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Lecture 6

PSY341H1 Lecture 6

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University of Toronto St. George
Hywel Morgan

PSY341H1S L6; July 24, 2013 o given personalized supports a person w mental retardation will generally improve (AAIDD) ADHD & Mental Retardation  Major changes in DSM V What are the adaptive skills essential for daily fn’ing?  Were in own chapters  Skills needed to live, work, and play in the community o ADHD lumped in w conduct disorder under disruptive  10 adaptive skill areas (need impaired fn’ing in at least 2) bhvr’al disorders of childhood 1) Communication  Since both thought to occur comorbidly to a large a. Learning, speaking, nonverbal degree 2) Self-care  DSM III called it ADD, DSM IV changed it to ADHD (Attention a. Grooming, dressing self Deficit Disorder w & w/o Hyperactivity) 3) Home living o Main feature is profound ability to cognitively focus on a. Ex. making own bed by age 10 4) Social skills info (specific type of info) o Seems to spontaneously remit as they grow older, but a. By age 4 shoul know when to say please & thank you not complete remission 5) Leisure  Now in Neurodevelopmental Disorders (autism, intellectual a. By 7 most boys usually play video games disability/difficulty, ADHD) 6) Health & safety a. By age 3, knw a boo-boo requires a bandaid Mental Retardation (from AAMR – American Association 7) Self direction a. Ex. route to school on Mental Retardation)  and 8) Functional academics a. Ex. Fn’al arithmetic: if a give you 5 cans of pepsi &  American Association for the Mentally Retarded (AAMR)  you drink 2, how many do you have left [to sell to American Association on Intellectual and Developmental Abilities (AAIDD) in 2010 me]? o 595 vs 96 (against) 9) Community use a. Ex. littering o Pretty overwhelming vote o Fused the two “abilities” together in the name 10) Work  Term “mental retardation” will still be used by ppl a. Typically doesn’t apply to children o Ex. multiple personality disorder – not valid, but still Adaptive skills usually assessed in the person’s typical used  The grp that influenced the change in DSM V envt across all aspects of the indiv’s life  A person w limits in intellectual fn’ing w/o limits in adaptive o Changing the name, and the diagnostic criteria fn’ing might not be diagnosed as MR What is mental retardation? o Might suspect ADHD, learning disorder (ex. an alexia)  (-)ve connotation – stigmatizing, offensive, insulting  Depends on age  Intellectual ability – defined by IQ (intellectual age over chronological age, x 100)  Grooming, dressing oneself o Normal = 100 o Severe or profound level, if can’t do this  Going to washroom o 15% above avg (120-125) o Below avg (75 or below) = intellectually disabled  Social fn’ing  IQ <75 & significant limitations in adaptive skills areas (2  Feeding  Cooking or more)  Levels: Mild, moderate, severe, profound  Work (older), play (younger) o Majority (80%) diagnosed in mild range  Go to school – ex. know a route, take transit (should know by age 12)  ACAP: often misunderstood & thought of derogatory; need both significantly low IQ & considerable problems adapting to How is mental retardation diagnosed? everyday life; can learn to adapt to envt; can live partially  DSM IV: used info from intelligence tests independently as adults o IQ tests done in static envts  Ex. Pamela (low adaptive tasks) & Ricky (also low) would be  DSM V: use criteria of adaptive fn (changing bhvr as result diagnosed w mental retardation since low IQ & low adaptive of change in envt) o Pushed by AAMR about 10 yrs ago fn’ing o Can be diagnosed w both autism & mental retardation (axis 2)  Wide recognition that simply using an IQ to defined retarded or disabled in insufficient  From the Association for Retarded Citizens (ARC): o Severe intellectual & developmental (interferes w o Many reasons why an indiv might score below avg on daily fn’ing) disorder that must occur before age 18 an IQ test  So interferes w child’s development o Depression – show IQs like that of mentally retarded o After 18, is prob brain damage  not motivated to give an answer o Must look at limitations in context of envt o Autism – not well motivated to give a response, but not o valid assessments must consider cultural and motivated to think about it much   IQ looks lower than their actual ability linguistic culturability o must consider individual limitations  For each section of WISC, Qs start very simpl progressively more difficult What are the causes of mental retardation? o Like SATs, GREs  Unlike autism, we know causes o When get 3 wrong  stop o Some twins develop autism together, but