Attention Deficit/Hyperactivity Disorder (ADHD)

  1. Symptoms: Hyperactivity (squirming, fidgeting, and restless behavior); attention deficit (distractibility, frequent shifts from one uncomplete activity to another, careless mistakes, poor organization or effort, and general “spaciness”); struggle with learning far more than behavior control; several symptoms begin before the age of 12; want to “be good”, but are impulsive and have trouble behaving
  2. Diagnosis:
    1. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (i) and (ii):
      1. Inattention: 6 (or more) of the following symptoms have persisted for at least 6 months 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 the oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults age 17 and older, at least 5 symptoms are required):
        1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (overlooks or misses details, work is inaccurate)
        2. Often has difficulty sustaining attention in tasks or play activities (has difficulty remaining focused during lectures conversations or lengthy reading)
        3. Often does not seem to listen when spoken to directly (mind seems elsewhere, even in the absence of any obvious distractions)
        4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (starts tasks but quickly loses focus and is easily sidetracked)
        5. Often has difficulty organizing tasks and activities (difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines)
        6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers)
        7. Often loses things necessary for tasks or activities (school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile phone)
        8. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts)
        9. Is often forgetful in daily activities (daily chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments)
      2. Hyperactivity and impulsivity: 6 (or more) of the following symptoms have persisted for at least 6 months 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 the oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults age 17 and older, at least 5 symptoms are required):
        1. Often fidgets wit or taps hands or feet or squirms in seat
        2. Often leaves seat in situations when remaining seated is expected (leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place)
        3. Often runs about or climbs in situations where it is inappropriate (note: in older adolescents and adults, may be limited to feeling restless)
        4. Often unable to play or engage in leisure activities quietly
        5. Is often “on  the go” acting as if “driven by a motor” (is unable to be or is uncomfortable being still for an extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with)
        6. Often talks excessively
        7. Often blurts out an answer before the question has been completed (completes people’s sentences; cannot wait for turn in conversation)
        8. Often has difficulty waiting his or her turn (while waiting in line)
        9. Often interrupts or intrude on others (butts into conversations games, or activities; may start using other people’s things without asking or receiving permissions; for adolescents and adults, may intrude into or take over what others are doing)
    2. Several inattentive or hyperactive-impulsive symptoms were persistent prior to the age of 12
    3. Several inattentive or hyperactive-impulsive symptoms are present in 2 or more settings (home, school, work; with friends or relatives; in other activities)
    4. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning
    5. The symptoms do not occur exclusively during the course of schizophrenia, or other psychotic disorder and are not better explained by another mental disorder (mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdraw)
  3. Course and Outcome: hyperactivity typically declines during adolescents, but attention deficits and impulsivity are more likely to continue ; prognosis for ADHD depends on whether or not there is a comorbid condition with oppositional defiant disorder or conduct disorder
  4. Frequency of Disorder: 9.5 % of children in the US have a lifetime diagnosis; 1 to 2% of children in Europe receive the diagnosis; diagnosis in the US increased by 2/3 between 2000 and 2010; more common among children of more affluent parents; 2 to 10 times as many boys as girls have externalizing problems
  5. Etiology:
    1. Family risk factors: increase fourfold when 2 are present and further when 3 or 4 are present: low income, overcrowding in the home, maternal depression, paternal antisocial behavior, conflict between parents, removal of child from the home
    2. Biological factors:
      1. Difficult temperament (inborn behavioral characteristics, including activity level, emotionality, and sociability)
      2. Neuropsychological abnormalities: brain damage was present on a CT scan in 5% of ADHD cases; many do not show soft signs (delays in fine motor coordination); minor anomalies in physical appearance, delays in reaching developmental milestones, maternal smoking and alcohol consumption, pregnancy and birth complications
      3. Genetics: couple be a single gene or could be polygenetic
      4. Social factors: socialization (process of shaping children’s behavior and attitudes to conform to the expectations of parents, teachers, and society)
      5. Parenting styles
      6. Coercion
      7. Negative attention: what seems to be a “punishment” sometimes may reinforce misbehavior
      8. Inconsistency in rules and expectations especially from parent to parent
      9. Influence of peers, neighborhoods, and media
      10. Psychological factors: low self-esteem, overestimation of self, self-protection, lack of self-control, delay of gratification
  6. Treatment:
    1. Psychostimulants (Ritalin, Dexedrine, Cylert, Adderall) increases alertness, arousal, and attention; shows improvements in behavior in about 75% of children with ADHD; taken for years, not days or weeks
    2. Antidepressants affect symptoms for unknown reasons
    3. Strattera for adults with ADHD and is the only nonstimulant medication approved by the US Food and Drug Administration
    4. Clonidine decreases aggressive behavior
    5. Behavioral Family Therapy (BFT) teaches parents to be very clear and specific about their expectations for children’s behavior to monitor children closely, and systematically reward positive behavior while ignoring or mildly punishing misbehavior; parent training; star charts or daily report cards; teaches punishment strategies such as time outs; rewards need to out weight punishments; goals is to teach authoritative parenting; benefits are generally limited to children under the age of 12; less effective when parents are unhappily marries, depressed, substance abusers, or harsh and critical with their children
    6. Problem-solving skills training (PSST) is one technique which children are taught to slow down, evaluate a problem, and consider alternative solution before acting

