Childhood Disorders: ASD

Autism is one of the most mysterious and perplexing of all disorders. It was first identified by an American doctor named Leo Kanner in 1943.

According to the Diagnostic and Statistical Manual of Mental Disorders (a guide created by the American Psychiatric Association in order to diagnose mental disorders), Autism is a long-term disorder characterised by extreme unresponsiveness to others, poor communication skills, as well as highly repetitive and rigid behaviour patterns. It affects about 5 out of 10,000 children; and around 80 percent of them are boys, according to the American Psychiatric Association.

Diagnosis

Autism can be diagnosed at any age, but it is a developmental disorder which typically appears during the first two years of life. Autism appears in the form of unresponsiveness and lack of interest in others. Autism is known as a Spectrum Disorder due to the wide variation in the type and severity of symptoms experienced by such individuals.

Autism tends to occur in all ethnic, racial, and economic groups; and although it is a lifelong disorder, treatment and services can help improve such a person's symptoms and ability to function. The American Academy of Paediatrics recommended that all children should be screened for the disorder. All caregivers should speak to their doctors about screening, or evaluation for autism.

Approximately 70 percent of autistic children are severely disabled. More than two-thirds of them are mentally challenged, with IQs below 70; frequently below 35. The rest have a normal to above-average intelligence. But, according to the American Psychiatric Association; even the highest functioning adults with autism have problems with communication; as well as restricted interests, activities, and difficulty relating to others.

Social Interaction & Behaviour

A central feature of Autism is the lack of social responsiveness towards others—including parents—such as, failing or being slow in responding when called by the name (or any other verbal attempts to gain attention), talking in length on certain subjects without noticing another's disinterest, not giving a chance for others to respond, having difficulty in conversations, being unable to understand other people's viewpoints, or being unable to predict or understand other people's actions.

Unlike infants without the disorder, infants with Autism don't reach out or make eye contact with their parents. They don't seem to recognise or care for the people around them, including their parents. Autistic children tend to not engage in normal play with either adults or peers.

They do not include others in their play and often don't even acknowledge their presence. Their facial expressions, movements, and gestures tend to not match what's being said, making it hard for others to understand how they feel. They tend to have an unusual tone of voice, which may sound like a sing-song, or flat and robot-like. They can also have a lasting interest in certain topics, such as numbers, details or facts.

Restrictive Repetitive Behaviour Patterns

Language and communication difficulties are common with half of the autistic people not developing a language. The languages developed by autistic individuals are strange, and often involve the repetition of words and phrases, with little recognition of their meaning. Many of them engage in echolalia, which is the echoing of others' words and phrases.

For autistic children, sameness and routine are very important, making them extremely upset at even a minute's change: a slight movement of a piece of furniture, or even one word changed in a song, tend to evoke a tantrum. According to the beliefs of some theorists, the sameness is an attempt at avoiding overstimulation. Autistic individuals can be more or less sensitive than other individuals to sensory input; including light, noise, temperature, or even clothing. Individuals with Autism Spectrum Disorder, or ASD, may experience problems with sleep, as well as irritability.

The behavioural patterns and interests of autistic individuals are repetitive. They may spend their time playing with objects such as jar tops (or objects that spin), flicking their fingers, or rocking their bodies. Some tend to behave in self-injurious behaviours, such as banging their heads against sharp objects, or biting chunks of flesh out of their bodies, causing such children to be restrained.

Although ASD individuals may have many challenges due to their disorder, some of them may exhibit extraordinary savant (French for 'wise' or 'learned') abilities, such as being able to learn things in detail and remember information for long periods; being able to excel in math, science, music, and art; or being strong in visual and auditory learning.

A common savant skill in such individuals is calendar calculation. An autistic person with such an ability will be able to tell you, in an instant, the day of the week in which your birthday will fall in far as 2050; while others are able to perfectly reproduce any song or commercial after hearing it just once. Such skills, when exhibited by them, tend to give the impression of superior intelligence.

