UNIT 6: AUTISM SPECTRUM DISORDER

AND ATTENTION DEFICIT

HYPERACTIVITY DISORDER*
Structure
6.1 Learning Objectives
6.2 Introduction
6.3 Autism Spectrum Disorder (ASD)
6.3.1 Clinical Picture in ASD
6.3.2 Causal Factors and Treatment of ASD
6.4 Attention Deficit Hyperactivity Disorder (ADHD)
6.4.1 Clinical Picture in ADHD
6.4.2 Causal Factors of ADHD
6.4.3 Treatment of ADHD
6.5 Let Us Sum Up
6.6 Key Words
6.7 Answers to Self Assessment Questions
6.8 Unit End Questions
6.9 References and Suggested Readings

6.1 LEARNING OBJECTIVES

After studying this Unit, you would be able to:
● Explain the clinical picture, causal factors, and treatment of Autism
Spectrum Disorder (ASD); and
● Elucidate the clinical picture, causal factors, and treatment of
Attention Deficit Hyperactivity Disorder.

6.2 INTRODUCTION
The present Unit will discuss about Autism Spectrum Disorder (ASD) and
Attention Deficit Hyperactivity Disorder (ADHD). You will also learn about
Intellectual disability and Specific learning disorder in the next Unit 7. All
these disorders begin in childhood and continue to adulthood. These are
categorized under the broader heading of Neurodevelopmental disorders
which refer to a group of severely disabling conditions considered to be a
result of structural and/or functional differences in the brain that are usually
evident at birth or become apparent as the child begins to develop.
It is important to note that one needs to be very careful about diagnosing a
mental health condition in children. First, behaviours related to mental health
issues and conditions might get confused with the normal/typical behaviour
*
 Adapted by Prof. Swati Patra, Discipline of Psychology, SOSS, IGNOU from Units 12
and 13 of BPCC 133 (BAG programme, IGNOU) written by Dr. Itisha Nagar, Assistant
Professor of Psychology, Kamala Nehru College, University of Delhi, New Delhi.
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exhibited by children. Hence, one needs to be careful in diagnosis. Second, Autism Spectrum Disorder
the behaviour of the child always need to be discussed in the context while and Attention Deficit
Hyperactivity Disorder
considering a diagnosis. To assess whether a child’s behaviour is ‘normal’ or
not, the behaviour needs to be compared to a sample of children of the same
age group, educational level, and socio-cultural background. For instance,
temper tantrums are common in two-year-old children but not for a 10-year-
old child. Consequently, a child’s behaviour is understood as typical or
atypical to his/her peers. Third, clinicians need to exercise care and caution
in diagnosing a child. They must understand that the repercussions of the
label ‘abnormal’ for a child or adolescent are immensely stigmatizing and
has significant implications in determining the future outcomes for the child
as an adult.

