Pyc3702 Tutorial Letter 503

PYC3702/503/3/2024
Tutorial Letter 503/3/2024

Abnormal Behaviour and Mental Health
PYC3702
Semesters 1 & 2
Department of Psychology
IMPORTANT INFORMATION
One of three tutorial letters, numbered 501, 502 and 503 for this module
code.
These tutorial letters are your study guides for this module code.
BARCODE
Open Rubric
Tutorial Letter 503/2024
(Third Study Guide for PYC3702)
Contents Page
Learning Unit 14 Schizophrenia Spectrum and Other Psychotic Disorders 5

(Chapter 12 in Sue et al., 2022)
Learning Unit 15 Neurocognitive Disorders 20

Learning Unit 16 Disorders of Childhood and Adolescence 45

(Neurodevelopmental Disorders and Elimination Disorders-
DSM-5)
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(First Study Guide for PYC3702)
Contents Page
Introduction 4
Learning Unit 1 Abnormal Behaviour (Chapter 1 in Sue et al., 2022) 9
Learning Unit 2 Prevention of Abnormal Behaviour 12
Learning Unit 3 Perspectives/Models of Abnormal Behaviour 17

Learning Unit 4 Psychopathology from an African Perspective 20
Learning Unit 5 Assessment and Classification of Abnormal 42

Behaviour (Chapter 3 in Sue et al., 2022)
Learning Unit 6 Personality Psychopathology and Disruptive, 56

Impulse-Control and Conduct Disorders
(Personality Disorders-DSM-5)
Learning Unit 7 Anxiety-, Obsessive-Compulsive and Related 90

Disorders (Chapter 5 in Sue et al., 2022)

(Second Study Guide for PYC3702)
Contents Page
Learning Unit 8 Somatic Symptom and Dissociative Disorders

(Chapter 7 in Sue et al., 2022) 4
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Learning Unit 9 Trauma- and Stressor-Related Disorders
Learning Unit 10 Substance-Use Disorders

Learning Unit 11 Sexual Dysfunction and Gender Dysphoria

Learning Unit 12 Depressive and Bipolar Disorders

Learning Unit 13 Suicide (Chapter 9 in Sue et al., 2022) 100
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Learning Unit 14:
Schizophrenia Spectrum and

Other Psychotic Disorders
Mrs Louise Henderson
Contents Page
Overview 5
14.1 Study unit: Five domains of abnormalities in Psychotic Disorders 7
14.2 Study unit: Schizophrenia 9
14.3 Study unit: Other Psychotic Disorders 15
Conclusion 19
References 19
Overview
The term ‘Schizophrenia Spectrum Disorders’ refers to a set of disorders that encompass what are
undoubtedly the most complex and frightening symptoms we will encounter. Individuals who suffer from
Schizophrenia Spectrum and other Psychotic Disorders may hear voices, think other people are stealing
their thoughts, feel insects crawling under their skin, believe other people want to kill or bewitch them, or
speak in a language that makes no sense at all. These symptoms are especially frightening because they
are completely outside the experience of most people. Somehow, most of us can visualise or imagine
how it might feel to suffer from a Mood Disorder like Major Depression or an Anxiety Disorder, as we
have most likely experienced some of the symptoms of these disorders. However, few of us have
experienced delusions and hallucinations and thus respond to these symptoms with fear and
apprehension.
The popular media have also contributed to the ‘mystery’ surrounding Schizophrenia Spectrum and other
Psychotic Disorders, as the publicity value of these disorders lies in the strange or bizarre features;
consequently, these symptoms have received the most attention. The popular media have furthermore
fed the confusion concerning the true nature of Schizophrenia by often describing Schizophrenia as a
case of “split personality”, implying more than one personality, which is incorrect. The ‘split personality’ is
in actual fact Dissociative Identity Disorder, which you will find in Learning Unit 8 (Chapter 7 of your
prescribed book), and not Schizophrenia.
A further reason for the uncertainty and negativity surrounding Schizophrenia Spectrum and other
Psychotic Disorders are that until recently, these disorders were considered untreatable, e.g. previously,
a diagnosis of Schizophrenia meant a life of misery and ‘madness’ in some or other institution. However,
this is no longer the case. Modern medicine has progressed (and is still evolving). There are treatment
options available to individuals who suffer from these Psychotic Disorders, which enable them to take up
their roles as fully functioning individuals in society.
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In this Learning Unit, you will study the different Schizophrenia Spectrum Disorders and other Psychotic
Disorders that make up this category of Disorders according to the DSM-5 classification system. You will
also study the causal factors in the development of Schizophrenia by way of the Multipath Model.
Furthermore, you will be challenged to consider how you can become involved in the prevention of
Psychotic Disorders in your community.
The following mind map shows an overview of the information that you will study in this Learning Unit:
Schizophrenia Schizophrenia
Spectrum and
Other Schizotypal (Personality) Disorder
Psychotic
Delusional Disorder
Disorders
Brief Psychotic Disorder
Five domains:
• Hallucinations Schizophreniform Disorder
• Delusions
• Disorganised Thinking Schizoaffective Disorder
Multipath Model
(Speech)
•Negative symptoms (see figure 12.4,
p.376,
•Grossly disorganised prescribed book)
or Abnormal Motor
behaviour (Including
Catatonia)
Catatonia
associated with another due to another medical

Unspecified
mental disorder condition
Activity 14.1
Scan-read chapter 12 in the prescribed book in order to familiarise yourself with the contents of this
chapter.
After scan-reading the chapter you will no doubt have become aware that the Schizophrenia Spectrum
Disorders are a group of disorders characterised by a diverse array of symptoms such as extreme
oddities in perception, thinking, action, sense of self, and manner of relating to others (Butcher, Mineka &
Hooley, 2010). According to the DSM-5 classification system, Schizophrenia, other Psychotic Disorders
(e.g. Delusional Disorder, Brief Psychotic Disorder, Schizopreniform Disorder, Schizoaffective Disorder)
and Schizotypal Personality Disorder all fall within this grouping of disorders. Take note that Schizotypal
Personality Disorder is considered in this category as well as in the Personality Disorders category of the
DSM-5. Although this disorder is a full-blown Personality Disorder, it is also considered in the Psychotic
Disorders category as it falls in the spectrum of Schizophrenia Spectrum Disorders. The different
Schizophrenia Spectrum and other Psychotic Disorders represent a gradient of psychopathology and
need careful consideration, thorough assessment and knowledge on the part of the clinician to make a
diagnosis. Disorders in this category of the DSM-5 are defined by abnormalities in one (or more) of the
following five domains:
• Delusions
• Hallucinations
• Disorganised Thinking (Speech)
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• Grossly disorganised or abnormal motor behaviour (including Catatonia)

• Negative symptoms
14.1 STUDY UNIT: Five domains of abnormalities in Psychotic Disorders
Outcomes
Once you have worked through study unit 14.1, you should be able to:
• Differentiate between the different domains of abnormalities in Psychotic Disorders.

• Provide definitions for the different abnormality types of each of these domains.
• Provide examples of each of these abnormalities.
Study
To be able to do the above, you need to study the section on the Symptoms of Schizophrenia on pages
397- 404 of your prescribed book as well as the section below in Study Unit 14.1.
Delusions
Delusions are fixed beliefs that are not amenable to change in the light of conflicting evidence. Delusions
are termed bizarre if they are clearly implausible and not understandable to same-culture peers and do
not derive from ordinary life experiences. The difference between a delusion and a strongly held idea is
often difficult to differentiate but in part has to do with the degree of conviction with which the belief is
held despite clear or reasonable contradictory evidence (APA, 2013, p.87).
The content of delusions may include a variety of themes. Refer to Table 14.1 below.
Table 14.1: Types of Delusions
Type of Delusion Content of Delusion
Belief that one is/going to be harmed/harassed etc. by an individual or

Persecutory
organisation etc.
Grandiose Believes one has exceptional abilities/wealth/fame.
Erotomanic False belief that another is in love with him/her.
Nihilistic Belief that a major catastrophe will occur.
Somatic Pre-occupation with health and organ function.
Belief that certain gestures, comments, environmental cues, etc. are

Referential
directed at you (gossip)
Jealousy Belief that partner/spouse is unfaithful.
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Religious Belief that one is Jesus/Moses etc.
Belief of loss of control over mind or body/being manipulated by others, and

Loss of Control
includes thought withdrawal/insertion/control.
Hallucinations
Hallucinations are perception-like experiences that occur without an external stimulus. They are vivid
and clear and are not under voluntary control. Hallucinations can occur in any sensory modality,
although auditory hallucinations are the most common in Psychotic Disorders. Auditory hallucinations
may involve both familiar and/or unfamiliar voices that are clearly distinct from the individual’s own
thoughts.
Hallucinations that occur only when falling asleep (hypnagogic) or waking up (hypnopompic) are
considered within the range of normal behaviour and not included in this section. Also, hallucinations
may furthermore be a normal part in a religious experience in certain cultures. Therefore care should be
taken when making a diagnosis of a disorder based on hallucinations of this type (APA, 2013, pp. 87-
88).
There are five types of hallucinations. Refer to your prescribed book on pages 400-401 for a discussion
of these different types.
Disorganised Thinking (Speech)
Disorganised thinking (formal thought disorder) is typically inferred from an individual’s speech. This
disorganisation must be severe enough to cause impairment, as mildly disorganised speech is common
and not necessarily indicative of a specific disorder.
The level of the impairment of disorganised thinking is difficult to make if the clinician is from a different
language group or background than the individual being assessed.
There are mainly three types of disorganised thinking that presents in speech namely:
• Derailment or loose association – when the individual switches from one topic to another.
• Tangentiality – when the answers the individual provides are only somewhat or indirectly related,
or completely unrelated to the question they were asked.
• Incoherence or word salad – severe linguistic disorganisation, incomprehensible and bordering
on aphasia (inability to speak normally) in its disorganisation (APA, 2013, p. 88).
Grossly Disorganised or Abnormal Motor Behaviour (including Catatonia)
Grossly Disorganised or Abnormal Motor Behaviour may manifests in a variety of ways ranging from
‘child-like’ behaviour (silliness) to unpredictable agitation. Problems may be noted in any form of goal-
directed behaviour, leading to difficulty in performing day-to-day activities.
Catatonic behaviour is a marked decrease in reactivity to the environment and may range considerably.
Refer to pages 402-403 and Figure 12.2 of your prescribed book for the different manifestations of
catatonia.
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Negative Symptoms
Negative symptoms account for a substantial portion of the morbidity associated with Schizophrenia but
are less prominent in other Psychotic Disorders. Mainly two types of negative symptoms are prevalent in
Schizophrenia, namely diminished emotional expression and avolition (decrease in motivated, self-
initiated and purposeful activity).
Other negative symptoms involve alogia (lack of meaningful speech), anhedonia (decreased ability to
experience pleasure from positive stimuli or degradation in the recollection of pleasure previously
experienced) and asociality (minimal interest in social relationships) (APA, 2013, p. 88).
14.2 STUDY UNIT: Schizophrenia
The symptoms of Schizophrenia can be divided into two broad categories, namely, positive and negative
symptoms. The positive symptoms seem to reflect an excess or distortion of normal functions, are
present during the active phase of Schizophrenia and tend to respond well to treatment, whereas the
negative symptoms seem to reflect the loss of or diminished normal functioning, are associated with
inferior premorbid functioning and have a poorer prognosis. The positive symptoms are delusions,
hallucinations and disorganisation (thinking, speech and motor behaviour); the negative symptoms are flat
or restricted affect, alogia, anhedonia, avolition and sociality.
Outcomes
• define Schizophrenia
• discuss the DSM-5 criteria for Schizophrenia
• comprehensively discuss the different symptoms of Schizophrenia, namely:
○ delusions
○ hallucinations
○ disorganised thinking and speech
○ disorganised motor disturbances
○ thought disturbances
○ flat affect
○ restricted affect (diminished emotional expression)
○ alogia
○ avolition
○ anhedonia
○ asociality
• discuss cognitive symptoms of Schizophrenia

• discuss the role of cultural factors in the manifestation and interpretation of symptoms of
Schizophrenia
• discuss the course of Schizophrenia
• discuss the aetiology of Schizophrenia according to the Multipath Model
• contribute to a primary prevention programme aimed at preventing the development of
Schizophrenia in your community
Study
To be able to do the above, you will need to study the introduction to this Learning Unit and study unit
14.1 and 14.2, and the DSM-5 diagnostic criteria for Schizophrenia in Activity 14.2, the course of
Schizophrenia in Activity 14.4 and the aetiology of Schizophrenia in Activity 14.5 in this tutorial letter and
the following sections in your prescribed book:
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• Introduction, pages 396-397
• “The Symptoms of Schizophrenia”, pages 397-404;
• Figure 12.2, “Prevalence of Symptoms in Thirty Young Patients with Catatonia”, page 403
• The sections “Did you Know?” on page 401;
• The section titled “Understanding Schizophrenia”, pages 404-406;
• Figure 12.3, page 404;
• The section titled “Etiology of Schizophrenia”, pages 406-417;
○ Biological Dimension
○ Psychological Dimension
○ Social Dimension
○ Sociocultural Dimension
• Refer to figure 12.4, page 407 ;
• Table 12.1, page 413.
Activity 14.2
The prescribed book does not include clear diagnostic criteria for a diagnosis of Schizophrenia.
Therefore, you need to study the DSM-5 diagnostic criteria for Schizophrenia included below.
DSM-5 diagnostic criteria for Schizophrenia
A Two (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 one of these must be (1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganised speech (e.g., frequent derailment or incoherence).
4. Grossly disorganised or catatonic behaviour.
5. Negative symptoms (i.e., diminished emotional expression or avolition).
B 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 the onset (or when the onset is in childhood or adolescence, there is
failure to achieve expected level of interpersonal, academic, or occupational functioning).
C Continuous signs of the disturbance persist for at least 6 months. This 6-month period must
include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e.,
active-phase symptoms) and may include periods of prodromal or residual symptoms. During
these prodromal or residual periods, 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 (e.g., odd beliefs, unusual perceptual experiences).
D Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been
ruled out because either 1) no major depressive or manic episode has 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 the illness.
E The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition.
F 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
(or less if successfully treated).
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Specify if:
The following course specifiers are only to be used after a 1-year duration of the disorder and if they
are not in contradiction to the diagnostic course criteria.
First episode, currently in acute episode: First manifestation of the disorder meeting the defining
diagnostic symptom and time criteria. An acute episode is a time period in which the symptom criteria
are fulfilled.
First episode, currently in partial remission: Partial remission is a period of time during which an
improvement after a previous episode is maintained and in which the defining criteria of the disorder
are only partially fulfilled.
First episode, currently in full remission: Full remission is a period of time after a previous episode
during which not disorder-specific symptoms are present.
Multiple episodes, currently in acute episode: Multiple episodes may be determined after a
minimum of two episodes (i.e., after a first episode, a remission and a minimum of one relapse).
Multiple episodes, currently in partial remission
Multiple episodes, currently in full remission
Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for the
majority of the illness course, with sub threshold symptom periods being very brief relative to the
overall course.
Unspecified
Specify if:
With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-
120, for definition).
Coding note: Use additional code 293.89 (F06.1) catatonia associated with schizophrenia to indicate
the presence of the comorbid catatonia.
Specify current severity:

Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including
delusions, hallucinations, disorganised speech, abnormal psychomotor behaviour, and negative
symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7
days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-Rated
Dimensions of Psychosis Symptom Severity in the chapter “Assessment Measures.”)
Note: Diagnosis of schizophrenia can be made without using this severity specifier.
(APA, 2013, pp. 99-100)
Activity 14.3
Read the following vignettes of personal accounts of individuals who suffer from Schizophrenia.
“On the way to the store, I had a flat tire. I thought this was also planned. At the petrol pump, the
men smiled at me with twinkles in their eyes, and I knew they were closing in. I was done for. They
would kill me. Suddenly, I saw their faces in the skies…”
“I developed a feeling that I smelled bad and that somewhere I had left a tap open and
consequently would be responsible for destroying a building, and that if I accidentally struck a
match, I would cause mass destruction and kill many people. I was suspicious about everyone …”
“At first, I strained to hear the voices. They were soft and working in the form of a code. I broke the
code after a long struggle. Then I could distinctly hear four voices. “The rotten prostitute …” said
one. “The gods will not leave her …” said the second. “I think you should kill yourself and spare
God the trouble …” said the third one addressing directly to me …”
(http://www.aarogya.com, accessed on 5 May 2010)
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Consider whether these vignettes represent mostly the positive or negative symptoms of
Schizophrenia. How many of these symptoms are you able to identify in these vignettes? If you are
unclear regarding the various symptoms of Schizophrenia and subsequently find it difficult to
identify these symptoms in the vignettes above, you need to refer back to the section on "The
Symptoms of Schizophrenia" on pages 397 to 404 of your prescribed book.
The course of Schizophrenia
Psychotic features of Schizophrenia typically emerge between the late teens and mid-thirties. Onset
before adolescence is rare. The onset of symptoms of Schizophrenia may be abrupt or insidious,
although the large majority of individuals develop a slow and gradual development of a variety of
clinically significant signs and symptoms. The peak age for the first psychotic episode seems to be in the
early to mid- 20s for males and late- 20s for females.
Psychotic symptoms seem to diminish over the course of a lifetime, probably due to the natural decline
in dopamine activity. Negative symptoms are more closely related to prognosis than positive symptoms
and seem to be the most persistent.
The course of Schizophrenia is divided into three phases, namely, (1) the prodromal phase when the
symptoms start to develop and build up, (2) the active phase when the symptoms are full-blown, and (3)
the residual phase when symptoms are less active or prominent.
Research on the long-term outcome of Schizophrenia is contradictory as the definition of Schizophrenia

changes over time as well as developments in the medical treatment of Schizophrenia.
Activity 14.4
Study the section titled, “Understanding Schizophrenia” on pages 404 to 406 of your prescribed
book.
The Aetiology of Schizophrenia
It is generally accepted that Schizophrenia, as with the majority of psychological disorders, is most likely
caused by the combined influence of a variety of factors such as biological, psychological, social and
sociocultural factors. In this chapter, the authors propose that the aetiology of Schizophrenia, and indeed
of other psychotic conditions, is best understood by using a Multipath Model that incorporates the above
aspects.
In this learning unit, we first consider each aetiological factor independently and then consider the
Multipath Model of Schizophrenia as a model that attempts to integrate all these separate etiological
factors into a single explanation for the aetiology of Schizophrenia while considering the interactive
relationships between all the individual aetiological factors.
Activity 14.5
Study the section titled “Etiology of Schizophrenia” on pages 406 to 417 of the prescribed book.
Activity 14.6
Explain the dopamine hypothesis for the development of Schizophrenia.
Refer to the relevant section in your prescribed book under the heading “Biological Dimension:
Neurotransmitters”. Compare your answer with the information in the prescribed book. If your
discussion is incomplete, study the relevant section again, and then elaborates on your answer.
Activity 14.7
Read the following case study and:
(a) diagnose Tladi’s abnormal behaviour according to the DSM-5 classification system.
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(b) justify your answer for each diagnosis in question (a).