Childhood Disorders: ADHD

The occurrence of psychological conditions can happen at any point in a person's life, including childhood. Mental health professionals have observed symptoms resembling clinical depression in children from infancy. According to Mash and Barkley, a wide range of behavioral issues are exhibited in infants and older children.

In a study conducted on several thousand children between the ages of 2 and 5, over 20% of children were diagnosed with disorders, and by their symptoms, half of them were considered to be significantly impaired (Lavigne). There are similar levels of incidence and impairment existence in between the ages of 9 and 17-year-old children, according to Satcher.

According to other studies, only 40% of children with psychological disorders are said to receive professional attention, and only half of this group is seen by qualified mental health professionals. In contrast, 74% of children with physical handicaps are said to receive professional treatment according to the U.S. Office of  Behaviour Technology. Failure to treat childhood behaviour disorders not only results in needless distress for these children and their families, but the impact of not treating these disorders early can result in them continuing into adulthood. According to a study in New Zealand, 4 in 5 adults diagnosed with such disorders have had histories of issues during childhood and adolescent that also met DSM criteria (Newman).

Although many childhood disorders are the subject of current research, two of them receiving particular attention are Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism. ADHD is of interest due to it being the most frequently diagnosed childhood disorder. On the other hand, Autism is being scrutinised due to it being more common and being one of the most baffling disorders.

Attention-Deficit/Hyperactivity Disorder (ADHD)

In ADHD, problems may take the form of inattention, hyperactivity/impulsivity, or a combination of the two. According to the ratings of teachers and parents, 7 to 10% of American children are said to meet the DSM criteria for ADHD, making it the most common childhood disorder. The disorder is more common in boys; four times the frequency in girls. Boys are more likely to exhibit more aggressive and impulsive behaviours, while girls are more likely to be primarily inattentive. Some professionals believe that ADHD diagnosis is applied too liberally, as normal children may also exhibit the behaviours in question, the fear being that this may cause some children to be inappropriately labelled and medicated.

Although it may be tempting to assume that children with Attention-Deficit/Hyperactivity Disorder routinely outgrow the disorder, follow-up studies of individuals diagnosed with the disorder suggest that 50 to 80% of the problems persist in adolescence; and for 30%, into adulthood. Adults with ADHD tend to have more occupational, familial, emotional, and interpersonal issues.

Despite many years of research, the precise causes of ADHD are yet to be found. There is a probability of genetic factors being involved, as concordance rates of Attention-Deficit/Hyperactivity Disorder are higher in identical twins than in fraternal twins. According to adoption studies done on ADHD children, the biological parents of these children are more likely to have ADHD than the adoptive parents. Experts have long suspected a biological basis to be the cause of ADHD, but studies of the brain's electrical activity, as well as imaging studies of brain structure and neurotransmitters, have failed to reveal any consistent differences between individuals with ADHD  and other groups. This could be due to the fact that Attention-Deficit/Hyperactivity Disorder is a multifaceted disorder with several subcategories of biological parents.

Environmental Factors

Several environmental factors that contribute to ADHD include inconsistent parenting, alcohol and drug abuse during pregnancy, exposure to environmental toxins such as lead at a young age, brain injuries. Individuals with ADHD have combinations of these symptoms as well; such as, overlooking or missing details, making careless mistakes in school or work (or any other activity), having trouble sustaining attention in tasks (conversations, lectures or reading), not seem to be paying attention when spoken to, failure in following through on instructions or duties, or quickly losing focus on tasks one started.

Having problems in organising tasks, avoid or dislike tasks that need sustained mental effort (such as homework, preparing reports, completing forms, or reviewing lengthy papers), losing necessities for activities and tasks, becoming distracted easily by unrelated thoughts and stimuli, forgetfulness in daily activities are also more symptoms.

Signs of Hyperactivity

Fidgeting or squirming while seated, getting up and moving around in situations not expected to do so (such as in a classroom or office), running or climbing in situations that are inappropriate, often feeling restless, being unable to engage in play or hobbies quietly, being constantly on-the-go, acting as if driven by a motor, talking nonstop, blurting out answers before questions are asked, finishing others' sentences, speaking without waiting for their turn in a conversation, and interrupting others are some signs of hyperactivity. Having these symptoms may not necessarily mean the individual has ADHD as depression, anxiety, and certain learning disabilities can have similar symptoms as well. The best way to diagnose your child's condition is to talk to a professional.