6.3 AUTISM SPECTRUM DISORDER

The term Autism is derived from the Greek word autos meaning self,
used by Eugen Bleuler (Swiss psychiatrist) for the first time. Autism is
a neurodevelopmental condition that is usually identified before a child is
30 months of age and may be suspected in early weeks of life. Autism is a
condition that affects social communication and is associated with repetitive
patterns of behaviour. DSM-5 has combined four independent diagnoses,
that is, Autistic disorder, Asperger syndrome, Pervasive developmental
disorder-not otherwise specified (PDD-NOS) and Childhood disintegrative
disorder into one diagnosis of Autism Spectrum Disorder (ASD). Recent
researches have suggested that all these disorders have the same essential
symptoms, varying in degrees of severity. No two children with ASD are
alike, they have wide range of deficits, abilities, difficulties, and challenges,
therefore, spectrum was found to be a suitable word to describe individuals
with autism.
Box 6.1 Case Study: Autism Spectrum Disorder
Abhishek is 5 years old. His mother took him to a doctor to get his hearing
tested at 2 years of age when he would not respond to his name and had
not started speaking even a single word. Even at 5 years of age, Abhishek
would turn his head away whenever someone would speak to him.
Sometimes he would mumble something unintelligible. Although toilet
trained and able to feed himself, schools asked his parents to take him out
of school, because Abhishek would not mingle with other children. He
actively avoided being touched and, on some days, he would start to cry
and scream and no amount of cajoling or loving him would soothe him.
Inconsistent eye contact and repetitive behaviour like lining up of his toy
cars can be seen. When seated, he often rocks back and forth in a rhythmic
motion for hours. Any change in routine is highly upsetting to him.
6.3.1 Clinical Picture in ASD
Lack of reciprocal social interaction is amongst the earliest markers of
autism, irrespective of cognitive or language ability. In infancy, the child
seems to be aloof from others. Mother’s remember that babies diagnosed
with autism later in life fail to respond to their name, do not reach out when
picked, would never smile or look at family when they are played with, or
may not notice people - family and strangers alike coming and going from
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Disorders of Childhood the room. This may make people assume that children with autism do not
have the ability to express emotions or may lack emotions,
However, the fundamental problem in autism comes from lack of social
understanding. As children with autism grow older, deficits in social
understanding can be seen in lack of initiation for social interactions with
others, social interaction is restricted to getting obvious needs met such as
food and water, the children appear to be content with being alone and may
ignore parents bid for attention, and inconsistent eye contact although not
reported for all children, but has been reported for many children on the
spectrum. Some children may approach others in an unusual manner, for
example, by licking, smelling or biting.
In teenagers, the social deficits are not manifested in seeming lack of
social interest, but in inability to maintain relationships appropriate to age
level. This is because in adolescence, an individual is faced with a more
complex social milieu, a person on the spectrum may lack the ability to
understand social conventions, making socialization extremely challenging.
For instance, the person may have difficulty in understanding jokes, irony,
sarcasm, and faux pas and because of this may become a victim of bullying
in school.
Individuals with autism find it difficult to understand and use verbal and non-
verbal communication. Deficits in verbal communication include, delay in
language development, mutism (inability to acquire speech), idiosyncratic
uses of speech (unusual ways of using some words), immediate or delayed
echolalia (repetition of words or phrases either immediately or later
sometime), or inability for pragmatic use of speech (inability to use language
for everyday social interactions). Individuals with autism may fail to initiate,
maintain, or respond to conversations; engage in one-sided conversations
which makes others who have no understanding of autism to reject them.
Additionally, children with ASD find it challenging to understand non-verbal
gestures, cues, and body language of others. About 70 percent of human
communication is largely non- verbal in nature; deficits in verbal in and
non-verbal communication prove to be a major impediment for successful
socialization even for extremely intelligent people on the spectrum.
Box 6.2: DSM-5 Criteria for Autism Spectrum Disorder (APA, 2013)
A. Persistent deficits in social communication and social interaction
across multiple contexts, as manifested by the following, currently
or by history (examples are illustrative, not exhaustive; see text):
. 1) Deficits in social-emotional reciprocity, ranging, for example,
from abnormal social approach and failure of normal back-and-
forth conversation; to reduced sharing of interests, emotions,
or affect; to failure to initiate or respond to social interactions.

. 2) Deficits in nonverbal communicative behaviors used for social

interaction, ranging, for example, from poorly integrated
verbal and nonverbal communication; to abnormalities in
eye contact and body language or deficits in understanding
and use of gestures; to a ( total lack of facial expressions and
nonverbal communication).
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 Autism Spectrum Disorder
3) Deficits in developing, maintaining, and understanding and Attention Deficit
relationships, ranging, for example, from difficulties Hyperactivity Disorder
adjusting behavior to suit various social contexts;
to difficulties in sharing imaginative play or in
making friends; to absence of interest in peers.

B. Restricted, repetitive patterns of behavior, interests, or activities, as

manifested by at least two of the following, currently or by history
(examples are illustrative, not exhaustive; see text):
1) Stereotyped or repetitive motor movements, use of
objects, or speech (e.g., simple motor stereotypies, lining
up toys or flipping objects, echolalia, idiosyncratic phrases).

2) Insistence on sameness, inflexible adherence to routines,

or ritualized patterns of verbal or nonverbal behavior
(e.g., extreme distress at small changes, difficulties
with transitions, rigid thinking patterns, greeting rituals,
need to take same route or eat same food every day).

3) Highly restricted, fixated interests that are abnormal in intensity

or focus (e.g., strong attachment to or preoccupation with unusual
objects, excessively circumscribed or perseverative interests).

