final Flashcards
APA code of ethics
guides behavior of clinical psychologists in dealing with confidentiality, multiple relationships, informed consent, competence
aspirational APA code
-philosophy of how they expect you to each, nonenforceable
-general principles section describes an ideal level of ethical functioning or what to strive for
enforceable APA code
-ethical standards sections includes rules of conduct that can mandate minimal levels of behavior and can be specifically violated
general principles of APA
-beneficence and nonmaleficence
-fidelity and respobsibility
-integrity
-justice
-respect for peoples rights and dignity
beneficence and nonmaleficence
-benefit people and do not do harm
-strive to protect the rights and welfare of those with whom they work professionally with (clients, animals)
fidelity and responsibility
-professional and scientific responsibilities to clients and society
-psychologists have a moral responsibility to help ensure that others working in their profession uphold high ethical standards
integrity
-be honest and forthright
-never deceive or misrepresent
justice
-equality for all
-be fair and impartial, practice within competence areas
respect for peoples rights and dignity
-autonomy and confidentiality
-psychologists should respect right to dignity, privacy, and confidentiality of those they work with professionally
10 ethical standards
-resolving ethical issues
-competence
-human relations
-privacy and confidentiality
-advertising and other public health statements
-record keeping and fees
-education and training
-research and publication
-assessment
-therapy
most common violations of APA issues
-confidentiality
-multiple relationships
confidentiality
-keeping information between client and therapist private is an ethical obligation
when is it permissible that therapist breach confidentiality
-danger to self or others
-disclose of intention to commit a crime
-suspected abuse of child, elderly person, resident of institution or disabled person
-court orders therapist to make records available
expectations to confidentiality
-clerical people handling information
-therapist consults with experts/peers
-therapist is receiving supervision
-sharing information with other mental health professionals with clients consent
duty to warn
when a psychologist believes that their client may hurt or kill a particular person, it is the psychologists duty to warn the authorities, victim and victims family
duty to protect
psychologists need to protect their clients and the general public from those that can be a danger to the public
Tarasoff case
-college student told his therapist he was going to kill his girlfriend (Tarasoff)
-therapist contacted campus police who detained him but was released
-he killed her
-family sued and won saying that the therapist had duty to warn potential victim
confidentiality when client is child
-parents have right to be informed
-often make arrangements by discussing with families upfront
-some issues such as child abuse require breaking confidentiality to protect child
dual relationships
-relationships with a power differential, potential for exploitation or where a loss of objectivity is present
no romantic relationships with previous clients can happen until
2 years after therapy has ended
psychologists may be expert witnesses for
-personal injuries
-child custody
-competence
-insanity
-predicting dangerousness
-memory
spyder cystkopf
-65 yr old man who strangled wife in domestic argument
-attempted to disguise her death as suicide
-law abiding, non violent, socially conforming man
-subarachnoid cyst in frontal lobe and first time brain imaging was used for a trial
-was found not guilty as there was a dysfunction in his brain
5th amendment
protection against self incrimination
6th amendment
assistance of legal counsel, right to confront accusers, right to trial by a jury of peers
dusky standard for competence to stand trial (1960)
defendant must have:
-sufficient present ability to consult with their attorney (capacity to assist counsel) with a reasonable degree of rational understanding
-a rational as well as factual understanding of the proceedings against him/her
macaurther competence assessment tool for criminal adjudication (MacCAT-CA)
-measures abilities related to dusky standard in semi-structured 22 question interview that are scored based on criteria related to:
-understanding (factual understanding)
macaurther competence assessment tool for criminal adjudication (MacCAT-CA)
-measures abilities related to dusky standard in semi-structured 22 question interview that are scored based on criteria related to:
-understanding (factual understanding)
-reasoning (capacity to assist counsel)
-appreciation (rational understanding)
-scoring based on norms established in national study from adults in jails, prisons, and forensic psych hospitals
MacCAT-CA procedure
-defendant is read hypothetical vignette
-understanding: address general roles and responsibility of prosecuting attorney, defense attorney, elements of a criminal offense, responsibilities of the judge, jury, sentencing and rights (Dusky standard)
-defendant must use logical reasoning in relation to legal information
-given information and needs to decide which piece of info has greater legal relevance to hypothetical situation
-weight alternatives in risk benefit format (plea or go to trial)
appreciation of MacCAT-CA
examine expectations of the defendant regarding their own case such as disclosing info to attorney, assistant from attorney, likelihood of being convicted, severity of punishment if convicted, and expectations about being treated fairly by the court
Evaluation of Competency to Stand Trial-Revised (ECST-R)
-uses semi-structured interview format with 18 items and 3 scales to asses factual and rational understanding of courtroom proceedings and ability to consult with counsel
-includes items and scared to screen for “feigned incompetence”
-developed to better address psychological abilities of Dusky v US and to provide clinicians with a standardized method of assessing feigned incompetence
4 sections of ECST-R
-nature of the attorney-client relationship (consult with counsel)
-factual understanding of courtroom proceedings
-rational understanding of courtroom proceedings
-atypical presentation (for feigned incompetence)
feigned incompetence
pretending to be incapable or insufficient at some task so that someone else will do it for you/to get out of trial?
