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71 Cards in this Set
- Front
- Back
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• Developmental disorders: overview
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• Childhood, infancy, adulthood
• Delays/deficits in normal development • Intellect, communication, learning, social skills, or self-care • Diagnosed first in infancy, childhood, adolescence • Can be limited or pervasive • Limited= affect 1 domain (ex. Math skills only) • Pervasive= affect many domains (ex. Autism) |
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• Intellectual Disability (mental retardation)
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• DSM IV: significantly sub-avg. intellectual functioning (found through ID test- standard deviation less than 70)
• Before age of 18 • Also must meet criteria for deficits in adaptive functioning (ability to complete everyday tasks that allow one to be independent) • EX. Language, social interactions, self-care, home living, self-direction • Range of impairment varies greatly |
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• Intellectual Disability: Subtypes
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• Subtypes by IQ (out of 100)
• Mild: IQ scores b/w 50/55 and 70 • Moderate: range= 35/40 to 50/55 • Severe: range= 20/25 to 35/40 • Profound: range= below 20/25 • Subtypes by assistance required • Intermittent: occasional (ex. Help moving) • Limited: consistent (ex. Paying bills) • Extensive: daily (cooking, communicating) • Pervasive: constant and intense (cant communicate, medical) |
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• Intellectual disability: Statistics
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• Prev: 0.78% → 2%
• 90% have mild intellectual disability • More men than women • More prev. in developing countries • Course: tends to be chronic • Prognosis varies greatly • Earlier intervention = better prognosis |
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• Intellectual Disability: Biological Risk
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• Genetics: multiple genes and @ times single genes
• Fragile X syndrome: damage to the FMR1 gene of x chrom. --Hyperactivity, self-stimulatory beh. (Rocking), aggression (b/c of lack of communication) and poor social skills • Phenylketonuria (PKU): mutation of chromosome 12 --Autosomal recessive disorder --Symptoms regulated thru diet (no phenylalanine) •Down syndrome: extra 21 chrom (often develop Alziheimers Disease) |
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• Intellectual Disability: psychosocial Risk
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• Prenatal: exposure to disease or drugs/toxins
• Brain abnormalities: • Induction deficits: probs in closure of the neural tubes, underdeveloped forebrain and/or corpus callosum • Migration deficits: probs w/ cell growth and distribution • Perinatal: difficulty during labor or delivery |
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Intellectual Disability: environmental Risk
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• Environmental deprivation or abuse
• Cultural familial intellectual disability (accounts for 50% of retardation) • Poverty and fam. Intelligence • 50% of cases (mild form) • Least understood • Associated w/ mild levels of int. disabilities but good adaptive skills |
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• Autism: 3 domains
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• Qualitative impairment of social interactions
• Probs. W/ communication • Restricted patterns of behavior, interest, and activities |
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• Autism: 1st domain
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• Qualitative impairment of social interactions
• Impaired in nonverbal beh. (Kids should make eye contact) • Fail to develop age-app. Relationships • Lack of spontaneous reciprocity |
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• Autism: 2nd domain
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• Probs. W/ communication
• Delay or absence of speech • Inadequate speech- failure to initiate/keep conversations • Stereotyped or repetitive speech • Echolalia: repeating what one has just heard • Pronoun Reversal: switching from I to you • they do NOT enjoy social interaction (unlike mental retardation) |
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• Autism: 3rd domain
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• Restricted patterns of behavior, interest, and activities
• Nonfunctional routines/rituals (schedule) • Stereotyped/ Rep. movements • Preoccupation that is abnormal in intensity or focus |
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• Autism: Statistics
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• As high as 1 in every 500 births
• More prev. in women w/ lower IQ than 35 • More prev. in men w/ higher IQ’s • Occurs worldwide • Symptoms usually appear in the first 3 years of life • Half of ppl w/ autism have avg. or higher than avg. IQ high language ability and IQ are reliable indicators of a good prognosis |
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• Autism: Risk
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• Medical conditions: not always related to autism
• Strong genetics but not complete explanations • 8x more likely • Neurobiological evidence of brain damage • Enlarged overall brain size • Less refined connections among brain regions • Small corpus callosum • Psychosocial factors unclear |
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• Asperger’s Disorder
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• Part of autism spectrum disorders
