ONTWIKKELINGS EN -
GEDRAGSSTOORNISSEN
Noor Desutter
2023-2024
,HOOFDSTUK 1: INLEIDING.........................................................................................................................9
ONTWIKKELINGSSTOORNISSEN...............................................................................................................9
(NEUROBIOLOGISCHE) ONTWIKKELINGSSTOORNISSEN..................................................................................9
GEDRAGSSTOORNISSEN........................................................................................................................11
IN DIT OPLEIDINGSONDERDEEL: ONTWIKKELINGS EN GEDRAGSSTOORNISSEN.........................................................11
WAT ?............................................................................................................................................................11
DIAGNOSE : VERSCHILLENDE VORMEN..................................................................................................13
INSTRUMENTEN....................................................................................................................................13
SCREENING....................................................................................................................................................13
SENSITIVITEIT EN SPECIFICITEIT....................................................................................................................14
ROC CURVE : AREA UNDER THE CURVE.........................................................................................................14
Goed screeningsinstrument?........................................................................................................................14
SCREENINGSINSTRUMENTEN........................................................................................................................16
DIAGNOSTISCHE INSTRUMENTEN.................................................................................................................16
ASSESSMENT INSTRUMENTEN......................................................................................................................17
FOCUS : ONDERKENNENDE DIAGNOSTIEK..............................................................................................18
REKENING HOUDEN BIJ DIAGNOSE MET...........................................................................................................18
DIAGNOTIEK MOET OP VERSCHILLENDE NIVEAUS GEBEUREN.....................................................................18
CONCREET VOORBEELD 1.............................................................................................................................19
CONCREET VOORBEELD 2.............................................................................................................................19
CONCREET VOORBEELD 3.............................................................................................................................19
CONCREET VOORBEELD 4.............................................................................................................................19
GENETISCHE OF CHROMOSOMALE STOORNIS – GEDRAGSMATIG FENOTYPE.........................................20
INTELLIGENTIE.......................................................................................................................................20
7.1. ONTWIKKELINGS – EN INTELLIGENTIETESTING......................................................................................20
7.2. IQ TEST, VOORBEELDEN...............................................................................................................................20
7.3. ONTWIKKELINGS – EN INTELLIGENTIETESTING......................................................................................21
7.4. INVLOEDEN OP PRESTATIE OP INTELLIGENTIETEST................................................................................21
7.5. MENTALE RETARDATIE DSM – IV – TR, VERSTANDELIJKE BEPERKING DSM – 5.....................................23
HOOGBEGAAFDHEID.....................................................................................................................................23
HOOGBEGAAFDHEID IS NIET GELIJK AAN SAVANTSYNDROOM....................................................................23
HOOFDSTUK 2: AUTISMESPECTRUMSTOORNIS (ASS)..............................................................................24
AUTISMESPECTRUMSTOORNIS VOLGENS DSM-5 MOET VOLDOEN AAN CRITERIA A,B,C,D EN E..............24
DSM - 5 : SPECIFIERS.....................................................................................................................................25
DSM IV(-TR) (1994, 2000)..............................................................................................................................25
IN VLAANDEREN............................................................................................................................................25
DSM-5 (2013): VAN MEER NAAR 1 EN VAN 1 NAAR MEER...........................................................................25
COMORBIDITEIT MET ASS.......................................................................................................................26
PREVALENTIE.........................................................................................................................................27
AUTISME EPIDEMIE?.....................................................................................................................................27
MEISJES / VROUWEN MET ASS.....................................................................................................................27
2
,GESCHIEDENIS VAN ASS..............................................................................................................................28
LEO KANNER.................................................................................................................................................28
HANS ASPERGER (1906 – 1980)....................................................................................................................29
ASPERGER SYNDROOM.................................................................................................................................29
DSM – IV – TR................................................................................................................................................29
DSM-5: GEEN ONDERSCHEID MEER TUSSEN AUTISTISCHE STOORNIS EN ASPERGER...................................31
WING : SOCIALE SUBTYPEN (1979)...............................................................................................................31
KEES MOMMA..............................................................................................................................................31
THEODORE HELLER.......................................................................................................................................31
DSM-IV-TR: DESINTEGRATIESTOORNIS VAN DE KINDERTIJD.........................................................................31
ANDREAS RETT..............................................................................................................................................31
DSM-IV-TR: HET SYNDROOM VAN RETT........................................................................................................32
