Ontwikelings- en gedrag stoornissen
1
,INHOUDSOPGAVE
1. INLEIDEND ................................................................................................................................................................................ 7
1.1. Ontwikkelingsstoornissen ........................................................................................................................................... 7
1.1.1. DSM-III-R (1987) .........................................................................................................................................................................7
1.1.2. DSM-IV (1994) * DSM-IV-TR (2000) ...........................................................................................................................................7
1.1.3. ICD-10 (1992) .............................................................................................................................................................................7
1.1.4. DSM- 5 (MEI 2013, NL 2014) ......................................................................................................................................................7
1.1.5. (Neurobiologische) Ontwikkelingsstoornissen ...........................................................................................................................9
1.2. Gedragsstoornissen ................................................................................................................................................... 10
1.2.1. DSM-III-R (1987) en DSM-IV(-TR; 1994, 2000): ........................................................................................................................10
1.2.2. DSM-5: .....................................................................................................................................................................................10
1.2.3. ICD-10 (1992): Behavioral & emotional disorders with onset usually occurring in childhood and adolescence .....................10
1.2.4. Wat zijn gedragsstoornissen ....................................................................................................................................................10
1.3. Ontwikkelings- en gedragsstoornissen in dit opleidingsonderdeel ........................................................................... 11
1.4. Diagnose: verschillende vormen................................................................................................................................ 12
1.4.1. Beschrijvende of onderkennende diagnose .............................................................................................................................12
1.4.2. Etiologische of verklarendediagnose .......................................................................................................................................12
1.4.3. Assesment, indicerende of handelings-gerichte diagnose ........................................................................................................12
1.5. Instrumenten ............................................................................................................................................................. 12
1.5.1. Screenings instrumenten .........................................................................................................................................................13
1.5.2. diagnostische instrumenten / diagnose ...................................................................................................................................16
1.5.3. Assessment instrumenten .......................................................................................................................................................17
1.6. Verschillende vormen diagnostiek ............................................................................................................................ 18
1.6.1. Focus onderkennende diagnostiek ..........................................................................................................................................18
1.6.2. Rekening houden met ..............................................................................................................................................................19
1.7. Diagnostiek moet op verschillende niveaus gebeuren .............................................................................................. 19
1.7.1. Genetische of chromosomale stoornis ~ gedragsmatig fenotype ..............................................................................................21
1.8. Intelligentie ............................................................................................................................................................... 22
1.8.1. Ontwikkelings en intelligentietesting .......................................................................................................................................22
Belangrijkste ontwikkelings- en intelligentie-testen in Nederlandse taalgebied (BFP, 2015) ..................................................................22
1.8.2. Invloeden op prestatie op intelligentietest ..............................................................................................................................23
1.8.3. Mentale retardatie DSM-IV-TR, Verstandelijke beperking DSM-5 ...........................................................................................23
1.8.4. hoogbegaafdheid .....................................................................................................................................................................23
AUTISMESPECTRUM STOORNISSEN .......................................................................................................................................... 25
1. AUTISMESPECTRUMSTOORNIS ( ASS) .......................................................................................................................................... 26
1.1. DSM-criteria .............................................................................................................................................................. 26
dsm-5 specifiers .......................................................................................................................................................................29
DSM IV(-TR) (1994, 2000).........................................................................................................................................................29
In vlaanderen ...........................................................................................................................................................................29
DSM-5 (2013): VAN MEER NAAR 1 EN VAN 1 NAAR MEER ......................................................................................................29
1.2. Comorbiditeit ............................................................................................................................................................ 30
1.3. Prevalentie ................................................................................................................................................................ 30
Autismespectrumstoornissen een epidemie? ..........................................................................................................................31
Meisjes/vrouwen met ass ........................................................................................................................................................31
1.4. Geschiedenis.............................................................................................................................................................. 31
Leo Kanner (1894-1981) ...........................................................................................................................................................31
Hans Asperger (1906-1980) .....................................................................................................................................................32
1.5. DSM IV TR .................................................................................................................................................................. 33
DSM-5: geen onderscheid meer tussen autistische stoornis en Asperger ...............................................................................33
1.6. LORA WING ............................................................................................................................................................... 34
sociale subtypen (1979) ...........................................................................................................................................................34
1.7. THEODORE HELLER.................................................................................................................................................... 34
ACHTERGROND ........................................................................................................................................................................34
DSM IV TR: Desintegratiestoornis van de kindertijd ................................................................................................................34
1.8. Andreas Rett .............................................................................................................................................................. 35
DSM-IV tr: hET SYNDroom van rett ..........................................................................................................................................35
2
, DSM-IV ATTYPISCHE AUTISME (PDD-NOs) ...............................................................................................................................36
