Diagnosis, Behavior Classification, and Adaptive Behavior PDF

Diagnosis, Behavior Classification and Adaptive Behavior This will also be a review of introduction lecture to reinforce learning Factors that influence cognitive styles Cognitive development: much like physical development, every individuals cognitive development happen...

Diagnosis, Behavior Classification and Adaptive Behavior This will also be a review of introduction lecture to reinforce learning Factors that influence cognitive styles Cognitive development: much like physical development, every individuals cognitive development happens at a different pace. As a result, individuals of the same age may not have the same reasoning skills. Brain development occurs at a different rate than physical development, which means that an individual’s thinking may not match the individuals appearance. Factors that influence cognitive styles Other factors that may affect brain development and how individuals think Learning styles: Every individual learns and processes information in different way. Individuals may find that some academic subjects are easier for them to learn or may be more interesting. Factors that influence cognitive styles Disabilities: A learning disability such as auditory processing disorder, dyslexia, and attention deficit/hyperactivity disorder (ADHD)- can affect cognitive development. Challenges will differ based on the disability, but being aware of the issues can help individuals access to the proper tools and resources so they can thrive. Under federal law, Individuals with Disabilities Education Act (IDEA) K-12 public schools must provide accommodations for students with disabilities, including learning disabilities. In California special education goes from ages 3-22. Factors that influence cognitive styles Trauma: For some Individuals , brain development might be more difficult because of earlier or ongoing trauma during the developmental period (0-18). Remember these are just a few factors that can influence cognition. We will learn more in future lectures. Factors that influence cognitive development In the relationship to developmental disabilities there are factors that can influence cognitive development. Lets look at some examples of developmental disabilities and cognitive issues that might affect them. Cerebral palsy Epilepsy Autism (ASD) Factors that influence cognitive styles Cerebral palsy, first of all what is CP? Is a disorder of movement, muscle tone, or posture. This is due to abnormal development of the brain or a brain insult. This occurs often before birth. (Will be discussed in detail in future lectures.) Epilepsy, a neurological disorder in which the nerve cell activity in the brain is disturbed, causing seizures. Epilepsy is the recurrence of these seizures. Cause can be genetic disorder or acquired brain injury, such as trauma or stroke. (Will be discussed in detail in future lectures.) Factors that influence cognitive styles Cerebral palsy Factors that influence cognitive styles Epilepsy Factors that influence cognitive styles Autism (ASD), a developmental disorder of variable severity that is characterized by difficulties in social interaction and communication and by restricted or repetitive patterns of thought and behavior. (Will be discussed in detail in future lectures.) Factors that influence cognitive styles Biology can affect cognition and cognition can affect biology…relationship is bidirectional. Physiological factors that impact: Brain processes Neurotransmitters Hormones Genes Physiological does not work alone since environmental stimuli can influence cognition. Stress, brain insult etc. Adaptive Functioning Usually a person must have deficits in at least two adaptive skill areas (as well as IQ) to be considered intellectually disabled. Adaptive behavior refers to the individuals adaptation to the demands of their environment. Measurement of adaptive behavior: Vineland Adaptive Behavior Scales (VABS) Semi-structured interviews with parents, caregivers, teachers that assess adaptive behavior. Usually a close correlation between scores on IQ test and adaptive test. *Adaptive abilities are more responsive to intervention than is the IQ score.* Deficits in the following areas of adaptive behavior Communication. Self-care. Social/Interpersonal skills. Use of community resources. Self-direction. Functional academic skills. Work, leisure, health and safety. Deficits in the following areas of adaptive behavior Communication: The developmentally disabled often have difficulty articulating their needs and wants. This can sometimes lead to negative behaviors. The client’s who doesn’t want to participate in an activity and cannot communicate will sometimes use escape or avoidance. They may also act out to avoid participating. Communication includes the ability to produce and understand language. Deficits in the following areas of adaptive behavior Self-Care: Clients often have difficulty or are unable to perform basic ADL tasks. Often clients require assistance and health education as well as physical inspection (body checks) Deficits in the following areas of adaptive behavior Home Living: Independent living is often difficult or impossible for the developmentally disabled. Performing the daily tasks that are required for home living is overwhelming. However the developmentally disabled do live independently with various degrees of assistance. Group homes are a good alternative to institutionalization. Deficits in the following areas of adaptive behavior Social/interpersonal skills: Clients often behave in ways that prevent them from social integration. Sometimes negative behavior is away to escape or avoid social situations that are not comfortable for the client. We as care providers have the chance to help our clients develop and us appropriate social skills. Deficits in the following areas of adaptive behavior Use of Community Resources: Often the services which are available to the DD in the community are not utilized. Things such as bus service, public assistance programs and support groups are under-utilized. Deficits in the following areas of adaptive behavior Self-Direction: Unfortunately many decisions facing the DD are made for them over and over again. This results in clients with no ability to make their own decisions about where they want to live, work, eat, and sleep. This can lead to frustration and behaviors issues. Whenever possible we want to offer our clients choices. Deficits in the following areas of adaptive behavior Functional Academic Skills: The lower IQ of the DD results in deficits in academic performance. Inability to read/write and frustration in completing associated tasks. Ability to read street signs and directions should be considered. Deficits in the following areas of adaptive behavior Work, Leisure, Health, and Safety: Work: provides feelings of self-work. Sheltered workshops. Leisure: DD’s have severe deficits in leisure skills. This can lead to boredom and acting out. Health: Often anomalies which cause retardation can lead to health problems. The DD might act out due to illness pain. Safety: Visual impairment and poor judgement