4) Hyper or hyporeactivity to sensory input or unusual interest in

sensory aspects of the environment (e.g., apparent indifference to
pain/temperature, adverse response to specific sounds or
textures, excessive smelling or touching of objects, visual
fascination with lights or movement).
C. Symptoms must be present in the early developmental period (but
may not become fully manifest until social demands exceed limited
capacities, or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social,
occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability

(intellectual developmental disorder) or global developmental delay.
Intellectual disability and autism spectrum disorder frequently co-
occur; to make comorbid diagnoses of autism spectrum disorder
and intellectual disability, social communication should be below
that expected for general developmental level.
Social and communication deficits have a reciprocal relationship in autism.
An innate inability for socialization affects language development in the
child, language and communication deficits in turn lead to challenges
with socialization as the child grows up. Understanding of this reciprocal
relationship between socialization and communication deficits led DSM-5
to assimilate socialization and communication impairments under a single
heading, ‘social-communication’ impairments. Social-communication
impairments in autism have been attributed to the inability of individuals
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Disorders of Childhood with autism to ‘read people’s minds’ also known as mindblindness.
Mindblindness refers to the difficulty in seeing things the way other people
do and make educated guesses about what other’s may be thinking or feeling.
This skill helps typical people navigate a number of social situations. For
instance, if a typical child finds her/his friend sitting and sulking, she/he is
likely to enquire about the reason for her/him sulking, whereas a child with
autism may be unable to ‘read’ the non-verbal gestures of sulking and start
talking about a topic that greatly interests him/her.

Fig. 6.1: Non-Verbal Communication

Along with social-communication difficulties, autism is characterised by

a number of behavioural difficulties in autism. Children with autism may
engage in stereotyped or repetitive speech, motor movements, or use of
objects. For instance, they may engage in self-stimulation i.e. repetitive
movements as head banging, spinning, and rocking, which may continue by
the hour. Lining up of objects is also commonly seen in children. Excessive
adherence to routines or rituals and resistance to changes in routines can
also be seen with children on the spectrum. The child may insist of taking
the same route every day, or make the bus stop at a particular point only
then would the child get down.
Children may form strong attachments to unusual objects like rocks, keys,
and light switches so much so that the attachment may interfere with other
activities. Highly restricted interest of unusual magnitude is not just limited
to objects such as pens, keys, action, figures, and particular toys but may
also extend to topics like dinosaurs or trains. Changes in the environment,
stereotypical routine, and/or an object with strong attachment leads to
resistance from the child ranging from discomfort to crying spell that
continue until the situation is restored.
Finally, an addition to DSM-5 diagnostic criteria for autism is sensory
difficulties. Sensory difficulties, i.e., hyper or hypo reactivity to sensory
input from the environment such as indifference to pain/heat/cold, over-
under reaction to certain sounds, distaste for certain food to the point
of being nauseous when made to eat it, fascination with lights etc. are
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pervasive and independent of age and ability. Although individuals with Autism Spectrum Disorder
autism have always experienced sensory hyper/hypo reactivity, practitioners and Attention Deficit
Hyperactivity Disorder
have only recently acknowledged it, because of the social-communication
difficulties inherent in autism. For instance, a child with autism would cry
when getting hair or nails cut, she/he may refuse to wear socks, or t-shirts
with labels because of hyper sensitivity to tactile stimuli. But many adults
would interpret this as disruptive behaviour instead of sensory difficulties
in autism.
Autism has a high comorbidity with intellectual disability. Earlier estimates
indicated that approximately 70 percent of individuals with autism also had
intellectual disability (Fombonne, 2005). However, recent estimates have
estimated that 50 percent of individuals with autism are also intellectually
impaired (Polynak, Kubina & Girirajan, 2005). This shift in the distribution
has been primarily attributed to an increase in identification of high
functioning children with autism, who were earlier missed out because their
cognitive abilities would often mask other deficits.

Unlike children with intellectual disability, children with autism are quite
adept at puzzles and fitting objects together often performing better than
even typical children. However, difficulties meaning is apparent, for
instance, if a child with autism is asked to arrange pictures in an order
so that they communicate a story, she/he is likely to perform poorer than
typical children.