DSM-IV-TR: ATYPISCH AUTISME (PDD-NOS).................................................................................................32
DSM-5: AUTISMESPECTRUMSTOORNIS..................................................................................................32
VOORBIJ HET AUTISME SPECTRUM........................................................................................................33
ETIOLOGIE.............................................................................................................................................33
GENETICA..............................................................................................................................................34
BROERTJES EN ZUSJES...................................................................................................................................34
ASS : NEUROBIOLOGIE...........................................................................................................................36
PURKINJE – CEL.............................................................................................................................................36
CONNECTIVITEIT...........................................................................................................................................37
CONCLUSIE GENETICA EN NEUROBIOLOGIE.................................................................................................37
ASS : OMGEVING (X GEN)..............................................................................................................................38
ASS : ETIOLOGIE SAMENGEVAT.....................................................................................................................38
NEUROPSYCHOLOGISCHE STUDIES EN PSYCHOLOGISCHE VERKLARINGSMODELLEN...............................38
PSYCHOLOGISCHE THEORIE..........................................................................................................................39
ZOEKTOCHT NAAR PRIMAIR DEFICIT.............................................................................................................39
THEORY OF MIND (TOM)..............................................................................................................................39
THEORY OF MIND BIJ DE MENS.....................................................................................................................39
“PROBLEEM”.................................................................................................................................................40
OPLOSSING?..................................................................................................................................................40
“NIEUW PROBLEEM”.....................................................................................................................................40
FALSE BELIEF TAAK ZELF EEN PROBLEEM?....................................................................................................40
ADVANCED TOM TAKEN...............................................................................................................................40
READING THE MIND IN THE EYES TASK.........................................................................................................41
WAT VOOR 4 JAAR?......................................................................................................................................41
MOGELIJKE VOORLOPERS VAN TOM............................................................................................................41
ASS EN IMITATIE............................................................................................................................................41
ASS EN SPIEGELNEURONEN..........................................................................................................................41
SPIEGELNEURONEN BIJ MENSEN..................................................................................................................42
EVIDENTIE.....................................................................................................................................................42
CONCLUSIE....................................................................................................................................................42
ASS EN JONT – ATTENTION...........................................................................................................................43
GERAPPORTEERDE DEFICIETEN.....................................................................................................................44
ASS EN SYMBOLISCH SPEL/ doen alsof spel..................................................................................................44
3
, TERUG NAAR TOM........................................................................................................................................45
TOM 2.0. HYPOTHESE : SPONTAAN TOM DEFICIT.........................................................................................46
RECENTE EVIDENTIE......................................................................................................................................46
CONCLUSIE ASS EN TOM...............................................................................................................................46
TOM : IMPLICATIES VOOR PRAKTIJK.............................................................................................................47
EXECUTIEVE FUNCTIES (EF) DEFICIT........................................................................................................48
ONDERZOCHTE EF – DOMEINEN...................................................................................................................48
EVIDENTIE.....................................................................................................................................................48
EF EN ASS – SYMPTOMEN.............................................................................................................................48
IMPLICATIES VOOR DE PRAKTIJK...................................................................................................................48
VERMINDERDE CENTRALE COHERENTIE.......................................................................................................49
EVIDENTIE.....................................................................................................................................................49
VERMINDERENDE CENTRALE COHERENTIE...................................................................................................50
CONCLUSIES VERKLARINGSMODELLEN.........................................................................................................50
DOUBLE EMPATHY.............................................................................................................................................50
PREDICTIVE CODING.....................................................................................................................................50
ASS : PREDICTIVE CODING HYPOTHESE..................................................................................................51
ASS : STERKTEN.....................................................................................................................................51