endangers safety. Assisting in development of cognitive skills Early start program for ages (0-3) Federal program to assist in identifying high risk kids for developmental delays. Special education a public school program. IEP- Individual Education Plan. Created for that child's specific needs. Day programs IPP-Individual Program Plan. Created for adults post special education. Assisting in development of cognitive skills Foundations: Cerebral Palsy Foundation, Epilepsy foundation and many others. Tri-Counties Reginal Center (TCRC) provides supports and services for children and adults with developmental disabilities. Note: TCRC was put in place by the Lanterman developmental disabilities service act. A California Law that entitles services and supports, including special education programs as well as vendor services needed for specific needs of clients. Importance of taking an individuals history The history should be taken from many areas not just medical but other areas. Medical does assist in a diagnosis being made but looking at other areas can dictate if services and supports are received. This can be different from state to state. i.e. (Laterman Act) Areas that need to be explored when taking history: Family history Onset Medical records Developmental Disability Is intellectual disability the same as developmental disabilities? No, but… “Developmental Disabilities” is an umbrella term that includes intellectual disabilities but also includes other disabilities that are apparent during childhood. Developmental Disability, cont. Developmental disabilities are severe chronic disabilities that can be cognitive or physical or both. The disabilities appear before the age 22 on a federal level. California is age 18, this will be discussed later. These chronic disabilities are likely to be lifelong. Developmental Disability, cont. Some developmental disabilities are largely physical issues such as cerebral palsy or epilepsy, but they too have some cognitive issues. Some individuals may have a condition that includes a physical and intellectual disability, for example Down syndrome or another type of syndrome. Intellectual Disability Intellectual disability encompasses the “cognitive” part of the definition that is a disability that is broadly related to thought processes. Because intellectual and developmental disabilities often co-occur, intellectual disability professionals often work with people who have both types of disabilities. Intellectual disability, cont. Is intellectual disability determined by an IQ test? No. The evaluation is a complex issue. There are three major criteria for intellectual disability: significant limitations in intellectual functioning, significant limitations in adaptive behavior, and onset before age 18. Intellectual disability, cont. Intellectual disability, this term replaces the older term “mental retardation”. This was changed in 2010 in federal legislation (Rosa’s law). DSM-5 Intellectual Disability (Intellectual Developmental Disorder) Diagnosing Intellectual Disability Essential features: 1. Onset during developmental period 2. Impairments in general mental abilities 3. Impairment in everyday adaptive functioning (“community standard of personal independence and social responsibility”, DSM-5) Begins with medical history and physical exam to rule out other conditions Adaptive and intellectual functioning should be assessed using standardized assessment tools (Intelligence Quotient standardized test not to be over emphasized; severity of DX based on impairment of functioning) Specific diagnostic tests if indicated by dysmorphic features- identifying cause leads to condition specific interventions Evaluation includes Referral to experienced health professional Detailed history of symptoms and behavior Interview and/or observation of child Input from school and other care providers Evaluation of family functioning Referral to psychological testing or behavior assessment, if appropriate Degrees of Intellectual Disability Mild: Intermittent support, certain situations, new environments (IQ=50-55 to approximately 70) Moderate: Limited support, may need support in everyday situations, assistance and training to increase functioning in self-care (IQ=35-40 to 50-55) Severe: Extensive support, daily assistance, limited communication and self-care (IQ=20-25 to 35-40) Profound: Pervasive support, 24 hr. supervision and assistance to ensure health and safety (IQ= Below 20-25) Intellectual Disability, Severity Unspecified: Strong presumption of Intellectual Disability, but the person’s intelligence is untestable by standard means. (Batshaw 8th ed., Children with Disabilities and American Psychiatric Assn., (DSM-5)) Levels of support for the developmental disabled Four levels of support: 1. Intermittent: as needed basis. 2. Limited: Consistently needs support but not as much fewer staff, less cost. 3. Extensive: Needs daily support, long term. 4. Pervasive: Constant intensive support. More staff members and supports might be of life sustaining nature. Speech-Language DX vs Developmental Disability Developmental language disorder is most common developmental disability of childhood Speech disorders-articulation, fluency, voice disorder Language disorders-impaired comprehension and/or use of spoken, written, or sign language Language disorders may be acquired or developmental (differential diagnosis: disorders that have similar clinical features) Autism spectrum disorder Landau-Kleffner syndrome Selective mutism Acquired aphasia Hearing Deficit vs Developmental Disability Hearing loss that is undetected and untreated can result in speech, language, and cognitive delays Early identification and effective treatment of hearing loss improves language, communication, and cognitive skills History & Physical that suggest a specific genetic syndrome, targeted genetic testing is performed to evaluate syndrome Intellectual disabilities and comorbid conditions include hearing and/or visual deficits (Batshaw 8th ed.) Intellectual disability or psychiatric disorder? When to consider a mental health diagnosis? New or unusual symptoms Behavior strategies are ineffective Behavior challenges are more severe or excessive compared to others at similar functioning level Increase or change in behavioral challenges Decline in adaptive skills Self-injurious behaviors Family history of mental illness (Individual factors are NOT evidence of mental health diagnosis) Psychiatric Disorder vs Developmental Disability How do you determine if problematic or challenging behavior is due to intellectual disability or mental disorder? Difficult for a person with severe ID to articulate feeling depressed or experiencing hallucinations Risk diagnosing someone as mentally ill and starting medication as intervention-person may be ID and need cognitive or behavioral interventions Examples of tests Aberrant Behavior Checklist-measures irritability, agitation, & crying; lethargy/social withdrawal; stereotypic behavior; hyperactivity/non compliance; inappropriate speech Yale-Brown Obsessive Compulsive Scale for OCD used in persons with autism spectrum disorder to evaluate compulsive behavior