social/educational background of dr denburg client
-intact household in midwest
-graduated highschool, got a BA and a masters
-single, only had girlfriend during graduate school
-no criminal history or substance abuse history
occupational background of dr denburg client
-military for 5 years in Afghanistan (honorable discharge), worked in construction not combat but was part of gun fire, friendly fire, etc
-returned to civilian life, worked in carpentry bit had to stop due to physical sensations such as eye, depression, feeling emotionally numb
dr denburg trial referral
-went to the west coast and was paranoid of west coast and the police
-late onset schizophrenia disorder
-“not the same after college”-mother (flat affect)
-arrested with pipe bomb/bomb
IQ scores of dr denburg trial client
-bright guy
-high scores except in processing speed, he was slow
-also bad at psychomotor speed tests(trail making test)
MMPI clinical scale for dr denburg trial client
-he was over reporting symptoms and had a spike in scale 6 (paranoia)
competency findings of dr denburg trial client
-MacCAT-CA: incompetent (felt harassed and followed by law enforcement, thought current lawyer is better and old, jury will realize the pipes were for invention and will receive lower sentence because it was for betterment of people’s lives)m
-ECST-R: competent (little evidence of psychotic behavior, no feigned incompetence, moderate impairment
DSM-5 diagnosis and determination of dr denburg trial client
-schizophrenia
-PTSD
found to be incompetent
old age statistics
-65 years +
-35 million in US
-12% of the population is 65+
projected rise of older aged americans by 2030
20% of population in US
fastest growing population
85 and older
sex ratio for older adults
W:M –> 3:2
Jeanne Calment
-lived to be oldest person 122 years old
-outlived daughter and grandson (both lived to be 36)
-last known person to meet van gogh
-lawyer gave her $1000/month for her apartment when she was 90 but she outlived him and he died (wife and kids had to keep paying)
-moved into nursing home at 110
-never worked, maybe low life stress
Jeanne Calment lifestyle
-smoked from 21 years old to 117 (2 cigarettes/day)
-poured olive oil all over food and skin
-drank 2 glasses of port per week
-ate one kilo of chocolate per week
changes in graphs for older ages (japan)
shift from pyramid (lots of young little older) to a rectangle (pretty much all equal)
-called rectangularization
iowa older adult demographics
-iowa has 3rd highest population in nation of 65+
-highest 80+ population
cognitive changes in normal aging
-changes are mild
-slowed speed of processing
-novel tasks may be more difficult
-recalling names can be particularly difficult
-often referred to as benign senescent forgetfulness or age associated memory impairment
highest decline of cognitive changes
executive functioning (affects gray matter and frontal lobe)
paradox of aging big takeaway
well being increases with age
paradox of aging video
-changes in aging population are due to culture
-older adults experience more mixed emotions (happy & sad)
-older adults are able to accept sadness better
-direct more cognitive power to more positive images
-realizing that they won’t live forever changes outlook in positive way
-as people’s bodies age/more morbidity, they are more content with life and themselves
Hartshorne and Germine (2015)
-used wexler memory and intelligence scales
-there is some decline at 30 years old
-everything begins to decline at 60
-vocab improves and then at 50 decreases
socioemotional selectivity theory (carstensen)
-motivational theory: suggests that secondary to an understanding of constraints on life longevity, older adults alter their strategies for emotional regulation
-do not focus/get as upset over things because they see time as short
-older adults focus on and demonstrate a bias towards positively valenced material
-data from several cognitive domains support this theory
positivity bias: emotional memory (denburg et al)
-correctly recalled items
-interaction effect where older adults remember positive items better than negative
-they recalled neutral items the worst
Denburg, Derksen (2014): older adults catch up to younger adults on
learning and memory task that involved collaborative social interaction, used a barrier task with pictures that approximates real world communication and encourages participants to problem solve collaboratively, shows that older adults are capable of learning and retaining new information, on par with younger adults when the task involves collaborative, social interaction
starting at age 65, prevalence of dementia ___ in each decade
doubles (5%–>10%)
prevalence of dementia by 85 years old
17%
“normal” aging is associated with
-variable degrees of cognitive weakness, cortical atrophy, accumulation of Alzheimer type pathology, and reduced cerebral blood flow
civil commitment laws