There is currently no cure for ADHD, but there is treatment available to help reduce the symptoms and improve the functioning in individuals with the disorder. These include medication, training therapy, or a combination of treatments. The first line of treatment includes stimulants which increase levels of the brain chemical called dopamine, which plays an essential role in thinking and learning.

Non-stimulants can be used, too, if stimulants either cause too many side-effects or are ineffective. Antidepressants are used sometimes to treat adults, although not approved by the FDA, especially for the treatment of ADHD. Different kinds of therapy have been attempted on ADHD individuals with no effect, but including therapy with other treatment may be beneficial for patients. Children with ADHD need guidance from their parents and teachers to reach their full potential in life. A professional could help parents in dealing with issues of ADHD, as well as learning how to communicate with their children.

Personality Disorders: Causal Factors of BPD

The cause of Borderline Personality Disorder (BPD) is not clear; but according to research, genetics, brain structure and function; as well as environmental, cultural, and social factors; play a role or may increase the risk of developing the disorder. People with BPD tend to have chaotic personal histories marked by interpersonal strife, abuse, and inconsistent parenting. This history, at times, may reflect their earliest memories (childhood memories).

In a study conducted with those with BPD and healthy participants, the two parties were asked to describe their earliest life memories. When the contents of the research were analyzed, researchers discovered that individuals suffering from Borderline Personality Disorder recalled times they had been treated in a malevolent manner six times more than the other party did. Furthermore, the individuals suffering from BPD had also viewed potential helpers as far less helpful to them.

Many BPD patients' parents are described as abusive, rejecting, and non-affirming; and some theorists suggest that an early lack of acceptance by their parents may cripple their self-esteem and lead to a clinging dependency as well as an inability to cope with separation. As they mature, the behaviours of these individuals tend to evoke negative reactions and rejections from others, which causes them to affirm a sense of worthlessness and a view of the world as being wicked towards them.

Not everyone suffering from Borderline Personality Disorder experiences all these symptoms; some may experience just a few of them, while others experience all of the symptoms. BPD patients may feel distressed by minor separations from the people whom they feel close to (even as simple as a business trip, or visiting a sick relative or friend). The severity and frequency of these symptoms depend on the individual, and his or her illness.

Psychological factors

Psychoanalysts Kernberg and Caligor's focus was on the dramatic changes exhibited by individuals with BPD, in their relationships with other people. Their sudden and vitriolic shifts from extreme love and clinging dependence to intense hate or feelings of abandonment, is a reflection of cognitive process called Splitting: the failure in interrogating negative and positive aspects of another's behaviour (for example, a parent who is mostly accepting but at times, voices disapproval) into a coherent whole.

This may result in BPD patients reacting as if the other person has two separate identities: one deserving of love; and the other, of hatred. Whichever of these seemingly independent images such an individual is reacting to at the moment determines how they relate or feel. Together with severe problems in emotional control, splitting makes for chaotic and unpredictable relationships in such individuals.

Biological factors

Biological factors also seem to play a part in this disorder (Depue & Lenzenweger). Close relatives of BPD individuals, such as siblings and parents, have five times more likelihood of having the disorder than those in the general population with the disorder (Torgerson). The impulsivity and emotional explosiveness of BPD individuals may also be a reflection of some biological abnormality in neurotransmitter systems, or areas of the brain that contribute to emotional self-regulation (Gurvitz).

It seems to be entirely possible that BPD reflects an interaction between biological factors and early history of trauma, rejection, as well as psychological and/or physical abandonment. Sociocultural factors also may contribute to the emergence of the disorder. Cases of Borderline Personality Disorder seem to be more prevalent in rapidly-changing, unstable societies, leaving some of its members with a sense of emptiness, problems with identity, and fear of abandonment.

