M03_GURA9675_01_SE_C03.indd Page 112 7/7/15 1:39 PM user /207/PHC00095/9780132879675_GURAL/GURAL_A_CHILD_AND_YOUTH_CARE_APPROACH_TO_ABNORM ... Chapter 3 Neurodevelopmental Disorders Dubova/Fotolia Neurodevelopmental disorders are associated with behaviours that are observed early in development and create significant impairments in the ability to achieve expected ­developmental milestones. Case Example: Jason Jason is a creative, highly intelligent 16-year-old who’s to be alone. He knows he’s different from other kids, and recently been diagnosed at the Manitoba Adolescent although that makes him feel upset, he has no interest in Treatment Centre (MATC) with a Generalized Anxiety Dis- making friends. Jason’s anxiety is now also causing him order. At the age of seven he was also diagnosed with extreme distress in exam situations and when doing home- Asperger’s syndrome. When the CYCP met with Jason, he work. Because he’s entirely focused on getting good told her that he had no friends at school, and that he was grades, he’s tending to obsess and perseverate about feeling nervous and anxious almost all the time. He said assignments as well. When he’s not studying, he usually that he still really liked the academic “parts” of school, spends his leisure time playing video games. There has particularly his math and science courses. Jason’s mother been a referral back to MATC for a psychiatric assessment, verifies that Jason is becoming increasingly anxious in all since the level of anxiety Jason is experiencing is signifi- social situations. Jason also told the CYCP that he prefers cantly disrupting his daily functioning. 112 Chapter 3 GRIDLINE SET IN 1ST-PP TO INDICATE SAFE AREA; TO BE REMOVED AFTER 1ST-PP M03_GURA9675_01_SE_C03.indd Page 113 7/7/15 1:39 PM user /207/PHC00095/9780132879675_GURAL/GURAL_A_CHILD_AND_YOUTH_CARE_APPROACH_TO_ABNORM ... Learning Objectives 1. Define developmental psychopathology and distinguish between the seven general ­categories of neurodevelopmental disorders. 2. Summarize the primary features of Autism Spectrum Disorder (ASD). 3. Summarize the psychological explanations for neurodevelopmental disorders, with an emphasis on ASD. 4. Define theory of mind and explain how it relates to ASD. 5. Explain whether inclusiveness is always the preferred approach for every young person with an ASD. 6. Describe the psychological approaches used in treating neurodevelopmental disorders. 7. Summarize interventions that CYCPs could use with children diagnosed with ASD. Chapter Overview In this chapter we explore the diagnoses that are among those first identified in the course of one’s development. Although young children are still developing various skills and abilities, certain expectations or norms exist in relation to when a young person should begin to use language to communicate, read, and problem solve. Why do some children fail to develop certain skills and abilities? From a psychological perspective, this chapter will identify those neurodevelopmental disorders presented in the DSM-5 and summarize their major symp- toms and characteristics. Psychological explanations and approaches to intervention for those diagnoses that CYCPs are most likely to encounter in their work are presented. In the CYC sections of this chapter, we introduce the main principles of strength- based practice with children and youth affected by one of the neurodevelopmental disor- ders: Autism Spectrum Disorder (ASD). We present a variety of theoretical causes of the ASDs; discuss the notion of “ableism” and the principles of inclusion; and suggest ways everyone can work to reduce labelling and stigma. As well, we examine the key features of ASDs and present interventions for the Autism Spectrum Disorder umbrella that fit well with a CYC approach. Why do we focus primarily on ASD? Although CYCPs won’t likely work exclusively with young people diagnosed with an ASD or another neurodevelopmental disorder (except ADHD), it’s important to have a solid foundational knowledge of the difficulties these chil- dren may experience. In any given youth population, CYCPs will likely be engaged with some children who are affected by neurodevelopmental difficulties, and so you’ll need to be aware of the sensory integration problems that affect many children and youth with special needs. However, given CYCPs’ limited involvement this area of practice, most of the DSM-5 categories of the neurodevelopmental disorders of children and youth are briefly introduced in the psychology section only. If this is an area of interest for you, we encourage you to explore it more fully. (ADHD, which is also categorized as a neurodevelopmental disorder in the DSM-5, is the subject of Chapter 4 and so is not ­discussed in this chapter.) Neurodevelopmental