Exam 3 Flashcards
Intellectual Disability - Description of Disorder Criteria
- Deficits in intellectual functioning, such as reasoning, problem-solving, planning, abstract thinking, judgment, academic and experiential learning as per clinical and IQ testing.
- Deficits in adaptive functioning resulting in failure to meet standards for personal independence and social responsibility.
- Onset of IQ and adaptive functioning deficits during the developmental period
Intellectual Disability - Severity Based On Adaptive Functioning in Conceptual, Social, and Practical Domains, Not IQ Testing
- Mild
- Conceptual: In preschool, difficult to tell diff., older kids/adults difficulty learning academic skills. Adults probs. w/ abstract thinking, planning, priorities, etc., poor short-term memory.
- Social: Difficulty in age-appropriate social perceptions, picking up on social cues, concrete communication, poor emotional regulation.
- Practical: Probably age-appropriate personal care; some care required for daily tasks, health care, raising a family.
- Moderate
- Conceptual: Markedly behind, language & pre-academic skills develop slowly; Academic skills develop to elementary school level in adults. On-going assistance in daily tasks requiring conceptual tasks.
- Social: Marked differences in social scenarios & communication; most relationships limited to family and accepting friends, sometimes limited romantic relationships as adults.
- Practical: Can function re. eating, dressing, elimination, hygiene as adults, but takes more intensive teaching; employment w/ basic responsibilities w/ support; can do simple games, sports and recreational exercises.
- Severe
- Conceptual: Little understanding of reading, writing, simple math, understanding time, extensive support in life
- Social: Vocab and grammar very poor, speech here & now focus, relationships limited to family & their friends
- Practical: Support in all daily activities, hygiene, bathing, dressing, etc., poor decision making, teaching intense.
- Profound
- Conceptual: non-symbolic, poor motor/sensory skills, poor functional use objects
- Social: simple instructions in speech, limited understanding of gestures, some nonverbal coms., poor emotional regulation, doesn’t initiate own social activities
- Practical: Dependent on others for all aspects of life.
Intellectual Disability - Etiology and Prevalence
- Due to combinations of causes they are usually grouped into:
- Primarily biological
- Primarily physical
- Combination of the two
-30-40% causes are unknown
- Prevalent in about 2% of the population (used to be 2 SD below mean)
- 1.5 to 1 male to female ratio
Intellectual Disability - Biological Influences
- Biological causes:
- chromosomal abnormalities, prenatal exposure to toxins, problems due to pregnancy, or medical conditions that develop in childhood or infancy
- Specific biological etiologies (about 80%)
- PKU
- Tay-Sachs Disease and Fragile X Chromosome Syndrome
- Down’s Syndrome (trisomy-21)
- Others:
- early deprivation of nutrition or oxygen
- HIV or viral infections
- injury to head or brain (resulting in specific problems)
- lead poisoning
- infections such as meningitis
Intellectual Disability - PKU
- A rare metabolic disorder where an enzyme that breaks down phenylalanine isn’t present.
- The infant appears normal at birth, but the build up of this amino acid in the blood leads to brain damage.
- Preventable if put on a low phenylalanine diet at early age, preferably before 6 months old
Intellectual Disability - Tay-Sachs Disease and Fragile X Chromosome Syndrome
-Only in males, large head, enlarged testes, violent, cognitive impairment
Intellectual Disability - Down’s Syndrome (trisomy-21)
- (10-30% of all cases of moderate to severe) extra chromosome at 21st pair.
- Often have heart problems and other physical disorders
Intellectual Disability - Psychosocial Influences
- Specific psychosocial causes (about 20%)
- Deprivation of nurturance
- Social and cognitive stimulation
- Poverty
- Deprivation of nurturance
Intellectual Disability - Influences of Poverty
- Exposure to poverty during childhood can influence health, wellbeing, educational opportunities, and deficits in general experience.
- 28% of children with intellectual disabilities found below federal property level in comparison to 16% of non- disabled children.
