Difficult behaviours in CPY Flashcards
1
Q
What is disorders of intellectual development?
A
- A group of etiologically diverse conditions originating during the developmental period
- Characterised by significantly below average intellectual functioning and adaptive behaviour that are approximately two or more standard deviations below the mean (approximately less than the 2.3rd percentile)
- Based on appropriately normed, individually administered standardized tests.
- Where appropriately normed and standardized tests are not available, diagnosis requires greater reliance on clinical judgment based on appropriate assessment of comparable behavioural indicators.
2
Q
What is mild disorder of intellectual development?
A
- Approximately two to three standard deviations below the mean (approximately 0.1 – 2.3 percentile)
- Affected persons often exhibit difficulties in the acquisition and comprehension of complex language concepts and academic skills.
- Most master basic self-care, domestic, and practical activities.
- Persons affected by a mild disorder of intellectual development can generally achieve relatively independent living and employment as adults but may require appropriate support.
3
Q
What is moderate disorder of intellectual development?
A
- Approximately three to four standard deviations below the mean (approximately 0.003 – 0.1 percentile)
- Language and capacity for acquisition of academic skills of persons affected by a moderate disorder of intellectual development vary but are generally limited to basic skills.
- Some may master basic self-care, domestic, and practical activities.
- Most affected persons require considerable and consistent support in order to achieve independent living and employment as adults.
4
Q
What is severe disorder of intellectual development?
A
- Approximately four of more standard deviations below the mean (less than approximately the 0.003rd percentile)
- Affected persons exhibit very limited language and capacity for acquisition of academic skills.
- They may also have motor impairments and typically require daily support in a supervised environment for adequate care, but may acquire basic self-care skills with intensive training.
- Severe and profound disorders of intellectual development are differentiated exclusively on the basis of adaptive behaviour differences because existing standardised tests of intelligence cannot reliably or validly distinguish among individuals with intellectual functioning below the 0.003rd percen4le.
5
Q
What is profound disorder of intellectual development?
A
- Approximately four of more standard deviations below the mean (approximately less than the 0.003rd percentile)
- Affected persons possess very limited communication abilities and capacity for acquisition of academic skills is restricted to basic concrete skills.
- They may also have co-occurring motor and sensory impairments and typically require daily support in a supervised environment for adequate care.
- Severe and profound disorders of intellectual development are differentiated exclusively on the basis of adaptive behaviour differences because existing standardised tests of intelligence cannot reliably or validly distinguish among individuals with intellectual functioning below the 0.003rd percen4le.
6
Q
Explain autism spectrum disorder
A
- Persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication Range of restricted, repetitive, and inflexible patterns of behaviour, interests or activities that are clearly
- atypical or excessive for the individual’s age and sociocultural context.
- Onset during the developmental period, typically in early childhood, but symptoms may not become fully manifest until later, when social demands exceed limited capacities.
- Deficits sufficiently severe to cause impairment in personal, family, social, educational, occupational or other important areas of functioning
- Pervasive feature of the individual’s functioning observable in all settings, although they may vary according to social, educational, or other context.
- Exhibit a full range of intellectual functioning and language abilities.
7
Q
Explain ADHD
A
- Persistent pattern (at least 6 months) of inattention and/or hyperactivity-impulsivity
- Direct negative impact on academic, occupational, or social functioning.
- Evidence of significant inattention and/or hyperactivity-impulsivity symptoms prior to age 12, typically by typically early to mid-childhood, though some individuals may first come to clinical attention later.
- Degree of symptoms outside the limits of normal variation expected for age and level of intellectual functioning.
- Relative balance and the specific manifestations of inattentive and hyperactive- impulsive characteristics varies across individuals, and may change over the course of development.
- Manifestations of inattention and/or hyperactivity-impulsivity must be evident across multiple situations or settings (e.g. home, school, work, with friends or relatives), but likely to vary according to the structure and demands of the setting.
- Symptoms not better accounted for by another mental, behavioural, or neurodevelopmental disorder and not due to thee effect of a substance or medication.
8
Q
What symptoms do ADHD people get?
A
- Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organisation.
- Hyperactivity refers to excessive motor activity and difficulties with remaining still, most evident in structured situations that require behavioural self-control.
- Impulsivity is a tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences.
9
Q
What is oppositional defiant behaviour?
A
- Persistent pattern (e.g., 6 months or more) of markedly defiant, disobedient, provocative or spiteful behaviour
- More frequently than is typically observed in individuals of comparable age and developmental level
- Not restricted to interaction with siblings.
- May be manifest in prevailing, persistent angry or irritable mood, often accompanied by severe temper outbursts or in headstrong, argumentative and defiant behaviour.
- Sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning
10
Q
What is conduct-dissocial disorder?
A
- Repetitive and persistent pattern of behaviour
- Basic rights of others or major age-appropriate societal norms, rules, or laws are violated e.g. aggression towards people or animals; destruction of property; deceitfulness or theft; and serious violations of rules.
- Sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
- Behaviour pattern must be enduring over a significant period of time (e.g., 12 months or more).
- Isolated dissocial or criminal acts are thus not in themselves grounds for the diagnosis.
11
Q
Explain challenging behaviour
A
- Some people with a learning disability display behaviour that challenges. ‘Behaviour that challenges’ is not a diagnosis
- Such behaviour is a challenge to services, family members or carers, it may serve a purpose for the person with a learning disability (for example, by producing sensory stimulation, attracting attention, avoiding demands and communicating with other people).
- Often results from the interaction between personal and environmental factors
- Includes aggression, self-injury, stereotypic behaviour, withdrawal, and disruptive or destructive behaviour. Can also include violence, arson or sexual abuse, and may bring the person into contact with the criminal justice system.
12
Q
Prevalence of challenging behaviours
A
- Prevalence rates are around 5–15% in educational, health or social care services for people with a learning disability.
- Rates are higher in teenagers and people in their early 20s, and in particular settings (for example, 30–40% in hospital settings).
- People with a learning disability who also have communication difficulties, autism, sensory impairments, sensory processing difficulties and physical or mental health problems (including dementia) may be more likely to develop behaviour that challenges.
13
Q
Patterns with challenging behaviours
A
- May appear in only certain environments, and the same behaviour may be considered challenging in some settings or cultures but not in others.
- It may be used by the person for reasons such as creating sensory stimulation, getting help or avoiding demands.
- Some care environments increase the likelihood of behaviour that challenges. E.g. those with limited opportunities for social interaction and meaningful occupation, lack of choice and sensory input or excessive noise.
- Also care environments that are crowded, unresponsive or unpredictable, those characterised by neglect and abuse, and those where physical health needs and pain go unrecognised or are not managed.
14
Q
Interventions with challenging behaviours
A
- Multiple factors are likely to underlie behaviour that challenges.
- To identify these, thorough assessments of the person, their environment and any biological predisposition are needed, together with a functional assessment.
- Interventions depend on the specific triggers for each person and may need to be delivered at multiple levels (including the environmental level).
- The aim should always be to improve the person’s overall quality of life.
15
Q
Assessment of challenging behaviours
A
Systemic approach needed for all 3 disorders. As minimum:
Home- Developmental history, problems, interaction, behaviour, functional performance (telling time, money, self-care etc)
School- academic performance, social function, behavioural/ disciplinary issues
Social- Interests, friends, activities, risks, forensic history
