contact,
appropriate facial expressions etc.
● Inability to regulate social interactions
● Lack of interest in making friends or in peer communication
, ● Inability to understand others’ emotions and intentions →may fail to
develop a Theory of Mind
● Indifference to what others are doing
◆ Communication:
● Delayed language development
● Speech may lack natural intonations and sound monotonous and bored
● About half never speak→only make unrelated sounds
● Echolalia: immediate repetition of the words and sounds they hear
● Pronoun reversal: may refer to self as he, she or you and is very difficult
to correct
● Oddities in grammar and articulation
◆ Imagination and flexibility of thought:
● May exhibit restricted, repetitive and stereotyped patterns of behavior
and interests
● Manifest during playing in childhood→rarely engage in symbolic play
● Can be very distressed if their routine or what they are used to is
disturbed
● May form very strong attachments to objects
● Stereotyped, self-stimulatory and repetitive body movements (hand
clapping, hair pulling, rocking, swaying, finger snapping, head banging
etc.) and can be harmful to the individual
◆ Intellectual deficits:
● Around 80% have an IQ score lower than 70
● Usually perform much better at visuospatial ability than verbal or social
abilities
● Savant syndrome: the extraordinary proficiency in one isolated area in
individuals with multiple cognitive deficiencies, closely linked with ASD
and Asperger’s syndrome (not a diagnosis anymore)
◆ Cognitive deficits:
● Executive functioning: Difficulty problem solving, planning, initiating,
organizing, inhibiting responses
● Also difficulties in underlying basic cognitive functions (shifting attention,
memory etc.)
● Theory of Mind: deficits to some degree seen in most people with
autism, Sally-Anne False Belief task used to measure
,➔ Causes:
◆ Genetic & environmental factors (e.g. perinatal stress)
◆ Abnormal brain development
◆ Heritability shown in sibling and twin studies
◆ Co occurrence is high with several genetic disorders
◆ As many as 15 genes may be involved, not a single responsible gene
◆ Affective (mood) disorders are common in parents, suggesting a genetic link
◆ Abnormalities in neurotransmitters like serotonin and dopamine may play a part,
research inconclusive
◆ Birth complications or perinatal stress factors like certain maternal diseases and
medication can be correlated but accounts for very few of the cases
◆ Infectious diseases in infancy and vaccinations don’t seem to have any effect
◆ Both anatomical and functional abnormalities in a number of brain area including
frontal lobes, cerebellum and limbic system, unusually large brain size and
enlarged brain ventricles, poorer brain connectivity
◆ Decreased activation of the amygdala and prefrontal cortex→can be related to
lack of ToM
◆ Empathizing-systemizing theory: suggests that deficits in ToM accounts for the
social and communication difficulties experienced by people with autism, but
fails to explain their strengths. They are better at systemization, which is noting
regularities and similarities within systems to understand the world. This
tendency explains their repetitive behaviors, narrow interests and resistance to
change.
➔ Interventions and care:
◆ Interventions can be hard because:
● Resistance to change
● Lack of very basic social skills (e.g. having to start from eye contact)
● Hard to find effective rewards and reinforcers
● Extremely selective attention, what they learn may not generalize into
similar situations
◆ Drug treatments:
● Antipsychotic drugs such as haloperidol and risperidone, aimed to
decrease repetitive behaviors, aggression, self-abuse and social
withdrawal
● Opioid receptor antagonist naltrexone can be used to control
hyperactivity and self-injurious behavior
, ◆ Behavioral training:
● Aim to teach basic behavioral and self-care skills
● Use modeling and conditioning
● Parent-implemented early intervention: training the parents to give the
training can be more useful and effective
◆ Social inclusion strategies:
● Supported employment: training to employer, support for the employee,
regular feedback sessions with both
_____________________________________
➔ Attention deficit hyperactivity disorder (ADHD):
◆ Persistent pattern of inattention and/or hyperactivity-impulsivity
◆ Hyperactivity: always fidgeting, difficulty sitting still, excessive talking, jumping
and running
◆ Inattention: shifting from one task to another without completing any, getting
distracted by irrelevant stimuli, careless mistakes and poor performance in
academic and occupational settings
◆ Impulsivity: impatience, preference for immediate rewards, difficulty delaying
responses
◆ Symptoms must be present before age 12 and be present in at least 2 contexts
and for at least 6 months
◆ One of the patterns may be more dominant if 6+ of the symptoms of one
subtype and less than 6 symptoms of the other subtype are present:
● ADHD, predominantly inattentive presentation
● ADHD, predominantly hyperactive/impulsive presentation
● ADHD, combined presentation
◆ Diagnosis usually take place when schooling starts because symptoms make it
very hard to adjust to this setting
◆ 5% of children and 2.5% of adults diagnosed
◆ Symptoms diminish in adolescence in most cases, but half continue into
adulthood
◆ Culture can have an influence as to what behaviors are acceptable in children
◆ More common in boys during childhood, but may have to do with gender bias
◆ Consequences & Comorbidity:
● Poorer academic achievement→ esp. associated w attention deficit
● Proneness to accidents→ esp. associated with hyperactivity & impulsivity
● Peer rejection
● Temper tantrums and disruptive behavior
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