- Poverty can bring exposure environmental and psychosocial hazards, which negatively affects intellectual development.
- e.g., poor nutrition, temperature extremes, environmental toxins
Intellectual Disability - Treatment Approaches
- Identity skill deficits or targets for training
- Conduct task analysis (steps necessary to perform task)
- Differential reinforcement
- Shaping
- Promoting
- Fading
- Incidental Teaching
- Discrete trials
- Referrals to Association for Retarded Citizens (ARC) and other support systems
- Parent training to manage behavior problems of child
Intellectual Disability - Identify skill deficits or targets for training
-Common examples: dressing, self-care skills, social skills
Intellectual Disability - Conduct task analysis (steps necessary to perform task)
-Decide method of chaining to be used to teach skill
- Backward starts from last sequence in response chain, then next to last, etc.
- e.g., teaching to put on shirt.
- Forward starts from 1st sequence in response chain, then 2nd response, etc.
- e.g., teaching a child to wash dishes.
Intellectual Disability - Differential reinforcement
- Reinforce desired behavior and ignore undesired behavior
- e.g., if child does stereotypies w/ hands, reinforce child for playing w/ hands
Intellectual Disability - Shaping
-Reinforcing successive approximations towards the desired behavior
Intellectual Disability - Prompting
-Pointing, instructing, modeling, visual cues, physical guidance
Intellectual Disability - Fading
-Start with minimal level of assistance necessary and fade out assistance with increased learning
Intellectual Disability - Incidental Teaching
- Wait for child to show interest in something, and elaborate on the stimulus event
- e.g., “bees bad” would be opportunity to discuss what bees do, how make honey, etc.
Intellectual Disability - Discrete Trials
- prompt provided
- child responds
- consequence provided
- Example:- Therapist: What is this?
- Child: Apple
- Therapist: (delivers candy)
- consequence provided
Specific Learning Disorder
-Difficulties learning and using academic skills
- 1 of the following in past 6 months despite provision of intervention targeting the deficit.
- Inaccurate/slow and effortful reading (reads single words incorrectly/slowly/hesitatingly, guesses words, difficulty sounding words out).
- Difficulty understanding meaning of what read.
- Difficulties spelling (add, omit, substitute vowels)
- Difficulties w/ written expression (multiple grammatical errors, poor paragraph organization, written ideas lack clarity)
- Difficulties mastering # sense, # facts, or calculation (lack # comprehension, magnitude, finger counting)
- Difficulties w/ math reasoning (applying math concepts, facts, procedures)
- Learning difficulties start during school age yrs.
- Not due to:
- intellectual disabilities
- sensory problems
- psychosocial adversity
- language of instruction
- inadequate educational instruction.
- The academic skills substantially and quantifiably below expected by age, causing academic/occupational/daily probs confirmed by standardized achievement tests and clinical assessment.
- 17 years and older may substitute standardized assessment w/ documented hx. of impairing learning difficulties.
Specific Learning Disorder - Prevalence
- 5 to 15% in kids
- 5% in adults
- Males to Females: 2:1 to 3:1
Specific Learning Disorder - Etiology and Prevention?
- Cognitive impairments in ability to process rapid, transient stimuli
- Lack of educational instruction at home
- Genetic
- Isolated chromosomes 6 and 15
- Left temporal and left parietal lobe deficits.
- Other less supported influences include exposure to:
- toxins
- early iron deficiency
- food allergies
- malnutrition
- Early Prevention Best:
- When identified in 1st or 2nd grade = 82% of youth brought up to regular classroom
- When identified in 3rd grade = 46%
- When identified in 5th to 7th grade = 13%
Specific Learning Disorder - Treatment Approaches
- Reading
- Math
- Written Expression
Specific Learning Disorder - Treatment Approaches for Reading
-Positive Practice
-Instruct child to read sentence
-If error occurs, say nothing until child reaches end of sentence as child may correct him/herself
-Ask child to attempt to sound out the word correctly
»If can’t pronounce word: tell child correct word and instruct child to repeat word 2 or 3 times
-Instruct child to repeat sentence
- Question Games (Ask child questions about passage)
- Start w/ 2 sentences and work up to a paragraph, page, etc.