6.3.2 Causal Factors and Treatment of ASD

Although most scientists believe that autism is an innate condition that
affects the development of the nervous system of a child, the precise
cause/causes of autism are unknown. Evidence from role of genetics in the
etiology of autism comes from studies examining the incidence rates of
autism in families. To have a parent or sibling with autism raises the chance
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Disorders of Childhood of an individual to have autism. According to WHO, 1 in 160 children
has ASD. A family with one child with autism have greater risk of having
another with autism. Twin studies have shown higher concordance for
monozygotic (60%) than dizygotic twins. Relatives of people with autism
may show sub-threshold social-communication deficits. Genetic researches
in autism has been found autism to be related to the faulty working of the
brain’s glutamate neurotransmitter system. However, it is unclear how the
genetic vulnerability transmits to leads to faulty wiring in early stages of
development.
Expression of the autism genes may be influenced by environmental factors.
Prenatal environmental factors (exposure to radiation, toxins, alcohol,
drugs, infections etc.) and pregnancy related factors (uterine bleeding, Rh
incompatibility, induced or prolonged labour, oxygen requirements at birth)
have been implicated in children with autism.
Based on the recent researches it is important to note that there is no cure
for autism. In spite of that, many children continue to be subjected to the
many fads in the market, promising them a ‘cure’ for the condition. Many
researchers and parents conceive autism to be unlike other mental illnesses
like depression and anxiety. Autism is seen as a condition, that leads to
differences in brain wiring relative to the typical population, Treatment of
autism includes management of problematic behaviours as well training of
teachers, schools, and workplaces to understand and make space for the
challenges of autism.
In the past medications for autism have proven to be effective. Currently
medicines are only prescribed for aggression and hyperactivity that may be
excessive and leading to self-harm. Behavioural therapy has been found to
be successful in development of some social and communication skills and
elimination of problematic behaviour. A successful intervention involves
one-to-one teaching of skills every day for several years in diverse settings
of the child i.e. clinic, school, and home. Adults including parents and
teachers are taught principles of behavioural therapy, such as use of rewards
and breaking down of complex tasks into smaller tasks. Use of punishment
or aversive techniques must be avoided.
1. Self Assessment Questions
1) Which of the following is a sign of Autism?
a) 2-year-old child does not react or respond when his name is
called.
b) Child consistently does not seem interested in the reactions of
others, even the reactions of parents.
c) Person does not seem aware of the feelings of others.
d) All of the above.
2) Which of the following causes Autism?
a) Cold parenting

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 Autism Spectrum Disorder
b) Poor prenatal nutrition and Attention Deficit
c) A single gene or chromosome Hyperactivity Disorder

d) There is no known single cause

3. Individuals with autism find it difficult to understand and use both
verbal and non-verbal communication. True or False
4. Mindblindness refers to the difficulty in reading one’s own mind.
True or false
5. In autism, children may form strong attachments to unusual objects
like rock, keys etc. True or false.
6. Sensory difficulties refere to hyper or hypo reactivity to sensory
input from the environment. True or False
7. Autism can be cured. True or false.
6.4 Attention-Deficit/Hyperactivity Disorder
Children with Attention-Deficit/Hyperactivity Disorder (ADHD) display
difficulties in maintaining sustained attention, excessive and exaggerated
motor activity, and impulsivity relative to their developmental level leading
to social, occupational/academic activities. DSM-5 classification lists it as a
neurodevelopmental disorder. It specifies several inattentive or hyperactive-
impulsive symptoms to be present prior to 12 years of age and can be
classified in terms of the current severity as mild, moderate and severe. There
are three sub-types of Attention Deficit/Hyperactivity Disorder such as:
combined presentation, predominately inattentive presentation (Attention
Deficit Disorder; ADD) and predominately Hyperactive/Impulsive
presentation. ADHD combined type is the most common presentation,
whereas ADHD predominantly inattentive type may be cases of pure ADD
or may include children who display attention difficulties along with sub-
threshold hyperactivity.

Fig. 6.2: Symptoms of ADHD

6.4.1 Clinical Picture in ADHD

Attention deficit is a multi-dimensional construct that includes problems
with arousal, alertness, selective focus, sustained attention/vigilance, and
distractibility. These difficulties can manifest in many situations making
it difficult to function adequately in school, workplace or with friends and
family. Issues with arousal and alertness can lead to children failing to
give attention to details, losing track of time or things, making careless
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Disorders of Childhood mistakes or day dreaming. A child with deficit selective attention is likely
to fail to understand instructions and follow through instructions. She/he
could appear to others as if she/he is “not listening” or that their “mind
is elsewhere”. Problems with sustained attention can most often be seen
in boring and repetitive activities but can also be apparent in free play.
The child has a tendency to “tune out” of these tasks, and tasks requiring
sustained attention (e.g. reading, mathematics, board games, etc.) are seen
as aversive and are generally avoided. Sustained attention deficits may lead
the child to shift from one task to another without completing any one of
them.
Finally, distractibility is the ability to be easily attend to irrelevant stimuli
in the environment (e.g. noise, background conversations, object in a room,
etc.). Attentional difficulties affect daily lives of people with ADHD. Their
work is often messy, disorganized and appears to have been done without
any considered thought. School material like pen, tiffin boxes, books
and notepads are often scattered, lost or damaged. Attentional problems
also make children and adolescents forgetful, for instance they would
forget to bring lunch, books, homework etc. Socially, ADHD individuals
find it difficult to keep track of conversations. Such children often find it
challenging to follow rules in games or different activities.