(c) explain the development of Tladi’s abnormal behaviour using the Multipath Model.
(d) discuss how Tladi’s behaviour would be explained and interpreted from an African
perspective.
(e) Imagine you were a community mental health care worker operating in Tladi’s community
when he was a child. Discuss how you would have gone about possibly preventing the
development of a full-blown disorder in Tladi
Case study
Tladi, a 40-year-old man, was brought to the local hospital after he was found wandering aimlessly in
the streets and talking loudly to no-one in particular. He used words and sounds that people around him
could not understand. His speech was fragmented and incoherent. His appearance was unkept and
dirty. He appeared agitated and became violent without provocation. He ran about wildly, assaulting
people and breaking things. Enquiries made by the clinician revealed that his illness had started two
years before being admitted to the hospital. According to family members, the illness started gradually,
and the patient deteriorated month after month.
His illness started with symptoms of general listlessness, sleep disturbances and bad dreams, loss of
appetite, withdrawal, emotionlessness and unprovoked bouts of anger. He often complained of hearing
voices in his stomach, which spoke a different language from his own. The voices told him that his wife
did not love him anymore. On one occasion, they told him that they had come to kill him as someone
else wanted to marry his wife. Whenever he became angry, he blamed the voices for causing it. Before
the illness started, the patient did not have any physical illness.
He was a hardworking father, married with three children, but his wife left him a year before the illness
started. At the time she left him, Tladi was spending many hours at work as he had been promoted and
was experiencing significant work-related pressure and stress. His wife and their children are now living
with her parents. Soon after the illness started, Tladi lost his job because of his unusual behaviour.
During the clinical interview, the patient reported that he had been bewitched by jealous people in his
community who were not happy about his success. He also reported that insects were moving inside his
body and that at times he could feel his brain move and heard voices threatening to kill him. His brothers
were of the opinion that his illness was caused by a witch or evil spirit sent by his wife who had left him,
or by another person.
Tladi grew up as part of a large family in a very poor rural area where violence amongst factions was
rife. His father left for the city to work in the mines when Tladi was very young, and they hardly ever saw
their father while growing up. On many occasions, Tladi and his siblings were sent to live with his
father’s parents as there were periods during which his mother was hospitalised for what the local
community called "bouts of madness". According to Tladi’s brothers, their mother would focus her
attention on Tladi when she was ill. She would confuse poor Tladi as she would often behave very
inconsistently towards him and blame him for their father’s departure but would then tell Tladi that he
was the only child she loved. Tladi’s brothers said that they thought she did this because Tladi was the
one child that was a lot like their mother, and that they always thought that he would "turn out" to be just
like her, and now it seemed they were right.
(a) Schizophrenia
Other problems related to primary support group – Disruption of Family by Separation or Divorce
(wife took the children and left to go and stay with her parents).
Occupational problems – Other Problem Related to Employment (Tladi lost his job).
(b) Tladi fulfils all the DSM-5 criteria for making a diagnosis of Schizophrenia. He has hallucinations (he
hears voices speaking to him, and feels insects moving inside his body and his brain moving). He
has delusions (he believes he was bewitched). His speech is incoherent and does not make sense.
He shows violent behaviour, agitation, withdrawal, emotional numbness, sleep disturbance, loss of
appetite, etcetera. His personal hygiene is non-existent. He is clearly disorientated and poses a
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danger to himself and others due to his violent outbursts. These symptoms have been going on for
at least six months (for the past year at least) and represent a decline in his previous level of social
and occupational functioning.
No information is given about his premorbid functioning but the probability of the presence of a
Personality Disorder is limited as Tladi is described as a "hardworking married father of three".
There is also no general medical condition present.
Other problems related to primary support group – Disruption of Family by Separation or Divorce
(wife took the children and left to go and stay with her parents).
Occupational problems – Other Problem Related to Employment (Tladi lost his job).
Due to the severity of his psychotic symptoms, the absence of personal hygiene, his incoherent and
disorganised behaviour and speech, and the possible danger Tladi poses to himself and others, he
is deemed incapable to function on his own and should be admitted to hospital in order to receive
adequate treatment.
(c) To explain the development of Tladi’s Schizophrenia according to the Multipath Model, you need to
consider the different dimensions, namely: biological, psychological, social and sociocultural and
how these dimensions are specifically relevant to Tladi’s life. You also need to consider how these
aspects interact with each other and how they combine in different ways to result in Tladi’s
Schizophrenia. How many of the aspects noted in figure 13.4 are specifically relevant to the case of
Tladi? Can you provide examples from the case study to support your view?
(d) Questions (a) to (c) concern the diagnosis and description of Tladi’s behaviour according to the
DSM-5 classification system and an explanation of his behaviour according to the Multipath Model.
Note that the DSM-5 classification system is used in the medical or biogenic approach to abnormal
behaviour and is the basis for understanding mental disorders in Western medicine. If Tladi had
been taken to a traditional healer in his community, the approach would have been very different.
Please refer to Learning Unit 4 in Tutorial Letter 501 for an explanation of the African perspective.
For a discussion of Tladi’s abnormal behaviour according to the African perspective, refer to the
section "Interpretation from an African perspective" and "Classification of Tladi’s abnormal
behaviour from an African perspective" in Activity 4.12 in Learning Unit 4 in Tutorial Letter 501.
It is important that you develop sensitivity to the different perspectives according to which abnormal
behaviour can be discussed and how these different perspectives approach mental health. In a
multicultural country such as South Africa, where Western, Eastern and African philosophies
coexist and are actively practised by various sub-groupings in the population, it is crucial that
mental health workers are aware of and sensitive to the varied ways in which a specific problem
can be interpreted and treated. It is humanly impossible to be a practitioner of each of these
approaches, but to be an ethical and proficient mental health practitioner in our country requires a
special awareness of and sensitivity to these complexities, so that we refrain from making
assumptions about the behaviour we see manifested before us and inadvertently force our
individual beliefs on our clients through our treatment regimes.
(e) Consider what you know regarding the Multipath Model for Schizophrenia and the factors that you
have identified in question (c) above. What type of primary prevention interventions would you
have implemented if the child Tladi was part of your case load? Would you have done parent
psycho-education and guidance in an attempt to assist Tladi’s mother to behave more congruently
towards him? Would you have tried to get financial and other support for the family in an attempt to
improve their socio-economic status and relieve the poverty that the community, and Tladi’s family
specifically, was experiencing? Would you have implemented programmes to curb the substance
use in the community? Reflect on how effective you think these and the other prevention strategies
that you would have considered would have been
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If you want to find out more about Schizophrenia and need information on where to find help concerning
the condition, you can contact the: Schizophrenia and Bipolar Disorder Alliance (SABDA).
Tel no: (011) 463 9901
E-mail: [email protected]
Webpage: http://www.supportsabda.co.za
14.3 STUDY UNIT: Other Psychotic Disorders
Schizophrenia is not the only type of Psychotic Disorder classified by the DSM-5. Other Psychotic
Disorders include Delusional Disorder, Brief Psychotic Disorder, Schizophreniform Disorder, and
Schizoaffective Disorder.
Outcomes
• define Brief Psychotic Disorder

• define Schizoaffective Disorder
• define Schizophreniform Disorder
• describe the core characteristics of each of these Psychotic Disorders and compare these
disorders with Schizophrenia and Delusional Disorder
• discuss the DSM-5 diagnostic criteria of Delusional Disorder
Study
To be able to do the above, you will need to study the introduction to this study unit in this Study Guide
and the following sections in the prescribed book:
• the section titled "Other Psychotic Disorders" on pages 424-429

• DSM-5 diagnostic criteria for Delusional Disorder in Activity 14.6
• Table 12.4 on page 429
• The section on Schizoaffective Disorder in Activity 14. 8
In Delusional Disorder, the major symptom is the presence of one or more delusions. Individuals suffering
from Delusional Disorder do not show the general decline in social and/or occupational functioning that is
seen in Schizophrenia. Thus, the presence of an unshakeable, non-bizarre delusion in an individual who
otherwise appears normal and functions well is the most striking characteristic of a Delusional Disorder.
Activity 14.6
The DSM-5 diagnostic criteria for Delusional Disorder are discussed very briefly in your prescribed
book. Complement this information with the more elaborate diagnostic criteria for Delusional
Disorder as proposed by the DSM-5 classification system
15
DSM-5 diagnostic criteria for Delusional Disorder
A Presence of one (or more) delusions with a duration of 1 month or longer.
B Criterion A for Schizophrenia has never been met.

Note: Hallucinations, if present, are not prominent and are related to the delusional theme (e.g. the
sensation of being infested with insects associated with delusions of infestation).
C Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired,
and behaviour is not obviously odd or bizarre.
D If manic or major depressive episodes have occurred, these have been brief relative to the duration
of the delusional periods.
E The disturbance is not attributable to the direct physiological effects of a substance or another
medical condition. It is not better explained by another mental disorder, such as Body Dysmorphic
Disorder or Obsessive-compulsive Disorder.
Specify whether:
Erotomanic Type: This subtype applies when the central theme of the delusion is that another person is
in love with the individual.
Grandiose Type: This subtype applies when the central theme of the delusion is the conviction of having
some great (but unrecognised) talent or insight or having made some important discovery.
Jealous Type: This subtype applies when the central theme of the delusion is that his or her spouse or
lover is unfaithful.
Persecutory Type: This subtype applies when the central theme of the delusion involves individual’s
belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged,
maliciously maligned, harassed, or obstructed in the pursuit of long-term goals.
Somatic Type: This subtype applies when the central theme of the delusion involves bodily functions or
sensations.
Mixed Type: This subtype applies when no one theme predominates.
Unspecified Type: This subtype applies when the dominant delusional belief cannot be clearly
determined or is not described in the specific types (e.g. referential delusions without a persecutory or
grandiose component).
Specify if:
With bizarre content: Delusions are deemed bizarre if they are clearly implausible, not understandable,
and not derived from ordinary life experiences (e.g. an individual’s belief that a stranger has removed his
or her internal organs and replaced them with someone else’s organs without leaving any wounds or
scars).
(APA, 2013, pp. 90-91)
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Activity 14.7
Compare Schizophrenia and Delusional Disorder.
Schizophrenia Delusional disorder
A Psychotic Disorder. A Psychotic Disorder.

Type
Onset during late teens and mid-30s, Onset generally from middle to late
Onset onset prior to adolescence rare. adult life. However, it can be from a
younger age.
Speech is disorganised, incoherent Speech is not affected as in
and digressive. Schizophrenia and Schizotypal
Personality Disorder.
Symptoms must be present for at
least six months, with psychotic The delusion must be present for at
symptoms (such as for the active least one month.
Clinical picture phase) present for at least one month.
Severe and bizarre hallucinations and Absence of hallucinations. If visual
delusions are present. and auditory hallucinations do occur,
they are not prominent.
Disorganised thinking and behaviour
are present, and a lowering in the Except for the delusion, the person’s
level of functioning occurs. behaviour and thoughts are not odd.
Poor, especially during the active Poor.
Insight psychotic phase.
Activity 14. 8
Read the section titled Schizoaffective Disorder on pages 428 to 429 of your prescribed textbook.
Schizoaffective Disorder
Schizoaffective Disorder includes symptoms that meet the criteria for both mood episodes (major
depressive or manic) and psychosis. However, to be diagnosed as Schizoaffective Disorder, the
psychotic symptoms must prevail for at least two weeks in the absence of prominent mood episode
symptoms, and the mood episode symptoms must be present for a majority of the time of the total
duration of the active and residual portion of the illness. Additionally, Criterion A for Schizophrenia has
been met at some time during the course of the illness. Suppose the mood episodes persist apart from
the psychotic symptoms. In that case, the diagnosis of a separate Major Depressive or Bipolar Disorder
should be considered depending on the nature of the mood episode being manifested (APA, 2013. p.
106).
Activity 14.9
Read the case study below and then answer the following questions:
(a) What would your DSM-5 diagnosis be given George’s case study?
(b) Justify your diagnosis in question (a) above.
17
Case study
George was a very successful executive in a large corporation. He was intelligent, hardworking and
quietly competitive. Those were the traits he thought were necessary to keep one step ahead of the
competition. George was happily married, the father of two children and well-liked by his friends and
colleagues. He had done well; his future was bright, and there was no sign of any problems.
One day, George got to the office before his secretary had arrived. At about 9 o’clock, a telephone
repairman arrived to install a new phone in George’s office. The secretary did not know that George was
already in his office and let the repairman into George’s office without announcing him. When the door to
his office opened, and George saw an unknown man carrying a heavy metal case and wearing a jacket
with the phone company emblem on it, he reached into his desk drawer, took out a .38 calibre revolver,
and shot the repairman at point-blank range. He then ran from the office but was soon caught and
arrested.
A psychological examination revealed that for years, George had suffered from a delusion that ‘others’
were plotting against him, was trying to steal his ideas and would eventually try to eliminate him. George
could not explain who the ‘others’ were but believed that ‘they’ got access to his mail and tapped his
phone to ‘track’ his ideas. George was in a competitive business in which there was some corporate
espionage, but his beliefs were clearly unsubstantiated even at further close examination. The extremity
of his delusions was reflected in the fact that he kept vans stocked with cans of food in four parts of the
city (north, south, east and west). The vans and the food were to be used to help in his getaway if they
tried to ‘close in’. When the repairman entered unannounced carrying a black metal case, George
thought ‘they’ were coming for him, and he shot in self-defence.
(Adapted from Holmes, 1997)
(a) Delusional Disorder: Persecutory Type (Primary diagnosis)

Target of (Perceived) Adverse Discrimination on Persecution – George manifested persecutory
delusions. Imprisonment or Other Incarceration - George was arrested for shooting another
person.
(b) George fulfils the DSM-5 criteria for a diagnosis of Delusional Disorder.
He suffers from delusions that the ‘others’ were out to get him and steal his ideas. This is, in fact, a
non-bizarre delusion as George worked in a very competitive environment where some corporate
espionage was taking place, and in life, such things can occur. This belief of his was, however, a
delusion as it was exaggerated and unsubstantiated. His delusions lasted more than a month. In
fact, they lasted several years. Apart from these delusions of persecution, and his behaviour
relating to these delusions (the vans with food), George was functioning at a high level. He was a
successful executive, intelligent, hardworking, happily married with two children and well-liked by
his friends and colleagues. He had, furthermore, never previously met the criteria for Schizophrenia
and his disturbance was not due to the direct physiological effect of a substance.
Activity 14. 10
The following activities will help you revise and summarise what you have studied in this chapter:
• At the beginning of chapter 12 of the prescribed book, there are five "Focus Questions" on
page 394 of the prescribed book. Answer questions 1,2,3, and 5 (not the treatment sections)
after you have worked through the chapter. Compare your answers to the answers provided
at the end of Chapter 12 on page 431 in the prescribed book under the heading "Summary". If
your answers are not complete, consult your study guide and prescribed book again on these
questions or contact one of your lecturers.
• Go back to the beginning of the chapter in the Study Guide to the "Key terms" and reflect on
your understanding of each term. Then, explain the meaning of these terms to a friend or
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family member in your own words. If you battle to do so, refer to page 432 of your prescribed
book for a glossary of key terms and your Study Guide.
• The learning outcomes of each of the three study units in this Learning Unit were set out
clearly in each of the study units. Make sure that you have acquired the necessary
knowledge, skills and insights set out in these learning outcomes.
CONCLUSION
In the first part of this Learning Unit, namely, study unit 14.1, you studied the key features of the
Schizophrenia Spectrum and Other Psychotic Disorders in general. Then, in Study Unit 14.2, you studied
Schizophrenia in more detail, including the diagnostic features, course and aetiology of Schizophrenia.
Finally, in Study Unit 14.3 you studied some of the Other Psychotic Disorders such as Brief Psychotic
Disorder, Schizophreniform Disorder, Schizoaffective Disorder and Delusional Disorder in more detail.
This information will help you to identify, describe and explain the manifestations of the Schizophrenia
Spectrum and Other Psychotic Disorder. In addition, you should now also be able to compare
Schizophrenia with Delusional Disorder, and distinguish between these different disorders.
You studied the Multipath Model for the development of Schizophrenia. The information will allow you to
explain and critically evaluate the different dimensions involved in the development of Schizophrenia. You
should now also be able to compare and distinguish between the different aetiologies of Schizophrenia.
You furthermore also reflected on possible primary prevention programmes and interventions that you
could develop and implement for a community similar to the community in which Tladi grew up, in an
attempt to curb the development of full-blown Schizophrenia in children exhibiting many of the aetiological
factors for the development of this disorder.
REFERENCES
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Arlington, VA: American Psychiatric Association.
Butcher, J.N., Mineka, S., & Hooley, J.M. (2010). Abnormal psychology (14th ed.). Boston, MA: Pearson
International.
Sue, D., Sue, D.W., & Sue, S. (2022). Understanding abnormal behaviour (12th ed.). Boston, MA:
Houghton Mifflin Company.
19
Learning Unit 15:
Neurocognitive Disorders
Mrs Louise Henderson
Contents Page
Overview 20
15.1 Study unit: Neurocognitive Disorders 21
15.2 Study unit: Assessment of brain damage. 25
15.3 Study unit: Delirium 25
15.4 Study unit: Mild and Major Neurocognitive Disorders 30
15.5 Study unit: Aetiology of Neurocognitive Disorders 33
Conclusion 43
References 43
Please note that the relevant chapter in the prescribed book namely Chapter 13 covers both the
Neurocognitive Disorders and the Sleep-wake Disorders. For this module you are only expected
to study the Neurocognitive Disorders (pages 434 to 460) and you may therefore omit the
sections on Sleep-wake Disorders (pages 460 to 467).
Overview
In the DSM-5 classification system, Neurocognitive Disorders (formerly known as Cognitive Disorders in
the DSM-IV-TR or Organic Disorders) are a grouping of disorders in which a clinical deficit in cognitive
functioning is the primary symptom. To be diagnosed as a Neurocognitive Disorder, this cognitive deficit
is acquired instead of developmental in nature. Although cognitive deficits are present in many other
Mental Disorders, only those disorders whose core features are cognitive, which were not present at
birth or very early life and therefore presented a significant decline from a previous level of functioning,
are included in this category of disorders.
Neurocognitive Disorders (NCD) are syndromes for which the underlying pathology and, therefore often
the aetiology, can potentially be determined. The NCD include Delirium and the syndromes of Major
NCD and Mild NCD and their aetiological subtypes.
The term Dementia has been retained in the DSM-5 and used in settings where both the doctors and
patients are accustomed to using the term, especially in the context of disorders and degenerative
dementias that usually affect older adults, while the term NCD is preferred when indicating conditions
which affect younger adults such as impairment secondary to traumatic brain injury or HIV. Also, the
term Major NCD as used in the DSM-5, has a broader definition than the term dementia. An individual
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with a substantial decline in a single domain (namely cognitive functioning) can receive this diagnosis.
For example, Amnestic Disorder, as defined in the DSM-IV-TR, is now diagnosed as a Major NCD due to
another medical condition. Here the term dementia will not be used.
The criteria for the NCD are all based on defined cognitive domains, namely complex attention,
executive function, learning and memory, language, perceptual-motor and social cognition (Table 15.1 in
this Learning Unit).
(APA, 2013)
The following mindmap illustrates what you will be studying in this Learning Unit:
Multipath
Model
Underlying Neurocognitive Disorders
pathology
Mild Neurocognitive
Major Neurocognitive Disorders Delirium
Disorders
Substance Intoxication
Delirium
Substance Withdrawal
• Alzheimer’s disease Delirium
•Frontotemporal lobar degeneration
•Lewy body disease Medication-Induced
•Vascular disease Delirium
•Traumatic brain injury
•Substance/medication use Delirium due to
•HIV infection another medical
•Prion disease condition
•Parkinson’s disease
•Huntington’s disease
•Another medical condition Delirium due to
•Multiple etiologies multiple etiologies
•Unspecified
Unspecified
15.1 STUDY UNIT: Neurocognitive Disorders (NCD)
In contrast to Intellectual Disability (previously termed Mental Retardation), as discussed in Learning Unit
16 of this Tutorial Letter, which is considered to be present from birth, Neurocognitive Disorders are
acquired disorders involving cognitive deficits. The underlying pathology which produces the
Neurocognitive Disorder also indicates the nature and age of onset of the different subtypes of
Neurocognitive Disorders.
The Neurocognitive Disorders involve a significant deficit in cognition that differs from typical functioning.
The DSM-5 distinguishes between three major types of Neurocognitive Disorders. They are Delirium,
Major Neurocognitive Disorders (NCD) and Mild Neurocognitive Disorders (NCD).
Additionally, Delirium is often seen in both Major and Mild NCD but can also occur independent of these
two disorders. Furthermore, Mild NCD and Major NCD are sometimes the earlier and later stages of the
same disorder. “The NCDs are unique among DSM-5 categories in that these are syndromes for which
21
the underlying pathology, and frequently the aetiology as well, can potentially be determined.” (APA,
2013, p. 591)
Outcomes
Once you have worked through Learning Unit 15.1, you should be able to:
• define various terms used in this section

• define the different cognitive domains
• define a Neurocognitive Disorder
• discuss the general characteristics of Neurocognitive Disorders
• discuss the differentiation between a Neurocognitive Disorder and normal aging
Study
To be able to do the above, you will need to study the introduction to this section in this Tutorial
Letter, Activity 15.1, 15.2, 15.3 and 15.4 in this tutorial letter and the following sections in the
prescribed book:
• The introduction to this chapter (Chapter 13) on pages 435 and 436
• Table 13.1: Neurocognitive Disorders, page 437
• Table 13.4: Neurodegenerative Disorders, page 441
• Table 13.5: Event Causes of Neurocognitive Disorders, page 442
• Table 13.3: Normal Aging or Neurocognitive Disorder? on page 439
Activity 15.1
Scan-read chapter 13 in the prescribed book (excluding the sections on Sleep-wake Disorders) to
familiarise yourself with the Neurocognitive Disorders related content of this chapter.
Activity 15.2
As the section on Neurocognitive Disorders has a strong medical foundation you might come
across different terms that are not familiar to you. Below we have provided you with a few terms
and their definitions. This is by no means a complete list, and you need to add to the list as you
work through this Learning Unit so that you have a sufficient vocabulary regarding the
Neurocognitive Disorders and the pathologies with which they are associated. Follow the definition
suggestions provided in Chapter 13 and the Glossary of the prescribed book.
Study (and add to) the following key terms and their definitions:
Term Definition
Abulia Loss or impairment of the ability to make decisions or act independently.