• Similar to autism ("high-functioning autism") • Sig. social impairment • Restricted/rep. stereotyped beh. • Diff form autism: • No severe adaptive, language, and/or cognitive delays • Causes= unclear • Family history= 46% • Cortical abnormalities |
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Retts Disorder and Childhood disintegrative disorder
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Retts: 5 mon-4 years, marked developmental delays in head growth, hand (motor) coordination, lack of social interaction, and language development
CDD: normal growth for a minimum 2 year period • before age 10, child experiences loss of language, social, adaptive, play, or motor skills •2 of the 3 domains of autism are also present |
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Learning Disorders: overview
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• marked by poor school achievement in reading, math. or written expression
•cannot be explained by mental retardation b/c intelligence is usually normal • discrepancy come from school achievement (low) and potential ability to learn (normal) •related to changes in a persons brain |
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7 Learning disorders
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• Dyslexia: any learning disorder that pertains to reading/spelling problems (letter reversal)
•Dyscalculia: prob. learning math • Dysgraphia: prob. w/ writing (writing off the page or very slowly) •dysomnia: prob. naming or recalling objects (saying fork when looking at a spoon) •dysphasia: prob. comprehending or expressing words in proper sequence (trouble understanding ppl or not being able to speak logically to others) • Dyspraxia: prob. w/ fine motor movements (buttoning a shirt) • Dyslalia: Prob. of articulation or trouble saying words clearly/understandably |
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• Developmental Disorder: Treatments
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• Behavioral treatments:
• Language training: discreet trial training- higher attention • Receptive labeling, expressive speech, imitation • Self-care skills training: task analysis, chaining, feedback, reinforcement • Social skills training |
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• Developmental Disorder: Integrated model
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• Preferred treatment
• Focus on children, families, school, home • Build in appropriate comm. and social support |
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• Disruptive Behavior Disorders:
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• ADHD
• Oppositional defiance disorder |
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• Attention Deficit Hyperactivity Disorder (ADHD) subtypes
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• Subtype: Inattention
• Difficulty focusing • Difficulty completing tasks • Easily distracted • Loses necessary items • Subtype: over activity-impulsivity • Impulsivity • Hyperactivity • On-the-go • Interrupt ppl • Effects 2+ domains (school, home, work, rel.) |
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• Attention Deficit Hyperactivity Disorder: Statistics
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• Symptoms present before age 7
• Prev= 5-12% • Boys to girls 3:1 • Worldwide • Genetics: runs in fam. • DAT1: gene (but polygenetic model) • Neurobiological: low dopamine and low nonephrine • Inactivity of frontal cortex and basal ganglia • Toxins: maternal drinking or smoking • No evidence that allergens and food additives are the cause |
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• Attention Deficit Hyperactivity Disorder: Psych Risk
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• Can influence the nature of ADHD
• Often viewed neg. by others • Peer rejection=social isolation • Fosters low self esteem |
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• Attention Deficit Hyperactivity Disorder: treatments
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• Stimulants (ex. Ritalin, Dexedrine)
• Reduce core symptoms in 70% of cases • Stimulants inhibitory centers • Benefits do not last after discontinuation • Beh. Reinforcement program • Increase appropriate and decrease inapp. Behaviors • Combined w/ parent training • Bio.-psycho-social treat. • Highly recommended –superior to medication or beh. Treat. Alone |
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• Oppositional Defiance Disorder (ODD): symptoms
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• Angry and irrational mood
• Short temp. • Touchy/easily annoyed • Resentful/spiteful • Defiant and vindictive beh. • Argue w/ adults • Actively defies or refuses to comply • Blames others |
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• Oppositional Defiance Disorder (ODD): Statistics
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• Most days → several months
• Prev: 2-11% • More boys than girls • 67% remit on own • 33% progress to conduct disorder |
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• Conduct Disorder
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• Destruction of property
• Sets fire to cause destruction, vandalism • Deceitfulness or theft • Break into homes, cars, buildings • Lies for gains • Steals w/out confronting victims • Aggression to people or animals • Fights, intimidates, and uses weapons to physically harm ppl/animals • Forces sexual activity • Steals while confronting victims (robbery) • Serious violation of rules • Curfew, running away overnight, truant |
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• Conduct Disorder: stats
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• Later onset=better prog.