DSM-iv autismespectrumstoornis ............................................................................................................................................36
Voorbij het autisme spectrum .................................................................................................................................................36
2. DIAGNOSTIEK AUTISMESPECTRUMSTOORNISSEN (DEEL 2) ................................................................................................. 37
2.1. Minimaal diagnostisch protocol ................................................................................................................................ 37
Overzicht ..................................................................................................................................................................................37
2.2. Diagnostisch protocol ................................................................................................................................................ 37
Psychodiagnostisch onderzoek.................................................................................................................................................39
2.3. Autismespectrumstoornis: differntiaaldiagnose ....................................................................................................... 39
Etiologie = mogelijke oorzaken van ass .....................................................................................................................................40
2.4. Genetica .................................................................................................................................................................... 40
Genetische factor .....................................................................................................................................................................40
Broertjes en zusjes ....................................................................................................................................................................41
Genetische oorzaak ..................................................................................................................................................................41
2.5. ASS: neurobiologie ..................................................................................................................................................... 41
Groei van brein .........................................................................................................................................................................41
Vertraagde en afwijkende ontwikkeling neuronale materie .....................................................................................................42
Connectiviteit ...........................................................................................................................................................................43
Derde vaststelling .....................................................................................................................................................................43
2.6. Conclusie genetica enneurobiologie.......................................................................................................................... 43
Rol genetische factor ................................................................................................................................................................43
Ontwikkeling brein ...................................................................................................................................................................44
2.7. ASS: omgeving (xgen) ................................................................................................................................................ 44
Genetica en omgeving ..............................................................................................................................................................44
2.8. ASS: Etiologie samengevat......................................................................................................................................... 44
Belang van genen .....................................................................................................................................................................44
Invloed omgevingsfactoren ......................................................................................................................................................45
3. NEUROPSYCHOLOGISCHE STUDIES & PSYCHOLOGISCHE VERKLARINGSMODELLEN .................................................................................... 46
3.1. Psychologische theorie .............................................................................................................................................. 47
Psychologische verklaringstheorie tussen genetisch-neurobiologisch en gedrag ......................................................................47
3.2. Zoektochtnaar primair deficit ................................................................................................................................... 47
Universeel – specifiek – stabiel en persistent ..........................................................................................................................47
3.3. Theory of Mind (Verklaringsmodel 1) ......................................................................................................................... 47
Het ontstaan van het concept ...................................................................................................................................................47
Alleen mensen? ........................................................................................................................................................................48
ToM bij demens .......................................................................................................................................................................48
3.4. ToM deficit bij kinderen met autisme (Baron-Cohen et al., 1985) ............................................................................... 49
Enkele cijfers ............................................................................................................................................................................49
Het ‘probleem’ .........................................................................................................................................................................49
Vervolgonderzoek ....................................................................................................................................................................49
Oplossing? ................................................................................................................................................................................50
Nieuw ‘probleem’ .....................................................................................................................................................................50
Reading the mind in the eyes task .............................................................................................................................................51
Conclusie advanced ToMtaken ................................................................................................................................................52
3.5. Mogelijke voorlopers vanToM................................................................................................................................... 52
ASS symptomen voor vier jaar, TOM vanaf 4 jaar? .....................................................................................................................52
Opsomming mogelijke voorlopers ............................................................................................................................................52
ASS en imitatie .........................................................................................................................................................................52
ASS en spiegelneuronen...........................................................................................................................................................53
Joint attention ..........................................................................................................................................................................55
Symbolisch spel ........................................................................................................................................................................56
3.6. Dilemma ToM ............................................................................................................................................................ 57
Centraal dilemma .....................................................................................................................................................................57
3.7. TOM 2.0 hypothese .................................................................................................................................................... 58
Spontaan ToM deficit ...............................................................................................................................................................58
Recente evidentie.....................................................................................................................................................................58
3.8. Conclusie ASS enToM ................................................................................................................................................ 58