An impairment of ability to recognise or identify familiar objects, entities, or
Agnosia people usually as a result of a neurological deficit or disorder despite an
intact sensory system.
Angiopathy Any of several diseases of the blood or lymph vessels.
An agent that is antagonistic to the action of parasympathetic or other
Anticholinergic
cholinergic nerve fibres.
An impairment of expression or comprehension of language caused by injury
Aphasia
or disease in the language centres of the brain.
A loss or diminution in ability, caused by neurological impairment to perform
Apraxia purposeful movements or gestures on request despite an intact motor
system.
A rare, progressive disease (considered by some a variant of Parkinson
Corticobasal disease) involving both cerebral cortex and extrapyramidal structures;
degeneration clinically manifest as disturbances of voluntary movements and rigidity;
pathologic characteristics include degeneration of the cerebral cortex with
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balloon neurons and degeneration of the substantia nigra; apraxia, cortical

sensory loss, myoclonus, and phantom limb syndrome have been reported.
A state of excitement and mental confusion, often accompanied by
Delirium hallucinations, caused by high fever, poisoning, brain injury, etc. Violent
excitement or emotion; frenzy.
Dysphagia Difficulty in swallowing, caused by obstruction or spasm of the oesophagus.
Executive Higher order brain functions such as planning towards a goal, sequencing,
functioning intellectual flexibility, abstract thinking, and to make inferences.
Ability of the brain to recognise previously learnt information, i.e. objects,
Gnosis
persons, places, collected from our senses.
Hyperorality A condition characterised by insertion of inappropriate objects in the mouth.
Hyperphagia Pathologically insatiable hunger (especially caused by brain lesions).
An amino acid used normally by the body in cellular metabolism and the
manufacture of proteins. Elevated concentrations in the blood are thought to
Homocysteine
increase the risk for heart disease by damaging the lining of blood vessels
and enhancing blood clotting.
Inability or failure to restrain sexual appetite.
Incontinence
Inability of the body to control the evacuative functions.
A decrease in the blood supply to a bodily organ, tissue, or part caused by
Ischemic
constriction or obstruction of the blood vessels.
Abnormal proteins that occur in the nerve cells of the cerebral cortex and the
Lewy bodies
basal ganglia, causing Parkinson's disease and dementia.
Irregular involuntary contraction of a muscle usually resulting from functional
Myoclonus disorder of controlling motor neurons; also: a condition characterised by
myoclonus.
Uncontrollable repetition of a particular response, such as a word, phrase, or
gesture, despite the absence or cessation of a stimulus, usually caused by
Perseveration brain injury or other organic disorder. The tendency to continue or repeat an
act or activity after the cessation of the original stimulus. The act or an
instance of persevering; perseverance.
The occurrence of something in different forms, in particular.
Polymorphism The occurrence of different forms among the members of a population or
colony.
Neurological process by which cognition directs motor action, i.e. planning
Praxis
what to do and doing it.
Progressive supranuclear palsy (PSP; also known as Steele-Richardson-
Olszewski syndrome) is a rare disease that gradually destroys nerve cells in
the parts of the brain that control eye movements, breathing, and muscle
coordination. The loss of nerve cells causes palsy, or paralysis, that slowly
Supranuclear palsy gets worse as the disease progresses. The palsy affects one’s ability to
move the eyes, losing balance when walking, gradual paralysis of the extra-
ocular muscles making upward and down-ward eye movement difficult or
impossible, dysarthria and stiffness of the neck and trunk muscles, followed
eventually by loss of memory and mild dementia.
Ability to interpret one’s own and others’ mental and emotional states,
Theory of mind
understanding that each person has unique motives, perceptions etc.
Activity 15.3
Study Tables 13.1, 13.4 and 13.5 on pages 437, 441 and 442 of your prescribed book respectively.
Activity 15.4
The criteria for the various NCDs are all based on defined cognitive domains. Refer to Table 13.2
on page 438 of the prescribed book. This is a summarised table of the cognitive domain and
therefore you need to supplement this information in your prescribed book with the information in
Table 15.1 below.
23
Study these six cognitive domains in Table 13.2 (prescribed book) and Table 15.1 provided below.
Table 15.1: Cognitive Domains
Cognitive Domain Examples of symptoms or observations
Major: difficulty in environments with multiple stimuli, easily

distracted. Unable to attend unless input is restricted and
Complex Attention simplified. Difficulty holding and recalling new information. Unable
to perform mental calculations. Thinking takes longer than usual
Sustained, selective and divided and components need to be simple to be processed.
attention and processing speed.
Mild: normal tasks take longer. Errors are found in routine tasks
and work needs to be double checked. Thinking is easier when
not competing.
Major: abandons complex projects. Needs to focus on one task at
Executive Function a time. Relies on others to plan instrumental activities of daily
living or make decisions.
Planning, decision making,
working memory, responding to
Mild: increased effort is required to complete multistage projects.
feedback or error correction,
Difficulty multitasking or resuming an interrupted task. Extra effort
overriding habits or inhibition,
is required therefore there is increased fatigue, due to the extra
mental flexibility.
effort required in social gatherings they become more taxing and
less enjoyable.
Major: constant repetition. Needs frequent reminding and is
Learning and Memory unable to keep track of daily things in a day.
Immediate memory span and Mild: difficulty recalling recent events and relies on notes and
recent memory and very-long- calendars. Needs reminding to keep track of visual entertainment.
term memory Constant repetition and loss of track overpaying bills.
Major: difficulties with expressive or receptive language. Uses

Language
general phrases and pronouns rather than names. Idiosyncratic
Expressive language, grammar word usage\, grammatical errors, and spontaneity of output and
economy of utterances occur. Stereotypy of speech occurs.
and syntax, and receptive
language Mild: word finding difficulty. Substitute general for specific terms.
Avoids using specific names of people. Grammatical errors.
Major: difficulties with previous familiar activities, navigating in
Perceptual-Motor familiar environments, confused at dusk.
Visual perception, visuo-
Mild: relies more on maps for directions. Follows other and uses
constructional, perceptual-motor,
notes to get to places. Find one’s self lost or having to turn around
praxis and gnosis.
due to lack of concentration. Less precise in parking. Needs to
expend greater efforts for spatial tasks.
Major: behaviour is out of acceptable social range insensitivity to
Social Cognition social standards of modesty. Focuses excessively on a topic
despite disinterest or direct feedback. Makes decisions without
Recognition of emotions and
regards to safety. Little insight into changes.
theory of mind.
Mild: subtle changes in behaviour or attitude.
Adapted from APA (2013, pp. 593-595).
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15.2 STUDY UNIT: The assessment of brain damage
Although we do not expect of you to have extensive medical knowledge regarding the many different
assessment techniques for assessing brain damage, you should be aware of the most common
techniques used in diagnostic medicine today. This knowledge will become important when you continue
your psychology studies as a post-graduate learner with your eye on a psychology degree in clinical or
neuropsychology, or if your occupation involves working in a medical setting such as nursing. It may even
come in handy for teachers who may be faced with reports from child psychiatrists or neurologists
regarding children in their class.
Outcomes
• explain the procedure clinicians follow in assessing and diagnosing NCDs.

• briefly explain the types of psychological assessment techniques used to assess brain damage.
• briefly discuss the different neurological testing tools i.e. EEG, CT, cerebral blood flow
measurement, PET, MRI etc. to assess brain damage.
Study
To be able to do the above you will need to study the introduction to this section in this Tutorial
Letter, and the following section in the prescribed book:
• The section on The Assessment of Brain Damage and Neurocognitive Functioning, pages 436 and
437 of the prescribed book.
• Specific sections of Chapter 3: Assessment and Classification of Mental Disorders of the
prescribed book, namely the sections titled “Tests for Cognitive Impairment” (on pages 89 and 90)
and “Neurological Tests” (on pages 90 to 92), Table 3.1: Structural Imaging Techniques on page
91 and Table 3.2: Functional Imaging Techniques on page 91 of the prescribed book.
Activity 15.5
Imagine you are a counsellor or psychologist working in a neurology unit of a hospital and an adult
patient is admitted that was involved in a serious motor vehicle accident. You see on the admission
notes that the patient was unconscious when the paramedics arrived at the scene of the accident
but has since regained consciousness. The emergency doctor states that the patients have most
likely sustained traumatic brain damage and refers him to a neurologist who schedules the patient
for evaluation and various clinical assessments to determine the extent of the damage. The
patient’s family arrives and asks the nursing staff on duty what treatment their loved one is
receiving and what the prognosis is. The ward sister then calls you to the ward to explain to the
family what is going to happen next and to answer any questions they might have.
Explain to the family what the procedures are that the neurologist will follow in order to arrive at a
diagnosis, to determine the extent of the damage, and to determine a possible prognosis of their
family member’s condition. Make sure to explain any medical terms that may be relevant and to
use language that will be understood by the family as non-medical professionals.
15.3 STUDY UNIT: Delirium
The essential feature of Delirium is a disturbance of attention or awareness that is accompanied by

changes in baseline cognition that cannot be better explained by pre-existing or evolving Neurocognitive
Disorders (NCDs). Delirium is often associated with a disturbance in the sleep-wake cycle and can
include features such as:
• Daytime sleepiness
• Night-time agitation
• Difficulty falling asleep
25
• Excessive sleepiness throughout the day or
• Wakefulness throughout the night
An individual with delirium may exhibit the following emotional disturbances:
• Anxiety
• Fear
• Depression
• Irritability
• Anger
• Euphoria
• Apathy
• There may be rapid and unpredictable shifts from one emotional state to another.
• The disturbed emotional state may also be evident in calling out, screaming, cursing, muttering,
moaning, or making other sounds.
• These behaviours are prevalent at night and under conditions in which stimulation and
environmental cues are lacking.
Most individuals with delirium have a full recovery with or without treatment and early recognition and
intervention shortens the duration of the delirium. Delirium may progress to stupor, coma, seizures, or
death, especially if the underlying cause remains untreated.
Outcomes
• define Delirium,
• know the main characteristics of Delirium
• name the most frequent features associated with Delirium
• discuss the emotional disturbances associated with Delirium
• discuss the DSM-5 diagnostic criteria for Delirium
Study
To be able to do the above you will need to study the introduction to this section and Activity
15.6 and 15.7 in this Tutorial Letter and:
• the mindmap in the introduction of this Learning Unit

• the section on Delirium on pages 439 to 440 of the prescribed book.
Activity 15.6
Your prescribed book does not contain the DSM-5 diagnostic criteria for Delirium, therefore you
need to study the criteria as provided below.
DSM-5 diagnostic criteria for Delirium
A A disturbance in attention (i.e. reduced ability to direct, focus, sustain, and shift attention) and
awareness (reduced orientation to the environment).
B The disturbance develops over a short period of time (usually hours to a few days), represents
a change from baseline attention and awareness, and tends to fluctuate in severity during the
course of the day.
C An additional disturbance in cognition (e.g. memory deficit, disorientation, language,

visuospatial ability, or perception).
D The disturbance in Criteria A and C are not better explained by another pre-existing,
established, or evolving neurocognitive disorder and do not occur in the context of a severely
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reduced level of arousal such as a coma.
E There is evidence from the history, physical examination, or laboratory findings that the
disturbance is a direct physiological consequence of another medical condition, substance
intoxication or withdrawal (i.e. due to a dug of abuse or to a medication), or exposure to a toxin,
or is due to multiple etiologies.
Specify whether:
Substance Intoxication Delirium: This diagnosis should be made instead of substance intoxication
when the symptoms in Criterion A and C predominate in the clinical picture and when they are
sufficiently severe to warrant clinical attention.
Substance Withdrawal Delirium: This diagnosis should be made instead of substance withdrawal
when the symptoms in Criterion A and C predominate in the clinical picture and when they are
sufficiently severe to warrant clinical attention.
Medication-Induced Delirium: This diagnosis should be made instead of substance intoxication

when the symptoms in Criterion A and C arise as a side effect of a medication taken as prescribed.
Delirium due to another medical condition: There is evidence from the history, physical
examination, or laboratory findings that the disturbance is attributable to the physiological
consequences of another medical condition.
Delirium due to multiple aetiologies: There is evidence from the history, physical examination, or
laboratory findings that the delirium has more than one aetiology (e.g. more than one etiological
medical condition, another medical condition plus substance intoxication or medication side effect).
Specify if:
Acute: Lasting a few hours or days.
Persistent: Lasting a few weeks or months.
Specify if:
Hyperactive: The individual has a hyperactive level of psychomotor activity that may be accompanied
by mood liability, agitation, and/or refusal to cooperate with medical care.
Hypoactive: The individual has a hypoactive level of psychomotor activity that may be accompanied
by sluggishness and lethargy that approaches stupor.
Mixed level of activity: The individual has a normal level of psychomotor activity even though
attention and awareness are disturbed. Also includes individuals whose activity level rapidly fluctuates.
Activity 15.7
Read the case study below and
(a) classify Jim’s abnormal behaviour according to the DSM-5 classification system and justify
your answer by referring to examples from the case study.
(b) draw a comparison table between Jim’s type of Neurocognitive Disorder and Schizophrenia.
Make use of the following headings:
Type
Clinical picture
Duration
27
Case study
Jim, a 67-year-old man, was brought to the emergency room of a local hospital at three o’clock in the
morning. His very distressed wife accompanied him. On several previous occasions, Jim had been
admitted to the same hospital, where he was treated for obstructions of his bowel. Jim was currently
showing the same symptoms. His abdomen was enlarged, and he was vomiting and reported extreme
pain in his abdomen. This time, however, Jim also showed some additional symptoms, which,
according to his wife, had developed over the last day and a half. He was clearly confused and
rambled on endlessly accusing his wife, whose name he could not remember, of having sinister
intentions towards him. He did not know where he was, how he had got there or what time it was; he
was also verbally abusive towards his wife and the emergency room staff. The doctor on call admitted
Jim to a ward and ran a few tests, which confirmed an obstruction of the bowel and ordered that Jim
be put on an intravenous drip. A catheter was also inserted, and Jim was given medication.
Throughout this whole process Jim remained confused but abusive and removed both the drip and
catheter forcefully soon after the nursing sister had inserted them. His behaviour was so disrupting that
he had to be sedated.
The following day, the doctor ran more tests, including a brain scan, but found nothing else wrong with
Jim. Jim’s wife also reported that Jim was not on any medication before this incident. She explained
that Jim had become increasingly disoriented over the previous two days. He had difficulty focusing his
attention on the tasks she had asked him to do and, in the end, did not even finish them. She said she
was very concerned about this because this was “not like Jim” at all. The doctor explained that Jim’s
abnormal behaviour could be ascribed to his current medical condition. The bowel obstruction caused
an imbalance in Jim’s electrolyte concentrations that, in turn, led to Jim’s confused state.
Jim’s wife reported that Jim had always been a perfectionist, especially in his work. No mistakes
slipped past Jim in his position as a clerk in the SARS office. He was extremely attentive to detail and
was known as the one person in the office who always stuck to the rules no matter what. His wife said
that he had been treated unfairly at work as he was, on more than one occasion, overlooked for a
promotion as his colleagues just did not like him and his controlling nature. She said that he had been
a good worker and provider for the family even though he had always been a very difficult man to live
with. She said that he always had very specific ideas on how things had to be done and described Jim
as a very strict and inflexible man, showing little affection even towards their children. She said that
she understood why he was the way he was as he had had an unhappy childhood.
Apparently, Jim had always been a perfectionist, a trait enforced by his very strict father. Jim was the
second oldest of five boys who grew up in the time of the Great Depression. Their father expected
them to work very hard and as soon as the boys reached 16 years of age, their father took them out of
school and instructed them to find a job. He always told them that the only way you learnt about life
was through hard work. He would wake them at four o’clock in the morning to do chores before they
left for school and then kept them busy with chores as soon as they got back from school. Jim’s father
indirectly made the sons compete with one another by rewarding the son whom he thought had been
the "toughest" during the week, by allowing that son to sleep until eight o’clock on a Sunday morning
while his brothers had to do his chores. The family was very poor, and the sons had to “earn” clothes
and shoes and, in their father’s words, “the food that was on the table”. Jim’s father also “disciplined”
the boys physically with a sjambok (whip) when they stepped out of line. Their mother was very
submissive to her husband and spent all her time doing the household chores, cooking, and cleaning
chores her husband said were the duties of a mother and wife. Even when the family had no money
Jim’s father refused to allow his wife to go out and find a job. Jim’s mother died when Jim was 24 years
old and his father expected Jim and his older brother to help support their younger siblings. It was at
this time that Jim met and married his wife.
(a) Delirium due to another medical condition (bowel obstruction resulting in electrolyte imbalance):
Jim’s symptoms meet the criteria for Delirium as proposed by the DSM-5 classification system. He
experienced a disturbance in consciousness – he did not know where he was, how he got there or
what time it was. He was clearly confused and was rambling on ‘endlessly’. He experienced
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cognitive impairment, such as problems focusing his attention on tasks. He also experienced
memory problems, for example, not remembering his wife’s name, and showed paranoid
symptoms, accusing her of sinister intent. He behaved abusively toward the hospital staff as well as
his wife and forcefully removed his catheter and drip. These symptoms developed over a short
period of time (day and a half) and could not be ascribed to substance use or another medical
condition. These symptoms were ascribed to the bowel obstruction that caused imbalances in the
electrolyte concentrations. There was no evidence of dementia.
Obsessive-Compulsive Personality Disorder: Jim showed the long-standing symptoms typical of

Obsessive-Compulsive Personality Disorder as proposed by the DSM-5 classification system. He
was a perfectionist. No mistakes ever slipped past him. He was extremely attentive to detail and
always stuck to the rules no matter what, which is an indication of rigidity in thoughts and
behaviour. His interpersonal relationships were problematic as he did not get on with his co-workers
due to his controlling nature and this caused occupational difficulties as he was overlooked for
promotion. His wife described him as a very difficult man to get on with very specific ideas on how
things were supposed to be done. His personal interpersonal relationships were also troubled, as
he was a very strict and inflexible father showing little affection even towards his children.
Other problems related to employment: (Jim experienced discord with co-workers and was
overlooked for promotion that caused further stress).
Unspecified Problem related to social environment: (Jim experienced recurrent health problems for
which he was repeatedly hospitalised and which separated him from his wife made significant
due to the fact that she was his sole source of support).
(b) For information on Schizophrenia refer to Learning Unit 14 in this tutorial letter and chapter 12 of
your prescribed book.
Delirium due to general medical

Schizophrenia
condition
Schizophrenia Spectrum and Other
Type Neurocognitive Disorder
Psychotic Disorder
Changes in at least one additional
area, e.g. memory and learning;
disorientation; alterations in
language; perceptual distortions; or
Disturbance in consciousness. Presence of
perceptual-motor disturbance.
delusions and hallucinations. These
Perceptual distortions include
Clinical symptoms cause significant impairment of
perceptual misinterpretations,
Picture social/ occupational functioning. The
illusions, and hallucinations. Memory
symptoms are not substance- induced or
problems and impairment of cognitive
caused by a general medical condition.
functioning such as focusing,
sustaining, and shifting attention. All
these symptoms are the direct result
of the general medical condition.
Symptoms must be present for at least 6
Develops over a short period (hours
months (of which at least 1 month of active
or days) and dissipates as soon as the
Duration phase symptoms are present.) Symptoms
general medical condition causing the
might improve with appropriate medication
symptoms is cured.
but are more chronic.
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15.4 STUDY UNIT: Major and Mild Neurocognitive Disorders
Major and Mild NCDs involve similar features and the main differentiation between them are mostly due
to the severity of the symptoms. The Major and Mild NCDs are sub-typed according to the known or
presumed etiological/pathological entity/entities underlying the cognitive decline and is distinguished on
the basis of a combination of the time-related course of the symptoms, the characteristics of the
cognitive domains affected and associated symptoms.
For certain aetiological subtypes, the diagnosis depends on the presence of a potentially causative entity
such as a medical condition, such as Parkinson’s or Huntington's disease, Traumatic Brain Injury, or a
Stroke. For other aetiological subtypes (mainly the neurodegenerative diseases such as Alzheimer’s
disease, frontotemporal lobar degeneration and Lewy body disease, the diagnosis is based primarily on
the cognitive, behavioural, and functional symptoms. These underlying pathologies (e.g. the medical
conditions or the neurodegenerative processes) must have a temporal association with the symptoms
that allows for a diagnosis of either a Major or Mild NCDs. A further specifier contained in the DSM-5
diagnostic criteria for the neurodegenerative NCDs and relates to the certainty with which the diagnosis
relates the NCD to its aetiological condition and are indicated by the terms possible or probable.
Consider the following descriptions of these terms:
Probable [medical disease e.g. Alzheimer’s disease] is diagnosed if there is evidence of a causative
[medical disease e.g. Alzheimer’s disease] genetic mutation from either genetic testing or family
history.
Possible [medical disease e.g. Alzheimer’s disease] is diagnosed if there is no evidence of a

causative [medical disease e.g. Alzheimer’s disease] genetic mutation from either genetic testing or
family history, and all three of the following are present:
1. Clear evidence of decline in memory and learning.

2. Steadily progressive, gradual decline in cognition, without extended plateaus.
3. No evidence of mixed aetiology (i.e., absence of other neurodegenerative or cerebrovascular
disease, or another neurological or systemic disease or condition likely contributing to cognitive
decline).
(Note that the above points are specific to each aetiological condition and you should know the
specific requirements for each of the neurodegenerative NCDs that you are required to study.)
Outcomes: Once you have completed study unit 15.4 you should be able to:
• define Mild and Major NCD,
• know the main characteristics of Mild and Major NCD
• discuss the DSM-5 diagnostic criteria for Mild NCD
• discuss the DSM-5 diagnostic criteria for Major NCD
• differentiate between Mild NCD, Major NCD and Delirium.
• distinguish between the symptoms of Major Depressive Disorder and neurodegenerative Mild and
Major NCD (Dementia)
Study
To be able to do the above you will need to study the introduction to this section and Activities
15.7, 15.8, and 15.9 and Learning Unit 12 in this Tutorial Letter and the following:
• the section on Mild NCS on pages 438 to 439

• the section on Major NCS on pages 437 to 438
• the section on Depressive Disorders in Chapter 8 on pages 247 to 248, and 250 to 253 of your
prescribed book
• Table 8.1 on page 246, Table 8.2 on page 250 and Table 8.3 on page 251 of your prescribed
book
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Mild Neurocognitive Disorders
In Mild NCD the individual manifests deficits in at least one major cognitive area (refer to Table 15.1 in
Activity 15.4 above). Although Mild and Major NCS have similar diagnostic features the severity of the
deficit(s) in Mild NCD are less than those seen in Major NCD
Activity 15.7
Your prescribed book does not contain the DSM-5 diagnostic criteria for Mild NCD and therefore
you need to study the criteria as provided below:
DSM-5 diagnostic criteria for Mild Neurocognitive Disorder
A Evidence of modest cognitive decline from a previous level of performance in one or more
cognitive domains (complex attention, executive function, learning and memory, language,
perceptual motor, or social cognition) based on:
1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild
decline in cognitive function; and
2. A modest impairment in cognitive performance, preferably documented by standardised
neuropsychological testing or, in its absence, another quantified clinical assessment.
B The cognitive deficits do not interfere with capacity for independence in everyday activities (i.e.,
complex instrumental activities of daily living such as paying bills or managing medications are
preserved, but greater effort, compensatory strategies, or accommodation may be required).
C The cognitive deficits do not occur exclusively in the context of a delirium.
D The cognitive deficits are not better explained by another mental disorder (e.g., major
depressive disorder, schizophrenia).
Specify whether due to:

Alzheimer’s disease (pp. 611-614)
Frontotemporal lobar degeneration (pp. 614-618)
Lewy body disease (pp. 618-621)
Vascular disease (pp. 621-624)
Traumatic brain injury (pp. 624-627)
Substance/medication use (pp. 627-632)
HIV infection (pp. 632-634)
Prion disease (pp. 634-636)
Parkinson’s disease (pp. 636-638)
Huntington’s disease (pp. 638-641)
Another medical condition (pp. 641-642)
Multiple etiologies (pp. 642-643)
Unspecified (p. 643)
Specify:
Without behavioural disturbance: If the cognitive disturbance is not accompanied by any clinically
significant behavioural disturbance.
With behavioural disturbance (specify disturbance): If the cognitive disturbance is accompanied by

a clinically significant behavioural disturbance (e.g., psychotic symptoms, mood disturbance,
agitation, apathy, or other behavioural symptoms).
(APA, 2013, pp. 605-606)
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Major Neurocognitive Disorders
In Major NCD the individual manifests deficits in one or more cognitive area (refer to Table 15.1 in
Activity 15.4 above) as well as in the ability to independently meet the demands of daily living. Although
Mild and Major NCD have similar diagnostic features the severity of the deficit(s) in Major NCD is
significantly of greater severity as for Mild NCD.
Activity 15.8
Your prescribed book does not contain the DSM-5 diagnostic criteria for Major NCD and therefore
you need to study the criteria as provided below:
DSM-5 diagnostic criteria for Major Neurocognitive Disorders
A Evidence of significant cognitive decline from a previous level of performance in one or more
cognitive domains (complex attention, executive function, learning and memory, language,
perceptual-motor, or social cognition) based on:
1. Concern, of the individual, a knowledgeable informant, or the clinician that there has been a
significant decline in cognitive function; and
2. A substantial impairment in cognitive performance, preferably documented by standardised
neuropsychological testing or, in its absence, another quantified clinical assessment.
B The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum,
requiring assistance with complex instrumental activities of daily living such as paying bills or
managing medications).
C The cognitive deficits do not occur exclusively in the context of a delirium.
D The cognitive deficits are not better explained by another mental disorder (e.g., major
depressive disorder, schizophrenia).
Specify whether due to:

Alzheimer’s disease (pp. 611-614)
Frontotemporal lobar degeneration (pp. 614-618)
Lewy body disease (pp. 618-621)
Vascular disease (621-624)
Traumatic brain injury (pp. 624-627)
Substance/medication use (pp. 627-632)
HIV infection (pp. 632-634)
Prion disease (pp. 634-636)
Parkinson’s disease (pp. 636-638
Huntington’s disease (pp. 638-641)
Another medical condition (pp. 641-642)
Multiple etiologies (pp. 642-643)
Unspecified (p. 643)
Coding note: Code based on medical or substance etiology. In some cases, there is need for an
additional code for the etiological medical condition, which must immediately precede the diagnostic
code for major neurocognitive disorder, as follows:
Etiological subtype:
Alzheimer’s disease
Frontotemporal lobar degeneration
Lewy body disease
Vascular disease
Traumatic brain injury
Substance/medication induced
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HIV infection
Prion disease
Parkinson’s disease
Huntington’s disease
Due to another medical condition
Due to multiple etiologies
Unspecified neurocognitive disorder
Specify:
Without behavioural disturbance: If the cognitive disturbance is not accompanied by any
clinically significant behavioural disturbance.
With behavioural disturbance (specify disturbance): If the cognitive disturbance is
accompanied by a clinically significant behavioural disturbance (e.g., psychotic symptoms,
mood disturbance, agitation, apathy, or other behavioural symptoms).