DIAGNOSTIEK........................................................................................................................................51
MINIMAAL DIAGNOSTISCH PROTOCOL (KIND)...............................................................................................51
DIAGNOSTISCH PROTOCOL...........................................................................................................................53
AUTISMESPECTRUMSTOORNIS : DIFFERENTIAALDIAGNOSE.........................................................................55
HOOFDSTUK 3: AANDACHTSDEFICIËNTIE / HYPERACTIVITEITSSTOORNIS (ADHD)...................................57
ADHD DSM 5-TR CRITERIA........................................................................................................................57
DSM – 5 ADHD SPECIFIERS............................................................................................................................58
ONTWIKKELINGSDIMENSIE............................................................................................................................58
COMORBIDITEIT MET ADHD........................................................................................................................59
ADHD EN OF ODD/CD.....................................................................................................................................59
ADHD EN/ OF TICSSTOORNISSEN..........................................................................................................................60
ADHD EN/ OF LEERSTOORNISSEN.........................................................................................................................60
ADHD EN/ OF TAALSTOORNISSEN.........................................................................................................................60
ADHD OF ?.....................................................................................................................................................60
ADHD +..........................................................................................................................................................61
EEN BLIK IN HET VERLEDEN VAN ADHD..........................................................................................................62
MELCHIOR ADAM WEIKARD (1775)....................................................................................................................62
HEINRICH HOFFMAN (1845)...............................................................................................................................62
JOHNY HEAD IN AIR............................................................................................................................................63
GEORGE FREDERIC STILL (1902°...........................................................................................................................63
PREVALENTIE VAN ADHD............................................................................................................................63
ADHD EPIDEMIE?......................................................................................................................................63
POLANCYZK ET AL. (2015)..................................................................................................................................64
STEPPED DIAGNOSIS EN CARE........................................................................................................................65
VIDEO: LIVING WITH ADHD.........................................................................................................................65
4
GEDRAGSSTOORNISSEN
Noor Desutter
2023-2024
,HOOFDSTUK 1: INLEIDING.........................................................................................................................9
ONTWIKKELINGSSTOORNISSEN...............................................................................................................9
(NEUROBIOLOGISCHE) ONTWIKKELINGSSTOORNISSEN..................................................................................9
GEDRAGSSTOORNISSEN........................................................................................................................11
IN DIT OPLEIDINGSONDERDEEL: ONTWIKKELINGS EN GEDRAGSSTOORNISSEN.........................................................11
WAT ?............................................................................................................................................................11
DIAGNOSE : VERSCHILLENDE VORMEN..................................................................................................13
INSTRUMENTEN....................................................................................................................................13
SCREENING....................................................................................................................................................13
SENSITIVITEIT EN SPECIFICITEIT....................................................................................................................14
ROC CURVE : AREA UNDER THE CURVE.........................................................................................................14
Goed screeningsinstrument?........................................................................................................................14
SCREENINGSINSTRUMENTEN........................................................................................................................16
DIAGNOSTISCHE INSTRUMENTEN.................................................................................................................16
ASSESSMENT INSTRUMENTEN......................................................................................................................17
FOCUS : ONDERKENNENDE DIAGNOSTIEK..............................................................................................18
REKENING HOUDEN BIJ DIAGNOSE MET...........................................................................................................18
DIAGNOTIEK MOET OP VERSCHILLENDE NIVEAUS GEBEUREN.....................................................................18
CONCREET VOORBEELD 1.............................................................................................................................19
CONCREET VOORBEELD 2.............................................................................................................................19
CONCREET VOORBEELD 3.............................................................................................................................19
CONCREET VOORBEELD 4.............................................................................................................................19
GENETISCHE OF CHROMOSOMALE STOORNIS – GEDRAGSMATIG FENOTYPE.........................................20
INTELLIGENTIE.......................................................................................................................................20
7.1. ONTWIKKELINGS – EN INTELLIGENTIETESTING......................................................................................20
7.2. IQ TEST, VOORBEELDEN...............................................................................................................................20