legal proceedings that determines a person is mentally disordered and may be hospitalized, even involuntarily (depends on each state)
Mrs E. P. W. Packard
in 1800s, crusaded for better civil commitment laws after being involuntarily confined to psych hospital for 3 years because her husband felt her religious views were dangerous to spiritual interests of his children and the community
conditions for civil commitment
- the person has a “mental illness” and is in need to treatment
- the person is dangerous to him/herself or others
- the person is unable to care for himself, a situation called “grave disability”
police power
government takes responsibility for protecting the public health, safety, welfare and can create laws and regulations to ensure this protection
parens patriae power
state applies this when citizens are not likely to act in their pwn best interest (mental health commitment, grave disability, do not recognize need for treatment)
general process of civil commitment
- petition by a relative or mental health professional submitted to judge
- court may request examination to assess psychological status, ability for self care, need for treatment, and potential hard
- judge takes information and decides if commitment necessary
rights of person in civil commitment
-similar to any case
-can request just hear evidence and make determination
-must be present during trial
-must have representation
-can examine witnesses and request an independent evaluation
court-ordered assisted outpatient treatment
a person with severe mental illness agrees to receive treatment as a condition for continuing to live in the community
mental illness
legal concept, severe emotional or thought disturbances that negatively affect an individual’s health and safety
mental illness is not synonymous with
psychological order (receiving a diagnosis according to DSM does not necessarily mean that a person’s condition fits the legal definition of mental illness)
dangerousness
tendency to violence that, contrary to popular opinion, is not more likely among mental patients
black males and violence/commitments
-black males are perceived as dangerous even when they don’t exhibit any violent behavior
-may explain why black individuals are over represented among those who are involuntarily committed to state psych institutions
Psychopathy Checklist Revised (PCL-R)
risk assessment tool used to identify person with psychopathy, best for identifying those at low risk of being violent but only marginally successful at accurately detecting who will be violent at later point
O’Connor v Donaldson, 1975 Supreme Court
-Kenneth Donaldson’s parents committed him to Florida State Hospital for paranoid schizophrenia (not considered dangerous)
-Dr O’Connor refused to release him for almost 15 years in which he received no treatment
-Donaldson sued and won $48,500
-Supreme Court found that a State cannot constitutionally confine a non-dangerous individual who is capable of surviving safely in the freedom of himself or with help of willing and responsible family and friends
Addington v Texas (1979)
supreme court ruled that more than just a promise of improving quality of life is required to commit someone involuntarily
-if non-dangerous people with mental illness can survive in the community with help of others they should not be detained against will
-limited government’s ability to commit individuals unless they were dangerous
criminalization
-restrictions on commitments tightened
-many who would normally have been committed to mental health facility were being handled in criminal justice system
-they were not receiving mental health services
deinstitutionalization
systematic removal of people with severe mental illness or intellectual disability from institutions like psych hospitals
in 1980s, there was an increase in
number of people who were homeless
% of homeless with severe mental illness (schizophrenia or bipolar)
30%
2 goals of deinstitutionalization
- close the large state mental hospitals
- create a network of community mental health centers where the released individuals could be treated (was not attained)
transinstitutionalization
movement of people with severe mental illness from large psych hospitals to nursing homes or other group residences, including jails and prisons, many of which provide only marginal services
criminal commitment
people are held because 1) they have been accused of committing a crime and are detained in a mental health facility until they can be assessed as fit or unfit to participate in legal proceedings against them or 2) they have been found not guilty of a crime by reason of insanity
actus rea
physical act
mens rea
mental state
M’Naghten rule (1843)
It must be clearly proved that at the time of committing the act, the party accused was labouring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing or if he did know it, that he did not know he was doing something wrong
