This document summarizes key aspects of neuropsychological development from infancy through adolescence, including major developmental milestones, disorders, and treatment approaches. It discusses phases of brain development, Piaget's stages of cognitive development, myelination and executive function development through the teen years. Common childhood neurodevelopmental disorders like learning disabilities, ADHD, autism, and Tourette's syndrome are described. Treatment approaches for these disorders focus on behavioral, educational, social skills, and medical interventions.

1. Neuropsychological Development of Children Brooke Schauder, PhD Erie Psychology Consortium

2. Phases of Development Primitive Brain Structures (Hindbrain/Midbrain) mature within first 3 years of life. By age 2, brain is 80% as large as an adult brain. Basic sensory and motor functions are gained in this phase. Frontal lobe functioning doesn’t begin to occur until between 5-7.

4. Piaget’s Stages in Relation to Neurological Development Sensorimotor (0-2) no language, no thought, no objective reality in beginning of this stage Preoperational Thinking:(2-7) Egocentric thought, reason dominated by perception; intuitive rather than logic, inability to conserve.

5. Concrete Operations (7-11) Ability to conserve; logic of categories and relationships; understanding of numbers; bound to concrete objects and events; development of reversibility. Formal Operations:(12-15) Generality of thought; propositional thinking; ability to deal with the hypothetical.

6. Myelination and Teen Years MRI Imaging shows that white matter (connection material) continues throughout teen years. EXECUTIVE Functions are the last to develop.

7. Developmental Milestones Age 5: stands on 1 foot for 10 seconds, draws a person with a body, speaks sentence of more than 5 words, talks about future events, counts to 10, names 4 colors, wants to please friends, aware of gender, differentiates obvious fantasy from reality.

8. Childhood Neurodevelopmental Disorders Learning Disabilities (5-10%) ADHD (7%) Tourette Syndrome (2%) Autism (<1%) and other PDDs (3%) Turner Syndrome Fragile X Syndrome Neurofibromatosis Down Syndrome Klinefelter Syndrome Phenylketonuria Rett Syndrome Seizure Disorders Prader-Willi Syndrome Williams Syndrome

9. Learning Disabilities Most common neurobehavioral disorder. Not a SINGLE entity or cause: Genetic (up to 35%) Environmental Teratogens Brain Trauma Malnutrition Early parent-infant relational problem, lack of sensory stimulation.

10. Abnormal Brain Structures in Reading Disorder (Dyslexia) Left Parietal Abnormalities Thin Corpus Callosum General Left Sided cell abnormalities Inferior frontal, superior temporal, parietal regions affected (not occipital or orbitofrontal)

11. Abnormal Brain Structures in Non-Verbal Learning Disorder (NLD) Mathematics Disorder Learning Disorder, NOS Social Skills problems & disorganization. Right-sided brain abnormalities – parietal lobe (however, left side may be involved as well)

12. Treatment of Children with Learning Disorders (30-40%)have ADHD type symptoms: impulsivity, distractibility. Conduct Disorder (Parental Intervention – basic behavioral principles) Anxiety disorder/Depression: CBT, relaxation, positive self-talk, desensitization, self-esteem building. Social Skills Deficits: Identifying and responding to emotions, conversation skills, Social Role Playing.

13. 4 Personality Patterns Found in LD Children (Wirt, Lachar, Klinedinst, & Seat, 1977) 44% displayed Balanced, well-adjusted social emotional functioning. 26% exhibited internalizing psychological disturbances (depression, anxiety, low social skills). 13% displayed normal personality fxn, but somatic concerns. 17% behavioral disturbance, ODD, conduct problems.

14. Attention Deficit Hyperactivity Disorder (ADHD) A “biopsychosocial” problem; interaction of biological/tempermental traits with environment. It is a “cluster” of deficits, rather than a single disorder with a single etiology.

15. Genetics and Brain Structure Dopamine transporter and receptor genes. Frontal lobe impairment (executive functions of attention, motor planning, mental flexibility, sustaining mental effort, and abstract reasoning. Reduction in Basal Ganglia: subcortical structure involved in movement and basic sensory regulation.