- Start w/ easy questions and progressively get more difficult
- Be praiseworthy
- Frequent breaks but not after undesired behavior
- Focus on headings and subtitles
- Ask self-questions
- Use self-instructional training to stay on task
- Read 1st and last sentence of paragraph
- Self-rewards
- Parent rewards
Specific Learning Disorder - Treatment Approaches for Math
- Teach to verbalize the steps needed to solve problem
- Self-instruct through the problem
- Positive Practice
- Instruct child to attempt math problem
- If error occurs, say nothing until child completes the problem as child may self-correct
- Show child correct solution and instruct child to solve problem 2 or 3 times
-Question Games
-To improve comprehension and excitement
»Guess what solution might be
- Be praiseworthy
- Take frequent breaks but not after undesired behavior
- Focus on instructions
- Ask self-questions
- Read 1st and last sentence of instructions for problems
- Self-rewards
- Parent rewards
Specific Learning Disorder - Treatment Approaches for Written Expression
-Handwriting
-1. Teacher models writing large letter while saying the name
-2. Student traces teacher’s letter while saying the name
-3. Student copies the letter while saying the name
-4. student writes the letter from memory
-5. Student practices words while providing self-instructions
»First I make one hump, then a 2nd one.
-Spelling
-Positive practice
»Child writes correct word several times
Pica
- Persistent eating of nonnutritive substances for at least 1 month
- Inappropriate to developmental level
- Not part of culturally sanctioned but practice
Pica - Prevalence
-More common in males than females, rare, may occur during infancy
Pica - Treatment
-Differential Reinforcement of Other behavior (DRO)
- Overcorrection
- ex. Put all cigarette butts in garbage, clean paint chips from wall and put in garbage
- Time-out (see ODD)
- Firmly state, “No!”
Anorexia Nervosa
- Restriction of energy intake leads to significantly low body weight
- Intense fear of gaining weight or doing things to not gain weight when too thin.
- A distorted body image
- Types:
- Restricting Type - not regularly engaged in binge-eating or purging
- Binge-Eating/Purging Type - regularly engages in binge-eating or purging
Anorexia Nervosa - Signs and Symptoms
- Dieting despite being thin – Severely restricted diet. Eating only certain low-calorie foods. Banning carbohydrates and fats.
- Obsession with calories, fat grams, & nutrition – Reading food labels, measuring and weighing portions, food diary, reading diet books.
- Pretending to eat or lying about eating – Hiding, playing with, or throwing away food to avoid eating. Making excuses to leave meals.
- Preoccupation with food – Constantly thinking about food. Cooking for others, collecting recipes, reading food magazines, making meal plans while eating very little.
- Strange or secretive food rituals – Refusing to eat around others or in public places. Eating in rigid, ritualistic ways (e.g. chewing food and spitting it out, using a specific plate).
- Dramatic weight loss – Rapid weight loss - no medical cause.
- Feeling fat, despite being underweight
- Fixation on body image – Obsessed w/ weight or body shape (clothing size). Frequent weigh-ins, and concern of fluctuations.
- Harshly critical of appearance – Spending a lot of time in front of the mirror checking for flaws.
- Denial of being too thin – Deny low body weight is a problem, while trying to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized clothes).
Anorexia vs. Bulimia
- Anorexia:
- Low body weight
- Bulimia:
- Maintain body weight
Bulimia Nervosa
- Frequent episodes of binge eating (w/in 2 hrs) more food than what would be typical in same time period under same circumstances;
- Recurrent inappropriate compensatory behaviors to prevent weight gain (laxatives, vomiting, exercise, diuretics)
- Compensatory behaviors occur at least 3x/wk. on average
- Self-evaluation unduly influenced by body shape and weight
- Does not exclusively occur during anorexia