• More boys than girls • Manifests differently in girls • Girls= more relational aggression |
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Conduct Disorder: Psychopathy
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• Callous unemotional traits
• This is a subgroup with CD • More severe and chronic and pervasive pattern of antisocial beh. • More premeditated and instrumental beh • Less responsive to treatments |
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Conduct Disorder: Psychopathy prev
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• 2-12%
• More common in boys • girls engage in more relational aggression |
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CD Psychopathy: Real world courts
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• Transferring youth to adult courts
• 1) Juvenile justice systems • Immaturity of kids/adolescents • Treatment and rehabilitation • 2) Adult correctional facility • Confinement and retribution • You do the crime you do the time • Less treatment focused |
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• Disruptive behavior disorders (DBD): Biological risk
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• Some genetic contributions (esp. for temperament)
• Low serotonin and cortisol • Limited evidence on brain structures and function (look @ amygdala) |
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• Disruptive behavior disorders: psych risk
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• Coercive parent-child interactions (harsh inconsistent punishment w/ bad temperament in child)
• Peer rejection and deviant peer associations • Social info processing (ex. Hostile attribution bias – see ppl around them as intentions of aggressive beh. • Parental monitoring (failure to monitor peers and behaviors) • Parent attributions and community level parent factors |
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• DBD Fast track treatment project
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• Design: high risk 5 year old randomly assigned treatment or control (non-fast track)
• Grades 1-10 (longitudinal) they received intervention • 3 Prevention methods: Childhood, adolescent |
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• DBD Fast track treatment project: Childhood prevention methods
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• School Methods
• Positive behavioral supports: self-control, emotional awareness, social problem solving • Enhance home school relations • General prevention methods • For all fast track kids • Parent group sessions: self control, anger coping, social problem solving • Parent child sharing: joint activities together, practice skills • Individualized prev. methods • Academic tutoring • Home visits • Men for paring (specific to child needs) |
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• DBD Fast track treatment project: adolescent prevention methods
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• Peer affiliation and influences
• Academic achievement • Social cognitions and identity development • Parent/family relations • Outcomes (small-outside intervention or moderate- during intervention) • Improves social problem solving, emotion recognition, anger management • Reduces harsh and inconsistent parenting and increases pos. parenting/involvement • Less contact w/ legal and mental health systems |
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• Neurocognitive Disorders: overview
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• Affect learning, memory, consciousness
• Broad impairments in cognitive functioning • Profound changes in behavior and personality • Most develop in late life (after 60) |
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• Neurocognitive Disorders: Classes
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• Delirium
• Minor neurocognitive disorder (early onset of dementia) • Major neurocognitive disorder (dementia) |
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• Delirium
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• Impaired consciousness and cognition (look like they are intoxicated)
• Develops RAPIDLY over several hours or days • Appear confused, disoriented, and inattentive • Marked memory and language deficits • Prev. increases w/ age (70-80) • Full recovery often occurs w/in several weeks (very short) |
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• Delirium: med. Conditions and treatments
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• Medical Conditions (stroke)
• Drug intoxication, poisons, withdrawal • Med for stroke • Infections, head injury/trauma • Sleep deprivation, excessive stress • Treatment (all try to keep person grounded in REALITY) • Attention to precipitating problems • Psychosocial= reassurance (coping strategies, involve in treatment decisions) • Prevention= proper medical care, use and adherence to therapeutic drugs |
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• Dementia (major neurocognitive disorder)
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• GRADUAL deterioration of brain functioning in
• Judgment and memory • Language (cant respond) • Advanced cognitive processes (day to day tasks) • Has many causes and may be irreversible • Differs from delirium because its chronic and progressive |
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• MND: Stages
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• Initial stages
• Memory and visuospatial skills impairment • Agnosia- inability to recognize familiar • Delusions, apathy, depression, agitation • Later stages • Cognitive functioning continues to decline • Total support for day to day activities • Death due to inactivity and onset of other illnesses |
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• Alzheimer’s Disease: Characteristics
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• Multiple cognitive deficits
• Develop gradually and steadily • Memory, orientation, judgment, and reasoning deficits • Additional symptom: agitation, confusion, or combativeness • Depression or anxiety • “Sundowner syndrome”- later in the day they get more agitated and more confused |
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• Alzheimer’s Disease: Cognitive deficits
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• Aphasia- difficulty w/ language