Fig. 6.3: Descriptions used by Parents and Teachers for Children with Significant
Attentional Difficulties

Hyperactivity refers to excessive activity manifested in two forms: motor

hyperactivity (restlessness, squirminess, and unnecessary body movements)
and vocal hyperactivity (excessive talking). Manifestation of hyperactivity
may vary with developmental level. In pre-school children hyperactivity
can be seen in children to engage in excessive jumping and climbing on
furniture, running around the house, and in difficulty in engaging the children
in sedentary activity like listening to story. In school aged children similar
behavior may be seen in hyperactive children although the behavior maybe
lesser in intensity and frequency. Hyperactivity in children can be seen in
the child’s difficulty to remain seated, they get up frequently, squirm, and
hang onto the edge of their seat. Not only do they fidget during academic
activities, they also find it challenging to sit through meals, TV, or play that
requires them to sit in one place. One is likely to find them fidgeting with
objects, pen, or shaking legs.
Girls with ADHD are more likely to display hyperactivity through excessive
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talking and interruptions when others are talking. It is a common misbelief Autism Spectrum Disorder
that adolescents/adults “out grow” their hyperactivity. However, in older and Attention Deficit
Hyperactivity Disorder
children hyperactivity manifests more as restlessness, excessive speech,
difficulty in engaging in solitary activities and increased aggression and
conflicts. Professionals stress on pervasiveness of hyperactivity, ADHD
children display hyperactivity throughout the day and even during night.
ADHD children find it difficult to fall asleep and may wake up early.
Hyperactivity is pervasive and displayed in all domains including home,
school, and playground.

Fig. 6.4: Descriptions Used by Parents and Teachers for Children with Hyperactivity

Impulsivity is one of the most common complaints parents and teacher’s

make about children with ADHD. Impulsivity refers to the tendency to
act on urges, apparently without thinking. Most common complaint made
about children with ADHD by parents and teachers is about this symptom.
Impulsivity can be seen in impatience, difficulty in waiting for their turn,
interrupting and intruding others to the point of causing difficulties in school,
social or occupational setting. Impulsivity is often responsible for the many
accidents that hyperactive children get into. More often than not children
with ADHD may knock over objects, bang into people, grab to hold a hot
pan, or even engage in potentially harmful activity like repeatedly climbing
trees and riding bicycle in traffic.
Children with ADHD also display some secondary problems. ADHD is
related to cognitive and academic difficulties as children with ADHD are
found to have delay in intelligence of about 7-10 IQ points, may be at high
risk for learning disability, and have lower academic intelligence than their
peers. Many children with ADHD suffer from socio-emotional difficulties
also. There is high rate of rejection by peers amongst ADHD children,
which is not because they are unfriendly but because ADHD may make
them inattentive to social cues and peers may get tired of their hyperactivity
and excessive talking. Unpopularity amongst peers may also be a result
of aggression and depression. Peer rejection and negative criticism from
parents and teachers negatively affects the self-esteem of these children.
Box 6.3: Case Study: Attention Deficit Hyperactivity Disorder
Rubin is a 9-year-boy who has been referred to a child psychologist at the
request of his school counsellor. The counsellor had been receiving multiple
complaints about Rubin from his class teacher. The teacher complained that