7.3. ONTWIKKELINGS – EN INTELLIGENTIETESTING......................................................................................21
7.4. INVLOEDEN OP PRESTATIE OP INTELLIGENTIETEST................................................................................21
7.5. MENTALE RETARDATIE DSM – IV – TR, VERSTANDELIJKE BEPERKING DSM – 5.....................................23
HOOGBEGAAFDHEID.....................................................................................................................................23
HOOGBEGAAFDHEID IS NIET GELIJK AAN SAVANTSYNDROOM....................................................................23
HOOFDSTUK 2: AUTISMESPECTRUMSTOORNIS (ASS)..............................................................................24
AUTISMESPECTRUMSTOORNIS VOLGENS DSM-5 MOET VOLDOEN AAN CRITERIA A,B,C,D EN E..............24
DSM - 5 : SPECIFIERS.....................................................................................................................................25
DSM IV(-TR) (1994, 2000)..............................................................................................................................25
IN VLAANDEREN............................................................................................................................................25
DSM-5 (2013): VAN MEER NAAR 1 EN VAN 1 NAAR MEER...........................................................................25
COMORBIDITEIT MET ASS.......................................................................................................................26
PREVALENTIE.........................................................................................................................................27
AUTISME EPIDEMIE?.....................................................................................................................................27
MEISJES / VROUWEN MET ASS.....................................................................................................................27
2
,GESCHIEDENIS VAN ASS..............................................................................................................................28
LEO KANNER.................................................................................................................................................28
HANS ASPERGER (1906 – 1980)....................................................................................................................29
ASPERGER SYNDROOM.................................................................................................................................29
DSM – IV – TR................................................................................................................................................29
DSM-5: GEEN ONDERSCHEID MEER TUSSEN AUTISTISCHE STOORNIS EN ASPERGER...................................31
WING : SOCIALE SUBTYPEN (1979)...............................................................................................................31
KEES MOMMA..............................................................................................................................................31
THEODORE HELLER.......................................................................................................................................31
DSM-IV-TR: DESINTEGRATIESTOORNIS VAN DE KINDERTIJD.........................................................................31
ANDREAS RETT..............................................................................................................................................31
DSM-IV-TR: HET SYNDROOM VAN RETT........................................................................................................32
DSM-IV-TR: ATYPISCH AUTISME (PDD-NOS).................................................................................................32
DSM-5: AUTISMESPECTRUMSTOORNIS..................................................................................................32
VOORBIJ HET AUTISME SPECTRUM........................................................................................................33
ETIOLOGIE.............................................................................................................................................33
GENETICA..............................................................................................................................................34
BROERTJES EN ZUSJES...................................................................................................................................34
ASS : NEUROBIOLOGIE...........................................................................................................................36
PURKINJE – CEL.............................................................................................................................................36
CONNECTIVITEIT...........................................................................................................................................37
CONCLUSIE GENETICA EN NEUROBIOLOGIE.................................................................................................37
ASS : OMGEVING (X GEN)..............................................................................................................................38
ASS : ETIOLOGIE SAMENGEVAT.....................................................................................................................38
NEUROPSYCHOLOGISCHE STUDIES EN PSYCHOLOGISCHE VERKLARINGSMODELLEN...............................38
PSYCHOLOGISCHE THEORIE..........................................................................................................................39
ZOEKTOCHT NAAR PRIMAIR DEFICIT.............................................................................................................39
THEORY OF MIND (TOM)..............................................................................................................................39
THEORY OF MIND BIJ DE MENS.....................................................................................................................39
“PROBLEEM”.................................................................................................................................................40
OPLOSSING?..................................................................................................................................................40
“NIEUW PROBLEEM”.....................................................................................................................................40
FALSE BELIEF TAAK ZELF EEN PROBLEEM?....................................................................................................40
ADVANCED TOM TAKEN...............................................................................................................................40
READING THE MIND IN THE EYES TASK.........................................................................................................41
WAT VOOR 4 JAAR?......................................................................................................................................41
MOGELIJKE VOORLOPERS VAN TOM............................................................................................................41
