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Anna Grivas Matejka

Chapter 12: SubstanceAbuse Prevalence and course: campaigns and advertisement working ie/cigarette smoking declining in adolescents. Marijuana abuse is increasing. 12% prevalence. Cormbid mental health condition will meet for substance abuse disorder. Study increase across the drugs in adolescents in alcohol is the leading drug, followed by marijuana and other illicit drugs.Age of onset: if start to engage in this behaviour before 14 then in a different at risk group. If starting under age of 14, then very strong predictor for meeting criteria for abuse disorder in adulthood. Longer the behavior starts, so start at 15 the correlation weakens. Longer the adolescent waits, the weaker correlation goes to meeting criteria. Pass behaviour predicts future behaviour. Stronger the connection in the brain becomes, the neural activity is creating that pathway, the longer it is happening the harder it is to break that because dealing with pattern of behaviour and neural activity that is ingrained. So more likely will not be successful with that individual. Intervention then is important for targeting ages under 14 specifically grade 6,7,8 ages 11 and 12. Parents have a negative reaction that schools are introducing these but these are the ages for maladaptive coping mechanisms. -in the native communities- at large is a very significant issue. Less than 40% finishing highschool because of substance abuse. And mental health concerns-more abuse. SES isn’t as correlated. Is a cross SES, wasn’t as predictive. Causes: 16, 17 when at there worst and a decline in adulthood. Developmentally expected that adolescents are going to behave in high risk behavior, alcohol engage in most, when move into adulthood, behaviour subsides. Concern about this because will engage in other high risk behaviours more commonly, ie/use alcohol then will use another drug, or unsafe sexual activity, more likely to drink and drive. Overall higher rate of death in adolescents for these reasons. Female adolescents in this group are 5 times more likely to be involved in an aggressive relationship, more likely to report dating into a violent relationship, drugs being the underlying cause. -this group perfers novelty- like new things, adventures, will report that they seek sensation , sensation seekers, like ambiguity- that is their personality.And they report this will be at higher risk and be in this drug and alcohol group abuse. Involved in social networks, their peers are engaged in this. Usually occurs in groups. Intervention in high school is to find out which are the groups engaging in this behaviour and targeting at the group level then individual level because if individual returns to group will not be powerful. Group is hard to do but more powerful, because looks classroom based. Clincians will do a class room intervention if high rate in school. Also disconnectedness specifically found school disconnectedness, also apart of personality. To be a part of school that they have support, people in the school that expect things from them will less likely to engage in abuse activity, protective factor. If disconnectedness, teachers expect them to fail, know they skip class, then significantly higher risk to mental health and drug abuse. -Family functioning: lack of parental involvement puts at high risk, poor monitoring, lots of negativity in family functioning, child and parental relationship conflict, low warmth. Historical aspect, histry of family who has had substance abuse issues, children will then be at risk. -Peers and culture- common behaviour, accepted within the group will be high risk, hard to intervene on. Culture where everyone is doing it, normalized behaviour. -targeting glamourization in social media can be a apart of intervention. -targeting 50% of adolescents, majority come from court mandates, arrested for DUI, other source right from the emergency room because parents are terrified, overdose, hallucinating, psychotic symptom. Long term these interventions are not great, usually see a relapse in the first three months. Actual rate of staying clean for a year is 20%.As economic investment not good, spending money for small 20% that actually benefit long term. -family based approach: Multisystemic therapy- everyone needs to come, peers, school and community level, all systems related to family are involved, effective but harder to do. Modify all negative interactions that occur within those systems.And communication- break down in communication and coping mechanisms is a component of family therapy. If have a fight with parent, need to express needs to parent with a faulty communication style.And work on problem solving skills, if this is increased then will decrease substance abuse directly. Turning to alcohol for adolescence is solving the problem. Increase adaptive skills then adolescents wont turn to drug abuse as much. This therapy is complicated and a lot of coursework. -Motivational interviewing-patient centered approach, addressing ambivalence, and discrepancies between current behaviour and their values, future goals.An outside source, therapist is needed who is disconnectedness from patient’life. Somewhat helpful mostly in private. CHAPTER 9: Intellectual Disability (Mental Retardation) Features of Intellectual Disabilities: Clinical