Mild: Difficulties with instrumental activities of daily living (e.g., housework, managing money).
Moderate: Difficulties with basic activities of daily living (e.g., feeding, dressing).
Severe: Fully dependent.
(APA, 2013, pp.602-605)
Activity 15.9
Distinguish between Depression, Delirium and Dementia.
Depression Delirium Dementia

Uneven progression over Acute onset over hours or Even progression over
Onset
weeks or months. days. months or years.
Mood Low/apathetic. Fluctuates Fluctuates
Chronic, responds to
Chronic, with deterioration
treatment.
Acute; responds to over time.
Course Often worse in morning,
treatment. Worse later in day or when
better as the day
fatigued.
progresses.
Unaware of or minimises
Aware of or exaggerates
Self- May be aware of changes disability.
disability.
awareness in cognition; fluctuates. Attempts to hide cognitive
Complains of memory loss.
deficits.
May neglect basic self- May be intact early,
Activities of care. impaired as disease
May be intact or impaired.
daily living. May abuse alcohol or other progresses.
drugs. Rarely abuses drugs.
(Sources: Oltmanns & Emery, 1995; Gagliardi, 2008)
15.5 STUDY UNIT: Aetiology of Neurocognitive Disorders
As discussed in the previous sections, we classify the Neurocognitive Disorders according to what
caused them; in other words, we classify them according to their aetiology. These aetiologies are
considered when making a diagnosis of a Neurocognitive Disorder. Therefore, the aetiological
discussion of the NCDs are focussed on the underlying causative pathology (e.g. medical condition,
substance/medication use, neurological causative events, etc.) instead of discussing it according to the
Multipath Model. However, you should take notice of Figure 13.1 on page 443 of the prescribed book in
which the Multipath Model is applied to the aetiology of the Neurocognitive Disorders.
33
We should take care to differentiate between the cognitive changes associated with the normal aging
process and abnormal cognitive changes resulting from the aforementioned conditions.
Outcomes
Once you have worked through study unit 15.5, you should be able to
• consider the Multipath Model representation of the aetiology of the Neurocognitive Disorders.
• discuss Traumatic Brain Injury as aetiological factor in Neurocognitive Disorders.
• discuss the DSM-5 diagnostic criteria for Major or Mild Neurocognitive Disorder Due to Traumatic
Brain Injury.
• discuss Cognitive Vascular Disorders as aetiological factors in the Neurocognitive Disorders.
• discuss the DSM-5 diagnostic criteria for Major or Mild Vascular Neurocognitive Disorder.
• discuss Alzheimer’s disease as neurodegenerative disorder involved in the aetiology of NCD.
• discuss the DSM-5 diagnostic criteria for Major or Mild Neurocognitive Disorder Due to Alzheimer’s
Disease.
• discuss NCD due to HIV Infection.
• discuss AIDS Dementia Complex as aetiology of Major NCD.
• discuss the DSM-5 diagnostic Criteria for Major or Mild Neurocognitive Disorder Due to HIV
Infection.
• discuss NCD due to Substance Abuse.
• discuss the DSM-5 diagnostic criteria for Substance/Medication-Induced Major or Mild NCD.
• discuss NCD due to Dementia with Lewy Bodies.
• discuss NCD due to Frontotemporal Lobar Degeneration.
• discuss NCD due to Parkinson’s Disease.
• Discuss NCD due to Huntington’s Disease.
• discuss how you would go about preventing the development of Neurocognitive Disorders in your
community.
Study
To be able to do the above you will need to study the introduction to this section, Activities 15.10,
15.11, 15.12, 15.13, 15.14, 15.15, 15.16 and 15.17 in this Tutorial Letter and the following sections
in the prescribed book:
• the section on Etiology of Neurocognitive Disorders on pages 440 to 442

• Figure 13.1 on page 443
• Neurocognitive Disorder due to Traumatic Brain Injury on pages 442 to 446
• Vascular Neurocognitive Disorders on pages 446 to 450
• Neurocognitive Disorder due to Substance Abuse on page 450
• Neurocognitive Disorder due to Alzheimer’s Disease on pages 450 to 453
• Neurocognitive Disorder due to Dementia with Lewy Bodies on pages 453 to 454
• Neurocognitive Disorder due to Frontotemporal Lobar Degeneration on page 455
• Neurocognitive Disorder due to Parkinson’s Disease on pages 455 to 456
• Neurocognitive Disorder due to Huntington’s Disease on page 456
• Neurocognitive Disorder due to HIV Infection on pages 456 to 457
• Table 13.6 on page 449
• Box: Focus on Resilience – Can we prevent brain damage?, on page 441
Activity 15.10
You will notice that the prescribed book does not contain the DSM-5 diagnostic criteria for Mild and
Major NCD due to Traumatic Brain Injury. Study the DSM-5 diagnostic criteria for Mild and Major
NCD due to Traumatic Brain Injury as provided below.
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DSM-5 diagnostic criteria for Major or Mild Neurocognitive Disorder Due to Traumatic Brain
Injury
A The criteria are met for major or mild neurocognitive disorder.
B There is evidence of a traumatic brain injury – that is, an impact to the head or other
mechanisms of rapid movement or displacement of the brain within the skull, with one or more
of the following:
1. Loss of consciousness.
2. Posttraumatic amnesia.
3. Disorientation and confusion.
4. Neurological signs (e.g., neuroimaging demonstrating injury; a new onset of seizures; a marked
worsening of a pre-existing seizure disorder; visual field cuts; anosmia; hemiparesis).
C The neurocognitive disorder presents immediately after the occurrence of the traumatic brain
injury or immediately after recovery of consciousness and persists past the acute post-injury
period.
Coding note: For major neurocognitive disorder due to traumatic brain injury, with behavioural
disturbance: For ICD-9-CM, first code 907.0 late effect of intracranial injury without skull fracture,
followed by 294.11 major neurocognitive disorder due to traumatic brain injury, with behavioural
disturbance. For ICD-10-CM, first code S06.2X9S diffuse traumatic brain injury with loss of
consciousness of unspecified duration, sequel; followed by F02.81 major neurocognitive disorder due
to traumatic brain injury, with behavioural disturbance.
For major neurocognitive disorder due to traumatic brain injury, without behavioural disturbance: For
ICD-9-CM, first code 907.0 late effect of intracranial injury without skull fracture, followed by 294.10
major neurocognitive disorder due to traumatic brain injury, without behavioural disturbance. For
ICD-10-CM, first code S06.2X9C diffuse traumatic brain injury with loss of consciousness of
unspecified duration, sequel; followed by F02.80 major neurocognitive disorder due to traumatic
brain injury, without behavioural disturbance.
For mild neurocognitive disorder due to traumatic brain injury, code 331.83 (G31.84). (Note: Do not
use the additional code for traumatic brain injury. Behavioural disturbance cannot be coded but
should still be indicated in writing.)
(APA, 2013, p. 624)
Activity 15.11
You will notice that the prescribed book does not contain the DSM-5 diagnostic criteria for Mild or
Major Vascular NCD. Study the DSM-5 diagnostic criteria for Mild and Major Vascular NCD as
provided below.
DSM-5 diagnostic criteria for Major or Mild Vascular Neurocognitive Disorder
B The clinical features are consistent with a vascular etiology, as suggested by either of the
following:
1. Onset of the cognitive deficits is temporally related to one or more cerebrovascular events.
2. Evidence for decline is prominent in complex attention (including processing speed) and frontal-
executive function.
35
C There is evidence of the presence of cerebrovascular disease from history, physical
examination, and/or neuroimaging considered sufficient to account for the neurocognitive
deficits.
D The symptoms are not better explained by another brain disease or systemic disorder.
Probable vascular neurocognitive disorder is diagnosed if one of the following is present;

otherwise possible vascular neurocognitive disorder should be diagnosed:
1. Clinical criteria are supported by neuroimaging evidence of significant parenchymal injury

attributed to cerebrovascular disease (neuroimaging-supported).
2. The neurocognitive syndrome is temporally related to one or more documented cerebrovascular
events.
3. Both clinical and genetic (e.g., cerebral autosomal dominant arteriopathy with subcortical
infarcts and leukoencephalopathy) evidence of cerebrovascular disease is present.
Possible Vascular Neurocognitive Disorder is diagnosed if the clinical criteria are met but
neuroimaging is not available and the temporal relationship of the neurocognitive syndrome with one
or more cerebrovascular events is not established.
Coding note: For Probable Major Vascular Neurocognitive Disorder, with behavioural disturbance,
code Probable Major Vascular Neurocognitive Disorder with behavioural disturbance. For probable
Major Vascular Neurocognitive Disorder, without behavioural disturbance, code Probable Major
Vascular Neurocognitive Disorder without behavioural disturbance. For Possible Major Vascular
Neurocognitive Disorder, with or without behavioural disturbance, code Possible Major Vascular
Neurocognitive Disorder. (Note: An additional medical code for the cerebrovascular disease is not
needed).
For Mild Vascular Neurocognitive Disorder, code Mild Vascular Neurocognitive Disorder (Note: Do
not use an additional code for the vascular disease. Behavioural disturbance cannot be coded but
should still be indicated in writing.).
(APA, 2013, p.621)
Activity 15.12
Major NCD due to Alzheimer’s Disease. Study the DSM-5 diagnostic criteria for Mild and Major
NCD due to Alzheimer’s disease as provided below.
DSM-5 diagnostic criteria for Major or Mild Neurocognitive Disorder Due to Alzheimer’s
Disease
B There is insidious onset and gradual progression of impairment in one or more cognitive
domains (for major neurocognitive disorder, at least two domains must be impaired).
C Criteria are met for either probable or possible Alzheimer’s disease as follows:
For major neurocognitive disorder:
Probable Alzheimer’s disease is diagnosed if either of the following is present; otherwise,

possible Alzheimer’s disease should be diagnosed.
1. Evidence of a causative Alzheimer’s disease genetic mutation from family history or genetic
testing.
2. All three of the following are present:
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a. Clear evidence of decline in memory and learning and at least one other cognitive
domain (based on detailed history or serial neuropsychological testing).
b. Steadily progressive, gradual decline in cognition, without extended plateaus.
c. No evidence of mixed aetiology (i.e., absence of other neurodegenerative or
cerebrovascular disease, or another neurological, mental, or systemic disease or
condition likely contributing to cognitive decline).
For mild neurocognitive disorder:
Probable Alzheimer’s disease is diagnosed if there is evidence of a causative Alzheimer’s

disease genetic mutation from either genetic testing or family history.
Possible Alzheimer’s disease is diagnosed if there is no evidence of a causative Alzheimer’s
disease genetic mutation from either genetic testing or family history, and all three of the
following are present:
1. Clear evidence of decline in memory and learning.

2. Steadily progressive, gradual decline in cognition, without extended plateaus.
3. No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular
disease, or another neurological or systemic disease or condition likely contributing to cognitive
decline).
D The disturbance is not better explained by cerebrovascular disease, another neurodegenerative

disease, the effects of a substance, or another mental, neurological, or systemic disorder.
Coding note: For probable Major Neurocognitive Disorder due to Alzheimer’s disease, with
behavioural disturbance, code Alzheimer’s disease first, followed by Major Neurocognitive Disorder
due to Alzheimer’s disease. For probable Neurocognitive Disorder due to Alzheimer’s disease,
without behavioural disturbance, code Alzheimer’s disease first, followed by Major Neurocognitive
Disorder due to Alzheimer’s disease, without behavioural disturbance.
For possible Major Neurocognitive Disorder due to Alzheimer’s disease, code possible Major
Neurocognitive Disorder due to Alzheimer’s disease (Note: Do not use the additional code for
Alzheimer’s disease. Behavioural disturbance cannot be coded but should still be indicated in
writing.)
For Mild Neurocognitive Disorder due to Alzheimer’s disease, code Mild Neurocognitive Disorder due
to Alzheimer’s Disease (Note: Do not use the additional code for Alzheimer’s disease. Behavioural
disturbance cannot be coded but should still be indicated in writing.)
(APA, 2013, pp.611-612)
Activity 15.13
Major NCD due to HIV Infection. Study the DSM-5 diagnostic criteria for Mild and Major NCD due
to HIV Infection as provided below:
DSM-5 diagnostic Criteria for Major or Mild Neurocognitive Disorder Due to HIV Infection
B There is documented infection with human immunodeficiency virus (HIV).
C The neurocognitive disorder is not better explained by non-HIV conditions, including secondary
brain diseases such as progressive multifocal leukoencephalopathy or cryptococcal meningitis.
37
D The neurocognitive disorder is not attributable to another medical condition and is not better
explained by a mental disorder.
Coding note: For Major Neurocognitive Disorder due to HIV infection, with behavioural disturbance,
first code HIV infection, followed by Major Neurocognitive Disorder due to HIV infection, with
behavioural disturbance. For Major Neurocognitive Disorder due to HIV infection, without behavioural
disturbance, first code HIV infection, followed by Major Neurocognitive Disorder due to HIV infection,
without behavioural disturbance.
For Mild Neurocognitive Disorder due to HIV infection, code Mild Neurocognitive Disorder due to HIV
infection. (Note: Do not code additionally for HIV infection. Behavioural disturbance cannot be
coded but should still be indicated in writing.)
(APA, 2013, p.632)
Activity 15.14
You will notice that the prescribed book does not contain the DSM-5 diagnostic criteria for
Substance/Medication-Induced Major or Mild NCD. Study the DSM-5 diagnostic criteria for
Substance/Medication-Induced Major or Mild NCD as provided below:
DSM-5 diagnostic Criteria for Substance/Medication-Induced Major or Mild Neurocognitive

Disorder
B The neurocognitive impairments do not occur exclusively during the course of a delirium and
persist beyond the usual duration of intoxication and acute withdrawal.
C The involved substance or medication and duration and extent of use are capable of producing
the neurocognitive impairment.
D The temporal course of the neurocognitive deficits is consistent with the timing of substance or
medication use and abstinence (e.g., the deficits remain stable or improve after a period of
abstinence).
E The neurocognitive disorder is not attributable to another medical condition or is not better
explained by another mental disorder.
Coding note: The ICD-9-CM and ICD-10-CM codes for the [specific substance/medication]-induced
neurocognitive disorders (see list below). Note that the ICD-10-CM code depends on whether or not
there is a comorbid substance use disorder present for the same class of substance. If a mild
substance use disorder is comorbid with the substance-induced neurocognitive disorder, the 4th
position character is “1”, and the clinician should record “mild [substance] use disorder” before the
substance-induced neurocognitive disorder (e.g., “mild inhalant use disorders with inhalant-induced
major neurocognitive disorder”). If moderate or severe substance use disorder is comorbid with the
substance-induced neurocognitive disorder, the 4th position character is “2”, and the clinician should
record “moderate [substance] use disorder” or “severe [substance] use disorder” depending on the
severity of the comorbid substance use disorder. If there is no comorbid substance use disorder, then
the 4th position character is “9”, and the clinician should record only the substance-induced
neurocognitive disorder. For some classes of substances (i.e., alcohol, sedatives, hypnotics,
anxiolytics), it is not permissible to code a comorbid mild substance with a substance-induced
neurocognitive disorder; only a comorbid moderate or severe substance use disorder, or no
substance use disorder, can be diagnosed. Behavioural disturbance cannot be coded but should still
be indicated in writing.
List of ICD-10-CM coded specific substance/medication:

Alcohol (mild or major neurocognitive disorder)
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Inhalant (mild or major neurocognitive disorder)

Sedative, hypnotic, or anxiolytic (mild or major neurocognitive disorder)
Other (or unknown) substance (mild or major neurocognitive disorder)
Specify if:
Persistent: Neurocognitive impairment continues to be significant after an extended period of
abstinence.
(Adapted from APA, 2013, pp.627-629)
Activity 15.15
(a) classify Mary’s abnormal behaviour according to the DSM-5 classification system. Justify your
choice of diagnosis by referring to the case study.
(b) distinguish between Mild or Major Vascular NCD and Mild or Major MCD due to the
Alzheimer’s disease.
Case study
At approximately 68 years of age, Mary, now 73-years-old, noticed that her memory was starting to fail
her. These memory problems progressively worsened over time and she found that she had to
compensate increasingly by writing things down and making lists and notes of things to do. During this
time, she also found herself groping for a word she had always known and noticed that she often lost
the thread of a conversation. Though she worried that her mind might be slipping, she did not want to
think about getting old and, most importantly, she did not want to be treated as if she were senile. She
was still enjoying life and was able to manage on her own.
Mary later got pneumonia and had to be hospitalised. In those strange surroundings, she could no
longer compensate for her forgetfulness. People told her where she was, but she forgot. She
complained that her daughter-in-law never visited her, though she had been there in the morning. This
strange behaviour prompted Mary’s physician to order a magnetic resonance imaging (MRI) scan of
her brain. The MRI results showed atrophy of the cortical brain tissue. Further examinations and tests
eliminated any additional neurological or general medical conditions that could in any way account for
Mary’s progressive decline in memory and cognitive functioning. The possibility of Mary’s symptoms
stemming from any medication or substance that she was taking was also eliminated.
Although the fever and infection passed, the illness had focused attention on the seriousness of her
condition. Her family realised she could no longer live alone. She moved in with her son’s family where
she was given a room. Because only some of her possessions were there, she thought that perhaps
the rest had been stolen while she was sick even though she had been told many times where her
things had been stored. She got lost on walks in the neighbourhood and often could not find her way
around her son’s house. Mary’s condition continued to deteriorate. Getting dressed became an
insurmountable ordeal. Because of her apraxia, she no longer knew how to button buttons or to unzip
zippers. Mary gradually lost the ability to interpret what she saw and heard. Words and objects began
to lose their meaning. Sometimes she would react with terror and panic, or with anger. Her things were
gone, her life seemed in disarray. She could not understand the explanations that were offered or, if
she understood, she could not remember them. However, Mary’s social skills remained so that when
she finally relaxed, she was personable and engaging. She also loved music and sang old familiar
songs. Music seemed to be embedded in a part of her memory that she retained long after much else
was lost. The time finally came when the physical and emotional burden of caring for Mary became too
much for her family, and she went to live in a nursing home. After the initial days of confusion and panic
passed, the reliability of the routine comforted her and gave her a measure of security. Mary needed
help bathing, dressing and eating, but was nonetheless concerned about her appearance. She insisted
on walking unaided but requested help in dressing up for visitors.
39
Four months after her arrival at the nursing home Mary fell on her way to the dining hall and fractured
her hip. The orthopaedic surgeon attending to Mary decided that there was too great a risk involved in
subjecting Mary to hip replacement surgery and prescribed bed rest and anti-inflammatory medication.
Since being practically bedridden, Mary has shown no interest in the daily routine of the home and
seems incapable of maintaining any degree of personal hygiene. Where she previously seemed
excited at the prospect of family visits, she now seems indifferent to the whole event. Most of the time
she does not even seem to recognise her family, let alone remember their names. It has now come to
the stage where Mary needs nearly constant care.
(Adapted from Rosenham & Seligman, 1995)
(a) Alzheimer’s Disease