Although individuals with BPD are said to have experienced traumatic events such as abuse, abandonment, or adversity during childhood, it doesn't necessarily mean that all such individuals would develop the disorder, although it is likely. And even though biological factors do contribute to the development of Borderline Personality Disorder, it doesn't necessarily mean such persons will get the disorder. Moreover, persons with no family history of the disorder could get the disorder nevertheless.

Diagnosis and Treatment

Borderline Personality Disorder was viewed as a difficult disorder to treat in the past, but with newer evidence-based treatment options, BPD patients are able to live better lives with fewer or milder symptoms, as well as improvements in the quality of life. It is important for patients of the disorder to receive specialized treatment from an appropriately-trained provider. Other types of treatment, or treatment provided by doctors or therapists who aren't properly trained, may not benefit these individuals.

It takes time for BPD symptoms to improve, once the treatment is begun; and it depends on many factors, so it is important for such individuals and their loved ones to be patient and to receive appropriate support during the treatment. A licensed mental health professional would be able to diagnose this disorder by; completing a thorough interview, which includes a discussion on symptoms; performing a thorough medical exam in order to rule out other possible causes of symptoms; as well as inquiring about family medical history, including any history of mental illness.

Borderline Personality Disorder may often occur with other mental disorders and hence, co-occurring disorders may make it difficult to diagnose and treat BPD, especially when symptoms of other disorders tend to overlap with it. For example, individuals with BPD may be more likely to experience symptoms of depression, anxiety disorders, Bipolar Disorder, eating disorders, and substance abuse disorders as well. According to studies, individuals who do not receive adequate treatment have a likelihood of developing other chronic mental or physical illnesses, and are more likely to fail in healthy lifestyle choices. They are also at high risk of self-harm and suicide.

Medication is not typically used for BPD patients as the benefits are unclear, but medications may be provided to treat other conditions associated with the disorder, such as mood swings, depression, and other co-occurring disorders. Treatment may be needed from more than one medical professional and medication could cause different side-effects, which need to be discussed with the medical practitioner. Some patients may be severely affected by the disorder and need intensive care, while others may be able to do with just outpatient treatment with no need for hospitalization.

Personality Disorders: Introduction to BPD

Borderline Personality Disorder (BPD) has been the focus of intense interest among clinical researchers due to the chaotic effects it has on the individuals suffering from it, as well as their families and therapists. There may be an occurrence rate of 3 to 5 percent among the general population, and around two-thirds of those diagnosed are women.

Black and White Vision

Individuals suffering from Borderline Personality Disorder see the world as black and white, with no grey areas around. They tend to change the way they feel about a person from one moment to the next, making a person they once adored and respected someone they distrust and despise. Their views and values tend to change rapidly.

Before 1980, the term Borderline was referred to an intermediate level of disturbance between psychotic and neurotic symptoms. However, at present, BPD refers to a collection of symptoms characterised primarily due to serious instability in emotion, behaviour, identity, and interpersonal relationships.

Borderline individuals tend to have intense and unstable interpersonal relationships. They also experience chronic feelings of extreme anger, loneliness, emptiness, distrust (due to the irrational fear of not knowing a person’s intentions); as well as fear of abandonment and momentary loss of personal identity, such as feeling cut-off from oneself or seeing oneself out of their body. They tend to engage in impulsive behaviours, such as going on shopping sprees, running away, promiscuity, binge-eating, as well as drug and alcohol abuse. Their lives are often marked by repetitive self-destructive behaviours such as reckless driving, self- mutilation, and suicide attempts, calling forth saving responses from the people in their lives.

The following is an example of the complex nature of Borderline Personality Disorder:

A 27-year-old married woman with two small children, had undergone a stormy adolescence. She had been forced into sexual relations with a brother six years her senior; whom, at first, she idolised; and later, feared. Their relationship had continued until just before she left home for college, at which time she confessed to her parents about it. In the ensuing emotional turmoil, she made a gesture of suicide (overdose of aspirin) but was hospitalised. 