3
, 3.9. Executieve functies (EF) deficit (Verklaringsmodel 2) ................................................................................................. 59
Evidentie? ................................................................................................................................................................................60
EF en ASSsymptomen ................................................................................................................................................................61
Implicaties voor praktijk ...........................................................................................................................................................61
3.10. Verminderde centrale coherentie (Verklaringsmodel 3) ............................................................................................. 61
Centrale coherentie ............................................................................................................................................................61
Andere cognitieve stijl .........................................................................................................................................................61
Cognitieve stijl: continuüm ..................................................................................................................................................63
Conclusie verklaringsmodellen ...........................................................................................................................................64
Sterktes ASS .........................................................................................................................................................................65
4. DIAGNOSTISCH PROTOCOL ......................................................................................................................................................... 66
4.1. Minimal diagnostisch protocol .................................................................................................................................. 66
4.2. Diagnostisch protocol................................................................................................................................................ 66
medische evaluatie ..................................................................................................................................................................66
Een psychodiagnostisch onderzoek. ........................................................................................................................................67
4.3. Autismespectrumstoornis: differentiaaldiagnose ..................................................................................................... 67
AANDACHTSDEFICIËNTIE- HYPERACTIVITEITSSTOORNIS (ADHD) ............................................................................................. 68
1. AANDACHTSDEFICIËNTIE- / HYPERACTIVITEITSSTOORNIS .................................................................................................................. 69
1.1. DSM 5 over ADHD ..................................................................................................................................................... 69
Omschrijving ADHD ..................................................................................................................................................................69
Relatief t.o.v. anderen in dezelfde context ..............................................................................................................................70
1.3. Bijkomende voorwaarden ADHD ......................................................................................................................................70
Adhd en comorbiditeit .............................................................................................................................................................71
Adhd en negatieve impact .......................................................................................................................................................72
Maar ook positieve impact van ADHD .....................................................................................................................................72
1.2. Een blik op het verleden ............................................................................................................................................ 72
Heinrich hoffmann, 1845 (zappel-phillipp) ..............................................................................................................................73
Sir George Frederic Still (1902) ................................................................................................................................................73
1.3. Prevalentie ................................................................................................................................................................ 74
ADHD EPIDEMie? .....................................................................................................................................................................74
Polanczyk et al., 2015...............................................................................................................................................................75
Adhd een epidemie ..................................................................................................................................................................75
2. DIAGNOSTIEK ADHD ............................................................................................................................................................... 76
2.1. Comorboditeit ........................................................................................................................................................... 76
2.2. Differentiaaldiagnostiek ............................................................................................................................................ 76
2.3. MULTIMODALE ASSESMENT ..................................................................................................................................... 77
Interview ..................................................................................................................................................................................77
vragenlijsten.............................................................................................................................................................................78
2.4. Testonderzoek ........................................................................................................................................................... 79
Intelligentieonderzoek .............................................................................................................................................................79
Neuropsychologisch onderzoek ...............................................................................................................................................79
Vaststellingen neuropsychologisch onderzoek ........................................................................................................................81
Conclusie neuropsychologisch onderzoek ...............................................................................................................................82
Observatie ................................................................................................................................................................................83
3. ETIOLOGIE .............................................................................................................................................................................. 84
3.1. Genetische component.............................................................................................................................................. 84
3.2. Mogelijkse omgevingsfactoren ................................................................................................................................. 84
Pre- en peri-natale complicaties (voor en tijdens zwangerschap) ...........................................................................................84
Post-nataal (na zwangerschap) ................................................................................................................................................85
3.3. Neurologische bevindingen ....................................................................................................................................... 85
In specifieke hersengebieden: .................................................................................................................................................85
Van regio’s naar netwerken .....................................................................................................................................................86
3.4. Neurochemische afwijkingen .................................................................................................................................... 87
3.5. ADHD een hersenziekte? ........................................................................................................................................... 87
3.6. Psychologische verklaringsmodellen ......................................................................................................................... 88
Defict in executief functioneren (a) .........................................................................................................................................88