Autism Spectrum Disorder (ASD)

  1. Symptoms: impairments in social interaction; social communication, and restricted, repetitive behavior; motor milestones may be reached late, and movement may appear awkward or rather uncoordinated; may see abnormalities from birth; in 20 to 40% or severe cases, the baby develops normally for a time but either stops learning new skills or loses the skills acquired earlier; look less at objects held by others; engage in more repetitive motor movements; restrictive, repetitive patters or behavior, interests, or activities; unusually fascinated with some activity; self-stimulation; respond to sound, touch, sight or smell in unusual ways; apparent sensory deficits (organ is not impaired by actions make it appear so); savant performance (exceptional ability in a highly specialized area of functioning often in areas of art, music, or mathematics)
    1. Social communication deficits: normal language accompanied by odd “body language” at one extreme to a total absence of verbal and nonverbal communication at the other; failure to develop normal speech; about half are mute; dysprosody (subtle disruptions in rate, rhythm, and in tone of speech); echolalia (uttering phrases back, perhaps repeatedly)
    2. Social impairment deficits: range from relatively mild problems with social or emotion reciprocity; in severe ASD cases, they have no interest in relationships and treat people like confusing, foreign objects; lacking theory of mind (failure to appreciate that other people have a different point of reference); deficits tend to be emotional and not cognitive; missing basic motivation to form attachments; gaze aversion
    3. Self-injurious behavior: repeated head banging and biting the fingers and wrists; may involve major bruises or they can be as severe as broken bones, brain damage, or death; is not suicidal behavior
  2. Diagnosis:
    1. 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):
      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 interactions, 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 communications
      3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers
      4. Specify current severity
    2. 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)
      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 difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food everyday)
      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 perseveration interests)
      4. Hyper or hypoactivity 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 movements)
      5. Specify current severity
    3. 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 later in life)
    4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
    5. These disturbances are not better explained by an 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 and intellectual disability, social communication should be below that expected for general developmental level
  3. Course and Outcome: the sooner children that are diagnose earlier can be treated more successfully and may have an increase in IQ; no cure; more children and adults are now being cared for in their homes and communities instead or institutions; a more positive outcome can be predicted by language skills at the age of 5 or 6; joint attention (coordinating attention with another person through gestures, social responding, or social initiation, predicts language development from preschool age to 9; a quarter or more of young people with classic autism develop seizure disorder as teenagers; in adults, affective disorders are common
  4. Frequency of Disorder: 200 in 10,000 (1 in 50) suffer from ASD; a 400% in prevalence of ASD between 1998 and 2007, and a 300% prevalence by 2012; four times as many boys as girls suffer from ASD (suggests it stems from fragile-X syndrome)
  5. Etiology:
    1. fragile-X syndrome
    2. Genetics: in 60% of monozygotic twins, if one has ASD the other does too; possible genetic mutation
    3. Neuroscience: larger than average brain; unusually rapid brain growth until the age of 2 or 3; smaller volume than normal of the vertebral and cerebellar brain; abnormalities in the cerebellum and limbic system and the frontal lobe; mirror neurons fires both when an individual performs an action and when the individual observes another performing the same action; abnormalities in endorphins and neuropeptides
  6. Treatment(s):
    1. Medication: many medications are misused for ASD; antipsychotic (risperidone) helps in behavior management; SSRIs may also help with some stereotyped behavior; no medication is considered an effective treatment
    2. Applied Behavior Analysis: most promising approach to treating classic autism; focuses on treating specific symptoms including communication deficits, lack of self-care skills, and self-stimulatory or self-destructive behaviors; sets specific and small goals; attempts to teach language; first goal in to identify very specific target behaviors, the second goal is to gain control over these behaviors through the use of reinforcement and punishment; efforts must be rewarded repeatedly with primary reinforcements such as a favorite food, at least in the beginning phases of treatment; concentrate on reducing the excess of self-stimulations, self-injurious behaviors, and general disruptiveness, as well as teaching new skills to eliminate deficits in self-care and social behavior; sometimes uses a gentle slap or a mild shock to reduce or eliminate potentially dangerous behaviors such as head banging

