Chapter 14: Cognitive, Communication, and Motor Problems

Raskin explores cognitive, communication, and motor problems, spanning intellectual and learning difficulties, tic disorders, stuttering, and neurocognitive conditions like dementia. Case examples illustrate challenges: Yolanda with Down syndrome and intellectual disability, Alfred with dyslexia-related learning struggles, Greta with Tourette’s tics, Bobby with childhood-onset stuttering, and Sanjay with Alzheimer’s dementia. DSM-5-TR and ICD-11 classify intellectual development disorder (IDD) by IQ and adaptive functioning, ranging from mild to profound, and distinguish specific learning disorder (SLD) subtypes—reading (dyslexia), writing, and math (dyscalculia). Controversies include the IQ-achievement discrepancy model versus response-to-intervention (RTI) for diagnosing learning disorders. Historical perspectives review the eugenics movement and coercive sterilization, while biological research identifies PKU, trisomy 21 (Down syndrome), fragile X, and environmental insults as causes of IDD, alongside brain differences in dyslexia. Psychological interventions include ABA, cognitive skills training, phonological awareness programs, and even rhythm-based music education. Sociocultural perspectives link intellectual disabilities to poverty, limited resources, stigma, and group homes, while social constructionist critiques question whether learning problems reflect systemic inequality rather than intrinsic deficits. Motor problems include developmental coordination disorder, stereotypic movement disorder, and tic disorders (provisional, chronic, and Tourette’s). Tourette’s is explained historically from Charcot and Gilles de la Tourette to modern dopamine hypotheses and PANDAS autoimmune theories. Treatments include antipsychotics, antiepileptics, cannabis, and deep brain stimulation (DBS), while psychological therapies like habit reversal training (HRT), comprehensive behavioral intervention for tics (CBIT), and exposure plus response prevention reduce tics. Stigma and bullying remain significant sociocultural challenges for youth with tics. Communication disorders such as speech-sound disorder, language disorder, and stuttering are explored, with stuttering linked to heritability (~80%), dopamine dysregulation, and implicated genes (GNPTAB, GNPTG, NAGPA, AP4E1). Interventions include antipsychotic medications, CBT, the Lidcombe Program for children, and constructivist therapy that reframes fluency into self-concept. Sociocultural perspectives emphasize stigma reduction through contact and education. Neurocognitive conditions such as delirium and dementia are also discussed. DSM defines delirium as a rapid, fluctuating cognitive disturbance due to medical causes, while ICD groups it similarly. Dementia (major neurocognitive disorder in DSM) is distinguished from mild neurocognitive disorder, with Alzheimer’s highlighted as the most common cause. Historical accounts trace from Ancient Egypt to Alois Alzheimer’s identification of plaques and tangles in Auguste Deter’s brain. Biological perspectives emphasize the amyloid and cholinergic hypotheses, tau protein tangles, early-onset genetic mutations (APP, PSEN1, PSEN2), and APOE in late-onset dementia. Drugs include acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine), memantine, NSAIDs, and new anti-amyloid therapies like lecanemab. Psychological and behavioral interventions include cognitive stimulation, cognitive training, cognitive rehabilitation, physical activity, and pre-therapy person-centered approaches. Sociocultural perspectives highlight education, social connectedness, leisure, hearing interventions, stress, poverty, and cultural differences in how dementia is framed—ranging from stigma in the West to spiritual meanings in Indigenous traditions. The chapter closes by stressing the rising prevalence of dementia worldwide and the WHO’s global action plan promoting dementia-friendly communities and dignity in care.