16. Treatment Most effective: combination of medical, behavioral, and environmental. Classroom: Organized and structured environment Rewards are consistent and immediate Response Cost program should be implemented Constant feedback from instructors Transition times should be monitored closely Consistent Parent- teacher communication

17. ADHD Parenting Skills Have the parents read “123 Magic” and/or “The Explosive Child” for basic behavior mod. Strategies Parents must distinguish incompetence from noncompliance Parents must give clear, operational commands. Parents should learn to use “start” and not “stop” commands. Must use consistent and frequent reinforcement.

18. Tourette Syndrome Usually begins at age 7. Motor tics preceed vocal tics. Etiology is genetic AND familial (learned). Abnormalities of basal ganglia (movement) Orbitofrontal Cortex: Decision Making, obsession, compulsion, attention.

19. Basal Ganglia Orbitotrontal Cortex

20. Treatment of Tourette Disorder Awareness/Self-Monitoring : record each incidence of the habit or tic for a specified amount of time each day (30 minutes). -have the child verbally describe the details of the habit or tic to the therapist. - Have the child become cognizant of where the tic/habit happens most frequently.

21. Tourette Treatment Competing-Response Training: Have the person engage in a response that is incompatible with the tic. Must be 1) incompatible 2) capable of being maintained for several minutes 3) able to strengthen the muscles antagonistic to those used when engaging in the tic behavior.

22. Tourette Treatment Relaxation Training: Progressive muscle relaxation, deep breathing, visual imagery, self-statements of relaxation. Contingency Management: Work with parents to set up rewards for decreased tic behavior.

23. Pervasive Developmental Disorders Characterized by severe deficits in multiple areas, including social interaction, communication, and behavioral stereotypes. Autistic Disorder Rett’s Disorder Childhood Disintegrative Disorder PDD NOS

24. Rett’s Disorder Onset of problems AFTER normal 5 months of development. Deceleration of head growth (between 5 and 48 months) Loss of motor skills Loss of social engagement Poorly coordinated trunk movements Severely impaired expressive and receptive language development

25. Childhood Disintegrative Disorder Normal development for 2 years (verbal and non-verbal, social skills, play, etc.) Loss of previous skills before age 10 in 2 of: Language -social skills Bowel or bladder -play Motor skills AND 2 of: Social interaction problems Communication problems Behavioral stereotypes or restricted interests

26. Autistic Disorder 6 of: Impairment in social interaction as: Impairment of non-verbal behavior Failure to develop peer relationships Lack of spontaneous seeking to interact Lack of social/emotional reciprocity Impairment of Communication Delay in spoken language Inablity to sustain conversation Stereotyped language Lack of make-believe or imitative play

27. (DSM Autistic Disorder Continued) Stereotyped behavior or interests: Preoccupation with interests Inflexible adherence to routine Repetitive motor mannerisms Preoccupation with parts of objects Delays in at least 1 area manifest BEFORE age 3.

28. Asperger’s Disorder Impairment in social interaction (as in autism) Stereotyped behavior or interests (as in Autism) NO clinically significant delay in language. NO impairment of cognitive development.

29. Neuroanatomical Feature MRI Studies and Total Brain volume (occipital, parietal, and temporal) Temporal is critical region. Limbic Regions. Decreased Purkinje cells.

30. Normal Purkinje Cell Autistic Purkinje Cell

31. Neurological/Heritable Abnormalities Endocrine Abnormalities Gastrointestinal dysfunction. Gene HOXA1 22 (40%) had one copy of the variant Underconnectivity Activation and time synchronization between cortical areas was lower in autistic group

32. Treatment of ASDs BEHAVIORAL TREATMENT Reinforcement is KEY Repetition Shaping Visual Works Best Communication: initiating spontaneous questions and comments Basic Conversation Skills Organizing thoughts into words

33. ASD Communication Treatment Eye Contact Non-verbal body language (identifying) Prosody and Intonation of Speech Social Stories

34. ASD Treatment Play How to pretend How to initiate play with others Sharing Idendifying Emotions Recognizing own emotions Recognizing and making facial expressions

35. Treatment of ASDs Use of Schedule Theory of Mind Time out / Quiet Place Decrease Self Injurious Behaviors Teach Me Language (Freeman, PhD) Asperger’s…What does it mean to me? (Faherty)