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43 Cards in this Set
- Front
- Back
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evolution degeneracy theory |
19th century, intellectual disability was attributed to the regression to an earlier period in human evolution. People with ID were seen as a disease to society and rejected socially |
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General Intelligence functioning; what is normal? is it stable? |
GIF= IQ= verbal, spatial, reasoning, WM, attention - first intelligence tasks developed by simon and binet - normal IQ is 70-130, under 70 is not good - IQ is relatively stable over time (although CAN change) , except during infancy (stabilizes around age 4)
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people with ID often have trouble not only with IQ but with... what are the 3 domains? |
adaptive functioning- how they cope with demands, how able to live indepedently etc - include conceptual skills (academic skills, time, money, reading/writing), social skills (interpersonal, responsibility, following rules, avoid victimization), and practical skills (self grooming, taking transportation, daily routines, housekeeping)
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IQ stability in people with ID; Flynn effect |
- people with ID have stable IQ even from very young infancy, unlike the rest of the population - this appears to be true for mild- severe levels of ID;
Flynn effect is that IQ is steadily increasing over time - can just be from simple explanations like familiarity with IQ test measures |
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DSM diagnostic criteria for ID (A, B, C) |
disorder with onset in developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social and practical domains. 3 criteria must be met:
1) deficits in intellectual functions such as reasoning, problem-solving, planning, abstract thinking, judgment, learning- confirmed by both clinical assessment and standardized testing 2) Deficits in adaptive functioning that result in fialure to meet development and sociocultural standards for independence and responsibility. Without ongoing support, there are impairments in at least one area of life
3) onset of deficits during developmental period
Specify: mild, moderate, severe, profound
** note that there is no specific IQ cutoffs |
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Describe the severity for intellectual disorder |
A) MILD = IQ 55-70 - some learning difficulties, immaturity, difficulty regulating behaviours, may need some support with daily living compared to peers but not much
B) MODERATE = IQ 40-54 - conceptual skills lag behind peers, language and academic skills slow, marked communication impairment, has friendships with others with communication problems, can preform daily routines independently only after extensive teaching
C) SEVERE = IQ 20-39 - has few conceptual skills, needs caregivers throughout life, very limited language, understands simple speech + gestures, needs long term teaching to acquire any skills
D) PROFOUND = IQ 20 or 25 - may use objects in goal-directed fashion, can match and sort, limited understanding of communication and symbols, can enjoy relationships, is dependent on others for all aspects of life. |
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The severity ratings are based primarily on___. What is the % of each in those with ID? when are they identified? |
ability and needed support rather than IQ; Mild: 85% - typically not identified untill elementary school years - overrepresentation in low SES minority
Moderate: 10% - usually identified earlier- in preschool years - applies to many people with Downs
Severe: 3-4% - often associated with clear organic cause like FAS- usually identified at very young age Profound: 1-2% - usually identified at infancy- almost always clear organic cause and often co-occurs with severe medical conditions |
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What is the prevalence of ID in general population? |
- about 1-4% - 1.6: 1 male to female ratio for mild, and may be similar for other severities - - more prevalence in low SES, minority, but differences only apparent for LESS severe ID |
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What is the most common cause of severe intellectual ability? |
chromosome abnormalities like seen in Downs
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Developmental -versus- difference controvery |
do all children progress through same developmental milestones in a similar sequence at different rates, or do ID children develop in a less sequential, less organized process
Similar sequence hypothesis: all children regardless of intellectual ability pass through the same stages in same order just maybe at different rates Developmental hypotheses: Similar structure hypothesis: if children with ID are match to normal children by their mental age, then you will see the same behaviours and underlying processes. Like above, this posits that these kids just go through the stages slower, and that they have an upper limit of attainment
Difference hypothesis: cog development of ID children differ in more than just rate and upper-limit. This suggests that if you match and ID with another child of the same mental age, the ID child will show different cognitive processes and problem-solving
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Is the developmental or difference hypothesis supported? |
developmental supported for children with familial not organic types of ID, except for those with autism or brain abnormalities - similar structure hypothesis supported for familial disabilities with the exception of slight memory and info processing deficits - organic ID (like Downs) is more straightforward: they will have one or more specific deficit areas, but pass through the same developmental sequences otherwise |
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Social, emotional, and Cognitive Deficits in ID (8) |
- lack motivation (set lower goals, expect little success) - language deficits, especially in Downs - many have problems developing secure attachments - deficits in internal state language - greater risk for emotional disturbance and psychopathology - self-injurious behaviour common (1 in 5) - ADHD related symptoms common - internalizing problems |
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slowing and stability hypothesis |
children with Downs will alternate between periods of gain in function and periods of plateau |
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life expectancy of ID; What are the 3 factors that may cause ID? |
- Downs= 60 years - much more chronic health symptoms
