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Lecture 6

PSY341 LEC6.docx

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Hywel Morgan

Wednesday July 24, 2013 Lecture 6 MENTAL RETARDATION & ATTENTION DEFICIT AND HYPERACTIVITY DISORDER  Major changes done in DSM-V in regards to these disorders  They were previously in different categories in DSM-IV o Mental retardation had its own category divided into 4 subtypes o ADHD was lumped under disruptive behavior disorders with conduct disorder and OD  Mental retardation no longer has its own category  DSM-III called it ADD but DSM-IV changed it to ADHD. Technically it is attention deficit disorder with/without hyperactivity o Main feature of this disorder: A profound inability to focus on a specific kind of information  These are now labeled as neurodevelopmental disorders along with autism & intellectual disability (ID) Intellectual Disability/Mental Retardation (Neurodevelopmental Disorder)  Intellectual age vs. Chronological age = intelligence quotient o If your age matches you intellectual age you have an IQ of 100 = normal (average) o One stdv ABOVE average IQ is 120-125 => genius, not considered a psychopathology o One stdv BELOW average IQ is below 70 => intellectually disabled/mentally retarded  There is a wide recognition that simply using an IQ in determining retardation is insufficient o There can be a number of reasons why people might score below average such as those affected by depression  They’re less willing & unmotivated to complete tasks because they don’t see the point in giving you the answer (same with Autism)  The WISC test questions start of easy then gradually get harder. o Once you get 3 wrong in a row that section is stopped, and that score will be your level of cognitive processing  Those who are mentally disabled may get the very first questions correct o First subtest is called Information (very easy questions) o The harder ones they won’t do well; questions we find moderately challenging they will not get o Their overall IQ score for that subsection is considerably low  There is a pattern in responses with those who are intellectually disabled o Their overall Intelligence for that subsection is considerably low  For children with depression, the pattern of responses looks different o Very different pattern of responses but the score is the same as those who are intellectually disabled. Ex. They might not get any of the easy ones but can answer the hard ones o As a psychologists it is your job to differentiate btw the two American Association for the Mentally Retarded (AAMR) is now…American Association on Intellectual and Developmental Disabilities (AAIDD)  This happened approx. 3 years ago (2010)  Their vote was 595 in favor 96 against and 11 spoiled ballets o Shows they really wanted to get rid of that name  It now not only has negative connotations, they also find it insulting  But will probably continue to be used in the professional community  The term mentally retarded will continue to be used, much the same as Multiple Personality Disorder  technically not the term, but still used by professionals  Visit their website (includes a lot of the info from lecture)  They were very influential in changing some of the diagnostic criteria in DSM 4  The AAMR about 10 years ago insisted that DSM must also use the criteria of adaptive functioning as well as intellectual disability to diagnose intellectual disability 1 Wednesday July 24, 2013 Lecture 6 o Functioning in the environment, functioning as a result of change in the environment o IQ is conducted in a static environment, need to be shown how they adapt in their own environment  Ex. Child dressing themselves, grooming, etc  If they can’t do these tasks appropriate for their age, you would diagnose them with either severe or profound mental retardation  Poor adaptive functioning for their age is a sign of intellectual disability  The largest group of people diagnosed with this disorder are in the mild range: can learn to take care of themselves with minor support o Most can learn how to adapt to the environment given minor levels of support o Most can lead partially independent lives  Pamela and Ricky: very low cognitive and adaptive functioning o Would be diagnosed mentally retarded given this criteria What is an Intellectual Disability (Mental retardation)? From the Association for Retarded Citizens  It is a severe (interferes with your daily functioning) disorder that must occur before the age of 18 o Interferes with the child’s development  If it occurs after 18 it is not considered mental retardation o Recognition that it is a developmental disorder o If your intelligence reverts, not considered mental retardation  After 18 it is called: Brain Damage  Essential to applying the diagnosis of retardation we must look at limitations in the context of the environment o Ex. 13 yr old who is brought up in Collingwood, and they are told to arrive at a location using the TTC and don’t know how, not considered retarded Cultural & Linguistic Considerations  We must also consider individual limitations  AAIDD: a person with mental retardation will generally improve with personalized support o Association for retarded citizen What are the Adaptive Skills for daily functioning?  Intelligence below 70 and 75 score on IQ score was previously sufficient to diagnose ID  AAIDD: Also need to consider adaptive functioning…  These are skills needed to live, work, and play in the community  There are 10 adaptive skill areas: there must be at least 2 of them because none are given more weight than the other o Communication o Self-care (grooming and dressing yourself) o Home living (by 11, you should know how to make your own bed) o Social skills (by 4, you should know how to say and when to say please and thank you) o Leisure (by 7, boys will usually play video games) o Health and safety (by 3&4, know that a cut requires a band aid) o Self-direction (your route to school) o Functional academics (if you are given 5 cans of Pepsi and drink 2, how many cans of Pepsis are you left with?)..3 etc…) o Community use (no littering) o Work  A person with limits in intellectual capabilities but are adaptive, may not be retarded but can have a learning disorder 2 Wednesday July 24, 2013 Lecture 6 Diagnostic Intellectual Disabilities  AAIDD proposed that the process of diagnosing requires 3 steps, and describes the systems of supports…A person needs to overcome adaptive functioning skills, they can be overcome 1. Qualified Person Gives Intellectual and Adaptive Tests (the assessment)  Standardized skill tests administered by the psychologist  Done on an individual basis (one-on-one) 2. Describe the Person’s Strength and Weakness across four dimensions  Intellectual behavioral skills, psychological and emotional considerations, physical health etiological considerations, and environmental considerations  These strengths and weaknesses can be determined by standardized tests, observation, interviewing the individual and interacting with this person in their daily lives or a combo of these approaches 3. Requires an Interdisciplinary Team to determine what type of support that person might require  Support that might be needed across 4 dimensions, and each given a label of intensity o Intermittent support—as needed basis, not constant support  Help to find a new job, and may be needed occasionally, and might be needed over a life span but not in a continuous basis o Limited—occurs over a limited span of a person’s life  Transition from one environment to the other, job training  The support has a limit of time to provide the needed the support o Extensive—assistance needed in a life area on a daily basis  Not limited by time, it is constantly needed in a particular life area  Involve support at work or at work o Pervasive—refers to constant support across multiple environment and life areas and may include life sustaining measures Causes of Intellectual Disability  There seems to be a link to a predisposition in some environments  Some of these conditions of mental retardation, we know what causes them  Diminished intellectual ability has hundred of different causes, but not the only thing  In about 1/3 of people diagnosed with mental retardation the cause remains unknown Major causes… Genetic Conditions  Most common genetic cause is down syndrome  Genetic conditions can be a result of inheriting genes from your parents, errors when genes combine (down syndrome), or the result of other faulty genetic conditions (most common is through infection)  PKU is a faulty recessive gene you’ve inherited from a parent, and is tested at birth o It can be compensated for, it is a build up of euria in your blood (enzyme can be replaced) o Was a common genetic cause but not babies are tested for it at birth  There is another common cause of when genes combine incorrectly… o Things in the environment that cause genes to combine incorrectly: teratogens o Radiation will genetically damage  Fragile X syndrome o X chromosome breaks o This does not effect females only boy
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