Durham rule (1954)
an accused is not criminally responsible if his unlawful act was the product of mental disease or mental defect
American Law Institute (ALI) rule (1962)
- a person is not responsible for criminal conduct if at the time of such conduct as a result of mental disease/defect he lacks substantial capacity either to appreciate the criminality (wrongfulness) of his conduct or to conform his conduct to the requirements of law
- as used in the article, the terms “mental disease/defect” do not include an abnormality manifested only by repeated criminal or otherwise antisocial conduct
diminished capacity (1978)
evidence of an abnormal mental condition in people that causes criminal charges against them requiring intent of knowledge to be reduced to lesser offenses requiring only reckless or criminal neglect
John Hinckley (1981)
shot president Reagan and other members of service, was judged by jury not to be guilty due to insanity
public perception of insanity defense
-public over estimate that insanity defense is used more often (37%) but it actually is not (0.9%)
-public over estimates how often the defense is successful and how often people go free
-public under estimates time spent in mental hospital as it is often longer than the jail sentence they would’ve received
insanity defense reform act (1984)
a person charged with a criminal offense should be found not guilty by reason of insanity if it is shown that, as a result of mental disease/retardation, he was unable to appreciate the wrongfulness of his conduct at the time of his offense
guilty but mentally ill verdict (GBMI)
- person found guilty given prison term as if they had no mental illness and then if determined to have mental illness they can recover in facility then be returned to finish out sentence in jail
- mentally ill offender is imprisoned and the prison authorities may provide mental health services (Idaho, Montana, Utah)
therapeutic jurisprudence
using what we know about behavior change to help people in trouble with the law, use of different courts such as drug treatment court, domestic violence court and other “problem solving” courts
Dusky v United States (1960)
in addition to interpreting a person’s state of mind during the criminal act, experts must also anticipate the person’s state of mind during the subsequent legal proceedings
competence
ability of legal defendants to participate in their own defense and understand the charges and roles of the trial participants
Medine v California (1992)
responsibility is on the defendant to provide the burden of proof that they are incompetent to stand trial
Tarasoff v Regents of the University of California (1974)
-Poddar was a grad student at UC Berkley and killed Tatiana Tarasoff who had previously rejected his romantic advances
-Poddar was receiving treatment due to his diagnosis of paranoid schizophrenia
-he hinted he was going to kill Tarasoff and therapist contacted campus police but they were reassured by Poddar that he would leave her alone
-he eventually shot and stabbed Tarasoff
-Tarasoff’s family sued the university, therapists and campus police in saying they should have warned Tarasoff she was in danger
-family won and set standard for duty to warn
duty to warn
mental health professionals responsibility to break confidentiality and notify the potential victim whom a client has specifically threatened
Thompson v. County of Alameda (1980)
CA supreme court ruled therapist does not have a duty to warn when a person makes non-specific threats against non-specific people
expert witnesses
person who because of specific training and experience is allowed to offer opinion testimony in legal trials
mental health professionals can predict a persons dangerousness for
2-20 days but not for longer periods
malingering
faking or grossly exaggerating symptoms
test most accurate to reveal malingering
Minnesota Multiphasic Personality Inventory test
Wyatt v Stickney (1972)
-employees of large institution filed lawsuit after fired for funding issues
-established minimum standards facilities had to meet for people hospitalized
-minimum staff-patient ratios and physical requirements (number of showers and toilets for given number of residents)
-mandated facilities make positive efforts to attain treatment goals for patients
-expanded least restrictive alternative
least restrictive alternative
whenever possible, people should be provided with care and treatment in the least confining and limiting environment possible
Youngberg v Romeo (1982)
reaffirmed the need to treat people in non-restrictive settings but essentially left the decision of treatment to professionals, concerned patient advocates as leaving judgement to professionals has not always resulted in the intended end for the people in need of help
Protection and Advocacy for Mentally Ill Individuals Act (1986)