Causes: - genetic factors: general heritability of Intelligence is about 50%, rare conditions associated with ID also inherited- neurobiological influences (prenatal, perinatal, postnatal)- environmental influences (deprivation of physical and emotional care, social stimulation, and early learning environment ) |
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Eitiologies of ID (2) Where is each most prevalent? |
- organic: - categorical- present of absent due to rare events - clear biological basis; includes chromo abnormalities, single gene conditions, and neurobiological influences - tend to be moderate, severe and profound cases, thus prevalence comparable across SES groups
Cultural/familial - on a continuum- there is variability - no clear cause, includes family history of ID, economic deprivation, inadequate childcare, poor nutrition, parental psychopathology - tend to be the more milder cases - higher rates in lower SES and minority
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Neurobiological Influences on ID |
- pregnancy and deliveries account for 10% of iD - FAS (especially during first trimester) ... pg 147 |
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Terminology + ID euphenism treadmill |
- historically whatever term has been used to define this condition has shifted to become an insult and offensive “euphemism treadmill"- idiot, imbecile, moron, were all once neutral terms used to describe ID- these terms were phased out in favour of mental retardation (DSM-4)
- now MR is seen as offensive, and advocates prefer intellectual disability of developmental disability and this is what is used in DSM 5 |
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Describe the WISC, what is average performance? |
- standardized - procedures for administering the tasks are highly specified - where to sit, how to interact - norms have been established- performance can be compared to other children of same age and gender- average performance is 100, standard deviation of 15 |
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What are some criticisms of the WISC? (4) |
- test knowledge associated with the cultural majority- focus on speed of processing - children with behaviour difficulties are likely to under perform
- tests do not perform well below mild ID level aka floor effects- good at making distinction between high and average, but not good at distinguishing between 40 and 60 and so everyone below that level ends up just doing really bad |
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What is the Videland? |
- Vineland Adaptive Behaviour Scales - Vineland is semi-structred, and thus interviewer has a lot of latitude - excellent for building rapport with parents- interviewer given a number of general questions and a set of more specific probes if needed |
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What are the 3 domains of the Vineland and the 3 subcategories of each? |
a) communication:-receptive language (listening+ following instructions);- expressive language (point when offered choice, use phrase with an and noun);- writing (own name, prints more than 20 words for memory) b) living skills:- Personal (drinks from cup, asks to use toilet) ;- Domestic (careful with hot/sharp objects;- Community (tell time, identify coins)
c) socialization:- interpersonal relationships (can express two or more emotions, make friends, looks at face of parent);- play and leisure time (respond to playfulness, play simple game, able to share);- Coping skills (controls angry feelings, changes easily from one activity to the next) |
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What are the three categories of Specific Organic syndromes and examples? |
Chromosome abnormalities: - most common cause of Severe ID - fragile X= X chromo inherited - Downs= trisonomy 21, mostly random - Prader- willi and Angleman= chrom 15, random
Single - gene problems: - PKU- cant metabolize phenelalynine, inherited
Neurobiological ingury - prenatal- FAS - Perinatal- Anoxia at birth - Postnatal- head injury
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Prevention of ID |
- prenatal screening ( test available for Downs, but ethics...) - prenatal care- reduce injury, good delivery, mothers health - early childhood care- lead paint, SES, stimulation by speech and environment |
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How many words per hour does a toddler with parents who have advanced degrees hear? What about without a uni degree? What about welfare? |
2100 in an hour or 45 million by the time they are 2 1251 words or 25 million 616 words per hour or 10 million |
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Carolina Abecedarian Study: methods, results at age 2, age 21 |
- low income famlies- 4 cohorts of children - randomly assigned as infants to receive full-time educational intervention at a project-run childcare centre OR to be cared for at home or in another care centre- offered enriched environments from infancy through preschool (lasted 5 years) - individualized education program, focus on language, games- by age 2, children who were receiving the program have higher test scores (IQ and math+reading) than children in control group and these were maintained over time - their scores stay higher over a prolonged period of time- still saw differences at age 21
- a larger percentage in intervention went to college |
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Cost - benefit of intellectual programs in low SES? |
- high scope perry preschool study : for every dollar spent on the program, the general public got 12.90 back- fewer crimes, increased taxes when the kids grew up
- yes intervention is costly but you get more than it back |
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Behavioural treatment for ID |
- basic principles of behavioural treatment: positively or negatively reinforce behaviours you want to see + administer consequences / remove rewards for behaviours you don’t want - building life skills like eating, modelling behaviour - also aimed at speech shaping, social skills, self-injurous behaviours and pica
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Family oriented strategies for ID; Residential treatment |
- individual services are more effective when family is involved - PMT for basic skill acquisition rather than problem behaviour reduction Residential Treatment- serious and dangerous behaviours such that the child requires full-tim supervision- intensive treatment programs- full or part time- research has shown that family involvement is critical- home visits, parental involvement |
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Risk factors for mental illness: poverty MTO study methods; what % used voucher |