The Notebook: Developmental Stages

In the 2004 movie, The Notebook, a dramatic love story between Noah Calhoun and Allie Hamilton.  The movie begins with an elderly man reading out of a notebook to an elderly woman as they are patients at a nursing home, both probably in their eighties.  The story follows the elderly two throughout their day as he reads her the story.  The story that is in the notebook tells the long forlorn love story of a wealthy seventeen year old, Allie, and the poor eighteen year old country boy, Noah.  The first part of the story retells a tale of summer love that eventually ends poorly when Allie’s parents forbid her to see Noah ever again.  The story continues on, giving short details of how their lives are proceeded separate from each other.  When the two come to be in their mid to late twenties, Allie who is pledged to get married to another man, but when she sees Noah’s picture in the paper with the house he promised to restore for her so many years before, she returns to see him.  In the end Allie must choose between her fiancé and Noah, and chooses to stay with Noah.  In this paper I am specifically examining Noah in early adulthood, and Allie in elderhood.  Two main developmental aspects that Noah experiences in early adulthood are how he copes with isolation, specifically with loneliness and depression, and also his exploration of intimate relationships.  In elderhood for Allie two main focuses of development are dementia and living arrangements within the nursing home.

First, Noah is coping with isolation quite a bit.  He is still working through the loss of the love of his life, Allie, his father’s death, and also, his saw his best friend die in the war.  After the war, Noah came back and spent most of his time with his father, but when his father died, he has no one left.  Noah would sleep with Martha Shaw, who was made a widow by the war, and this was the only contact made visible in Noah’s life in the movie.  As it is said in the movie, Noah used Martha Shaw to cover the loneliness that was resulting from the void left when Allie was torn out of his life.  All the events that have occurred with the loss of Allie and the death of both Fin and his father seems to have caused Noah to be greatly depressed, which he copes with by heavily drinking alcohol.  The only thing that seems to improve Noah’s loneliness and depression is the return of Allie.  Instead of working through this during the roughly ten year period since Allie left the first time, he instead continues to wallow in the loss of his love until her return.

The second major developmental aspect that Noah confronts during this period of early adulthood, is intimacy and the readiness for marriage.  Noah is willing to experience an intimacy with Martha Shaw in order to cope with his loneliness, but avoids having a real relationship with her.  Martha asks Noah to go on what would be consider dates, but he has an excuse not to do most of the activities and eventually just says not.  Noah has no desire to marry or have a true relationship with anyone but Allie.  Though most people in this period would be experiencing a readiness for marriage, Noah instead avoids relationships, but does use intimacy as a coping mechanism.

In a different developmental period, elderhood, Allie experiences dementia which greatly affects her everyday life.  Allie’s dementia is as a result to Alzheimer’s disease, and she has lost her memories of the past.  Allie does not remember that the man reading to her is her husband and she does not remember her children when they come to visit.  Due to Allie’s Alzheimer’s disease, it leads to another developmental aspect which is living arrangements in old age.  Due to Alzheimer’s, routine can be key to making this comfortable as they the disease progresses in their brain.  Family members are given the decision to be caregivers at home or to institutionalize them.  Allie’s family chose to put her in an institution where she could be cared for by other people, but with this Noah also choose to go to the nursing center with her so he could still somewhat care for her.  Within the institutionalized home, Allie could receive the care she needed from doctors and nurses without the burden being specifically on her husband and children.

Though there are other developmental periods for both characters as well as several other developmental aspects within these periods, these periods for these characters highly exemplify psychological development within a particular person.  Noah’s character further developed with the addition of the other periods of his life in the movie, but this is the period that most highly exemplifies the psychological part of his personality.  Similarly, Allie also shows development in her character over the year, but due to her development of Alzheimer’s, there is a very big psychological development.  Though Noah coped very poorly with his developmental aspects of early adulthood, with the help of her family, Allie was able to cope very well with elderhood.