Major NCD due to Probable Alzheimer’s disease
Mary shows cognitive deficits that developed over a long period of time. The first time she noticed
memory problems was at the age of 68. Her memory problems have progressively worsened over
the past five years (she is now 73). She had to start compensating for the gradual failure of her
memory by making notes etcetera. She also showed signs of aphasia as she found herself groping
for words she knew and often lost the thread of a conversation. In the hospital her memory
impairment became more apparent as she could no longer compensate by making notes and by
moving around familiar territory. She could not remember where she was, even though people kept
telling her (impaired ability to learn new information) and could not remember that her daughter-in-
law had visited her in hospital on the same day that the visit took place.
Her brain scan showed brain atrophy not related to any other neurological condition or general
medication. Medication was not implicated in causing her symptoms. Through a process of
elimination, the doctor diagnosed Alzheimer’s disease as the cause of the atrophy.
Her condition did not improve when she moved into her son’s home. She kept on thinking that her
things had been stolen and could not find her way around the house and neighbourhood (signs of
memory impairment and disturbance in executive functioning). She developed apraxia (not being
able to button her buttons or zip her zips) and lost the ability to interpret what she heard and saw
(symptoms of agnosia). She also seemed unable to understand the explanations given to her
(disturbance in executive functioning) and if she did, could not remember them.
These symptoms most definitely impacted on her social and personal functioning as she could no
longer live alone and eventually ended up in a nursing home.
We could consider the possibility that the hip fracture acted as a stressor that caused her to
develop a Depressive Disorder. This would account for the loss of interest in the daily activities of
the nursing home and her neglect of personal hygiene. There is, however, not enough information
to make a definite diagnosis of a Major Depressive Disorder.
The doctor diagnosed Alzheimer’s disease as her brain scan showed brain atrophy not related to
any other neurological condition or systemic condition. No medication was implicated in causing her
symptoms.
The fractured hip needs mentioning as this served as stressor and had a great impact on Mary’s
functioning. It should also be considered in any therapeutic intervention.
Problems related to social environment – adjustment to life cycle transition. Mary experienced
problems related to her social environment, as she had to adjust to a life-cycle transition. She had
to give up living alone and being independent and entered her son’s home and eventually a nursing
home. This caused Mary significant stress.
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(b)
Mild or Major NCD due to Alzheimer’s
Mild or Major Vascular NCD
Disease
(1) Course is variable and typically (1) Course characterised by gradual onset
progresses in a stepwise fashion. and continuing cognitive decline.
(2) Focal neurological signs and (2) Cognitive deficits not due to other central
symptoms and/or laboratory evidence nervous system conditions, systemic
of vascular disease. conditions or substance-induced.
Activity 15.16
(a) diagnose Adolf’s condition on the DSM-5 classification system.
(b) discuss the three levels of prevention that one could use to eradicate Adolf’s condition or any
other psychological condition.
Case study
Anna found it impossible to have a conversation with her husband Adolf, since he somehow never
remembered the preceding discussion. Since he had turned 50 the previous December, it seemed to
have gotten worse almost every month. At first she thought his bad moods had something to do with
the promotion that he had lost to a younger colleague, but lately she had begun to wonder whether the
reason for his not being promoted had something to do with this annoying condition. His boss was
probably not as accommodating and tolerant as she was. If she needed to remind him of all the points
that went before in order to get him to focus his attention on the problem at hand, what was it like for his
boss and his colleagues? She had engaged in this tedious process time and again, and when she
eventually had his attention, after having presented him with all the necessary factual details and points
of discussion, she waited for his opinion on the matter. But he would only get a puzzled look on his
face, and his answer would be the same every time: "I am too tired now to think, what would you like to
do?" or "This is too complicated now, can we talk about this another day?" Anna felt deserted and
overburdened. She was eventually forced by his behaviour to make most decisions on her own, without
the slightest input from his side.
Adolf could also never remember where he had left his keys, pens, briefcase, notebook, documents,
wallet and even the things he had bought at the shops. Time, effort, money and nerves had been
repeatedly wasted on locating mislaid items. Adolf would frantically search through Anna’s orderly
drawers and cupboards, leaving everything ajar and in disarray, neglecting to look amongst the mess in
his own car and boot, his piles of unfiled papers on his writing desk, and in his five briefcases which
were scattered about the house.
A myriad of diverse little pieces of paper with important information were left everywhere he went. Anna
had specially bought a basket into which she deposited all the items that she found in the laundry
basket, in the kitchen, in his car, in the bathroom, tool shed and garage. When Adolf was looking for
some name, date, or number that he could not remember, she would hand him the basket, since this
was the only way of escaping emotional abuse. At times she felt as if her whole life consisted of looking
for misplaced items, locating forgotten information, and picking up after her husband.
Adolf is a physically fit man who plays tennis every Saturday. After a good game of tennis and a dozen
beers he tends to fall into a deep sleep until Sunday morning. During the week however, he often lies
awake at night, which always makes him feel anxious. He therefore resorts to taking sleeping tablets
almost every night. This behaviour has been taking place for well over a year. He has had numerous
fights with Anna concerning this medication use of his, but he nevertheless persists in this behaviour.
He starts off the day with two cups of coffee with milk and sugar and has several more at work. He says
that he needs the coffee to help him think.
41
(a) Sedative-Induced Mild NCD (alcohol and sleeping pills)
Occupational problems (work pressure and was overlooked for a promotion)
(b) The three levels of prevention have been called primary, secondary, and tertiary prevention. The
main emphasis in the prevention of psychopathology is on the promotion of mental health, the
reduction of the number of new cases, the reduction of the duration of disorders among the
afflicted, and the reduction of the disabling effects of disorders.
Primary prevention focuses on the promotion of mental health by adding to and strengthening the
resources in a community and by eliminating those features that threaten mental health. Secondary
prevention is an attempt to shorten the duration of mental disorders and to reduce their impact on
the individual and society. Tertiary prevention focuses on the person’s readjustment to the
community after having been treated in a hospital for a mental disorder.
Adolf’s Sedative Induced Mild Neurocognitive Disorder could be prevented as follows:
Primary prevention could be aimed at strengthening the resources in his family, workplace and
community. Resources could also be added in those life areas in which there is a lack. At the same
time those features that threaten Adolf’s mental health should be eliminated. Examples of primary
preventative measures would be teaching Adolf and his family and friends, to provide emotional
support, developing his socialisation skills and relaxation techniques, building Adolf’s self-esteem,
and assisting him with family life and financial and other issues.
Secondary prevention could be aimed at shortening the duration of the amnesia and reducing the
impact which withdrawal from the substances that Adolf was using would cause. (Since treatment is
not included in this course, you need not give examples. The therapist’s orientation will determine
the kind of treatment chosen.)
Tertiary prevention, in Adolf’s case, should be focused on reversing the negative effects of
institutionalisation, ensuring a smooth transition to a productive life at home, his workplace and in
the community. This could be achieved by educating the public about the role that each individual
plays in the promotion of mental health. Family, friends, and business associates should be given
the facts about Adolf’s condition to dispel the fears and stereotypes that arise as a result of
ignorance. These measures would help to modify their attitude towards Adolf and may lead to their
gracious acceptance of his condition and his rehabilitation into the community.
Activity 15.17
Considering the knowledge that you have gained in studying this Learning Unit you will no doubt be
able to identify individuals in your own family or community who might be experiencing problems
similar to the disorders discussed here. At undergraduate level you are not yet allowed to diagnose
or classify abnormal behaviour, but we hope that you have nonetheless acquired a sensitivity that
will help you recognise potential difficulties relating to mental health and illness. You can use the
knowledge that you have acquired to make informed referrals, at the request of the affected
individuals, to resources in your community that will be able to support them and provide them with
assistance. There are many agencies and organisations working in the field of mental health.
Concerning the Neurocognitive Disorders specifically, you can find further help at the following
numbers. Even if these organisations are not in your area, they are sure to have further contact
details for /and information on services in your area.
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Organisation Contact Details Services
Cnr 4th Avenue & Rabie Street, We are dedicated to providing

Fountainebleau, Randburg support for families and
individuals to improve the
Alzheimer’s South Africa
Contact Details: 011 792 2511 lives of people with
Alzheimer’s/Dementia as well
[email protected] as their carers.
(011) 787–8792
South African
Private Bag X36
Parkinsonian Association
Bryanston, 2021
+27 21 421 0077

+27 21 421 0078
Support for carers and
+27 21 418 5888
Dementia SA family members of people
living with dementia
24-hour national helpline
0860 MEMORY/0860 636 679
Activity 15.18 Fax number

The following activities will help+27
you 21 418 and
revise 2772summarise what you have studied in this chapter:
• At the beginning of chapter General email

13 of the prescribed book there are five Focus Questions on page
434. Answer questions [email protected]
to 3 after you have worked through the Learning Unit. Compare
your answers to the answers provided at the end of Chapter 13 in the prescribed book under
the heading “Chapter Summary”. If your answers are not complete, consult this Study Guide
and prescribed book again on these questions or contact one of your lecturers.
• Go back to Activity 15.2 to the key terms and reflect on your understanding of each term.
Explain the meaning of these terms to a friend or family member in your own words. If you
battle to do so, refer to your prescribed book and Study Guide.
• The learning outcomes of each of the five study units in this chapter were set out clearly in
each of the study units. Make sure that you have acquired the necessary knowledge, skills
and insights set out in these learning outcomes.
CONCLUSION
In this Learning Unit you have studied the key features of the different types of Neurocognitive Disorders,
namely, Delirium and Mild or Major Neurocognitive Disorders. You also looked at the assessment
techniques for assessing brain damage and the varied nature of brain damage. Now that you have
studied the various aetiologies for explaining the development of these disorders, you should be able to
identify, describe and explain the development of the various Neurocognitive Disorders. You should also
be able to compare and distinguish between the different Neurocognitive Disorders and their varied
aetiologies. You also considered the differentiation between the cognitive aspects of normal aging and
the Neurocognitive Disorders.
REFERENCES
43
Butcher, JN, Mineka, S & Hooley, JM. (2010). Abnormal Psychology (14th ed.). Boston: Pearson
International.
Gagliardi, J.P. (2008). Differentiating among Depression, Delirium, and Dementia in Elderly Patients.
Virtual Mentor. 2008;10(6):383-388. doi: 10.1001/virtualmentor.2008.10.6.cprl1-0806.
Oltmanns, T.F. & Emery, R. E. (1995). Abnormal psychology. Englewood Cliffs, NJ: Prentice-Hall.
Rosenham, DL & Seligman, M. E. P. (1995). Abnormal psychology. (3rd ed.). New York, NY: Norton.
Sue, D., Sue, D. W., Sue, D. & Sue, S. (2022). Foundations of Abnormal Behaviour (10th ed.). Boston,
MA: Cengage Learning.
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Learning Unit 16:
Disorders of Childhood and

Adolescence
Prof. Christine Laidlaw & Mrs Banti Mokgatlhe
Contents Page
Overview 45
Neurodevelopmental Disorders 49
16.1 Study unit: Autism Spectrum Disorder 49
16.2 Study unit: Attention Deficit/Hyperactivity Disorder 56
16.3 Study unit: Intellectual Disability (Intellectual Developmental Disorder) 62
Elimination Disorders 68
16.4 Study unit: Enuresis and Encopresis 68
Depressive Disorder 71
16.5 Study Unit: Childhood Depression 71
Conclusion 74
References 74
Overview
This Learning Unit looks at the most commonly diagnosed disorders in infancy, childhood and
adolescence. Many childhood problems are usually identified when a child enters school. Although these
problems may have existed earlier, they may have been tolerated or not seen as “problems” in the home
or when the child was younger. It is important to note that what could be socially acceptable behaviour at
an earlier age could be socially unacceptable or inappropriate at a later stage when a child is older.
Child psychopathology is a recent field of study. Prior to the 17th century, children were thought of as little
adults without personalities of their own. No fixed beginning can be established for the emergence of the
field of child psychopathology, although many divergent forces and variables appearing in the late 19th
45
century and early 20th century were influential in the field’s development. A study of child
psychopathology examines only part of the broader phenomenon of child mental health.
Between 12 and 15 per cent of children in Western countries are estimated to suffer from some kind of
childhood psychopathology. In the South African context, clear structural causes (e.g. poverty and
political variables) and circumstances resulting from interpersonal contexts (family, eco-cultural contexts,
physical conditions) contribute to the development of psychopathological conditions in children. Many
children are at risk of sexual or physical abuse, experiencing the stress of divorce or living with parental
illness, alcoholism, drug abuse, unemployment and violence.
According to the Policy Guidelines: Child and Adolescent Mental Health (Retrieved from
www.info.gov.za/view/DownloadFileAction?id=94167), mental health professionals in South Africa
“address mental health in the prenatal period (conception to birth), childhood (birth to 9 years) and
adolescence (12 to 18 years). They adopt a broad definition of child and adolescent mental health: Child
and adolescent mental health is the capacity to achieve and maintain optimal psychological functioning
and well-being. It is directly related to the degree of age-appropriate bio-psychosocial development
achieved using available resources. Child and adolescent mental health include a sense of identity and
self-worth; sound family and peer relationships; an ability to be productive; a capacity to use
developmental changes and cultural resources to maximise development” (p. 5).
It is important to remember that there are many causes and reasons for the development of
psychopathology in children. Developmental processes and changes within the child play a major role in
the development of psychopathology in children -in fact, the field is often referred to as developmental
psychopathology.
Children do not live in isolation and the context (environment) which constitutes part of their lives should,
therefore, be taken into account when describing their individual behaviour and the severity of the
disorder. Some pathological conditions are transient, (e.g. Anxiety Disorders), while others (e.g.
Intellectual Disability) are of a permanent nature. It is also important to establish whether the behaviour in
question is appropriate for the child’s age. Temper tantrums, for example, or eating inedible objects might
be regarded as abnormal for a 10-year-old, while they are quite normal for a two-year-old.
It has been argued that emotional, behavioural and cognitive functioning is socially and culturally
constructed, and that the expression and recognition of a disorder cannot be studied outside the socio-
cultural context and the social relation and structures which give it meaning (Swartz, 1986). The socio-
cultural context includes the family, peers, the school, social class and culture. It is also important to bear
in mind that the description of symptoms differs from culture to culture. Aggressive behaviour may be
acceptable in one culture (e.g., United States of America), which views such behaviour as assertive, while
unacceptable in others (e.g., Thailand).
Children may suffer from different types of abnormal behaviour patterns at various ages. Some of these
abnormalities are transient in nature (e.g., Enuresis Disorder or bed-wetting), while other disorders are
more permanent.
Many factors contribute to the development of childhood pathology. Risk factors in the development of
childhood psychopathology include:
• hereditary influences: genetic abnormalities

• prenatal influences
• birth defects, complications, premature birth
• postnatal disease and damage, especially to the nervous system
• inadequate nutrition
• poverty
• detrimental early social experiences
• family psychopathology, stress, negative interactions
• child abuse, neglect
• poor peer relationships
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• poor peer relationships behavioural/psychological patterns (e.g. low self-esteem, depressive

thinking, difficult temperament)
• specific stress (e.g., loss of a parent)
Studying childhood disorders (psychopathology) will enable you to identify some of the disorders.
Referral to helping professions is vital as you will then be playing a key part in primary prevention and the
enhancement of mental health in children.
• Look at the following visual maps of the mental disorders that commonly occur in infancy, childhood
and adolescence. Remember to continue to integrate your knowledge from your previous Learning
Units so that you can identify disorders across categories:
Disorders of Childhood and Adolescence
Attention-Deficit/
Hyperactivity Motor Disorder
Disorder
Autism Spectrum
Disorder
Tic
Disorders
Neuro- Other
Intellectual
Disabilities developmental Neurodevelopmental
Disorders
Disorders
Global
Intellectual Develop- Communication
Disability mental Disorders
Delay
Specific Learning
Disorder
47
Other Disorders Commonly Manifested in Childhood & Adolescence
Enuresis
Elimination Disorders
Encopresis
Reactive Attachment Disorder
Trauma and Stress-Related Disinhibited Social Engagement
Disorders Disorder
Posttraumatic Stress Disorder
Gender Dysphoria Gender Dysphoria in Children

Oppositional Defiant Disorder
Disruptive, Impulse-Control
and Conduct Disorders Conduct Disorder –
Childhood/Adolescent-onset type
Problems related to Family
Other Conditions That May Upbringing
Be a Focus of Clinical
Attention Child Maltreatment
and Neglect Problems
Bipolar I Disorder
Bipolar and Related
Disorders Bipolar II Disorder
Cyclothymic Disorder
Disruptive Mood Dysregulation
Disorder
Depressive Disorders Major Depressive Disorder
Persistent Depressive Disorder
(Dysthymia)
Separation Anxiety Disorder
Selective Mutism
Anxiety Disorders
Specific Phobia
Social Anxiety Disorder
Activity 16.1
Scan-read chapter 16 in the prescribed book (pp. 547-586), in order to familiarise yourself with the
contents of the chapter and this Learning Unit.
Activity 16.2
While working through this Learning Unit, look out for the following Key terms. Follow the definition
suggestions provided in Chapter 16 and the Glossary in the prescribed book. Add to the definitions
as you encounter more information about the terms. Illustrate your understanding of the definitions
with appropriate examples. Ensure that after you have completed this Learning Unit you know what
these terms refer to:
• Neurodevelopmental Disorders
• Autistic Spectrum Disorder (ASD)
• Attention Deficit/Hyperactivity Disorder (ADHD)
• Intellectual Disability, Intellectual Developmental Disorder (IDD)
• Down Syndrome (DS)
• Fetal Alcohol Syndrome (FAS)
• Intellectual Disability, mild
• Intellectual Disability, moderate
• Intellectual Disability, severe
• Intellectual Disability, profound
• Elimination Disorders
• Enuresis
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• Encopresis
NEURODEVELOPMENTAL DISORDERS
Introduction
Neurodevelopmental Disorders are disorders involving severe childhood impairments in areas such as
reciprocal social interaction skills, communication skills and the display of stereotyped interests and
behaviours.
Neurodevelopmental Disorders includes Autism Spectrum Disorder, Attention-Deficit/Hyperactivity

Disorder, Intellectual Disabilities, Specific Learning Disorder, Communication Disorders, Motor
Disorders, Tic Disorders, Other Neurodevelopmental Disorders and Unspecified Neurodevelopmental
Disorders. For the purposes of this module we will be focusing on the following three
Neurodevelopmental Disorders only:
Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, and Intellectual Disability. Refer to

pages 564 to 585 in your prescribed book).
16.1 STUDY UNIT: Autistic Spectrum Disorder
Autism Spectrum Disorder (ASD) in the DSM-5 incorporates four disorders from the previous diagnostic
manual: Autistic disorder, Asperger’s disorder, Childhood Disintegrative Disorder, and the catch-all
diagnosis of Pervasive Developmental Disorder Not Otherwise Specified. Researchers found that those
four diagnoses, rather than distinct disorders, actually represented symptoms and behaviours along a
severity continuum. ASD reflects that continuum and is a more accurate and medically and scientifically
useful approach. The new Autism Spectrum Disorder encompasses the DSM-IV autistic disorder,
Asperger’s disorder, and childhood disintegrative disorders. Based on a theory that Asperger’s is a mild
form of autism, diagnosis requires deficits in social communication and repetitive behavioural patterns
rated along a dimension of severity (refer to the block on page 527 of your prescribed book).
Autistic Spectrum Disorder (ASD) is a lifelong, complex and severe childhood disorder which results in
disordered brain development and function, altering the child’s quality of development in areas such as
communication and social interaction as well as stereotyped patterns of behaviours, interests and
activities and imagination skills.
Although the cause of ASD is unknown, it is found equally amongst all population groups, affecting 4
times more boys than girls. International statistics put the incidence of ASD at 1 per 168 births
regardless of race, ethnic or socio-economic background.
ASD in a family may be devastating to all concerned as most often parents may feel helpless not
knowing how to effectively deal with their child’s perceived problematic behaviour. Such children need
constant supervision, are in some instances hyperactive, destructive, not showing love towards family
members and are often shunned by their peers. They have difficulty communicating with others in a
meaningful way. Their speech may be delayed, absent, or inappropriate and facial expressions appear
to be meaningless to them. They may spend time doing unusual, repetitive activities which are markedly
different from those of normal children. They appear aloof and always play alone. They may appear
happiest living in the world of their own, using others only to fulfil their needs. The first signs that may
cause concern for parents of such children could be an uncuddly baby who shows signs of speech
delay, appears as if deaf, prefers to play alone, has unusual play patterns and acts undisciplined and
naughty.
Although 70% of children with ASD usually have accompanying learning difficulties, there is 30% of
those who may have abilities that are outstanding in relation to their overall functioning, e.g an
exceptional memory in a specific field of interest. Raymond in the movie "Rain man", the young man with
49
an encyclopaedic memory and amazing maths skills portrayed by Dustin Hoffman is a good example of
such individuals.
Prognostically, although ASD cannot be cured to date, much can be done to improve the child with
ASD’s quality of life (by maximising his/her independence) and to also empower the child’s family with
adequate coping skills in dealing effectively with his/her disorder.
Outcomes
Once you have worked through this section on Autistic Spectrum Disorder you should be able
to:
• Define Neurodevelopmental Disorders

• Define Autistic Spectrum Disorder
• Describe the DSM-5 criteria for Autistic Spectrum Disorder
• Discuss the aetiology of Autistic Spectrum Disorder
Study
To be able to do the above you will need to study the introduction to this section as well as
Activity 16.3 in the study guide and the following sections in the prescribed book:
• The section on “Neurodevelopmental Disorders” on page 563;

• The section on “Autistic Spectrum Disorder” on pages 568-576;
• Table 14.6. Continuum of Symptoms Associated with “Autism Spectrum Disorders” on page 571;
• “Etiology” pages 572-575;
• Biological dimension, pages 573-575;
• Psychological dimension, page 575;
Activity 16.3
The prescribed book contains insufficient information on the DSM-5 diagnostic criteria for Autism
Spectrum Disorder. Ensure that you know these criteria below well.
DSM-5 Diagnostic Criteria for Autism Spectrum Disorder
A Persistent deficits in social communication and social interaction across multiple contexts as
manifested by the following, currently or by history:
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 response to social interactions.
2. Deficits in nonverbal communicative behaviours 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.
3. Deficits in developing, maintaining relationships and understanding relationships ranging for

example, from difficulties adjusting behaviour to suit different social contexts, to difficulties in
sharing imaginative play or in making friends, to absence of interest in peers.
Specify current severity: Severity is based on social communication impairments and restricted,
repetitive patterns of behaviour.
B Restricted, repetitive patterns of behaviour, interests, or activities as manifested by at least two of

the following currently or by history:
1. Stereotyped or repetitive motor movements, use of objects; or speech (simple motor stereotypies,
lining up of toys or flipping objects, echolalia, idiosyncratic phrases).
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2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or

nonverbal behaviour, (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 hypo-reactivity 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).