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Disorders of Childhood
Rubin is extremely restless, he is hardly ever on his seat and roams around
in the class in spite of the many instructions given against getting up
in class. He finds it difficult to pay attention to lessons in class and his
work is messy and incomplete. His restlessness disturbs other children.
Sometimes, he talks to other students making it difficult for them to
concentrate on their individual classwork.
The teacher reports that Rubin does not seem to have any control
over his unpredictable behaviour and is quite polite and good natured.
Clinical interview with parents revealed that Rubin has had behavioural
difficulties ever since he was a toddler. Even when he was three years old,
he was and extremely restless who required little sleep and woke before
anyone else. When he was four, he had managed to unlock the door of
the house and wandered off by himself on a busy road. He was brought
back by a neighbour who found him wandering on the streets. Teachers
in play school complained that Rubin would find it difficult to follow
any instructions given to him and his restlessness made it difficult for the
teacher to look after his well-being.
The prevalence rate of ADHD has been increasing over the years. The
average prevalence of ADHD worldwide is found to be 5.9 - 7.1 percent and
2.6 - 4.5 percent (Willicut 2012, Polanczyk et al. 2015). Some researchers
believe that the increase in the number of children diagnosed with ADHD
may be a result of an increase in awareness about ADHD or society’s
intolerance to childhood activities because of urban life pressures and loss
of support, or extended family. Also, boys are three times more likely to be
diagnosed with ADHD. This may be because adults may be more tolerant
of hyperactivity in girls who engage in less direct aggressive. Secondly,
research on ADHD has focussed on boys, thereby ignoring the experience
and manifestation of ADHD symptoms in girls. There is high co-morbidity
of aggression and depression in ADHD.
Box 6.4: DSM-5 Criteria for ADHD (APA, 2013)
A. A persistent pattern of inattention and/or hyperactivity- impulsivity
that interferes with functioning or development, as characterized by
(1) and/or (2):
1) Inattention: Six (or more) of the following symptoms have persisted
for at least 6 months (for children up to age 16) to a degree that is
inconsistent with developmental level and that negatively impacts
directly on social and academic/occupational activities:
Note: The symptoms are not solely a manifestation of oppositional
behavior, defiance, hostility, or failure to understand tasks or
instructions. For older adolescents and adults (age 17 and older), at
least five symptoms are required.
a) Often fails to give close attention to details or makes careless
mistakes in school work, at work, or during other activities
(e.g., overlooks or misses details, work is inaccurate).

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 Autism Spectrum Disorder
b) Often has difficulty sustaining attention in tasks or play and Attention Deficit
activities (e.g., has difficulty remaining focused during Hyperactivity Disorder
lectures, conversations, or lengthy reading).
c) Often does not seem to listen when spoken to directly (e.g.,
mind seems elsewhere, even in the absence of any obvious
distraction).
d) Often does not follow through on instructions and fails to
finish schoolwork, chores, or duties in the workplace (e.g.,
starts tasks but quickly loses focus and is easily side-tracked).
e) Often has difficulty organizing tasks and activities (e.g.,
difficulty managing sequential tasks; difficulty keeping
materials and belongings in order; messy, disorganized work;
has poor time management; fails to meet deadlines).
f) Often avoids, dislikes, or is reluctant to engage in tasks that
require sustained mental effort (e.g., schoolwork or homework;
for older adolescents and adults, preparing reports, completing
forms, reviewing lengthy papers).
g) Often loses things necessary for tasks or activities (e.g., school
materials, pencils, books, tools, wallets, keys, paperwork,
eyeglasses, mobile telephones).
h) Is often easily distracted by extraneous stimuli (for older
adolescents and adults, may include unrelated thoughts).
i) Is often forgetful in daily activities (e.g., doing chores,
running errands; for older adolescents and adults, returning
calls, paying bills, keeping appointments).
2) Hyperactivity and impulsivity: Six (or more) of the following
symptoms have persisted for at least 6 months (children up to the age
of 16 years) to a degree that is inconsistent with developmental level
that negativ impacts directly on social and academic/occupational
activities:
Note: The symptoms are not solely a manifestation of oppositional
behavior, defiance, hostility, or a failure to understand tasks or
instructions. For older adolescents and adults (age 17 and older), at
least five symptoms are required.
a) Often fidgets with or taps hands or feetor squirms in seat.
Often leaves seat in situations when remaining seated is
b) 
expected (e.g., leaves his or her place in the classroom, in the
office or other workplace, or in other situations that require
remaining in place).
c) Often runs about or climbs in situations where it is
inappropriate.
(Note: In adolescents or adults, may be limited to feeling
restless.)
d) Often unable to play or engage in leisure activities quietly.