• Apraxia- impaired motor fun. • Agnosia- don’t recognize familiar • Executive functioning deficits: • Planning, organizing, and sequencing • Abstracting info (balancing check books) |
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• Alzheimer’s Disease: Course
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• Until recently diagnosis=autopsy
• Deterioration is slow during early and late (rapid in middle) • Avg. survival= 8yrs w/ad • Onset in 60’s or 70’s • Prev. higher in west • Low in some ethnic groups (native Americans) • Theory: AD is considered a “natural/normal” progression so they don’t report it as MHD |
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• Alzheimer’s Disease: Biological factors
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• Dominant factors: mostly protein
• Genes concordance rate 75% →83% • Amyloid precursor protein and chromosome 21: large amount of APP • Apoe-4 and chrom. 19: highly predictive • Presenilin-1 and chrom. 14: early onset • Presenilin-2 and chrom. 1: late onset • Neurotransmitters: low acetocholine, norepinephrine, and serotonin |
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• Alzheimer’s Disease: Brain changes
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• Neurofibrillary tangles= twisted fibers inside nerve cells
• Mutation of TAU protein causes neuron structure (microtubule) to become twisted, collapse, and snarl together • Amyloid plaques (senile or neurotic)= beta amyloid proteins become insoluble and clump • Brain gradually atrophies over time |
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• Alzheimer’s Disease: Causes
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• Environmental:
• Don’t cause directly • May influence onset/course • Lifestyle factors: drug use, diet, exercise, stress • Psychosocial: • Educational attainment, coping skills, social support |
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• MND: Vascular etiology (vascular dementia)
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• Caused by blockage or damage to blood vessels
• Different form AD: • History of stroke • Obvious neurological signs of brain tissue damage • Onset=sudden • Patterns of impairment are variable (patchy) and deterioration step wise • Better retention of cog. Skills |
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• MND: Prevention
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• Be healthy
• Eat food high in antioxidants, fish oil, and low saturated fat/cholesterol • Avoid drugs and nicotine, drink moderate red wine (once a week) • Challenge your brain/body • Be happy • Stay social • Travel/ new hobbies • Manage stress and seek help for MHD symptoms /disorders • Stay up to date on scientific advances |
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• MND: Biological Treatments
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• Medications→ best if enacted early
• Few exist for most types of dementia • Most attempt to slow progression of deterioration (don’t actually stop it) • Gene therapy • Introducing new genes to higher neuron growth/regeneration • Still experimental but might have potential |
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• MND: Psych treatment for patients
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• Focus: delay onset/ progression
• Enhance quality of life • Reminiscence therapy: life review to create meaning and resolve conflict • Enhance cognitive function • Memory training: repeated practice of skills, mnemonic strategies, simplify environment • Reality orientation: consistent feedback about time, place, events and people |
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• MND: Psych treatment for caregivers
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• Educate (self) about symptoms, cause, and expected course
• Enlist resources, support, and relief • Ensure (their own) psychological and physical health • General tips: • assess and incorporate patients independence • create safe, consistent, distraction-free environment • adjust expectations: be patient and flexible • promote communication: try to see things from their view |
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• MH Degrees: Doctoral overview
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• Doctoral degrees are top of the line→ unsupervised
• Doctoral degrees= scientists AND practitioners (3 Reasons) • 1) Consumer of science: enhancing the practice • 2) Evaluator of science: determining the effectiveness of the practice • 3) Creator of science: conduct research that leads to new procedures useful in practice |
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MH Degrees: Doctoral degrees
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• Ph.D (doctor of philosophy) = research degree (science based)
• 4+ years of (research focused) grad. Training, clinical internship, and (many times) postdoctoral work (9+ years total) • Psy.D (doctor of psychology)= professional degree (clinical focus) • Similar years of training as Ph.D • Very expensive • M.D (doctor of medicine)= psychiatrists; professional degree (for most) • Medical and clinical focus • 4+ years of graduate training, 3-9 additional years of specialty training |
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• MH Degrees: lower level degrees
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• Ed.D (Doctor of education)= focus on learning and school system
• Research on interventions for effective teaching and learning • Masters degree (ex. Psychiatric social work) = professional degree • Provide clinical services (but do not do psych assessments) w/ supervision • Less school but less independence and may not be able to practice in some states • Allied fields: psychiatric nurse, family therapists, paraprofessionals… |
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• Considering a mental health degree?
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• Know yourself: identify your interests and passions
• Ask lots of ?’s and seek advice (faculty, grad students, campus groups) • Get good grades (gpa: 3.6+) and good admissions test scores • Get hands-on experience (clinical and research) • Search and keep searching • All degrees require post grad internships and clinical work |
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• Individual treatments: do they work?