Severity is based on social communication impairments and restricted, repetitive patterns of
behaviour.
C Symptoms must be present in 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 or Global Developmental
Delay. To make comorbid diagnoses of ASD and Intellectual Disability, social communication
should be below that expected for general developmental level.
Specify if:
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor
Associated with another neurodevelopmental, mental, or behavioural disorder
With catatonia
(Adapted from APA, 2013, p. 50-51)
Activity 16.4
Read the case study below carefully and classify Tsidi’s abnormal behaviour according to the
DSM-5 classification system. Use a highlighter as you read through the case study to pick up key
features. Briefly justify your choice of the diagnosis drawing on features in the case study.
Case Study
Tsidi, an 11-year-old, was referred to a psychologist as her parents had become worried about her
aggressive behaviour and social isolation both at home and school.
Tsidi was born as a result of a full-term pregnancy without complications. At the age of seven weeks
she developed a high fever and was hospitalised, at which point she was tested for meningitis. Results
of the test were negative, and it was determined that there was no obvious explanation for Tsidi’s fever.
Her parents reported that, during infancy, Tsidi’s behaviour appeared to be normal, however, on further
contemplation, they realised that she rarely smiled, never babbled, and had difficulty falling asleep.
At age two years, Tsidi was able to produce single words and a limited number of two-word utterances.
As she grew older her language abilities failed to progress, which led her parents to become concerned
about her development. At age three years, Tsidi began to speak less frequently and continued to be
limited to short verbal phrases. Furthermore, her parents noticed that, socially, she demonstrated
limited interest in other children and would often isolate herself. In terms of other developmental
milestones, her parents reported no delays in her eating, walking, or toilet training.
51
Between the ages of three and five years Tsidi’s speech was limited to repeating phrases from her
favourite movies. In addition, Tsidi began to have difficulty using and understanding nonverbal gestures
such as pointing or nodding to communicate. She also reversed the pronouns, you and I. Socially, Tsidi
demonstrated poor eye contact and was limited in her use of facial expressions. She rarely attempted
to interact with others and seemed only interested in members of her immediate family.
In the interview with the psychologist, Tsidi was able to communicate her basic wants and needs.
However, she reportedly had difficulty communicating her emotions and rarely took part in reciprocal
conversation. In addition, she engaged in verbal rituals, which consisted of repeating a statement until
the other person responded with a specific word or phrase. In addition, her responses to other people’s
phrases were often ‘off topic’. She would select a single word and relate it to something not involved in
the conversation topic. She also had difficulty controlling voice volume.
Socially, her parents reported that Tsidi had few friends and experienced difficulty playing with groups
of children. They also reported that Tsidi preferred to be around adults rather than children. Tsidi’s
parents described her displaying aggressive behaviours such as screaming, hitting, slapping, head-
butting, pinching, biting, and kicking others. In addition, she would occasionally hit herself in the head or
bang her head against a wall, particularly when attempting to get her mother’s attention.
Tsidi also would become upset in reaction to noises such as the loudspeaker at school, fire alarms,
toilets flushing, and vacuum cleaners. In addition, she often made high-pitched noises, flapped her
hands, and paced back and forth.
Her parents stated that Tsidi had difficulty with changes in their family schedule and had experienced
difficulty in adjusting to new environments when they went on holiday away from home. Tsidi also had a
particular interest in stuffed animals. She referred to the stuffed animals as “her friends” and carried
them with her wherever she went. According to her parents, Tsidi arranged the animals in a specific set
way. She became upset if their order or placement was disrupted. Other interests of Tsidi’s reported by
her parents were Tsidi working on a computer and typing short stories.
(Adapted from Matson, LoVullo, Boisjoli, & Gonzalez, 2008)
You should have diagnosed Tsidi’s abnormal behaviour as follows:
Autistic Spectrum Disorder, without accompanying intellectual impairment, with accompanying language
impairment (Principal Diagnosis)
Tsidi has significant impairments in the core areas associated with Autism Spectrum Disorder, social and
communication deficits for example, as infant she did not babble, as well as stereotyped behaviours. In
terms of social skills, Tsidi demonstrates a limited use of nonverbal behaviours such as smiling or using
facial expressions to communicate. She has inappropriate social responses, few peer relationships, and
exhibits limitations in shared enjoyment with others, she thus has a lack of engagement with her peers.
Although, Tsidi is able to communicate with others, much of her speech is in the form of echolalia and
tangential. She often engages in verbal rituals with others. In addition, Tsidi has limited use of non-verbal
communication and reciprocal conversation skills.
Tsidi’s interests are highly focused on computers and typing and she confines herself to these interests.
Her repetitive movements include arm-flapping and head-banging. Tsidi also insists on routines and
becomes highly distressed when there is a change in environment for example family holidays are
impossible. She insists on sameness for example arranging her toys in a specific way. She shows a
hyper-reactivity to sensory input in terms of an aversion to loud noises common in daily life.
Her symptoms stem from when she was a toddler and cause significant distress especially when
accompanied with aggression.
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Activity 16.5
Read the case study below carefully and,
(a) classify Cedric’s abnormal behaviour according to the DSM-5 classification system. Use a
highlighter as you read through the case study to pick up key features. Briefly justify your
choice of the diagnosis drawing on features in the case study.
(b) explain the aetiology of Cedric’s abnormal behaviour in terms of the biogenic model.
Case Study
Three-year old Cedric was referred by his family doctor to a paediatrician because he displayed
some unusual behaviours and lacked a number of others, particularly social and verbal skills. During
the previous two years the doctor had seen Cedric only when he had been ill.
Cedric was the second child of parents in their twenties, Mr and Mrs Benn. Cedric was conceived five
months after the birth of their first child as Mrs Benn thought she could not fall pregnant while breast-
feeding. She consulted her doctor because she could not menstruate. She then received an injection
to help her menstruate. Neither she nor her doctor were at that time, aware that she was pregnant
because a pregnancy test was negative. According to Mrs Benn, for a week after the injection, she
had felt extremely ill and nauseous, vomited and was dizzy. During this time, she had to stay in bed.
The pregnancy progressed uneventfully, and birth was normal. Cedric weighed a little over 2, 5 kg.
Mrs Benn reported that she had had some difficulty in caring for two infants, but that Cedric had been
a very good baby who gave little trouble except during feeding. Because feeding him was difficult Mrs
Benn explained that Cedric appeared to be happier when left alone and she recalled how as a young
infant he did not smile, nor did he seem to recognise her.
During his first year, Cedric’s motor development appeared to be somewhat advanced. At nine
months he learned to walk and from the start his motor skills were especially competent, he never fell
nor hurt himself. He developed into an attractive, overactive child.
Mr and Mrs Benn first became concerned about Cedric’s development during his second year when
he did not begin to talk. He did, however, appear to love music. At that time Mr and Mrs Benn were
told that Cedric was probably a late developer and that perhaps he did not need to talk as they were
anticipating his needs. Their concern, however, increased when they realised that he was not
responding when they spoke to him and he seldom made eye contact. They insisted on a hearing
test which revealed no hearing loss.
Furthermore, he was obsessed with food. Instead of playing with his toys in a conventional way he
would rather turn the wheels of his toy car and would often put it into his mouth. He also rocked his
body back and forth for long periods and banged his head against the wall. Otherwise he showed
little emotional reaction. Cedric’s obsession with food and his other unusual behaviours together with
the continued difficulty in communication and lack of response occasionally warranted a visit to the
paediatrician.
Cedric’s parents, both university graduates, were deeply concerned about their son and were
prepared to go to lengths to help him by obtaining appropriate treatment. The family appeared to be
stable and there was no family history of psychiatric problems.
(a) You should have diagnosed Cedric’s abnormal behaviour as follows:
Autistic Spectrum Disorder, without accompanying intellectual impairment, with accompanying

language impairment
Associated with an injection during mother’s pregnancy
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Autistic Spectrum Disorder is a severe childhood disorder characterised by significant impairment
in social interaction and communication skills and by restricted, stereotyped patterns of behaviours,
interests and activities. The disturbance must be manifested by delays or abnormal functioning in
across multiple contexts. Cedric displays the following symptoms:
Impairment in social interaction:

• Lack of social and emotional reciprocity: Cedric did not smile or seem to recognise his
mother as a young infant. He did not respond when his parents spoke to him. He did not
seek physical contact with his parents. Cedric also showed very little emotional reaction.
• Marked impairment in the use of multiple non-verbal behaviours such as eye-to eye gaze:
Cedric seldom made eye-contact.
• A lack of spontaneous sharing of enjoyment or interests with other peers: Cedric appeared to
be happier when left alone.
Impairment in communication:
• Total lack of the development of spoken language: fifty percent of all autistic children do not
develop normal speech, as was the case with Cedric
Restricted repetitive and stereotyped patterns of behaviour, interests and activities:
• Stereotyped and repetitive motor mannerisms: Cedric rocked his body backwards and
forwards for long periods and often banged his head against the wall.
• Persistent pre-occupation with parts of objects: Instead of playing with his toys in a
conventional way, Cedric would rather turn the wheels of his toy car and would put it into his
mouth.
• Cedric was obsessed with food.
• The impairment in social interaction and communication and restricted, stereotyped interest
and activities, and abnormal functioning have been present in the early developmental period
Exposure to a medical factor (injection given to Cedric’s mother during early pregnancy)
(b) All the following variables may have possibly contributed to the development of Cedric’s abnormal
behaviour according to the biogenic perspective.
• Prenatal influences, it is possible to assume that Cedric’s foetus was affected by the injection
administered by Mrs Benn’s physician during early pregnancy (neurodevelopment).
• Genetic influences, the possibility of a genetic cause should also not be ruled out (fragile x
chromosome). Some researchers believe that genetic factors influence the amount of certain
substances found at specific sites of the brain. It is possible that there is a history of Autistic
Spectrum Disorder in Cedric’s family.
• Biochemical imbalances (adrenalin and dopamine imbalances) in the brain are transmitted
from nerve cell to nerve cell. It is possible that biochemical imbalances can be responsible
for Cedric’ Autistic Spectrum Disorder.
• Brain Impairment, although there is no known biological marker for autism, several brain
abnormalities have been identified as consistent with early neural development disturbance
before birth. It is possible that Cedric’s Autistic Spectrum Disorder can be due to brain
impairment.
Activity 16.5
Mention the five criteria required for a diagnosis of Autistic Spectrum Disorder according to the
DSM-5. In answering this question make sure you include the following:
• Persistent deficits in social communication and social interaction

• Restricted, stereotyped interest and activities
• Delays or abnormal functioning in one of the above major areas during the early
developmental period (seen as generally before the age of three)
• Symptoms cause impairment in functioning
• Not better explained by Intellectual Disability or Global Developmental Delay.
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Activity 16.6
Imagine you have been invited at your local community centre to address parents on the early
warning signs of Autistic Spectrum Disorder. What can you include in your talk?
Make sure you include the following as early warning signs of Autistic Spectrum Disorder.
Encourage the parents that if their child displays any of these signs, to bring it to the attention of
their doctor.
• No babbling by 12 months
• No pointing, waving and other gesturing by 12 months
• No two-word spontaneous (not echoed) phrases by 24 months
• Any loss of language or social skills at any age
• Inability to make or hold eye contact
• Inability to respond to one’s name being called
• Inability to look where someone points
• Lack of interest in pretend play by 18 months
• Arches back to avoid touch
• A lack of warm, joyful expressions while gazing at parent/caregiver
• Rocks or bangs head
• Makes hardly any attempt to communicate
(Adapted from Barlow & Durand, Instructor’s manual, 2009).
Activity 16.7
Familiarise yourself with these organisations which can be contacted should you have a family
member with ASD. Autism South Africa is a national body for children and adults with ASD.
• Autism South Africa, PO Box 84209, Greenside, 2034, E-mail: [email protected] Cape
Town
Gauteng
The Key School. PO Box 84611, Greenside, 2034, E-mail: [email protected]

The Child Clinic at Tara Hospital
Association for Autism, PO Box 35833, Menlo Park, 0102, E-mail: [email protected]
UNICA School, PO Box 35182, Menlo Park, 0102, E-mail: [email protected]
KwaZulu-Natal
Parents of Autistic Children Kwazulu-Natal (PACK), PO Box 116, • Pinetown, 2600
Eastern Cape
Eastern Cape Association for Autism (ECAA)

Quest School, PO Box 2948, Riebeeckhoogte, Uitenhage, 6231, E-mail: [email protected]
Western Cape
Autism Western Cape. PO Box 60375, Flamingo square, 7439, E-mail: [email protected]
Vera School, P/bag X 4, Clareinch, 7440, E-mail: [email protected]
Alpha School, PO Box 48, Woodstock, 7915, E-mail: [email protected]
Hurdy Gurdy House (Private Residential Centre for adults with autism). 70 De Hulk Road, Penhill,
Cape Town, 7100, E-mail: mwrlc@ mweb.co.za
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A few international contacts:
National Autistic Society, United Kingdom E-mail [email protected]

Autism Society of America Website: http://www.autism-society.org/
16.2 STUDY UNIT: Attention Deficit/Hyperactivity Disorder
Introduction
In this study unit we introduce you to Attention Deficit/Hyperactivity Disorder. The primary characteristics
of Attention Deficit/Hyperactivity Disorders are inattention, hyperactivity and impulsivity. These
characteristic symptoms may contribute to secondary problems such as poor school performance, low
self-esteem and poor relationships with peers.
ADHD is characterised by a pattern of behaviour, present in multiple settings (e.g., school and home),
that can result in performance issues in social, educational, or work settings. In the DSM-5, symptoms
are divided into two categories of inattention and hyperactivity and impulsivity that include behaviours
like failure to pay close attention to details, difficulty organising tasks and activities, excessive talking,
fidgeting, or an inability to remain seated in appropriate situations.
Children must have at least six symptoms from either (or both) the inattention group of criteria and the
hyperactivity and impulsivity criteria, while older adolescents and adults (over age 17 years) must
present with five. ADHD criteria and examples have been altered to allow for the growing diagnosis of
ADHD in adulthood. Onset of symptoms must now occur by age 12 rather than seven.
ADHD criteria have no exclusion criteria for people with Autism Spectrum Disorder, since symptoms of
both disorders co-occur. However, ADHD symptoms must not occur exclusively during the course of
Schizophrenia or another psychotic disorder and must not be better explained by another mental
disorder, such as a depressive or bipolar disorder, anxiety disorder, dissociative disorder, personality
disorder, or substance intoxication or withdrawal.
Activity 16.8.
The prescribed book contains insufficient information on the DSM-5 Diagnostic criteria for Attention
Deficit Hyperactivity Disorder. Ensure that you know the information in the introduction of this study
unit and the criteria below:
DSM-5 Diagnostic Criteria for Attention Deficit/Hyperactivity Disorder (ADHD)
A Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or

development as characterized by (1) and/or (2):
(a) Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a
degree that is inconsistent with the developmental level and that negatively impacts directly on
social and academic/occupational activities.
Note: The symptoms are not solely a manifestation of oppositional behaviour, 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 schoolwork, at
work, or with other activities.
(b) Often has trouble holding attention on tasks or play activities.
(c) Often does not seem to listen when spoken to directly.
(d) Often does not follow through on instructions and fails to finish schoolwork, chores, or
duties in the workplace (e.g., loses focus, side-tracked).
(e) Often has difficulty organizing tasks and activities.
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(f) Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long
period of time (such as schoolwork or homework).
(g) Often loses things necessary for tasks and 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.
(b) Hyperactivity and Impulsivity: Six (or more) of the following symptoms have persisted for at
least 6 months to a degree that is inconsistent with the developmental level and that negatively
impacts directly on social and academic/occupational activities.
Note: The symptoms are not solely a manifestation of oppositional behaviour, 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 fidgets with or taps hands or feet, or squirms in seat.

(b) Often leaves seat in situations when remaining seated is expected.
(c) Often runs about or climbs in situations where it is not appropriate (Note: In adolescents
or adults may be limited to feeling restless).
(d) Often unable to play or take part in leisure activities quietly.
(e) Is often "on the go" acting as if "driven by a motor".
(f) Often talks excessively.
(g) Often blurts out an answer before a question has been completed.
(h) Often has trouble waiting his/her turn.
(i) Often interrupts or intrudes on others (e.g., butts into conversations or 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).
In addition, the following conditions must be met:
B Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
C Several 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, school,
or work functioning.
E The symptoms do not happen only during the course of schizophrenia or another psychotic
disorder. The symptoms are not better explained by another mental disorder (e.g. mood
disorder, anxiety disorder, dissociative disorder, or a personality disorder, substance intoxication
or withdrawal).
Specify whether:
Combined presentation: if both Criterion A1 (inattention) and Criterion A2 (hyperactivity-impulsivity)
are met for the past 6 months
Predominantly inattentive presentation: if Criterion A1 (inattention) is met but Criterion A2

(hyperactivity-impulsivity) is not met for the past six months
Predominantly hyperactive-impulsive presentation: if Criterion A2 (hyperactivity-impulsivity) is and

Criterion A1 (inattention) is not met for the past six months
Specify if:
In partial remission: When full criteria were previously met, fewer than full criteria have been met for
the past 6 months, and the symptoms still result in impairment in social, academic, or occupational
functioning.
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Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and
symptoms result in no more than minor impairments in social or occupational functioning.
Moderate: Symptoms or functional impairment between “mild” and “severe” are present.
Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that
are particularly severe, are present, or symptoms result in marked impairment in social or occupational
functioning
(Adapted from APA, 2013, p. 59-61)
Outcomes
Once you have worked through study unit 16.2, you should be able to
• discuss the DSM-5 criteria for ADHD

• distinguish between the various subtypes of ADHD
• discuss the aetiology of ADHD
• describe the main characteristics of ADHD, Conduct Disorder (CD) and Oppositional Defiant
Disorder (ODD).
Study
To be able to do the above you will need to revise CD and ODD by referring back to Learning Unit
7 in Tutorial Letter 501 (Study Guide) and for ADHD the following sections in the prescribed
book:
• “Attention Deficit/Hyperactivity Disorder”, pages 564-568;

• “Etiology”, pages 566–567
Activity 16.9
Carefully read the following case study and,
(a) classify Amy’s abnormal behaviour using the DSM-5 classification system and briefly justify
your choice of diagnosis(es)
Case study
Amy, a 17-year-old young woman, decided to consult a clinical psychologist for an evaluation at her
parents’ urging after she had failed all her modules at the end of her first semester of university. She
presented as a shy, young woman who appeared younger than her stated age, both in her facial
expressions and the way that she dressed. Amy was friendly and cooperative throughout the
evaluation, though her eye contact was minimal, primarily directed to the floor.
Amy relayed that she was the only child of her parents who were both accomplished professionals
who had busy work schedules that necessitated frequent trips away from home. Amy’s difficulties at
university especially troubled her parents, who had questions about her ability to maintain the “self-
discipline” needed to handle university requirements.
She had embarked on her first semester full of excitement to be starting her adult life. However, her
experience soon became “horrendous” after classes started. She reported feeling overwhelmed by the
“million things” she had to keep up with and the density of information presented in each class.
Following the flow of lectures was difficult and she noticed herself frequently checking the notes of the
students around her to get information she had missed. Amy also reported difficulty managing the
volume of required reading in her classes. She reserved large blocks of study time for reading but had
difficulty focusing her attention on the material and would eventually stop studying altogether.
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Other areas of her life also suffered because of her disorganisation. She spent excessive amounts of
time locating her textbooks and notes, mismanaged her bank account, and found that she was eating
unhealthy foods often and not sleeping enough.
Amy wondered whether these difficulties were just her adjusting to her first year at university in terms
of time mismanagement, “wrong choices,” and too much socialising, too little sleep, procrastination.
Her self-initiated efforts to “buckle down,” work harder, and cut out excessive going out did not
produce her desired results. She continued to have difficulties even after reducing social commitments
to focus on her studies. Feeling unmotivated, Amy stopped attending lectures altogether.
On an encouraging note, Amy formed solid friendships in her residence and through her involvement
in campus clubs. After she stopped attending classes, her friendships and club activities soon became
her only reasons for leaving her room and were, according to Amy, her only relief from distress. By the
end of the semester, she was hopelessly behind in her work. Subsequently, her parents were
surprised when they learned that she had failed all her modules.
Amy’s mother, who at Amy’s request accompanied her to the initial appointment to the psychologist,
described Amy as having been shy and cautious as a child. Reportedly, she did not exhibit any major
problematic behaviour and was considered “sensitive and warm.” She had a tendency to be “sloppy,”
was “immature”, and she experienced difficulties getting along with other children despite her generally
likeable personality. In particular, her mother recalled Amy becoming extremely upset by minor
frustrations such as disagreements over a board game.
Amy was quick to learn things in school but had difficulty making use of them. For example, she
learned to read earlier than other children did, but both Amy herself and her mother characterised her
as a “slow reader.” Her mother remembered that teachers regularly commented that Amy was a
pleasant learner, but she often seemed to be daydreaming and would not complete assignments that
were well within her capabilities. Reading continued to be difficult for Amy throughout primary and high
school, because of her inability to sustain attention on the page rather than from any difficulty with
comprehension. She also described having difficulty with paying attention during class presentations
and with following class discussions. Amy said her typical first response on being called on in class
was, “Wait . . . what?”. She earned decent school marks but relied on “cramming” because she was
“scared of getting in trouble,” and extensions on her assignments from her teachers. Her parents also
actively monitored her progress during school and made sure that she kept up with her schoolwork.
Nonetheless, Amy sometimes misplaced completed assignments or forgot them at home.
Although being described as sensitive and friendly, Amy had difficulty getting along with certain
children when she was younger, and she socialised with only a few close friends. Her mother recalled
that teachers said Amy was occasionally teased by peers for immature behaviour or for becoming
emotional over what was considered a relatively minor matter (e.g., bursting into tears over a dispute
on the playground). By the time she became a teenager, she had a small circle of close friends. Amy,
encouraged by her friend, joined the drama group at her school. As her confidence grew, so did her
social network and her extra-mural activities. Amy experienced a leap in social acceptance and grew
more accepting of herself. In turn, she found more satisfaction in her relationships with her peers and
teachers. By this time, Amy began to set her sights on improving her school marks and expanding her
extramural activities to apply to different universities. She gained acceptance to a well-resourced
university in a different city to her hometown and now six months later she is experiencing problems.
(Adapted from Ramsay & Rostain, 2005)
You should have diagnosed Amy’s abnormal behaviour as follows:
Attention Deficit/Hyperactivity Disorder, Inattention Type, severe (Principal Diagnosis). Educational

problems (Academic Problem: failure)
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As she is 17 years old, Amy, need only display five or more symptoms. Amy displays the following
inattention symptoms:
• often has difficulty sustaining attention in tasks (difficulty in remaining focused during lectures and
lengthy reading
• fails to finish academic work (starts studying but quickly loses focuses and is easily side-tracked)
• often has difficulty organising tasks (difficulty keeping materials and belongings in order,
disorganised work, has poor time management, fails to meet deadlines)
• often reluctant to engage in tasks that require sustained mental effort (preparing for exams)
• often forgetful in daily activities (paying her accounts)
• often loses things necessary for tasks or activities (learning materials, books)
• is often easily distracted by extraneous stimuli (she easily finds herself daydreaming instead of
staying focused in lectures)
• Other Problems That May Be a Focus of Clinical Attention: Educational problems (Academic
Problem: failure). Amy has failed her first semester of university.
Though her parents are concerned this has not currently led to significant conflict in their relationship
with their older adolescent and therefore there is no need to diagnose Parent-Child Relational Problem.
Amy’s symptoms are severe as they are in excess of the required five symptoms and the symptoms has
led to significant impairment in her daily functioning in that she is failing academically and the symptoms
may lead to problems in her relationship with her parents if not addressed soon. Furthermore, her
symptoms have led her to mismanage her bank account which could jeopardise her financial well-being.
Keep in mind that Amy displayed:

No signs of Intellectual Disability, as she has a history of obtaining good marks during high school and
met the admission requirements for her University course
No Personality Disorder (A Personality Disorder can only generally be diagnosed after the age of 18.)
No medical condition
Activity 16.10.
Carefully read the following case study and
(a) classify Ken’s abnormal behaviour on the five axes of the DSM-5 classification system and
briefly justify your choice of diagnosis.
(b) provide a concise description of the aetiological factors that may have contributed to Ken’s
abnormal behaviour.
Case study
Ken, a nine-year-old boy, is currently repeating Grade Two. As a result of continuous academic and
scholastic problems, and scholastic problems, as well as an unsympathetic elderly teacher during his
first year of school, his parents moved him to another school in the same neighbourhood.
Since the beginning of his school career, Ken’s behaviour has been disruptive in class. He cannot sit
still and often leaves his desk during class. On hearing the sound of oncoming cars, he runs to the
window and watches them pass by. During class, he constantly fidgets and shouts out the answers
even before the teacher has finished formulating questions. He talks incessantly. He is forever
searching for his pencil when he needs it and seldom completes tasks. He has a short attention span
and his teacher constantly has to repeat instructions. Although he has an average IQ and is repeating
Grade Two, his academic progress is poor and far below the class average. Efforts to discipline him
have proved unsuccessful.
Ken regularly throws books and toys at his classmates and will hit any person close to him with the
slightest provocation. He consequently has no friends. The children do not want to play games with him
as he does not obey the rules and constantly disrupts organised games. The parents of children in the
neighbourhood have barred him from their homes because he plays with everything, messes up
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everything, scatters things and refuses to tidy up.
According to his parents, Ken, their only child, has experienced adjustment problems from a very young
age. Ken’s misbehaviour has made it impossible to go out as a family for meals. There have been many
arguments between his parents as a result of his behaviour. Ken’s father’s patience has run out, and he
has decided that a good hiding is the only remedy. He often beats Ken excessively. Ken has become
very fearful of his father and when he sees him, Ken’s behaviour becomes even more uncontrollable.
Ken’s behaviour has caused such friction between his parents that his mother recently filed for a
divorce. Neither of the parties, however, feels capable of dealing with Ken alone. As a last resort, Ken’s
mother took him to a psychologist.
(a) You should have diagnosed Ken’s abnormal behaviour as follows:
Attention Deficit/Hyperactivity Disorder, Combined Type, severe (Principal Diagnosis).
Ken displays the following symptoms:

• impulsive and hyperactive
• fidgets, has difficulty keeping still
• is easily distracted
• has difficulty taking turns
• seldom completes tasks
• talks excessively
• often blurts out answers before questions have been completed
• often loses articles necessary for tasks
Ken’s symptoms are severe as they are in excess of the required six symptoms and the symptoms
has led to significant impairment in his daily functioning in that he is performing poorly
academically and the symptoms have led to problems in his relationship with his parents to such
an extent that it has also put such strain on his parents’ marriage that his mother has filed for
divorce. His parents find they cannot control his behaviour, and that his father has resorted to
physical punishment. Importantly, unrestrained physical punishment could put Ken at risk for Child
Abuse. Furthermore, he has become isolated form any social contact from his peers, even when
adult supervision is possible. He also is a danger to his peers as he hits them and throws things at
them.
Other Problems That May Be a Focus of Clinical Attention:

• Parent Child Relational Problem (Problems with parents)
• Disruption of Family by Divorce (Ken’s mother filed for divorce)
• Educational problems (discord with teacher, academic problems)
• Social Rejection (purposefully excluded from the activities of peers in his social environment)
Keep in mind that Ken displayed:

No signs of Intellectual Disability, since he has an average IQ
No Personality Disorder (A Personality Disorder can generally only be diagnosed after the age of
18.)
No medical condition
(b) All the following variables may possibly have contributed in one way or another to the diagnosis of
ADHD:
• academic/scholastic factors (poor school progress, repeating grade, change of schools)

• possible neurological factors (hyperactivity, poor motor control)
• psychosocial factors (teacher-learner relationship, home environment)
• the influence of certain nutritional factors
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16.3 STUDY UNIT: Intellectual Disability (Intellectual Developmental Disorder)
Introduction
In this study unit you are going to look at the phenomenon of Intellectual Disability (Intellectual
Developmental Disorder) which is also classified in the category of Neurodevelopmental Disorders in the
DSM-5. You will learn how to classify and identify features of Intellectual Disability (Intellectual
Developmental Disorder) which in previous diagnostic manuals was named Mental Retardation. You will
also have the opportunity to study the diverse aetiological factors of Intellectual Disability (Intellectual
Developmental Disorder)
In Intellectual Disability (Intellectual Developmental Disorder) there are deficits in cognitive capacity
beginning in the developmental period. Thus, Intellectual Disability (Intellectual Developmental Disorder)
is a disorder present from childhood and is characterised by significantly below-average intellectual and
adaptive functioning. The diagnosis of Intellectual Disability (formerly Mental Retardation) now
emphasises level of adaptive functioning as opposed to an exact IQ score. The individual experiences
difficulties with day-to-day activities and these difficulties are a result of the combined influence of the
degree of his or her intellectual impairment and the daily context in which they are expected to function.
Intellectual Disability (Intellectual Developmental Disorder) is an extremely varied phenomenon – firstly
concerning the degree and severity of the impairments and secondly concerning the Aetiology of these
impairments. Complete reversal of Intellectual Disability (Intellectual Developmental Disorder) is
impossible. Intellectual Disability (Intellectual Developmental Disorder) is long-standing, chronic and less
amenable to treatment than other mental disorders.
Outcomes
Once you have worked through Study Unit 16.3 you should be able to:
• Describe the DSM-5 criteria for Intellectual Disability (Intellectual Developmental Disorder).
• Discuss the different levels of Intellectual Disability (Intellectual Developmental Disorder).
• Discuss environmental factors as aetiology of Intellectual Disability (Intellectual Developmental
Disorder).
• Discuss the genetic factors as aetiology of Intellectual Disability (Intellectual Developmental
Disorder).
• Discuss the non-genetic biological factors as aetiology of Intellectual Disability (Intellectual
Developmental Disorder).
Study
To be able to do the above you will need to study the introduction to this section in this study
guide and the following sections in the prescribed book:
• “Intellectual Disabilities”, page 576-580;

• Levels of Intellectual Disabilities, pages 576-577;
• “Etiology of Intellectual Disabilities”, pages 577-580:
o Psychological, Social and Sociocultural Dimensions (Factors), pages 579-580
o Genetic Factors, pages 577-578
o Non-genetic biological factors, pages 578-579
Activity 16.12
The DSM-5 diagnostic criteria for Intellectual Disability are discussed very briefly in your prescribed
book. Add to this information from the more elaborate diagnostic criteria for Intellectual Disability
as outlined by the DSM-5 classification system (APA, 2013).
Note that an individual cannot be diagnosed with ID unless a registered psychologist has
conducted an individualised consultation where an intellectual assessment (IQ test) and adaptive
functioning assessment (for example the Vineland Adaptive Behaviour Scale (VABS) has been
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conducted. Study the DSM-5 diagnostic criteria below for Intellectual Disability (Intellectual
Developmental Disorder):
DSM-5 Diagnostic Criteria for Intellectual Disability (Intellectual Developmental Disorder)
Intellectual Disability (Intellectual Developmental Disorder) is a disorder with onset during the
developmental period that includes both intellectual and adaptive functioning deficits in conceptual,
social, and practical domains. The following three criteria must be met:
A Deficits in intellectual functions such as reasoning, problem-solving, planning, abstract thinking,

judgment, academic learning and learning from experience confirmed by both clinical assessment
and individualised, standardized intelligence testing.
B Deficits in adaptive functioning that result in failure to meet developmental and sociocultural
standards for personal independence and social responsibility. Without ongoing support, the
adaptive deficits limit functioning in one or more activities of daily life, such as communication,
social participation, and independent living, across multiple environments, such as home, school,
work, and community.
C Onset of intellectual and adaptive deficits during the developmental period.
Specify current severity (based on adaptive functioning)
Mild
Moderate
Severe
Profound
(Adapted from APA, 2013, p. 33)
As we have mentioned in the overview of this Study Unit, there are diverse possible causes of IDD.
Possible causes can roughly be divided into the following categories:
• unexplained (the largest category as a specific Aetiological factor is not identified or remains
undiagnosed in the majority of cases of IDD)
• trauma (such as intracranial haemorrhage, hypoxic injuries before and during birth, severe head
injury etc)
• infections (both congenital and postnatal, including rubella, meningitis, etc)
• chromosomal abnormalities (such as Down’s Syndrome, Klinefelter’s Syndrome etc)
• genetic abnormalities and inherited metabolic disorders (such as Tay-Sachs Disease, Rett’s
Disorder, phenylketonuria etc)
• metabolic (such as congenital hypothyroidism, hypoglycaemia etc)
• toxic (such as intra-uterine exposure to alcohol and drugs or lead poisoning etc)
• nutritional (such as Kwashiorkor, malnutrition etc)
• environmental (factors such as poverty and low socio-economic status).
(Adapted from the Excite Health Webpage at http://adam.excite.com/ info/?id=001523,2 November

2000)
Activity 16.13
Read the case study below and,
(a) diagnose James’s abnormal behaviour using the DSM-5 classification system. Justify your
diagnosis by highlighting key features from the case study. You may need to use the table
below, “Levels of Intellectual Disability” and the Table 16.7 on page 532 of your prescribed
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book to identify the severity level of his disorder. Also study these two tables for future case
studies.
(b) discuss how genetic factors can contribute to James’ disorder by referring to the case study.
Levels of Intellectual Disability

Level Intelligence Ability at Ability at School Ability at Adult Age (21 Years
Quotient Preschool Age Age (6 to 20 and Older)
(IQ) Range (Birth to 6 Years) Years)
Mild 50-69 Can develop Can learn up to Can usually achieve sufficient
social and about Grade 6 by social and vocational skills for
communication late adolescence; self-support; may need
skills; motor can be expected guidance and assistance
coordination is to learn during times of unusual social
slightly impaired; appropriate social or economic stress, can
often not skills establish long-term intimate
diagnosed until relationships and raise
later age children
Moderate 35-49 Can talk or learn Can learn some May achieve self-support by
to communicate; social and performing unskilled or semi-
social awareness occupational skills; skilled work within sheltered
is poor; motor can progress to workshops; needs
coordination is junior primary supervision and guidance
fair; can profit school level in when under mild social or
from training in schoolwork; may economic stress
self-help learn to travel
alone in familiar
places
Severe 20-34 Can say a few Can talk or learn May contribute partially to
words; able to to communicate; self-care under complete
learn some self- can learn simple supervision; can develop
help skills; has health habits; some useful self-protection
limited speech benefits from habit skills in controlled
skills; motor training environment
coordination is
poor
Profound 19 or Extreme cognitive Some motor May achieve very limited self-
below limitation; little coordination; care; usually needs nursing
motor limited care
coordination; may communication
need nursing care skills
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Case Study
James, a 17-year-old high school pupil, was brought to the psychologist by his mother because of his
disruptive behaviour at school as well as at home. He was increasingly getting into fights with his older
brothers as well as with his mother. James had Down’s Syndrome and was described as being very
likeable and at times mischievous. He enjoyed rollerblading, bike-riding and all the other activities
popular amongst teenage boys. In fact, his desire to take part in all these activities was the source of
conflict between him and his mother. He wanted to go for his driver’s license, but his mother felt he
would be discouraged if he failed the test. James also had a girlfriend whom he wanted to date, and
this caused his mother further concern.
The schoolteachers had complained about James. They said that he did not participate in school
activities and in the "work-programme course" (part of the special education of his school), was very
sullen and often got in fights with the instructors and his classmates. It had become so serious that
they were considering moving James to another programme with more supervision and less
independence.
James was the youngest of three children. His mother became pregnant with him when she was in her
40s, not planning for a child at her age but eagerly anticipating his birth, nonetheless. It was apparent
at birth that James had Down’s syndrome, initially because of the characteristic facial features and
later through formal assessment. He was born with a congenital heart defect, a hole in his heart, that
required several surgical operations, and he today wears a pacemaker. At the time he was born (the
mid-1970s) doctors tried to be supportive and suggested that his mother might want to consider
placing him with a local institution that would care for him. His mother recalls that, although she was in
shock after the birth, she quickly felt the same love and affection for the infant that she did for her
other two children. She decided he would come home and be part of the family.
Because James’s mother was a single parent – his father left the family shortly after his birth – and
had continuing financial difficulties, the family moved frequently during his youth. They experienced
striking differences in the way each community they lived in responded to James’s intellectual
difficulties. During his school years, some schools immediately placed him in classes with other
children his age and provided his teachers with additional assistance and consultation to help them
adapt to James’s needs. Others just as quickly recommended placements separate from the
mainstream classroom. Sometimes the school had a special classroom in the school for children who,
like James, had intellectual difficulties.
Other had specific programmes that they expected James to follow and this meant that James would
at times have to travel an hour to and from school each day to get to these programmes. Every time
he was assessed by a psychologist in a new school, the evaluation was similar to earlier ones. He
would receive scores on his IQ tests in the range of 40 to 50.
Each school raised the same concerns. The teachers and other professionals were competent and
caring individuals who wanted the best for James and his mother. Yet what differed was their attitude
towards children like James. Some believed that James needed a separate place where he would
learn skills in a programme with specialised staff. Others felt they could provide a comparable
education for children like James in a regular classroom, and that an added benefit would be for him to
have peers without disabilities to model, for children with learning problems, but he would participate in
some classes such as physical education with students who did not have the same difficulties. His
current difficulties in physical education – not participating – and in the classroom – being oppositional
– were jeopardising his placement in both programmes.
When the psychologist spoke to James’s mother, she expressed frustration that the work programme
was "beneath him" and that he was asked to do boring, repetitious work such as folding paper. James
expressed a similar frustration, saying that they treated him like a baby. He could communicate fairly
well when he wanted to, although he sometimes would get confused about what he wanted to say,
and it was difficult to understand everything he was trying to articulate.
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On observing him at school and at work, and after speaking to his teachers, the psychologist realised
that a common situation had developed. The teachers would give James work to do and he would
resist if he thought it was too easy. His teachers interpreted his resistance to mean that the work was
too hard for him and they would give him even simpler tasks. He would resist or protest more
vigorously, and they would respond with even more supervision and structure. This vicious circle was
escalating to the point that James was now becoming very difficult and started aggressively refusing to
co-operate.
(Adapted from Barlow & Durand, 1995)
(a) You should have diagnosed James’ abnormal behaviour as follows:
Intellectual Disability (Intellectual Developmental Disorder), Moderate (Principal Diagnosis)

Parent Child Relational Problem (Problems with mother)
Sibling Relational Problem (fighting with his older brothers)
Educational problems (discord with teacher, peers, academic problems: inconsistent academic
programme to meet his needs)
Low income (his single mother has financial difficulties, many job changes)
Social Rejection (purposefully excluded from the activities of peers in his social environment)
James’ intellectual ability falls within a range between 40 and 50, a below-average IQ score, and
he shows deficits in adaptive behaviour all of which first occurred in the developmental period.
Furthermore, the genetic aetiology of his principal diagnosis is traced to Down Syndrome
• Problems with primary support group: James is experiencing problems in his relationships
with his older brothers and his mother. He is increasingly getting into fights with them. Thus,
you can identify both a Parent Child Relational Problem and a Sibling Relational Problem.
• Educational problems: James is experiencing difficulties at school. He is experiencing
discord with his teachers and classmates.
• Economic Problems: his single mother has financial difficulties, many job changes.
• Other Problems Related to the Social Environment: Social Rejection: Purposefully excluded
from the activities of peers in his community.
(b) Refer to pages 434-435 in the prescribed book to the section entitled “Genetic Factors” under the
heading “Etiology of Intellectual Disability”. The section on “Down’s Syndrome” is especially
important as James has Down’s syndrome and this is the primary cause of his IDD. This condition
influences the individual’s life in more ways than one. Apart from the actual direct biological and
genetic influence that this syndrome has on the individual’s cognitive functioning, it also impacts
indirectly on the individual’s life. Consider for example the physical appearance of individuals who
have Down’s syndrome and the response these individuals consequently often receive from
others. Other people often assume that an individual whom they can visually identify as having
Down’s syndrome is seriously cognitively impaired. Even though individuals who have Down’s
syndrome are often not impaired to the extent that others assume them to be, they do not
necessarily have the communication abilities to accurately express this and often then "act out"
their dismay at these assumptions. As a result, the situation is not rectified and in fact becomes
increasingly misconstrued. This is exactly what happened to James in the work programme.
Elaborate on your answer using the information in the sections of the prescribed book which are
relevant to the case study of James.
Activity 16.14
Read the case study below and,
(a) diagnose Mark’s abnormal behaviour using the DSM-5 classification system. Justify your
diagnosis by highlighting key features from the case study.
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Case Study
Mark was a 10-year-old boy in the fourth grade. At the time of referral, he was struggling with
schoolwork since Grade 1. He had also previously repeated a year of pre-school. Mark’s current
teachers reported that he was overactive and excitable and continued to act out in class. For example,
his English teacher had reported a recent incident when he had become excited and, subsequently,
had thrown chairs and desks. In addition, when he felt that someone was looking at him, he typically
became upset and pushed the person away. Mark, an only child, was living at home with his parents.
Mark’s mother was 46 years old at the time of referral and a full-time housewife. His mother reported
having speech and learning problems herself as a child and, as a result, she had a history of special
educational services throughout her development. She was not hyperactive as a child although she
believed her husband may have been. Her husband had also received special education services as a
child.
During the interview, Mark’s mother indicated that Mark was born following a normal pregnancy and
delivery at 38 weeks. However, some of Mark’s developmental milestones were delayed: He did not
walk until 18 months of age and he was not fully toilet-trained until four years of age. Speech delay
was also present; for example, his first words were not spoken until 17 or 18 months of age. Mark’s
mother her son as being overactive as a toddler as well as having difficulty remaining focused for any
period of time.
Mark was assessed by a speech therapist at age three and seen six to eight times privately. His
developmental level for language and communication was delayed by approximately one year. Mark
was enrolled in a language group at a tertiary level hospital when he was four years old. He was also
evaluated at that time by an occupational therapist and his functioning was reported as being delayed
by one to two years. His fine motor skills were found to be weaker than his perceptual and gross motor
abilities.
As a result of these assessments, Mark and his mother were enrolled in an early childhood
intervention programme offered at the hospital, with treatment lasting for 12 months; attendance was
twice per month for both Mark and his mother. In addition to appointments with the occupational
therapist and speech therapist, Mark’s mother was taught how to stimulate Mark’s language, problem-
solving, and social interactions and she also learned strategies for behavioural management.
Mark had also been assessed at age 4 years 4 months for developmental delays, and there were
reported problems in attention and overactivity by a previous psychologist. Overall, Mark was
estimated to be functioning one to two years below his age level. Mark’s paediatrician commented that
he had been slow in all areas of his development, although doctors had been unable to identify any
specific underlying neurological disorder. Subsequent to the interview in terms of the intellectual
assessment conducted by the psychologist, Mark scored a Full-Scale IQ score of 61 with his
performance being closer to a 6- to 7½-year-old child than his chronological age of 10 years old.
During a visit to Mark’s school, his teachers and principal expressed a great deal of concern over his
behavioural problems. Mark was described as often seeking negative attention and disrupting the
classroom. He was described as not having adequate social skills and, therefore, having minimal
interaction with children of his own age. When a visit was made to observe Mark in his classroom, he
became very distracted and put a book in front of his face. He also would not settle down and was
intent on going out to play on the school playground. When given materials to draw he quickly lost
interest and took out his marbles. After two minutes he became disinterested and started to disrupt the
lesson and needed to be taken out of the classroom.
When at home, Mark also ran around the TV room constantly shifting his focus to his next toy or TV
programme. His mother voiced that he was a “spinning top” that seemed to be on the move constantly.
He battled to even stay at the dinner table to eat his meal and even when he did manage to sit down,
he fidgeted non-stop.
(Adapted from Taube-Schiff & Serbin, 2006)
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(a) You should have diagnosed Mark’s abnormal behaviour as follows:
Intellectual Disability: (Intellectual Developmental Disorder), Mild (Principal Diagnosis)