- operated from 1994 to 1998- Baltimore Boston Chicago LA NYC- eligible families with children living in public housing or high poverty neighbourhoods (poverty rate >40%)- 4608 families volunteers and were assigned to 3 groups: 1) a voucher to move into private market housing in a low poverty neighbourhood 2) got the voucher but didn’t have to move to a lower poverty neighbourhood 3) given services but no voucher - only 47% used the voucher to moved in restricted group, 68% in the non restricted group moved, but mostly to low poverty areas
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what are the characteristics of the MTO sample? |
- 22% of household heads were employed- 87% single parent female headed houses- Baltimore and Chocago sampkes re almost 100% african american- LA, NY roughly 50% african american, 50% hispanic
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what were the outcomes of the MTO? Why the results for girls? |
- assignment to either of the mobility groups led to adults feeling safer and more satisfied - improved mental health outcomes for girls: the low poverty voucher group had less psych distress fewer behaviour problems, section 8 group had less depression, both moving groups less GAD - made male youth have more risky behaviour- maybe more likely to get arrested now - MTO had no detectable effects on the math and reading achievement of kids - Why? neighbourhood wealth can effect children in dif ways. access to resources might be more helpful, but might make them more aware of their relative deprivation. - Safety may mean dif things to girls and boys |
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Risk factors : child abuse Describe the nurse- family partnership program overview. What were the targeted outcomes? |
-child abuse= risk factor for many types of disorders: conduct, depression, bulimia - support for mothers at risk- low income, single, young - treatment model: structured home visits, education and social support, high intensity during pregnancy, high intensity right after pregnancy - lower intensity after age 2 1/2 NFT target outcomes- pregnancy: smoking + sub use, premature births- caregiving: abuse, neglect- Maternal life course: education and employment, number and spacing of additional births- long term youth behaviour |
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NSF participants + design |
- 400 pregnant women - 62% unmarried - 47% younger than 19 - 61% working poor - 89% Caucasian Design= random assignment to : a) usual services group= going to clinic, b) NSF visitation during pregnancy only c) NSF visitation during and after |
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Outcomes of NSF |
In mothers: - 25% less smoking - fewer infections - fewer preterm deliveries
In kids: - 27% less ER visits, - 56% fewer accidents, - 80% less abuse - fewer runaways - fewer arrests, convictions, probation violations 15 years later |
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What was the design/methods of MacMillin et al. the NSF spinoff study? who were the participants? what was the goal? targeted outcome? |
- in Olds NFP program, women are visited during pregnancy- can a similar program when children are older stop child abuse?- nurse-home visitation program targeting stopping recurrence of child abuse- families recruited from child protection agencies- physical abuse/neglect had occurred in previous 3 months- child was still living with families - randomly assigned to treatment group (standard services, home visits by a nurse every week for 6 months then every 2 weeks for 6 months then monthly for 12 months, nurse visits focused on family support, education and helping them get services) and a control group: standard services provided by child protection agency- goal of treatment was to reduce stressors and increase support- outcome was looking at cases of abuse or neglect
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what were the outcomes of the NSF spinoff study? |
- intervention had no effect, no dif between groups- were not seeing lower rates of recurrence n intervention group and the cases were as severe as in the control group- suggests that once a family is involved with CPS it may be hard to help
- importance of intervening before |
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Parental Psychopathology + mental illness, what works best? |
- associated with a number of problematic outcomes in childhood - primary prevention of targeting children in general has not been very effective - programs targeting high-risk samples work better
- children of parents with depression are at higher risk for developing a depressive disorder |
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Describe the Clarke et al. Group CBT study |
* coping with stress course * reduce negative thoughts before sub-clinical symptoms become more signficant * can we: reduce symptoms? prevent depressive episodes? |
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Results of Clarke et al. |
- right after (post) see a decrease in self reported symptoms, effects are maintain at 12 months but comes back up at 24 months- are seeing significant improvement * youth in experimental group were less likely to experience a depressive episode than youth in control group
* at 16 months, 90% of youth in experimental group remained non-depressed, compared with 70% in control group |
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Garber et al |
- same as Clarke et al. but 8 week 90min sessions, 6 months - rate of depressive episodes lower in CBT group - symptoms declined at greater rate in intervention group - demonstrates that this intervention can be delivered other than those who designed the intervention |
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does treatment really work? is it being used? |
- far less evidence about effectiveness relative to efficacy - evidence based treatments not widely being used in usual care- much more based on therapist personal preferences -therapists in comity mental health clinic report using more psychodynamic techniques during treatment of depression than cognitive and behavioural techniques
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why arent evidence based treatments being used |
* efficacy vs effectiveness * rapport (client not liking begin on a manual or exposure cause its stressful) * manuals too inflexible (may miss sessions, or too distressed to do it on a given day) |
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Is evidence based practice associated with greater improvement in treatment? |
* plotting the avg level of depression symptoms from youth in the CBT arm of randomized controlled trials |