description:  Considerable range of abilities and interpersonal qualities  DSM-IV-TR diagnostic criteria: to meet criteria Iq must be 70 or below. Impairment in adaptive functioning has to below their same age peers and under the age of 18. B.c if not there before then is a medical issue, not developmental problem. Epilepsy, metabolic reasons, or trauma (head injury) are causes for this, over age of 18 that they lose functioning-stroke, loss of oxygen, not developmental hasn’t been there since birth. Cognitive functioning loss due to epilepsy. If put off a label in early childhood, don’t diagnose intellectual disability until age 4 or 5. We give children time and stimulation and wait until 4 or 5, and still functioning below iq of 70 then give diagnoses. Unless dealing with 2 or 3 yr old that is functioning like an infant, must be that profound of a delay to give diagnoses. Ie/ infant doesn’t know how to sit, swallow, reflex delay. Profound mental retardation. Lots of kids show mild to moderate form of delay, 20% infants will show a profile similar to a mild impairment and then catch up over time with the right stimulation. So don’t want to give false positive, so will defer.  *If do those 20% are issues if 2 or 3 yr old, diagnoses is global developmental delay is what it is deferred to. Different from delay which implies children may catch up, rather than using disability or disorder. In this case, follow children put intervention, if 4 or 5 iq below 70 and adaptive impairment will change global development delay to disability. Disability means child will not catch up, gap between them and their same age peers will only get bigger. Clincially called slow learners, iq of 70 metnal retardation, 85 is not far away so slow learner.  MID- mild intellectual disability- slow learners have IQ not below 70, will be put into MID classroom.  Criteria are arbitrary and a label of MR has serious ramifications, including placement in school learning environment Degrees of Impairment 1. Mild MR (IQ of 55 to 70): vast majority fall in this group, 85% of intellectual disability are mildly impaired. Majority not identified until grade 1,2,3 b.c mild. Don’t ever diagnose until later. Able to learn to communicate, language well in their capacity, learn a single language quite well and learn social skills quite well. Friendships, love, how to maintain interactions. Stop learning to grade 5 student b.c academically people with a mild intellectual disability is the highest they can go to, then becomes challenging. Can live independently but needs to have support, check in regularly, few times a week to help manage bills, money, cooking on hot stove is high risk. Group homes with other people who have mild MR for long term support-supportive housing with individual families, or staff. Problem- wait list. Family advocacy groups, that get together buy a house and as a unit support those people. Pricing spots for crisis will get a spot where there is no support, or go into a state of psychosis. 2. Moderate MR (IQ of 40 to 54): 10% of this group are meeting criteria. Picking up at 3-4 years, preschool years b.c more significantly affected. Fully supportive environment throughout life, need staff a home all the time, can be trained with vocational skills, language skills lower more basic, at most 3 or 4 words, socially and interpersonally like a young child, these people are often taken advantage of, easily manipulative so need full support. Capacity of a grade 1 student, can learn letters, spell their name, numerical sense but reading and writing difficulty. Can hold a job with supervision. 3. Severe MR (IQ of 25 to 39) 3-4%. Picked up very early even if deferred diagnosis, 2 or 3 years old. Full support, not able to do things like hold a job. Language not in capacity, use other form of communication other than spoken language. 4. Profound MR (IQ below 20 or 25) 1-2%, are identified in first couple years of life, lots of biological and physical evidence ie/facial disformia, organ issues, wet fingers and toes who are showing low functioning, hard time eating, learning to suck, swallow and thrive. Requiring long term care and in supportive environment. Defining and Measuring Children’s Intelligence andAdaptive Behavior 4 yr old scores is how they perform compared to their peers. • General intellectual functioning is now defined by an intelligence quotient (IQ or equivalent) based on standardized intelligence tests • ID is not defined solely on the basis of IQ; level of adaptive functioning is also important  Adaptive functioning: how effectively individuals cope with ordinary life demands and how capable they are of living independently and abiding by community standards. Daily skills, how do they cope with day tasks. Collected through interviews and observations. Used by using VinelandAdaptive Behaviour Scales. *Four areas:  1.communication includes-day to day functioning and expressive language, receptive language, (words they use and understand) and if appropriate their written language.  2. Daily living skills-cleaning, grooming. Domestic skills- help with chores, cleaning. Community: at 3 yrs old, keep seatbelt on, stay on sidewalk.  3. Social: intrapersonal relationships, how are they with other people, play and leisure. Use toys appropriately, engage in imaginative skills. Coping: do they adapt, say polite words, adapt to changes in their routine.  