4
1
,INHOUDSOPGAVE
1. INLEIDEND ................................................................................................................................................................................ 7
1.1. Ontwikkelingsstoornissen ........................................................................................................................................... 7
1.1.1. DSM-III-R (1987) .........................................................................................................................................................................7
1.1.2. DSM-IV (1994) * DSM-IV-TR (2000) ...........................................................................................................................................7
1.1.3. ICD-10 (1992) .............................................................................................................................................................................7
1.1.4. DSM- 5 (MEI 2013, NL 2014) ......................................................................................................................................................7
1.1.5. (Neurobiologische) Ontwikkelingsstoornissen ...........................................................................................................................9
1.2. Gedragsstoornissen ................................................................................................................................................... 10
1.2.1. DSM-III-R (1987) en DSM-IV(-TR; 1994, 2000): ........................................................................................................................10
1.2.2. DSM-5: .....................................................................................................................................................................................10
1.2.3. ICD-10 (1992): Behavioral & emotional disorders with onset usually occurring in childhood and adolescence .....................10
1.2.4. Wat zijn gedragsstoornissen ....................................................................................................................................................10
1.3. Ontwikkelings- en gedragsstoornissen in dit opleidingsonderdeel ........................................................................... 11
1.4. Diagnose: verschillende vormen................................................................................................................................ 12
1.4.1. Beschrijvende of onderkennende diagnose .............................................................................................................................12
1.4.2. Etiologische of verklarendediagnose .......................................................................................................................................12
1.4.3. Assesment, indicerende of handelings-gerichte diagnose ........................................................................................................12
1.5. Instrumenten ............................................................................................................................................................. 12
1.5.1. Screenings instrumenten .........................................................................................................................................................13
1.5.2. diagnostische instrumenten / diagnose ...................................................................................................................................16
1.5.3. Assessment instrumenten .......................................................................................................................................................17
1.6. Verschillende vormen diagnostiek ............................................................................................................................ 18
1.6.1. Focus onderkennende diagnostiek ..........................................................................................................................................18
1.6.2. Rekening houden met ..............................................................................................................................................................19
1.7. Diagnostiek moet op verschillende niveaus gebeuren .............................................................................................. 19
1.7.1. Genetische of chromosomale stoornis ~ gedragsmatig fenotype ..............................................................................................21
1.8. Intelligentie ............................................................................................................................................................... 22
1.8.1. Ontwikkelings en intelligentietesting .......................................................................................................................................22
Belangrijkste ontwikkelings- en intelligentie-testen in Nederlandse taalgebied (BFP, 2015) ..................................................................22
1.8.2. Invloeden op prestatie op intelligentietest ..............................................................................................................................23
1.8.3. Mentale retardatie DSM-IV-TR, Verstandelijke beperking DSM-5 ...........................................................................................23
1.8.4. hoogbegaafdheid .....................................................................................................................................................................23
AUTISMESPECTRUM STOORNISSEN .......................................................................................................................................... 25
1. AUTISMESPECTRUMSTOORNIS ( ASS) .......................................................................................................................................... 26
1.1. DSM-criteria .............................................................................................................................................................. 26
dsm-5 specifiers .......................................................................................................................................................................29
DSM IV(-TR) (1994, 2000).........................................................................................................................................................29
In vlaanderen ...........................................................................................................................................................................29
DSM-5 (2013): VAN MEER NAAR 1 EN VAN 1 NAAR MEER ......................................................................................................29
1.2. Comorbiditeit ............................................................................................................................................................ 30
1.3. Prevalentie ................................................................................................................................................................ 30
Autismespectrumstoornissen een epidemie? ..........................................................................................................................31
Meisjes/vrouwen met ass ........................................................................................................................................................31
1.4. Geschiedenis.............................................................................................................................................................. 31
Leo Kanner (1894-1981) ...........................................................................................................................................................31
Hans Asperger (1906-1980) .....................................................................................................................................................32
1.5. DSM IV TR .................................................................................................................................................................. 33
DSM-5: geen onderscheid meer tussen autistische stoornis en Asperger ...............................................................................33
1.6. LORA WING ............................................................................................................................................................... 34
sociale subtypen (1979) ...........................................................................................................................................................34
1.7. THEODORE HELLER.................................................................................................................................................... 34
ACHTERGROND ........................................................................................................................................................................34
DSM IV TR: Desintegratiestoornis van de kindertijd ................................................................................................................34
1.8. Andreas Rett .............................................................................................................................................................. 35
DSM-IV tr: hET SYNDroom van rett ..........................................................................................................................................35
2
, DSM-IV ATTYPISCHE AUTISME (PDD-NOs) ...............................................................................................................................36
