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
-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
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
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
• 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
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
• 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
• Prenatal: genetic causes. Something happened in formation of embryo, trauma in
• 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
,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
• 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.