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Disorders of Childhood
e) Is often”on the go,”acting as if”driven by amotor”(e.g., is
unable to be or uncomfortable being still for extended time,
as in restaurants, meetings; may be experienced by others as
being restless or difficult to keep up with).
f) Often talks excessively.
g) 
Often blurts out an answer before a question has been
completed (e.g., completes people’s sentences; cannot wait
for turn in conversation).
h) Often has difficulty waiting his or her turn (e.g., while waiting
in line).
Often interrupts or intrudes on others (e.g., butts into
i) 
conversations, games, or activities; may start using other
people’s things without asking or receiving permission; for
adolescents and adults, may intrude into or take over what
others are doing).
B. Several inattentive or hyperactive-impulsive symptoms were
present prior to age 12 years.
C. Several inattentive or hyperactive-impulsive symptoms are present
in two or more settings (e.g., at home, school, or work; with friends
or relatives; in other activities).
D. There is clear evidence that the symptoms interfere with, or reduce
the quality of, social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of
schizophrenia or another psychotic disorder and are not better
explained by another mental disorder (e.g., mood disorder, anxiety
disorder, dissociative disorder, personality disorder, substance
intoxication or withdrawal).
6.4.2 Causal Factors of ADHD
Researchers understand that the causes of attention deficit hyperactivity
disorder are not social in origins. Genetic factors play a role in ADHD as
twin and family studies report high degree of heritability of ADHD. Adoption
researches have also reported higher rates of hyperactivity in biological
parents of hyperactive children than adoptive parents of such children.
Molecular genetic studies have found that multiple genes contribute to the
risk for ADHD. In particular, DAT-1 or dopamine transporter gene has been
implicated.
Neuropsychological studies have found structural and functional difference
in brains of people with ADHD and typical control. In particular, difference
have been seen in frontal lobe, basal ganglia, and cerebellum. Executive
functions (high order cognitive processes), such as working memory,
attention, and inhibition of responses has been found to be poorer for ADHD
individuals relative to typical control. ADHD is related to dysfunction
in two neurotransmitters, dopamine and nor-epinephrine. Scientists have
found that inattention and distractibility appear to be related to low levels of
norepinephrine whereas impulsivity and hyperactivity problems appear to
be related to low levels of dopamine in the brain.
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Thus, because child feels lack of stimulation in the brain, hyperactivity is Autism Spectrum Disorder
a way to compensate for that. That is why, stimulants are prescribed as and Attention Deficit
Hyperactivity Disorder
medicines for children with ADHD. Pregnancy and birth factors like mother’s
age at delivery (younger), mother’s educational level (lower), time between
labour (longer), and premature delivery related to higher probability of the
child developing ADHD. Prenatal exposure to environmental toxins like
lead, alcohol and tobacco have been implicated. Certain medicines, such
as medicines for seizures are likely to result in problems with in attention
and hyperactivity. Some researchers also report that the behavior of some
ADHD children is worsened after eating foods with artificial colors, certain
preservatives, and/or allergens.
While social factors like parenting style, schooling, and peer relations may
moderate the types and degrees of impairment but they do not cause ADHD.
Overall critical, harsh and negative behaviour of parents of hyperactive
children is related to difficult, disruptive and non-compliant behaviour of
ADHD children. Early television viewing has also been found to shorten
attention span of children. Aggressive and hyperactive portrayal of
characters in TV shows has also been found to exaggerate difficult behavior.
6.4.3 Treatment of ADHD
Some of the treatment options for ADHD are indicated below:
Prescription of medicine like Ritalin (methylphenidate), an amphetamine
in some children with attention deficit hyperactivity disorder is a common
treatment for ADHD. Ritalin is a stimulant and has a quietening effect on a
child with ADHD, opposite of what is expected for a typical adult for whom
stimulant leads to increased arousal and experience of excess energy. Ritalin
has been found to help children reduce restlessness and aggression, helping
them focus on studies and moderate difficult behaviours in classroom and
home. Some significant side effects are also related to the use of Ritalin in
children including decreased blood flow to the brain, which can result in
impaired thinking ability and memory loss; disruption of growth hormone,
leading to suppression of growth in the body and brain of the child; insomnia;
psychotic symptoms; and others. Medicines like Ritalin do not cure ADHD,
but they do result in moderation of behavioural symptoms.
Psychological interventions along with medications are important in
providing holistic treatment. Behavioural strategies include selective
reinforcements in classroom and structuring of material in a way that
enhances the experiences of success. For instance, a girl with ADHD
should be praised for increasing the amount of time she sits in classroom
even if she sits for 15 minutes in a half an hour class, if she was unable
to previously sit for anything more than say five minutes. Family therapy
helps in making parents and sibling understand behavioural strategies to
maximize productive behavior and extinction of aggressive and destructive
behavior.
School based intervention programs aim to teach teachers to deal with
hyperactivity and inattention difficulties in classroom.
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Disorders of Childhood
Self Assessment Questions 2
1. Which of the following is NOT an example of a neurodevelopmental
disorder?
a) ADHD
b) Childhood Depression
c) ASD
d) SLD
2. Developmental disorders refer to those conditions that occur
________in life.
a) Early b) Late c) After retirement
3. Children with _____________ disorder seem to have particular
difficulty controlling their activity in situations that call for sitting
still, such as in the classroom or at mealtimes.
4. Hyperactivity refers to excessive activity manifested in two forms:
________ hyperactivity and ____________ hyperactivity.
5. Selective attention deficits may lead the child to shift from one task
to another without completing any one of them. True or False.
6. Social factors like parenting style, schooling, and peer relations
may moderate the types and degrees of impairment are responsible
for causing ADHD. True or False
7. Name the three main sub-types of ADHD.