4.Motor skills: gross and fine motor skills. Gross how do they use large muscles, how they jump, run, climb and fine is small muscles usually in the hands. Can they open a juice box, open and close doors. Graph: Score of average is 100 IQ, 50 percentile. 1 standard deviation from the mean is 115. Plus one standard deviation. 130 is 2 standard deviation above the mean. 85 minus one standard deviation. Majority of the population falls between 85 and 115 or one standard deviation below or above the mean which is 68% of the population which is the average. Highest measurable IQ is 150. If have an IQ of 150, cant compare you to anyone b.c no one has that. Iq 70 or below is 2 st. dev. Below the mean so representing 2% of the population.Akid with high functioning, IQ is high is failing b.c think they have a disability but are bored of high curriculum, unmotivated. Another problem is misdiagnosed, behavior, off task, roaming the halls, troubled behavior. Socially they struggle. IQ scores: 96% will fall below or above the st. deviation. Is high average. Between 1 and 2 standard deviation is below average.Above 2 standard deviation is superior range, 3 or more is very superior. 1 below is low functioning, 3 is very low. 2 below is intellectually deficient but cannot use this term because it is not enough, must have the adaptive scores in the same range. The Wechsler Scales • Different versions for infants, children, and adults. *IQ score yields verbal- left brain functioning (language) and performance IQ scores-visual spatial skills (right brain functioning). Scales divided to represent two hemispheres.Average child has equal functioning, if 100 on RS then 100 on LS with confidence intervals. People who don’t fall in this have other pathology. • *Two other main scores is processing speed and working memory. Subtypes that represent these. How quick you process simple and difficult information, and working memory is how efficiently do you do something with it to store it in ST or LT memory. If these two are deficient highly correlated to other concerns. If no discrepancies between verbal and language then combine them to give average overall score. Can combine them to yield an overall IQ score. • Based on deviation IQ: comparing individual performance to age-mates’average. Number is deviation because show how many others in the same range. The Controversial IQ: bad press around Iq score but IQ is relatively stable over time, except when measured in young, normally-developing infants.Anytime over 4 or 5 years, and IQ is higher or average, then is reliable measure. Not reliable when younger than 4 is not predictive later in life. Only time when iq is reliable is when score is extremely low and can give a diagnoses. • Mental ability is always modified by experience so is controversial. • Range of Reaction: genetically IQ is driven by genetics.Agene drives IQ to be around 100, the second gene drives range of reaction. Some people have a wide range of reaction meaning that whatever environmental stimulation you have can drive a higher IQ. You have an enrich environment. 80 to 135 wide gap are vulnerable to environment. If narrow range of reaction is 90 to 110, if very stimulating goes to 110 if not enrich environment then 90. *If someone has down syndrome born with IQ genetically will be around 70, have a narrow range of reaction, regardless of environment, genetically predetermined to stay in the deficient range. To increase IQ is mothers vocabulary. More sophisticated language, higher vocab mother has and uses with child more higher IQ. • Are IQ tests biased or unfair? African american score 1 standard deviation below children who are white is a consistent finding due to SES explains this. Quality of the programs in the communities of higher SES are different than low SES so the experiences are very different. Race, Sex, and SES Prevalence • Approximately 1-3% of population. Twice as many males as females among those with mild MR. 2 to 1 ratio from mild to moderate. Males mostly b.c sex linked chromosome disorder, females have two copies of every gene and are protective of mutated gene causing this condition. Males will show clinical symptoms. More common for low SES and minority groups, and environmental differences especially for mild MR Developmental Course andAdult Outcomes • Chromosome abnormalities are the most common cause of severe mental retardation. Ie/ Down Syndrome most sever of MR.  Developmental-versus-difference controversy: whether children with ID progress through the same developmental milestones in a similar sequence as other children. normal child and abnormal go through the same progression of development or structure different-the way they learn to see differences in functioning. Similar sequence. Similar structure • Difference viewpoint: cognitive development of children with ID is qualitatively different in reasoning/problem-solving Emotional and Behavioral Problems • Rate is three to seven times greater than in typically developing children. *limited in communication skills, don’t know how to share ideas, or connect with other people will lead to associated pathologies, emotional and mood diagnoses. Lots of additional stressors, social networking becomes difficult, school problems lead to other types of pathologies. • Most common psychiatric