Outwardly flirtatious, although inwardly shy and ill at ease, she felt intensely lonely, causing her to go through a period of mild alcohol abuse and brief sexual affairs in order to cope with feelings of anxiety and a sense of inner emptiness, which was halted at the age of 19 when she married a classmate and dropped out of school.

For the first few years of marriage, she was fairly at ease. But with the birth of her second child, she became anxious, bored and got into fits of sadness and fearfulness. Her mood started fluctuating from hour to hour and day to day, but the negative feelings were greatly intensified on the 3 or 4 days before her period. As the family expanded, the husband had become less attentive towards her.

As a response, she became increasingly irritable, provocative, and even abusive at times (hurling insults and breaking plates). This resulted in her husband beginning an extramarital relationship, which she eventually discovered. This caused her to get seriously depressed, which caused her a loss of appetite and sleep. She then began abusing alcohol and sedatives and also made several gestures of suicide, including an instance where she cut her wrists. On two occasions, she hid for several nights in motels without informing anyone of her whereabouts (Stone).

Association with Other Disorders

BPD is highly associated with a number of other disorders, which include mood disorders, PTSD, and substance abuse disorders. In one study, BPD's symptoms of impulsivity and emotional instability had predicted recurrent problems in academic achievements and social relationships two years later (Bagge). In one intensive study of 57 individuals diagnosed with BPD, a total number of 42 suicide threats, 40 drug overdoses, 38 episodes of drug abuse, 36 instances of self-mutilation, 36 instances of promiscuity with near strangers, as well as 14 accidents mainly caused by reckless driving, were revealed.

The chaos that marks the lives of BPD patients extends to their relationships with their psychotherapists. These individuals are considered to be among the most difficult patients to treat, owing to their clinging dependency, irrational anger, and tendency to engage in manipulative suicidal gestures and threats as an effort of controlling the therapist (Linehan).

Every individual with Borderline Personality Disorder does not experience all these symptoms. Some may experience a few symptoms, while others experience the whole array of them. Symptoms can be triggered by ordinarily simple events; for example, individuals with BPD may feel angry and distressed due to minor separations from the people they are close to, even if it’s just a business trip. The severity and frequency of symptoms, as well as the lengths of the periods, may vary depending on the individual and their illness.

These behaviours and symptoms occur primarily during a period of elevated mood and energy. Therefore, If you know anyone like this, you may need to consider that they may not be suffering from Borderline Personality Disorder; instead, they may be signs of a mood disorder.

Borderline Personality Disorder, though historically viewed as a difficult disorder to treat; with new evidence-based treatment, many individuals with this disorder suffer fewer or less severe symptoms—and an improved quality of life.

ASPD and Experimental Psychopathology

Punishment seems to have little effect on future destructive behaviour of individuals with Antisocial Personality Disorder (ASPD). One explanation of this is a deficiency in fear of arousal, which appears to cause antisocial behaviour in normal individuals. The lack of fear arousal is a contributor to poor avoidance learning, which in turn causes these individuals to get themselves into trouble, repeatedly.

What would happen if there was a possibility to make people with ASPD more psychologically reactive or fearful? Would it cause their deficiency in avoidance learning to disappear?

Stanley Schachter and Bibb Latane set out to answer this important question.

Method

Schachter and Latane selected two groups of inmates at state prisons on the basis of psychologists diagnoses and life history data. One group consisted of people with ASPD. These prisoners were described by prison psychologists as being completely free from any symptoms of anxiety, lacking any sense of responsibility or shame, being manipulators and habitual liars, able to commit antisocial acts without guilt or remorse, as well as lacking insight and unable to profit from negative experiences.

Most, if not all of these prisoners, would meet current diagnostic criteria for ASPD. A normal (non-psychopathic) group consisted of prisoners matched in age and intelligence, who did not exhibit this pattern of behaviour. Life history data showed that the psychopaths had been arrested more often (8.3 versus 3.3 arrests), and had spent most of their adult lives in prison (36.2% versus 18.1%).

The two groups of prisoners were recruited as paid participants in an investigation of a newly-developed hormone thought to enhance learning. "The researcher used an experimental apparatus which required the participants to learn a complicated mental maze, which consisted of a counter mounted on a metal cabinet, two pilot lights, and four switches.

