678 CHAPTER 14
In contrast to autism and Asperger’s dis-
order, childhood disintegrative disorder is
characterized by normal development up to
at least 2 years of age, followed by a profound
loss of communication skills, normal types of
play, and bowel control.
Rett’s disorder also involves the loss
of skills already mastered, but the onset of
the disorder occurs between 5 months and
2 years of age. Mental retardation always ac-
companies Rett’s disorder, which affects only
females.Thinking like a clinician
The center where Clare works also has cli-
ents with pervasive developmental disorders.
Based on what you have learned, what is the
most important information that Clare should
know about people with pervasive develop-
mental disorders, and why? What particular
pervasive developmental disorders would be
most and least likely to be seen in people who
need the type of care that Clare’s workplace
provides? How might Clare use her knowledge
about pervasive developmental disorders—
and autism in particular—when she is work-
ing with the center’s clients?Summary of
Learning Disorders
A learning disorder is characterized by a sub-
stantial disparity between an individual’s
performance on a standardized test and the ex-
pected level of performance based on the
individual’s age, intelligence, and education
level. DSM-IV-TR includes three types of learn-
ing disorders: reading disorder (dyslexia),
mathematics disorder, and disorder of written
expression.
Genes contribute to learning disorders.
Dyslexia appears to result from disruptions in
brain systems that process language and
in brain systems that process visual stimuli.
Motivation and social support influence an
individual’s ability to overcome and compen-
sate for a learning disorder.
Treatment for learning disorders may
involve accommodations and services man-
dated by IDEA. Various cognitive techniques
can help a person learn to compensate for a
learning disorder.Thinking like a clinician
Nikhil recently graduated from college and is
about to start working in the Teach for Amer-
ica program. He’s been assigned to teach at an
inner city school. Nikhil was a math major in
college and doesn’t know much about learn-
ing disorders. However, he was a peer tutor in
college and saw that some people had a reallyhard time understanding different elements of
math. Based on what you’ve read, what infor-
mation should Nikhil know (and hopefully will
be taught as part of his training) about learn-
ing disorders before he walks into a class-
room, and why should he learn this?Summary of
Disorders of Disruptive
Behaviors and Attention
Conduct disorder is characterized by a violation
of the basic rights of others or of societal norms
that are appropriate to the individual’s age. The
disorder may begin in childhood or adoles-
cence. Conduct disorder is commonly comorbid
with ADHD and substance use or abuse.
Childhood-onset conduct disorder with
callous and unemotional traits has the high-
est heritability among the various types of
conduct disorder. Individuals with this type
of conduct disorder often have more severe
symptoms. People with childhood-onset con-
duct disorder without callous and unemo-
tional traits are less aggressive, although they
are likely to be aggressive impulsively, in re-
sponse to (mis)perceived threats. Adolescent-
onset conduct disorder tends to involve mild
symptoms that are usually transient.
Oppositional defi ant disorder is character-
ized by a behavioral pattern of disobedience,
hostility, defi ance, and negativity toward peo-
ple in authority. The behaviors are usually not
violent nor do they cause severe harm, and
they often occur only in certain contexts.
Attention-deficit/hyperactivity disor-
der (ADHD) is characterized by inattention,
hyperactivity, and/or impulsivity. The inat-
tentive type of ADHD is associated with aca-
demic problems, whereas the hyperactive/
impulsive type is associated with disruptive
behaviors, accidents, and rejection by peers.
Criticisms of the DSM-IV-TR diagnostic crite-
ria for ADHD include the diffi culty in applying
the criteria to adults, the arbitrariness of the
age cutoff for the onset of symptoms, and
failure to acknowledge different symptoms in
females. Oppositional defi ant disorder, con-
duct disorder, and ADHD are highly comor-
bid, making it diffi cult to sort out factors that
contribute uniquely to one of the disorders.
Neurological factors that contribute to
ADHD include frontal lobe problems (which
lead to the symptoms of inattention, impaired
executive function, and memory diffi culties).
Too little dopamine, and imbalances in other
transmitters may also play a role. Genes also
contribute to ADHD and conduct disorder, in
part by affecting temperament.
Psychological factors that are associ-
ated with ADHD include low self-esteem anddifficulty recognizing facial expressions of
anger and sadness. People with oppositional
defiant disorder and conduct disorder tend
to have either low self-esteem or overly high
self-esteem, are relatively unresponsive to
the threat of punishment, and exhibit high
levels of emotional distress and poor frustra-
tion tolerance.
Social factors that contribute to ADHD
include parents’ not giving children enough
credit for their positive behaviors. For opposi-
tional defi ant disorder and conduct disorders,
social factors include abuse, neglect, inconsis-
tent discipline, and lack of positive attention.
Treatment targeting neurological fac-
tors in ADHD involves medication—typically
methylphenidate, or atomoxetine. Treatments
targeting psychological factors in ADHD, op-
positional defi ant disorder, and conduct disor-
der may use behavioral methods—especially
reinforcement programs—to increase a per-
son’s ability to tolerate frustration and to de-
lay reward, and cognitive methods to enhance
social problem-solving ability. Treatments
that target social factors in all three disorders
include group therapy and comprehensive
treatments such as contingency management
program, parent management training, and
multi-systemic therapy.Thinking like a clinician
Nikhil has some first-hand familiarity with
oppositional defi ant disorder and conduct dis-
order—he went to a large middle school and
large high school, where some kids always
acted up and got into trouble. And during
high school and college, some of his friends
and then one of his roommates had ADHD.
Even though Nikhil may think he knows some-
thing about disruptive behavior disorders and
ADHD, based on what you have read, what
information about these disorders should he
be given before he begins to teach, and why?Summary of Other
Disorders of Childhood
Separation anxiety disorder is characterized
by excessive anxiety about separation from
home or from someone to whom the child is
strongly attached. Separation anxiety disorder
is moderately heritable and is more likely to
arise in tight-knit families. Separation anxiety
disorder is treated with methods used to treat
other anxiety disorders: CBT that includes ex-
posure and cognitive restructuring, along with
family therapy.
Communication disorders are character-
ized by problems in understanding or using
language. Feeding and eating disorders are
characterized by problems with attaining or