6.5 LET US SUM UP

In the present Unit you learned about two of the important developmental
disorders that can affect children. These are Autism spectrum disorder
(ASD) and Attention deficit hyperactivity disorder (ADHD). These are also
called neurodevelopmental disorders which have a heritable component.
You learned about exercising care and caution while diagnosing mental
health conditions in children and adolescents. The unit presented the clinical
picture in ASD. Autism is a condition that affects social communication and
is associated with repetitive patterns of behaviour. Although there is no cure
for autism, behavioural interventions and parent/teacher training program
can help with problematic behaviours of children with ASD. Behavioural
therapy has been found to be successful in development of some social and
communication skills and elimination of problematic behaviour in autism
spectrum disorder.
You also learned about the diagnostic features, causal factors and treatment
in case of ADHD. Children with Attention deficit hyperactivity disorder
display difficulties in maintaining sustained attention, excessive and
exaggerated motor activity, and impulsivity relative to their developmental
level, which affects their academic, social, and occupational activities.
Various psychological and school-based interventions for the treatment of
ADHD were also discussed.
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 Autism Spectrum Disorder
6.6 KEY WORDS and Attention Deficit
Hyperactivity Disorder
Neurodevelopmental Disorders: A group of severely disabling conditions
considered to be a result of structural and/or functional differences in the
brain that are usually evident at birth or become apparent as the child begins
to develop.
Autism: A condition that affects social communication and is associated
with repetitive patterns of behavior.
Echolalia: Repetition of words or phrases either immediately or later
sometime.
Mutism: Inability to acquire speech.
Distractibility: Easily attends to irrelevant stimuli in the environment (e.g.
noise, background conversations, object in a room, etc.).
Impulsivity: The tendency to act on urges, apparently without thinking.
Mindblindness: Difficulty in seeing things the way other people do and
make educated guesses about what other’s may be thinking or feeling.
Attention Deficit Hyperactivity Disorder: Includes difficulties in
maintaining sustained attention, excessive and exaggerated motor activity,
and impulsivity relative to their developmental level, which affects their
academic, social, and occupational activities.

6.7 ANSWERS TO SELF ASSESSMENT

QUESTIONS
Answers to Self Assessment Questions 1
1. d
2. d
3. True
4. False
5. True
6. True
7. False
Answers to Self Assessment Questions 2
1. b
2. a
3. Attention deficit/Hyperactivity disorder
4. Motor hyperactivity and vocal hyperactivity
5. False
6. False
7. Inattention, hyperactivity, and impulsivity

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Disorders of Childhood
6.8 UNIT END QUESTIONS
1. Discuss the clinical features of autism spectrum disorder.
2. Provide the clinical picture of Attention Deficit/Hyperactivity
Disorder.
3. Explain the causal factors related to ASD.
4. Describe the intervention measures for childrenwith ADHD.

6.9 REFERENCES AND SUGGESTED

READINGS
Barlow, D.H. & Durand, M.V. (2015). Abnormal Psychology (7th Edition).
New Delhi: Cengage Learning India Edition.
Bennett, P. (2006). Abnormal and Clinical Psychology: An introductory
textbook. New York: Open University Press.
Mineka, S., Hooley, J.M., & Butcher, J.N., (2017). Abnormal Psychology
(16th Edition). New York: Pearson Publications.
Kring, A. M., Davison, G. C., & Neale, J. M. (2014). Abnormal psychology
(13th Edition). New York: John Wiley & Sons.
Veeraraghavan, V., & Singh, S. (2014). A textbook of abnormal and clinical
psychology. New Delhi: McGraw Hill Education (India).
References for Figures
Fig. 6.2: Non-Verbal Communication. Retrieved 14th September 2019,
from https://globalcommunicationcorporation.weebly.com/non-verbal-
communications.html
Web Resources
● ADHD brain.
https://www.webmd.com/add-adhd/adult-adhd-17/video-adult-adhd-
brain
● Micheal Phelp’s Story of ADHD. https://www.understood.org/en/
learning-attention-issues/personal-stories/famous-people/celebrity-
spotlight-how-michael-phelps-adhd-helped-him-make-olympic-
history

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