DSM-iv autismespectrumstoornis ............................................................................................................................................36
Voorbij het autisme spectrum .................................................................................................................................................36
2. DIAGNOSTIEK AUTISMESPECTRUMSTOORNISSEN (DEEL 2) ................................................................................................. 37
2.1. Minimaal diagnostisch protocol ................................................................................................................................ 37
Overzicht ..................................................................................................................................................................................37
2.2. Diagnostisch protocol ................................................................................................................................................ 37
Psychodiagnostisch onderzoek.................................................................................................................................................39
2.3. Autismespectrumstoornis: differntiaaldiagnose ....................................................................................................... 39
Etiologie = mogelijke oorzaken van ass .....................................................................................................................................40
2.4. Genetica .................................................................................................................................................................... 40
Genetische factor .....................................................................................................................................................................40
Broertjes en zusjes ....................................................................................................................................................................41
Genetische oorzaak ..................................................................................................................................................................41
2.5. ASS: neurobiologie ..................................................................................................................................................... 41
Groei van brein .........................................................................................................................................................................41
Vertraagde en afwijkende ontwikkeling neuronale materie .....................................................................................................42
Connectiviteit ...........................................................................................................................................................................43
Derde vaststelling .....................................................................................................................................................................43
2.6. Conclusie genetica enneurobiologie.......................................................................................................................... 43
Rol genetische factor ................................................................................................................................................................43
Ontwikkeling brein ...................................................................................................................................................................44
2.7. ASS: omgeving (xgen) ................................................................................................................................................ 44
Genetica en omgeving ..............................................................................................................................................................44
2.8. ASS: Etiologie samengevat......................................................................................................................................... 44
Belang van genen .....................................................................................................................................................................44
Invloed omgevingsfactoren ......................................................................................................................................................45
3. NEUROPSYCHOLOGISCHE STUDIES & PSYCHOLOGISCHE VERKLARINGSMODELLEN .................................................................................... 46
3.1. Psychologische theorie .............................................................................................................................................. 47
Psychologische verklaringstheorie tussen genetisch-neurobiologisch en gedrag ......................................................................47
3.2. Zoektochtnaar primair deficit ................................................................................................................................... 47
Universeel – specifiek – stabiel en persistent ..........................................................................................................................47
3.3. Theory of Mind (Verklaringsmodel 1) ......................................................................................................................... 47
Het ontstaan van het concept ...................................................................................................................................................47
Alleen mensen? ........................................................................................................................................................................48
ToM bij demens .......................................................................................................................................................................48
3.4. ToM deficit bij kinderen met autisme (Baron-Cohen et al., 1985) ............................................................................... 49
Enkele cijfers ............................................................................................................................................................................49
Het ‘probleem’ .........................................................................................................................................................................49
Vervolgonderzoek ....................................................................................................................................................................49
Oplossing? ................................................................................................................................................................................50
Nieuw ‘probleem’ .....................................................................................................................................................................50
Reading the mind in the eyes task .............................................................................................................................................51
Conclusie advanced ToMtaken ................................................................................................................................................52
3.5. Mogelijke voorlopers vanToM................................................................................................................................... 52
ASS symptomen voor vier jaar, TOM vanaf 4 jaar? .....................................................................................................................52
Opsomming mogelijke voorlopers ............................................................................................................................................52
ASS en imitatie .........................................................................................................................................................................52
ASS en spiegelneuronen...........................................................................................................................................................53
Joint attention ..........................................................................................................................................................................55
Symbolisch spel ........................................................................................................................................................................56
3.6. Dilemma ToM ............................................................................................................................................................ 57
Centraal dilemma .....................................................................................................................................................................57
3.7. TOM 2.0 hypothese .................................................................................................................................................... 58
Spontaan ToM deficit ...............................................................................................................................................................58
Recente evidentie.....................................................................................................................................................................58
3.8. Conclusie ASS enToM ................................................................................................................................................ 58