established a series of protection and advocacy agencies in each state to investigate allegations of abuse and neglect and to act as legal advocates
Riggins v Nevada (1992)
Because of the potential for negative side effects (involultary movements associated with tardive dyskinesia) people cannot be forced to take antipsychotics
Washington v Harper (1990)
made allowance for involuntary medication, a due process hearing that allows mental health professionals to argue for the merits of medication use and the patient to provide a counterargument, was also used in case of Jared Loughner
rights of people participating in psychological research
- right to be informed about purpose of the research study
- right to privacy
- right to be treated with respect and dignity
- right to be protected from physical and mental harm
- the right to choose to participate or to refuse to participate without prejudice or reprisals
- the right to anonymity in the reporting of results
- the right to the safeguarding of their records
informed consent
formal agreement by subject to participate after being fully apprised of all important aspects of the study, including any hard
greg aller
23 schizophrenic research participant given medication then taken off. his hallucinations returned and his parents needed to plee for him to be put back on meds
Agency for Healthcare Research and Quality
establish uniformity in delivery of effective health and mental health care and to communicate to practitioners, policy makers, and patients aline about latest developments in treating disorders
most effective treatment for health care costs
alleviating their pain and distress by treating effectively
clinical efficacy axis
consideration of scientific evidence to determine whether the intervention in question-is effective when compared with alternative treatment or no treatment
quantified clinical observations
clinicians rely on information from various clinics where large number of practitioners are treating certain condition and look so see outcomes (how many cures, somewhat improved, did not respond, etc)
clinical consensus
leading experts
clinical utility axis
-concerned with external validity (the extent to which an internally valid intervention is effective in different settings or under different circumstances from those tested)
-generalization-ability (the extend to which an intervention is effective with patients of differing backgrounds as well as in different settings or with different therapists
neurodevelopmental disorders
neurologically based disorders that are revealed in a clinically significant way during a child’s developmental years
echolalia
repeating the speech of others (intermediate step in development
amnestic mild cognitive impairment (MCI)
-transitional stage of cornitive impairment preceding Alzheimer’s dementia
-weakness in 1 domain of cognition but still fully functioning in everyday
MCI progression to dementia every year
15-20%
-cumulative rate of alzheimers dementia is 80% by 6 years
dementia
-2+ areas of cognition problems (2 SD’s below average) and dysfunction in everyday life
senile dementia
65+
pre senile dementia
under 65
warning signs on dementia
-memory loss that affects normal activities
-excessive word finding problems
-difficulty performing familiar tasks
-disorientation to time or place
-changes in mood, behavior, personality
-poor judgement and decision making
common causes of dementia
-alzheimers
-vascular disease (tissue in brain affected, stroke)
-parkinson’s disease
-picks disease
-medication side effects
-depression
-alcohol/drugs
-brain tumors
-hydrocephalus (fluid in ventricles does not move normal)
most common cause of dementia
alzheimers disease
senile dementia breakdown
-alzheimers: 54%
-vascular dementia: 16%
-other: 30%
pre senile dementia breakdown
-AD: 34%
-frontotemporal: 12%
-alcohol related: 10%
-dementia with lewy bodied: 7%
-huntingtons disease: 5%
-other: 14%
*lots of different causes
Dr Alzheimer
-psychiatrist interested in pathology
-looked into neurosyphilis (high fever and cognitive disturbance)
-2 patients
-defined neuropathalogical plaques and tangles
alzheimers disease
-an age related, irreversible brain disorder that develops gradually and results in memory loss, decline in thinking abilities, and changes in behavior and personality. these deficits and changes are due to breakdown and death of brain cells
neurofibrillary tangles
-twisted protein fibers (tau) found within cells (in nucleus center)
-causes abnormal neuronal functioning
-after cell dies become ghost/tombstone cells
neuritic plaques
-deposits of beta-amyloid protein that forms in spaces between cells
-interfere with communication between cells
-without communication neurons breakdown or die
video on patient with alzheimer’s disease
-Dr Gribowski is talking to a woman with dementia
-she could not count back from 20 to 1 and then started 10 to 1 and got confused