  1. Symptoms: changes in the way a person thinks, feels, and relates to other people and the outside environment; no single symptom or specific set of symptoms is a characteristic of schizophrenic patient; problems with their own subjective satisfaction and their ability to complete an education, hold a job, and develop social relationships with other people; about 10% of schizophrenic patients commit suicide; first episode is usually between the ages of 15 and 35, and rarely after 55; fluctuate in severity over time
    1. Prodromal phase: obvious deterioration in role functioning as a student, employee, or homemaker; peculiar behavior, unusual perceptual experiences, outbursts of anger, increased tension, and restlessness; social withdraw, indecisiveness, and lack of will power
    2. Active phase: hallucinations, delusions, and disorganized speech
    3. Residual phase: dramatic symptoms have improved; impoverished expression of emotions
    4. Positive symptoms: hallucinations (sensory experiences that are not caused by actual external stimuli), delusional beliefs (false beliefs based on incorrect inferences about reality)
    5. Negative symptoms: flattening or restrictions of the person’s nonverbal display of emotions (diminished emotional expression/blunted affect); fail to exhibit signs of emotions or feeling; neither happy nor sad; appear to be completely indifferent to their surroundings; voices lack the typical fluctuations in volume and pitch; events in the environment hold little consequence; lack of concern for themselves and for others; anhedonia (inability to experience pleasure); loss of interest in recreational activities and social relationships; unable to experience pleasure from physical sensations (such as taste and touch); malfunction of interpersonal relationships; social withdraw; indecisiveness, ambivalence, and loss of willpower (avolition); algoia (speech disturbance)
    6. Disorganization: thinking disturbances; disorganized speech; making irrelevant responses to questions, expressing disconnected ideas, using words in peculiar ways; shifting topics too abruptly (loose association/derailment); responding to a questions with an irrelevant response (tangetiality); persistently repeating the sae word or phrase over and over again (preservation); catatonic behavior (obvious reduction in reactivity to external stimuli); exhibit reduced or awkward spontaneous movements; unusual postures or remain in a rigid standing or sitting positions for long periods of time; resist attempts to alter position; stuperous state (generally reduced responsiveness); inappropriate affect (incongruity and lack of adaptability in emotional expression)
  2. Diagnosis: subtypes: 3 types: paranoid, disorganized, catatonic, and undifferentiated
    1. 2 (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least 1 of these must be the first three below
      1. Delusions
      2. Hallucinations
      3. Disorganized speech
      4. Grossly disorganized or catatonic behavior
      5. Negative symptoms
    2. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to onset
    3. Continuous signs of disturbance persist for at least 6-month. This 6-month period must include at least 1-month of symptoms that meet criterion A and may include periods of prodromal or residual symptoms.  During these prodromal or residual, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form
    4. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of illness
    5. The disturbance is not attributable to the physiological effects of a substance or another medical condition
    6. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1-month.
  3. Course and Outcome: deteriorating course of the condition; many patients improve in terms of symptoms; evidence indicates that different dimensions of outcomes (social adjustment, occupational functioning, and symptoms severity are only loosely correlated)
  4. Frequency of Disorder: approximately 1% of people in the US have schizophrenia or other psychotic disorders; men are 30 to 40% more likely to develop schizophrenia than women; men exhibit overt symptoms younger by 4 or 5 years and exhibit more negative symptoms; rates of schizophrenia vary from country to country
  5. Etiology:
    1. Biological Factors: genetics, pregnancy and birth complications (diseases/infections, extended labor, forceps delivery, breech delivery, umbilical cord wrapped around the baby’s neck, dietary factors such as malnutrition), viral infections, neuropathology reflecting the increased and decreased use of different areas of the brain, chemicals in the brain
    2. Social Factors: nutritional variables, stressful life events, social class (amount of hardships, harmful events), immigrants have higher rates of schizophrenia
    3. Psychological Factors: family interactions can have effect on the course of schizophrenia
  6. Treatment(s):
    1. Antipsychotic medications: classical/traditional antipsychotics such as chlorpromazine (Thorazine); atypical antipsychotics such as risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel); other medications have been used over the years
    2. Psychosocial Treatment: Family orientated after care, social skills training, cognitive therapy, assertive community treatment, institutional programs