ASS EN IMITATIE............................................................................................................................................41
ASS EN SPIEGELNEURONEN..........................................................................................................................41
SPIEGELNEURONEN BIJ MENSEN..................................................................................................................42
EVIDENTIE.....................................................................................................................................................42
CONCLUSIE....................................................................................................................................................42
ASS EN JONT – ATTENTION...........................................................................................................................43
GERAPPORTEERDE DEFICIETEN.....................................................................................................................44
ASS EN SYMBOLISCH SPEL/ doen alsof spel..................................................................................................44
3
, TERUG NAAR TOM........................................................................................................................................45
TOM 2.0. HYPOTHESE : SPONTAAN TOM DEFICIT.........................................................................................46
RECENTE EVIDENTIE......................................................................................................................................46
CONCLUSIE ASS EN TOM...............................................................................................................................46
TOM : IMPLICATIES VOOR PRAKTIJK.............................................................................................................47
EXECUTIEVE FUNCTIES (EF) DEFICIT........................................................................................................48
ONDERZOCHTE EF – DOMEINEN...................................................................................................................48
EVIDENTIE.....................................................................................................................................................48
EF EN ASS – SYMPTOMEN.............................................................................................................................48
IMPLICATIES VOOR DE PRAKTIJK...................................................................................................................48
VERMINDERDE CENTRALE COHERENTIE.......................................................................................................49
EVIDENTIE.....................................................................................................................................................49
VERMINDERENDE CENTRALE COHERENTIE...................................................................................................50
CONCLUSIES VERKLARINGSMODELLEN.........................................................................................................50
DOUBLE EMPATHY.............................................................................................................................................50
PREDICTIVE CODING.....................................................................................................................................50
ASS : PREDICTIVE CODING HYPOTHESE..................................................................................................51
ASS : STERKTEN.....................................................................................................................................51
DIAGNOSTIEK........................................................................................................................................51
MINIMAAL DIAGNOSTISCH PROTOCOL (KIND)...............................................................................................51
DIAGNOSTISCH PROTOCOL...........................................................................................................................53
AUTISMESPECTRUMSTOORNIS : DIFFERENTIAALDIAGNOSE.........................................................................55
HOOFDSTUK 3: AANDACHTSDEFICIËNTIE / HYPERACTIVITEITSSTOORNIS (ADHD)...................................57
ADHD DSM 5-TR CRITERIA........................................................................................................................57
DSM – 5 ADHD SPECIFIERS............................................................................................................................58
ONTWIKKELINGSDIMENSIE............................................................................................................................58
COMORBIDITEIT MET ADHD........................................................................................................................59
ADHD EN OF ODD/CD.....................................................................................................................................59
ADHD EN/ OF TICSSTOORNISSEN..........................................................................................................................60
ADHD EN/ OF LEERSTOORNISSEN.........................................................................................................................60
ADHD EN/ OF TAALSTOORNISSEN.........................................................................................................................60
ADHD OF ?.....................................................................................................................................................60
ADHD +..........................................................................................................................................................61
EEN BLIK IN HET VERLEDEN VAN ADHD..........................................................................................................62
MELCHIOR ADAM WEIKARD (1775)....................................................................................................................62
HEINRICH HOFFMAN (1845)...............................................................................................................................62
JOHNY HEAD IN AIR............................................................................................................................................63
GEORGE FREDERIC STILL (1902°...........................................................................................................................63
PREVALENTIE VAN ADHD............................................................................................................................63
ADHD EPIDEMIE?......................................................................................................................................63
POLANCYZK ET AL. (2015)..................................................................................................................................64
STEPPED DIAGNOSIS EN CARE........................................................................................................................65
VIDEO: LIVING WITH ADHD.........................................................................................................................65
4