-could not remember the 2 words dr asked her to remember (penny, apple)
-could not name things such as penny or ring
-count not remember she was talking to dr gribowski
-could hold conversation, upbeat, high social skills, good awareness of husband
-had anasignosia
anasignosia
lack of insight into deficit
characteristic of alzheimer patients brain scan
bilateral tempro-parieto hypometabolism (both lobes)
declarative memory
memory for facts and events (ex: repeating what you read in newspaper this morning)
anterograde
learning and memory formation of new material
retrograde
recall of previously acquired memories
procedural memory
memory for a behavioral response (riding a bike)
word list learning and recall in alzheimers disease
-flat learning curve for first 4 trials and then by trial 5 did not know word list
tests for procedural memory
rotor pursuit (eventually those with alzheimers caught up showing they can learn procedural memory)
mirror tracing
procedural memory
-striatum, cerebellum, motor cortex
-involves a behavioral response, not conscious recall
-learned through repeated exposure or practice
-preserved in amnesia or Alzheimers disease
-different structures than declarative memory
progressive muscle relaxation (PMR) in alzheimers disease
-34 patients randomized to PMR or control
-5 training sessions and 38 home sessions over 5 weeks
-significant improvement for PMR in frequency of caregiver rated behavioral problems (anger outbursts, wandering, fidgeting, anxiety) and neurophysholocigal performance
when showing sad movie clips
-amnestics stayed sad longer than normal people but could not remember why
-sadness and amusement elicited the appropriate mood for well over 15 minutes
-mood endured beyond ability recall film clips
intellectual disability prevalence
1% of US population
AAIDD
American Association on Intellectual and Developmental Disabilities
-significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period
intellectual disability definition
- significantly subaverage general intellectual functioning (IQ score of 70 or below aka 2 SD’s below)
- deficits in adaptive behavior (deficits in degree person meets standards of personal independence and social responsibility for their age group, may be problems with learning, maturity, independent living, and social skills)
- developmental period (time of conception through 18 years)
predisposing factors to ID
- hereditary: 5% of those diagnosed, genetic and chromosomal abberations (Tay-Sach’s disease, Down’s syndrome, fragile X syndrome)
- difficulties in embryonic development and during pregnancy: 40% of cases, maternal alc/drug use, infections, malnutrition, prematurity, hypoxia, high blood levels (PKU), trauma
- medical conditions acquired during infancy or childhood: 5%, infection, trauma, other factors like lead poisoning
- environmental influences and other mental disorders: 20%, deprivation of nurturance and social, linguistic and other stimulation, autism
% of ID cases with no problems involving associated risk factors
30%
Mild ID
-IQ: 55-70
-mental age of 9-12
-85% of cases
-get educable mentally impaired designation (learn well in traditional classroom but may need para help)
moderate ID
-IQ: 40-55
-mental age of 6-9
-10% of cases
-get trainable mentally impaired (TMI) designation ( learning to read, write, math possible but harder to do, tend to do better in repetitive work like a line job or workshop)
severe ID`
-IQ: 25-40
-mental age of 3-6
-3-4% of cases
may not be verbal
profound ID
-IQ under 25
-mental age under 3
-1-2% cases
-pretty much always non verbal
2 larger subgroups of ID
mild/moderate [M/M]
severe/profound [S/P]
Severe/profound subgroup
-usually diagnosed during preschool or infancy
-lifelong
-usually placed outside the home
-have associated medical/neurological problems
-often have family members with normal intelligence
-range of social classes
-tends to be associated with some biological abnormality
mild/moderate ID subgroup
-usually diagnosed during school years
-may improve functioning
-individual stay in the home
-have fewer medical problems
-tend to have family members with below average intelligence
-lower SES overrepresented
-can be thought of as just one extreme across the entire range of normal intellectual functioning
intelligence tests can be useful for
- placement in special education classes and determining eligibility for special services
- determining areas of strength, especially as it relates to identifying appropriate vocational settings
adaptive behavior
what someone can do for themselves in real world
AAMD Adaptive Behavior scale
-self report questionnaire, tend to over report
-adaptive behavior subdomains: independent functioning, physical development, economic activity, language development, numbers and time, domestic activity, vocational activity, self-direction, responsibility, socialization