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• Yes-better than no treatment
• No one treatment = best • Match treat. To disorder • Cognitive-behavioral therapy: anxiety, depression, and eating disorders • Dialectical beh. Therapy for borderline PD • Manualized treatments: instructions to the therapist conducting treat. (not appropriate for all people) |
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• Why treatment works for clients
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• Client achieves self-control
• Changes/restructures thoughts, physiological responses, and beh. • Req. a lot of practice and taking risk • Client achieves insight • Understands why they have certain thoughts/emotions and engages in maladaptive beh. • Client experiences catharsis • Release emotions, grief, anger, secrets, etc |
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• Why treatment works: therapists
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• Placebo effect: simply expecting treat. To help-helps
• Therapist characteristics • Experience: working w/ specific clients & more complex understanding of client/ course of treatment • Acceptance, empathy, respect, building hope • Therapeutic alliance: attachment to therapist • Trusting, open, honest, and productive • Good predictor of POSITIVE treat. Outcomes |
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• Why treatment works: community
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• Self-help groups: ppl w/ shared issues work together to resolve them
• Ex. AA- uncertified help, National Alliance for the Mentally Ill (MAMI)-certified professional help • Helps a lot of ppl @ once • Doesn’t always have certified professional • Public Policy= creating or influencing policies and practices at an institutional, state, or national level • Ex. testifying as an expert witness, presenting scientific evidence to legislators, etc. |
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Mental health commitments: Civil commitment criteria
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• Person has a MHD and needs treatment
-- Mental illness is a legal concept (not synonymous w/ psychological disorders) and it varies by state • Person is in danger to self/others • Grave disability-inability to care for self |
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Mental health commitments: Civil commitment 3 Stages
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1) Person fails to seek help when others feel it is needed
2) petition made to a judge-person is evaluated •immediate danger=short term commitment are made w/out formal legal proceedings 3)commitment hearing: person and attorney present witnesses examined, etc. •judge decided whether further (if any) commitment is necessary |
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Mental health commitments: Criminal commitment
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• accused of committing a crime and held in a mental health facility because:
1) they have been found not guilty by reason of insanity 2) their competency to stand trail is being evaluated |
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Not guilty by reason of insanity (NGRI)
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• not guilty of the crime if, b/c of mental illness/retardation, they were unable to appreciate the wrongfulness of their conduct AT THE TIME OF THE OFFENSE
• diagnosis of a MHD does NOT mean you have insanity • sent to a mental health facility instead of prison |
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Research on Insanity Defense (silver) & Alternatives to NGRI
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• Public views the insanity defense as a legal loophole
--Reality: NGRI defendants spend more time in a mental health hospital than they would in jail • Public thinks that NGRI is used in 37% of felonies --Reality: NGRI is used in less than 1% of felony cases • ALternative to NGRI= guilty but mentally ill (GBMI): after they get better they serve the rest of their time in prison (allows for treatment and punishment) |
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Competence to stand trial (2 areas)
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• hospitalized if, b/c of mental disease, the person can't:
1) understand the charges brought against them 2) assist w/ their own defense (don't understand the court proceedings or what is going on) • hospitalization is used to "restore" these abilities |
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4Roles of Mental Health Professionals (in legal matters)
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• The expert witness= ppl w/ specialized knowledge and expirtese by:
1) assist in competency determination 2) assisting in making a reliable DSM diagnosis 3) advise the court (regarding psych assess./diagnosis) 4) assess for malingering |
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5 Ethical Principles
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• Aspirational Goals to guide psychologists toward the highest ideals of psychology
• 5 principles: 1) Beneficence/nonmaleficence: doing good & not harm 2) Fidelity/Responsibility: uphold professional conduct 3) integrity: promote accuracy, honesty, and truthfulness 4) Justice: fairness to all ppl, preventing potential personal biases to cause unjust practices 5) Respect for peoples right/dignity: valuing and protecting privacy, confidentiality, and self-determination of others |
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Important Ethical Terms/principles
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•Informed consent: an educated agreement to enter therapy or assessment
•confidentiality: info shared w/ a clinician is privileged (exceptions: suicidal thoughts, abuse) • dual relationships: engaging in a friendship, buisness, or sexual relationship w/ a current client (highly unethical and punishable by law) --must wait 2 years to establish any type of relationship w/ former clients |
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Becoming a Client
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• ask yourself: what goal do you want to accomplish in therapy?
• get referrals from knowledgeable people • go to a specific clinic to get help with your problems • ask questions: • what are your fees and will my insurance cover it? • what should i expect? what kind of assessments do you use? |