The maze consisted of 20 choice points. At each choice point, the participant selected one of the four switches. If it was the correct one, a green light flashed and the learner advanced to the next point. If one of the three incorrect switches had been selected, a red light flashed; recording an error on the counter visible to the participant. When the 20th choice point was reached, the procedure began again from the start. The learner repeated the maze 21 times, with the objective being to learn the correct response at each choice point, minimising the total number of errors.

To study avoidance learning, one of the three incorrect switches at each choice point not only activated the red light and recorded an error, but it also resulted in a moderately painful electric shock to the learner. Thus, the learner would do well to learn to avoid not just the correct switch at each point, but also the one that delivered the shock (i.e. to do good and avoid evil).

To manipulate emotional arousal, the prisoners were injected with the experimental hormone, Suproxin, to see if it enhanced learning ability. The prisoners were informed that there would be no side effects. The injection was used to manipulate autonomic arousal. The contents of the injection were adrenaline, which would increase arousal; or placebo, which would inhibit it. Each participant worked until he learned two different mental mazes; one while under the influence of adrenaline and the other, while under the placebo. Half of them received adrenaline on the first maze and placebo for the second. The other half received injections in the reverse order.

Results

In the overall learning, the two groups of prisoners did not differ; their number of responses and errors were similar. This meant they did not differ in ability to learn the positively-reinforced 'correct' responses. Then, a major interest was the avoidance learning measure, which is the ability to learn the positively-reinforced 'correct' responses. Of major interest then, was the avoidance learning measure, (the ability to learn to avoid choosing the switch at each point of choice which would result in an electric shock). The variables of the dependents here were the percentage of incorrect responses made by each participant that resulted in electric shocks. The lower the percentage of shocked incorrect responses, the better the avoidance learning over trials through each maze. 

Avoidance learning under the placebo condition, in which both, those with ASPD and normal prisoners, experienced their normal arousal levels; the normal prisoners made a lower percentage of shock responses during later trips through the maze, indicating avoidance learning. In contrast, the psychopaths showed almost no evidence of learning during their later trials through the maze; they were still as likely to choose the shocked switch as in their previous trials.

If the lack of fear present in those with ASPD underlies their lack of conditioning, what would happen if one artificially increased their arousal levels? When injected with adrenaline, psychopaths showed dramatic evidence of avoidance learning. They actually performed better than the normal prisoners, whose performance on this complex task may have been somewhat impaired by increasing their already-existing fear responses.

Critical discussion

This study was done a half-century ago, but it's still considered a classic. Schachter and Latane tested a clinical explanation for a behaviour disorder under controlled laboratory conditions. They not only demonstrated that the deficiency in avoidance learning was presumed to underlie antisocial behaviour; but also showed that it could be reversed, if there was a possibility to experimentally create psychological arousal, which people with ASPD lacked.

The increased arousal produced by the adrenaline injection had a notable effect on the psychopaths, who learned to avoid even better than the normal prisoners did in the placebo condition. This could be due to the former's arousal in this fear-inducing was different from their normal experience.

It is important, however, to rule out other possible explanations for the results, such as whether the pain was experienced differently due to the injections motivating their shock avoidance? The researchers rule this out with evidence of the two groups' rates of pain being equally unpleasant under both injection conditions. Therefore, the psychopathic and normal prisoners apparently experienced pain equally when shocked.

This study exemplifies a research area known as Experimental Psychopathology, a study process on clinical populations in order to underlie a particular disorder under controlled conditions; such as a laboratory, using state-of-the-art science techniques from other areas of psychology such as social psychology, cognitive psychology, and behavioural neuroscience. This kind of research helps in identifying the mechanisms contributing to behavioral disorders.

It also allows researchers to test hypotheses derived from existing theories of psychopathology and, sometimes, to directly pit competing theories against each other. In this manner, clinical observation informs science, and science helps inform clinical understanding and the hopeful treatment of behavioural disorders.