diagnoses? Mood andAnxiety. In older years see a lot of depression in mild group. • Consistent with their normally developing peers, internalizing problems and mood disorders in adolescence are common • ADHD-related symptoms are also common, Pica-profoundly with severe MR individuals, Self-injurious behavior (SIB): life threatening, severe and profound, nonverbal so must find coping mechanisms, as communication skills increase SIB will decrease, need a communication system, augmentative communication system. Picture tool for nonverbal kids.Physical Disabilities: epilepsy-seizure and seribal plausy of nervous system • Causes: • Prenatal: genetic causes. Something happened in formation of embryo, trauma in the womb • Perinatal: just beofre or after birth, prematurity more likely it is to have ID. In third trisemester is important for brain functioning. Onyxia: loss of oxgyen. Concern during birth. More than 10 seconds will have brain damage. • Postnatal: majority of the time, after child is born. Menigidice is leading cause in other countries and second leading cause is head trauma. Genetic and Constitutional Factors: Single-gene conditions (inborn errors of metabolism):  Excesses or shortages of certain chemicals that are necessary during developmental stages  3-7% of cases of severe MR  Phenylketonuria (PKU) results in lack of liver enzymes necessary to metabolize phenylalanine. Lack enzyme that digest milk.  Can be treated successfully by environmental changes  Smith Lemli Optic Syndrome: child is born w.o the gene to metabloize good cholestral which is required to coats the nerves in the brain. If don’t have this then not protecting nerves in the brain, will damage when brain is developing.At 1 yr, rapid development occurs so will show brain damage. Now gene can be found before birth and pump good cholestral. Common Genetic Causes of ID: Klinefelter Syndrome, Down Syndrome-duplication of chromosome 21, leads to variety of physical and developmental issues, flat face, extra fold of skin under the eye, pertuding tongue due to weak muscles, floppier, delayed to walk, more effort to move, shorter limbs, ID. Turner Syndrome- females missing X chromosome so XO-short of stature, webbed neck, mental retardation ,Fragile X- XXY, males have extra X chromosome, tall, lean, large forehead, large gap btw lip and nose, mental retardation Neurobiological Influences: malnutrition during pregnancy, record feeding, need to nourish brain, concern about toxins, stress for mother is linked to ID. Adverse biological conditions:Infections, traumas, and accidental poisonings during infancy and childhood • FetalAlcohol Spectrum Disorder (FASD): a range of outcomes associated with prenatal alcohol exposure. Some report little and lots of alchol. Correlation not known, depends on mother, worst thing is binge drink-4 drinks or more within 2 hours. • Teratogens that increase risk of MR are viral infections Social and Psychological Dimensions: Least understood and most diverse factors causing MR  Environmental influences and other mental disorders account for 15-20% of MR:  Deprived physical and emotional care and stimulation of the infant- physically:not being fed, not warm, brain damage  Other mental disorders accompanied by MR, such as autism  Parents are critically important *Difference between Intellectual Disability and Learning Disability? LD- to be diagnoses needs to be general learning problems in a formal educational setting, different from core cognitive capacity-memory, processing speed, language, visual skills is different from learning in LD, different from adaptive skills. -IQ scores: ID two standard deviations below the mean (1 percentile), LD-average range. -adaptive function is delayed in ID, for LD not part of the diagnostic. ID academically to learn in the classroom- programming in the classroom is to focus on those adaptive skills-putting communication system in place, to live with some form of independence, vocational skills (train individual to hold some job to make an income) LD-focus is if right support this person can achieve just as much as a person without a LD, so intervention is effective and can accommodate this in the classroom to work on processing issue because there cognitive functioning is average. CHAPTER 11: Communication and Learning Disorders • Learning disability: the general term for learning problems that occur in the absence of other obvious conditions (e.g., MR or brain damage) • Learning difficulties show up in schoolwork and cause problems with a child’s ability to learn to read or write or do math, as well as other parts of life • Main characteristic of learning disabilities is not performing up to expected level in school. Have average intellectual functioning. In order to meet criteria for LD, must fall in the average range. Majority of people who have diagnoses in LD rank average to above average so cognitive not affecting. Gifted LD- IQ scores are in the 90 percentile, still meeting criteria for LD. Most Misunderstood students in the school system b.c abstract thinking, talking very well, get the perception that they are lazy so failing class. Intervention goes to motivation, behavioural problems and skills are there but choosing not to using them. Don’t go to clinical setting for a long time until grade 6.
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