Disorders 113 GRIDLINE SET IN 1ST-PP TO INDICATE SAFE AREA; TO BE REMOVED AFTER 1ST-PP M03_GURA9675_01_SE_C03.indd Page 114 7/7/15 1:39 PM user /207/PHC00095/9780132879675_GURAL/GURAL_A_CHILD_AND_YOUTH_CARE_APPROACH_TO_ABNORM ... WHAT IS A DeVeLoPMeNTAL DISoRdeR? From a psychological perspective, human development is associated with specific age- related changes in the physical, social-emotional, and cognitive domains. Early develop- mental changes lay the foundation for future developmental change. For example, learning to differentiate between basic sounds in language lays the foundation for later ability to combine these sounds into specific words with particular meanings. Accordingly, problems that arise early in development (e.g., the inability to distinguish between such basic sounds as s and z) are likely to have lasting impacts on later development (e.g., the inability to read or understand language). Developmental psychopathology is the study of how disorders emerge in the course of one’s development and how they change or persist over time (Scott, 2012). The primary focus in this area of psychology is to identify the specific processes that underlie a particular behaviour pattern that creates distress or impairs functioning. For example, knowing that deficits in the ability to sustain attention and in inhibiting behav- iour underlie the symptoms of ADHD allows these limitations to be addressed and altered so as to maximize functioning and future developmental changes. Thus, it’s important to keep in mind that although this group of disorders tends to occur early in one’s develop- ment, it doesn’t mean that early identification and interventions are not important. Before moving on to a discussion of the psychological approach of developmental disorders, examine your own ideas and assumptions about one particular developmental disorder, Autism Spectrum Disorder (one form of which was previously referred to as Asperger’s), in the Think About It! exercise. Think About It! Exercise: Experiences of Autism Spectrum Disorder My greatest fear is myself Control is not absolute; a constant struggle to maintain It drains my strength. I am always tired: I never get enough sleep. Events beyond my control happen around me: I do things that scare me, if I’m confused or angry or tired, I slip up and my body takes over. Watching your life like a void is scary. It takes an Effort of will to take control again and not just let it happen I’m afraid of what I feel. Emotions weakens my control, Making its grip easier to break. When I think, I sometimes think of letting go, just Letting it all slip away. It hurts fighting all the time. I just want peace and rest. —Daniel Woodhouse, a poem about living with Asperger’s (in Attwood, 1999, p. 160) What are your thoughts after reading this poem describing writes “It hurts fighting all the time” and “I just want peace the experience of living with Autism Spectrum Disorder? and rest,” what does this suggest about him, or about any- Can you better imagine what fears and concerns someone one with ASD? Might you be concerned about suicide ide- with this diagnosis might have? Do you think that a person ation? Do you know anyone who struggles with an ASD? like Daniel might be vulnerable to depression? When he Does this poem change your thoughts in any way? 114 Chapter 3 GRIDLINE SET IN 1ST-PP TO INDICATE SAFE AREA; TO BE REMOVED AFTER 1ST-PP M03_GURA9675_01_SE_C03.indd Page 115 7/7/15 1:39 PM user /207/PHC00095/9780132879675_GURAL/GURAL_A_CHILD_AND_YOUTH_CARE_APPROACH_TO_ABNORM ... WHAT IS A NeURodeVeLoPMeNTAL DISoRdeR? THe PSYcHoLoGIcAL PeRSPecTIVe Although all psychological disorders are influenced to some degree by neurological fac- tors, the DSM-5 distinguishes those disorders that are primarily neurological in nature in the general category of neurodevelopmental disorders (APA, 2013). Because they’re largely neurologically based, disorders in this grouping are observed early on in the child’s development. However, the challenges associated with these disorders continue through the life course. General impairments in this category include the following: ■ deficits in general mental abilities (e.g., problem solving, planning, abstract thought) ■ deficits in specific areas of learning (e.g., mathematics, spelling) ■ deficits in communication (e.g., difficulty producing or understanding speech) ■ deficits in social communication and interaction ■ deficits in motor skills (e.g., motor or vocal tics) Similar to all disorders identified in the DSM-5, the developmental deficits associated with these disorders interfere with young people’s personal, academic, and social function- ing, creating impairments in a number of different areas. DSM-5 Categories Neurodevelopmental disorders are