3
, 3.9. Executieve functies (EF) deficit (Verklaringsmodel 2) ................................................................................................. 59
Evidentie? ................................................................................................................................................................................60
EF en ASSsymptomen ................................................................................................................................................................61
Implicaties voor praktijk ...........................................................................................................................................................61
3.10. Verminderde centrale coherentie (Verklaringsmodel 3) ............................................................................................. 61
Centrale coherentie ............................................................................................................................................................61
Andere cognitieve stijl .........................................................................................................................................................61
Cognitieve stijl: continuüm ..................................................................................................................................................63
Conclusie verklaringsmodellen ...........................................................................................................................................64
Sterktes ASS .........................................................................................................................................................................65
4. DIAGNOSTISCH PROTOCOL ......................................................................................................................................................... 66
4.1. Minimal diagnostisch protocol .................................................................................................................................. 66
4.2. Diagnostisch protocol................................................................................................................................................ 66
medische evaluatie ..................................................................................................................................................................66
Een psychodiagnostisch onderzoek. ........................................................................................................................................67
4.3. Autismespectrumstoornis: differentiaaldiagnose ..................................................................................................... 67
AANDACHTSDEFICIËNTIE- HYPERACTIVITEITSSTOORNIS (ADHD) ............................................................................................. 68
1. AANDACHTSDEFICIËNTIE- / HYPERACTIVITEITSSTOORNIS .................................................................................................................. 69
1.1. DSM 5 over ADHD ..................................................................................................................................................... 69
Omschrijving ADHD ..................................................................................................................................................................69
Relatief t.o.v. anderen in dezelfde context ..............................................................................................................................70
1.3. Bijkomende voorwaarden ADHD ......................................................................................................................................70
Adhd en comorbiditeit .............................................................................................................................................................71
Adhd en negatieve impact .......................................................................................................................................................72
Maar ook positieve impact van ADHD .....................................................................................................................................72
1.2. Een blik op het verleden ............................................................................................................................................ 72
Heinrich hoffmann, 1845 (zappel-phillipp) ..............................................................................................................................73
Sir George Frederic Still (1902) ................................................................................................................................................73
1.3. Prevalentie ................................................................................................................................................................ 74
ADHD EPIDEMie? .....................................................................................................................................................................74
Polanczyk et al., 2015...............................................................................................................................................................75
Adhd een epidemie ..................................................................................................................................................................75
2. DIAGNOSTIEK ADHD ............................................................................................................................................................... 76
2.1. Comorboditeit ........................................................................................................................................................... 76
2.2. Differentiaaldiagnostiek ............................................................................................................................................ 76
2.3. MULTIMODALE ASSESMENT ..................................................................................................................................... 77
Interview ..................................................................................................................................................................................77
vragenlijsten.............................................................................................................................................................................78
2.4. Testonderzoek ........................................................................................................................................................... 79
Intelligentieonderzoek .............................................................................................................................................................79
Neuropsychologisch onderzoek ...............................................................................................................................................79
Vaststellingen neuropsychologisch onderzoek ........................................................................................................................81
Conclusie neuropsychologisch onderzoek ...............................................................................................................................82
Observatie ................................................................................................................................................................................83
3. ETIOLOGIE .............................................................................................................................................................................. 84
3.1. Genetische component.............................................................................................................................................. 84
3.2. Mogelijkse omgevingsfactoren ................................................................................................................................. 84
Pre- en peri-natale complicaties (voor en tijdens zwangerschap) ...........................................................................................84
Post-nataal (na zwangerschap) ................................................................................................................................................85
3.3. Neurologische bevindingen ....................................................................................................................................... 85
In specifieke hersengebieden: .................................................................................................................................................85
Van regio’s naar netwerken .....................................................................................................................................................86
3.4. Neurochemische afwijkingen .................................................................................................................................... 87
3.5. ADHD een hersenziekte? ........................................................................................................................................... 87
3.6. Psychologische verklaringsmodellen ......................................................................................................................... 88
Defict in executief functioneren (a) .........................................................................................................................................88
4