Attention Deficit Hyperactivity Disorder, Predominantly hyperactive-impulsive presentation, severe
Educational problems (discord with teacher, peers, academic problems)
Social Rejection (purposefully excluded from the activities of peers in his social environment)
Intellectual Disability and ADHD can be diagnosed co-morbidly but it’s difficult to often tease out
what behaviours are symptoms of inattention and what symptoms are indicative of Intellectual
Developmental Disorder. Therefore, it is important that ADHD symptoms are present when the
individual is engaged in non-academic tasks. A diagnosis of ADHD is made only if the child with
IDD displays ADHD symptoms that are excessive in relation to the child’s mental
(intellectual/cognitive) age.
Mark is displaying severe symptoms of hyperactivity and inattention even when not engaged in
schoolwork or at school where academic demands are made.
ELIMINATION DISORDERS
Introduction
In this study unit the focus will be on two types of Elimination Disorders, Enuresis and Encopresis.
Elimination Disorders are basically problems of impaired control over urination (Enuresis) and bowel
movement (Encopresis) that cannot be accounted by organic causes. It is a well-known fact that infants
eliminate waste products reflexively. However, through toilet training children develop the ability to inhibit
the natural reflexes that controls urination and bowel movements. However, there are cases of some
children who have already reached an age at which they are expected to control these bodily functions,
yet they experience problems with control elimination in the form of enuresis and encopresis and their
symptoms are not caused by physical illness. Although, Elimination Disorders cause considerable stress
to the child they usually abate with increasing age.
16.4 STUDY UNIT: Enuresis and Encopresis
Enuresis
An Elimination Disorder in which a child who is at least five years old experiences repeated involuntary
bedwetting or wetting of his/her clothes. It usually occurs at night during sleep but may also occur during
the day for at least twice weekly for three months. Enuresis may be triggered by stressful life events,
such as family problems, hospitalisation, entrance into school or any emotional distress that a child might
experience in his environment. Many children with Enuresis experience significant distress or impairment
in their social, academic, or other areas of functioning.
Encopresis
An Elimination Disorder in which a child who is at least four years old repeatedly defecates in his or her
clothes, in inappropriate places such as in one’s clothing or on the floor at least once a month for three
months. Although less common than Enuresis, it important that the incidents are not due to the use of
laxatives. Intense social problems can arise through shame, embarrassment, and attempts to conceal
the disorder. Ostracism by peers, anger on the part of caregivers, and rejection can aggravate the
problem. Also add the following information below on the DSM-5 criteria of Elimination Disorders to the
information in this Learning Unit.
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Outcomes
Once you have worked through the section on Elimination Disorders in Study Unit 16.3, you
should be able to:
• Define Elimination Disorders;

• Describe the DSM-5 criteria for Enuresis and Encopresis.
Study
To be able to do the above you will need to study the introduction to this section in the study
guide, as well as Activities 16.15 and 16.16:
Activity 16.15
Study the following diagnostic criteria for Elimination Disorders
DSM-5 Diagnostic Criteria for Enuresis
A Repeated void of urine into bed or clothes, whether involuntary or intentional.
B The behaviour is clinically significant as manifested by either a frequency of twice a week for at
least 3 consecutive months or the presence of clinically significant distress or impairment in social,
academic (occupational), or other important areas of functioning.
C Chronological age is at least 5 years (or equivalent developmental level).
D The behaviour is not due exclusively to the physiological effects of a substance (e.g., a diuretic, an
antipsychotic medication) or another medical condition (e.g., diabetes, spina bifida, a seizure
disorder).
Specify whether:
Nocturnal only: Passage of urine only during nighttime sleep
Dinurnal only: Passage of urine during waking hours
Nocturnal and Diurnal: A combination of the two subtypes above
(APA, 2013, p. 355)
DSM-5 Diagnostic Criteria for Encopresis
A Repeated passage of feces into inappropriate places (e.g., clothing or floor) whether involuntary or
intentional.
B At least one such event occurs each month for at least 3 months.
C Chronological age is at least 4 years (or equivalent developmental level).
D The behaviour is not attributable to the physiological effects of a substance (e.g., laxatives) or
another medical condition except through a mechanism involving constipation.
Specify whether:
With Constipation and Overflow Incontinence: There is evidence of constipation on physical examination
or by history.
Without Constipation and Overflow Incontinence: There is no evidence of constipation on physical

examination or by history.
(APA, 2013, p. 358)
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Activity 16.16.
(a) classify Sbu’s abnormal behaviour using the DSM-5 classification system and briefly justify
your choice of diagnosis.
Case study
Sbu, a healthy and thriving boy aged eight years, has never been able to achieve complete dryness
during the night time since being potty trained at age three years by his mother. During consultation
with the psychologist, Sbu’s mother mentioned that she occasionally recalled Sbu experiencing a dry
night or two, but it had not been sequential or predictable.
During the consultation, Sbu voiced that he was excited about visiting his grandmother and cousins in
the Eastern Cape for the entire holidays, and thus was highly motivated to stop wetting his bed before
his trip. Sbu’s mother relayed to the psychologist, that she has stopped giving Sbu beverages after
suppertime. She also reported that Sbu hardly drinks beverages during the daytime, with the majority of
his fluid intake occurring right after he arrives home from school at 16:00p.m.
Sbu, confirmed going to the bathroom only once a day during school hours. He also voiced that,
“making a poo is very sore”. Sbu, tended to experience pain when having two painful bowel movements
per week and became constipated.
(Adapted from Weber, 2013)
(b) You should have identified Sbu’s abnormal behaviour as follows:
Enuresis, Nocturnal only (Principal Diagnosis).
Sbu, meets the criteria for Enuresis that occurs in the nighttime. No soiling of his clothes is
mentioned in the case study therefore insufficient evidence is supplied whether he also meets the
criteria for Encopresis but it should be investigated as he complains of Constipation which can be a
key feature of Encopresis
Activity 16.17
(a) classify Reggie’s abnormal behaviour on the five axes of the DSM-5 classification system
and briefly justify your choice of diagnosis.
Case Study
Reggie, the youngest of three sons, was a neat, well-mannered, and quiet, seven-year-old boy. His
parents were separated, and his mother worked to support the family. Reggie was referred to a
psychologist by the principal of the school for the problem of fecal soiling in his pants during school.
Reggie’s teacher confirmed this and reported that within the preceding 6-month period Reggie had to
be sent home on three separate occasions because of noticeably soiled clothing. Reggie was
repeating Grade One.
In the interview with the psychologist, Reggie’s mother indicated that during the preceding year Reggie
had never gone an entire week without soiling himself at least two to three times. Before this year of
soiling he was toilet-trained since, 3 years old.
When now Reggie soiled himself, he would come home, take a bath, rinse out his clothing, change
clothes and then continue with his daily activities, generally outdoor play. On days when the mother
worked and did not arrive home until early evening, she was made aware that Reggie had soiled
himself by the fact that he was not wearing the same clothing that he had put on in the morning.
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Reggie’s mother reported that she had attempted to deal with this problem by repeatedly urging
Reggie to remember to use a toilet.
(Adapted from Allyon, Simon & Wildman, 1975)
(a) You should have identified Reggie’s abnormal behaviour as follows:
Encopresis, Without Constipation and Overflow Incontinence (Principal Diagnosis)
Educational problems: (Academic problems having to miss school)
DEPRESSIVE DISORDERS
16.5 STUDY UNIT: Childhood Depression
Introduction
The 12th Edition of the prescribed book does not contain sufficient information on Depression occurring
in childhood (see pages 554-557 of the prescribed book), however it is an important study unit and as
such needs to be studied very well. Do you ever find yourself wishing you could recapture the carefree
days of childhood? A lot of us tend to think that children have absolutely nothing to worry about: No bills
to pay, bosses to answer to, or obligations to keep. They have none of the everyday stresses that we
adults have. In fact, a common reaction to hearing that a child is depressed is, “what does she have to
be depressed about?” When children experience disappointment, disapproval, or other inevitable
negative experiences in their lives, their sadness, anger and frustration are expected to be short-lived.
But, is childhood really a time of bliss? The truth is childhood is far from being without stress.
Most children are often faced with many difficulties that they are ill-equipped to handle emotionally:
divorce, poverty, learning disabilities, abuse, and neglect just to name a few. Children by nature feel
powerless against these situations and the effects can remain with them well into adulthood. But what if
your child does not fall into any of these categories? Does this guarantee a child free from depression?
The answer is no.
A very important factor in Childhood Depression is that it may be a biologically based illness. Children
with an inherited tendency for depression will be highly susceptible to the strains caused by the need for
peer acceptance. Because it is caused by an imbalance in brain chemistry, it may appear to you that
there is nothing so severely wrong in your child’s life that would merit being depressed. Just as with adult
depression, a child’s perception of the world may be distorted. He may feel that he is unlovable, “stupid”,
or “bad” even though these things may not be true.
Further complicating matters is the fact that young children do not have labels for these feelings and
cannot vocalise what it is that’s happening to them. What can you as a parent, teacher, or other
concerned adult do to help? The most important thing you can do is to realize that children can become
depressed just like adults and you should promptly seek out help if you see the signs of depression in a
child.
Childhood Depression is however manifested differently in adults. Most often many young people
seldom express their feelings of sadness but would rather express their depression through irritable
mood. Perhaps you know a child who is constantly sad, shows little enthusiasm for anything, is moody or
worst thinks that life is not worth living. That child may be having Childhood Depression. For many young
people it is pervasive, disabling, long-lasting and life threatening as suicidal behaviour among teens is
frequently associated with depression.
Childhood Depression manifests with extreme, persistent, or poorly regulated emotional states for
example, excessive happiness, or swings in mood from deep sadness to high elation. Unlike most
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children who bounce back quickly when they are sad, children who are depressed cannot simply “snap
out of it” as their sadness interferes with their overall functioning, notably their social relationships,
school performance, and family relationships. The same DSM-5 diagnostic criteria for Major Depressive
Disorder can be used for children, with the addition of possible irritability as well. Refer to Chapter 9,
Study Unit 11.2 regarding the DSM-5 criteria for Major Depressive Disorder.
The warning signs of Childhood Depression fall basically into four different categories: emotional signs,
cognitive signs (those signs involving thinking), physical complaints, and behavioural changes. It is
however significant to note that not every child who is depressed experiences every symptom.
Emotional Signs
Typical moods or emotions experienced by children suffering from depression include:
• Sadness – The child may feel despondent and hopeless. They may cry easily. Some children will
hide their tears by becoming withdrawn.
• Loss of pleasure or interest – A child who has always enjoyed playing sports, for example, may
suddenly decide to not try out for the team this year. They may complain of feeling “bored” or reject
an offer to participate in an activity, which they had always enjoyed in the past.
• Anxiety – The child may become anxious, tense, and panicky. The source of their anxiety may well
give you a clue to what is causing their depression.
• Turmoil – The child may feel worried and irritable. They may brood or lash out in anger as a result
of the distress they are feeling.
Cognitive Signs
A depressive mood can bring on negative, self-defeating thoughts. These skewed thought processes
may help perpetuate the problem because they make the child resistant to words of encouragement or
advice. Once the depression lifts, the child will be much more receptive to help. The signs to look for are:
• Difficulty organising thoughts – People with depression often have problems concentrating or
remembering. In children, this may be evidenced by problems in school or an inability to complete
tasks.
• Negative view – People with depression may become pessimistic, perceiving themselves, their life,
and their world in a very negative light.
• Worthlessness and guilt – Depressed children may obsess over their perceived faults and failures,
feel tremendous guilt, and declare themselves worthless.
• Helplessness and hopelessness – Depressed children often believe that there is nothing they can
do to relieve their feelings of depression. In particular, a child with dysthymia may perceive that this
is “just the way it is” because this is their only experience.
• Feelings of isolation – A child who has been picked on frequently may become very sensitive to
slights from his peers.
• Suicidal Thoughts – Thoughts of death are not limited to adults. Children may also wish that they
were dead and express these thoughts.
Physical Signs
Depression is not just an illness of the mind. It causes changes in us physically as well.
• Changes in appetite or weight – Many people with depression find that their appetite either
decreases or increases. Children who usually have a healthy appetite may suddenly lose interest
in eating. Children may also respond in the opposite way, by eating too much to self-medicate their
feelings.
• Sleep disturbances – Children with depression may have difficulty falling asleep and staying asleep
once they do. They may wake too early or oversleep. They may have trouble staying awake during
the day at school.
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• Sluggishness – Children with depression often talk, react, and walk slower. They may be less
active and playful than usual.
• Agitation – Depressed children may show signs of agitation by fidgeting or not being able to sit still.
Behavioural Signs
These signs will be the most obvious and easy for you to detect.
• Avoidance and withdrawal – Children with depression may avoid everyday or enjoyable activities
and responsibilities. They may withdraw from friends and family. The bedroom can become a
favourite place to escape and find solitude.
• Clinging and demanding – The depressed child may become more dependent on some
relationships and behave with an exaggerated sense of insecurity.
• Activities in excess – A depressed child may appear to be out of control in regard to certain
activities. He or she may spend long hours playing a video game or overeat.
• Restlessness – The restlessness brought on by depression may lead to such behaviours as
fidgeting, acting up in class, or reckless behaviour
• Self-Harm – Depressed individuals may cause themselves physical pain or take excessive risks.
Self-injury is one example of such behaviour.
If you suspect that a child is depressed, the next step is seeking professional help in obtaining a
diagnosis and treatment.
Outcomes
Once you have worked through this section on Depression in children, you should be able to:
• Define Childhood Depression

• Describe the DSM-5 criteria for Major Depressive Disorder
Study
To be able to do the above you will need to study the section on childhood Depression as well as
Learning Unit 12 on Depressive Disorders in Tutorial Letter 502
Activity 16.18
Add to the information in the prescribed book on Childhood Depression by making use of the DSM-
5 diagnostic criteria for Major Depressive Disorder. (Refer to Chapter 8 of the prescribed book and
Learning Unit 12 of Tutorial Letter 502 (Study Guide)
It is important to highlight the fact that children and adolescents may suffer from either Major
Depressive Disorder or Dysthymic Disorder.
Activity 16.19.
Go to http://kidsandmeds.umwblogs.org/dsm5/ and for interest read about the history of mental
illness in childhood.
Activity 16.20
The following activities will help you to revise and summarise what you have studied in this
chapter:
(1) At the beginning of Chapter 16 in your prescribed book there are three “focus questions” on
page 546 of the prescribed book. Answer questions 1 to 3 after you have worked through the
chapter. Compare your answers to the answers provided at the end of Chapter 16 in the
prescribed book under the heading “summary” (p. 584). If your answers are not complete,
consult your Tutorial Letters 501, 502 and 503 (Study Guide) and prescribed book again on
these questions or contact one of your lecturers.
73
(2) Go back to the beginning of this Learning Unit to the “Key terms” and reflect on your
understanding of each term. Explain the meaning of these terms to a friend or family member
in your own words. If you struggle to do so, refer back to your prescribed book and Tutorial
Letters 501, 502 and 503 (Study Guide).
(3) The learning outcomes of each of the study units in this Learning unit were set out clearly in
each of the study units. Make sure that you have acquired the necessary knowledge, skills
and insights set out in these learning outcomes.
(4) Go to the following internet resources and read more on disorders that begin or often occur
during infancy, childhood or adolescence:
http://www.mentalhealth.com/p20-grp.html
http://www.mentalhelp.net/poc/center_index.php?id=37http://webspace.ship.edu/cgboer/child
disorders.html
http://www.childhooddisorders.com/
CONCLUSION
This Learning unit introduced you to childhood psychopathology which is a real and individual
phenomenon, and definitions of pathological states should not be unreservedly generalised across
communities, countries and continents. Available data on the nature and prevalence of psychopathology
in South African children, or on differences between children from different backgrounds who have been
exposed to very different life experiences, need to be updated. The documentation of the nature and
prevalence of psychopathology cannot be divorced from a study of the dynamic aetiological
interrelationship between risk and protective factors. The complexity of a South African childhood is both
daunting and challenging, and there is a pressing need for research to inform preventive and curative
services.
REFERENCES
Ayllon, T., Simon, S. J., & Wildman, R. W. (1975). Instructions and reinforcement in the elimination of
encopresis: A case study. Journal of Behaviour Therapy and Experimental Psychiatry, 6, 235–238.
Butcher, J.N., Mineka, S., & Hooley, J.M. (2007). Abnormal psychology. (13th ed.). Boston, MA: Pearson
Education.
Davison, G.C., & Neale, J.M. (1998). Abnormal psychology (7th ed). New York, NY: John Wiley & Sons.
Matson, J.L., LoVullo, S. V., Boisjoli, J. A., & Gonzalez, M.L. (2008). The behavioural treatment of an 11-
year-old girl with autism and aggressive behaviours. Clinical Case Studies, 7(4), 313-326. DOI:
10.1177/1534650107312243
Nevid, J.S., Spencer, A.R., & Greene, B. (2008). Abnormal psychology in a changing world. (7th. ed.).
London, England: Pearson Education.
Nolen-Hoeksema, S. (2008). Abnormal psychology: Media and research update. (4th ed.). New York, NY:
McGraw-Hill.
Sue, D., Sue, D.W., & Sue, S. (2022). Understanding abnormal behaviour. (12th ed.). Boston, MA:
Houghton Mufflin.
Swartz, L. (1986). Transcultural psychiatry in South Africa: Part 1. Transcultural Research Review, 23,
273–3.
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Ramsay, J. R., & Rostain, A.L. (2005). Girl, repeatedly interrupted: The case of a young adult woman
with ADHD. Clinical Case Studies, 4(4), 329-346. DOI: 10.1177/1534650103259741
Taube-Schiff, M., & Serbin, L. A. (2006). The case of a 10-year-old boy presenting with cognitive delays
and behavioural problems: Working with a developmentally challenged family. Clinical Case
Studies, 5(4), 345-360. DOI: 10.1177/1534650104267961
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PYC3702/503/3/2024

Tutorial Letter 503/3/2024

Tutorial Letter 503/3/2024

Learning Unit 14 Schizophrenia Spectrum and Other Psychotic Disorders 5

Learning Unit 15 Neurocognitive Disorders 20

Learning Unit 16 Disorders of Childhood and Adolescence 45

Tutorial Letter 501/3/2024

Tutorial Letter 501/3/2024

Learning Unit 1 Abnormal Behaviour (Chapter 1 in Sue et al., 2022) 9

Learning Unit 2 Prevention of Abnormal Behaviour 12

Learning Unit 3 Perspectives/Models of Abnormal Behaviour 17

Learning Unit 4 Psychopathology from an African Perspective 20

Learning Unit 5 Assessment and Classification of Abnormal 42

Learning Unit 6 Personality Psychopathology and Disruptive, 56

Learning Unit 7 Anxiety-, Obsessive-Compulsive and Related 90

Tutorial Letter 502/3/2024

Tutorial Letter 502/3/2024

Learning Unit 8 Somatic Symptom and Dissociative Disorders

Learning Unit 10 Substance-Use Disorders

Learning Unit 11 Sexual Dysfunction and Gender Dysphoria

Learning Unit 12 Depressive and Bipolar Disorders

Learning Unit 13 Suicide (Chapter 9 in Sue et al., 2022) 100

Learning Unit 14:

Schizophrenia Spectrum and

14.1 Study unit: Five domains of abnormalities in Psychotic Disorders 7

14.2 Study unit: Schizophrenia 9

14.3 Study unit: Other Psychotic Disorders 15

associated with another due to another medical

• Grossly disorganised or abnormal motor behaviour (including Catatonia)

14.1 STUDY UNIT: Five domains of abnormalities in Psychotic Disorders

• Differentiate between the different domains of abnormalities in Psychotic Disorders.

Table 14.1: Types of Delusions

Type of Delusion Content of Delusion

Belief that one is/going to be harmed/harassed etc. by an individual or

Grandiose Believes one has exceptional abilities/wealth/fame.

Erotomanic False belief that another is in love with him/her.

Nihilistic Belief that a major catastrophe will occur.

Somatic Pre-occupation with health and organ function.

Belief that certain gestures, comments, environmental cues, etc. are

Jealousy Belief that partner/spouse is unfaithful.

Belief of loss of control over mind or body/being manipulated by others, and

Disorganised Thinking (Speech)

Grossly Disorganised or Abnormal Motor Behaviour (including Catatonia)

14.2 STUDY UNIT: Schizophrenia

• discuss cognitive symptoms of Schizophrenia

DSM-5 diagnostic criteria for Schizophrenia

F If there is a history of autism spectrum disorder or a communication disorder of childhood, onset,

Specify current severity:

(APA, 2013, pp. 99-100)

(http://www.aarogya.com, accessed on 5 May 2010)

The course of Schizophrenia

Research on the long-term outcome of Schizophrenia is contradictory as the definition of Schizophrenia

The Aetiology of Schizophrenia

(b) justify your answer for each diagnosis in question (a).

14.3 STUDY UNIT: Other Psychotic Disorders

• define Brief Psychotic Disorder

• the section titled "Other Psychotic Disorders" on pages 424-429

A Presence of one (or more) delusions with a duration of 1 month or longer.

B Criterion A for Schizophrenia has never been met.