don’t know o Ex. similarity test (verbal intelligence), information test what causes it st (1 test on verbal section)  Problem: 100s of dif causes for diminished intellectual o Verbal tests & visuo-spatial tests – try to get 2pts per Q abilities & adaptive fn’ing o Pattern of responses in ppl w intellectual disabilities  1/3: cause unknown  Good at easy Qs, bad at hard Qs  Get the 1 few Qs Major causes: o Pattern of response in ppl w depression  Genetic conditions  Get some of the easy, some of the hard Qs (up & o Most pervasive, most common down)  but same overall score as IDs o Problems w inheriting genes from parents, errors when genes combine, or other faulty genetic Classifying a Person as Having Mental Retardation: conditions (ex. infection) 3 Steps from the AAMR o Ex. Most commonly Down syndrome  The AAIDD proposed a process as containing 3 steps for  Errors when genes combine (trisomy 21) diagnosing MR o Ex. PKU – faulty recessive gene inherited from parent  DSM IV different,, DSM V similar to this  Now tested as birth, can be compensated for (can  Propose the adaptive fn’ing skills can be remediated replace the enzyme to break down blood urea) (overcome)  Toxins in blood damage brain cells o Ex. Conditions in envt that cause genes to combine 1) Have a qualified person give 1 or more standardized incorrectly (comparing to other ppl, ex. WISC) intelligence tests & a  Teratogens – particularly radiation o Ex. Fragile X Syndrome standardized adaptive skills test, on an individual basis (1 on 1).  X chromosome fragile, breaks o Assessment by a psychologist  Not sure of cause, seems to be inherited  Doesn’t affect girls (since have spare) 2) Describe the person’s strengths & weaknesses over 4 o Can see physical changes too (ex. Down syndrome, but dimensions: not in Fragile X) a. Intellectual & adaptive bhvr skills b. Psychological/emotional considerations  Problems during pregnancy c. Physical/health etiological considerations o Teratogens: radiation, most commonly alcohol & drug d. Envt’al considerations use, thalidomide (very affective & cheap therapy for leprosy; never approved for use in USA but was very  Can be determined by formal testing, observations, physically teratogenic), pesticides, lead, cigarette interviewing key ppl in the indiv’s life, interviewing the smoke  Even small or moderate amts of alcohol can cause indiv, interacting w the indiv in their daily life, or a combo of those approaches MR in children  Not clear how much is needed to affect 3) Need of support across all 4 dimensions is determined,  Shouldn’t drink during nursing either nd each support identified 1 of 4 levels of intensity:  Most sensitive period of fetal development is 2 a. Intermittent support – on an ‘as needed basis’ trimester o Specific situations  Evidence from animals studies shows alcohol o Ex. trying to find a new job ingestion anytime during pregnancy can affect o Might be needed over lifespan but not on a fetus continuous daily basis  Generally over the counter meds are now heavily tested & are okay b. Limited support – over a limited time span o Ex. transition btwn envts, job training, moving o Infection: bacteria, parasites, viruses c. Extensive support – needed on a daily basis in a  Infection w influenza virus during pregnancy  particular life area onset of adult schizophrenia of offspring o Not limited by time  High correlation o Constantly needed in a particular life area  Cook food properly o May involve support in home or at work  HIV  poor cognitive development d. Pervasive support – constant support across multiple  Doesn’t cross placental barrier easily envts & all life areas  Often give non-teratogenic anti-viral drugs o Might include life-sustaining measures  Rubella, cytomigla virus, HIV  hurt brain development  Interdisciplinary team o Psychiatrists, physicians, etc.  Problems at birth o To determine what kind of support they require o HIV infection – often do C-section so controlled  Might be needed across 4 dimensions o Lack of oxygen (anoxia) – relatively common  Each support identified is assigned 1 of 4 levels of intensity  Breached birth – when an infant doesn’t go out o Hoped that the children w/o IDs would accept the ID head first  could suffocate, need to turn fetus kids – didn’t happen  around  Umbilical cord wrapped around fetus’s neck – Vocational Training more serious since harder to deal w  possibly  Numerous workshops around the continent have been stillbirth (born dead) established to teach the mentally retarded employment skills & improve their self-esteem  Problems after birth  Adults w mild MR: Vocational training & p
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