-maladaptive behavior subdomains: violent and destructive behavior, antisocial behavior, rebellious behavior, untrustworthy behavior, withdrawl, stereotypic behavior, odd mannerisms
-scale designed to assess what the child can do (versus what is done on a regular basis)
Vineland Adaptive Behavior Scale
-interview with caregiver, more like a conversation
-assesses 4 domains and 11 subdomains (communication, daily living, socialization, motor skills, also have maladaptive behavior domain)
-designed to assess what child does on a regular basis (more accurate picture of functioning)
-allows to account for behaviors child does not have opportunity to engage in because of varying expectations between homes (more culturally fair instrument)
mainstreaming education
base is self contained classroom and child only joins others for non academic subjects such as PE, art so that they get socialization with peers
inclusive education
child spends entire day in regular classroom but has modified curriculum within the classroom (typically have para with them)
labeling/downward spiral effect of ID
-lower teacher expectations perpetrate any deficiencies
-more of a concern in mainstreaming since expectations are lower
-in inclusive ed, may subject child to more social problems and problems with self esteem
learning disabilities fall into category of
neurodevelopment disorder
3 main assumptions in learning disability diagnosis
- specificity: the learning problem is specific, generally confined to one or 2 cognitive areas
- IQ-achievement discrepancy: the individuals achievement is not commensurate with his/her ability/aptitude (WAIS) or chronological age (2 or more SD between aptitude achievement)
- exclusionary criteria: the learning difficulty is not a result of some other condition or lack of opportunity
specific learning disorder definition
statistically significant discrepancy between aptitude (IQ) and academic achievement that is caused by developmental neuropsychological impairment
impairment in reading
-dyslexia
-a developmental, unexpected difficulty in word reading accuracy, reading rate or fluency and /or reading comprehension
alexia
acquired inability to read (stroke/brain tumor)
impairment in written expression
a developmental, unexpected difficulty in spelling accuracy, grammar or punctuation accuracy and/or clarity or organization of written expression
agraphia
acquired difficulties in writing or spelling
impairment in mathematics
developmental, unexpected difficulty in number sense, memorization of arithmetic facts, accurate or fluent calculation and or accurate math reasoning
acalculia
acquired disturbance of mathematics operations
prevalence of learning disabilities
-2-10% (1994)
-5-15% (2013)
sex ration of learning disabilities
M:F –> 2-3:1
neurological correlates of dyslexia
-right and left side of brain symmetrical/same size (normal is L side larger than right side)
- temporal lobes are also symmetrical (specifically in Wernike’s area that plays a role in speech sounds in language/phonological is smaller in those with dyslexia)
-major neocortical subdivisions differ in size, brains of dyslexic individuals follow abnormal developmental pattern
nonverbal learning disabilities (NLD)
-developmental dysfunction in right hemisphere
-triad of symptoms associated with R hemisphere damage described by Rudel, Teuber, Twitchell (1982)
Triad in NDL
-arithmetic deficits (more around 1 SD)
-visuospatial-visuconstrictional deficits (poor nonverbal skills)
-significant deficits in social perception, social judgement and social interaction skills
-good rote verbal skills– “cocktail party speech”
-average to above average verbal intellect
-verbal IQ performance discrepancy of at least 12 points
right hemisphere is specialized for
-agnosia (impaired recognition of previously meaningful stimuli)
-anosognosia (lack of insight into into abilities/deficits)
-dysprosodia (a loss os sing song aspect/intention in voice)
-visuospatial defects
prevalence of NLD
0.1-1%
M:F –> 1.2:1
NLD early signs
-poor coordination, especially with fine motor control (hold pencil awkwardly)
-as preschoolers, less interested and skilled at drawing and puzzles
-at school age, poor eye hand coordination and less facility with building things
neuropsychology of NLD
-verbal IQ better than performance IQ
-auditory linguistic tasks better than visuo constructive tasks
-verbal anterograde memory better than visual anterograde memory
-selectively low math achievement
-spatial difficulties
-socio-emotional problems; shyness depression, and a tendency toward social isolation
Tranel et al. (1987)
-11 patients over 3 years that received neuro testing, psych exam, CT, EEG, assessment or paralinguistic skills
-found the triad of NLD plus impaired prosody and eye contact (verbal intellect, verbal memory, language intact)
-depression seen in all 11 patients
-CT normal
treatment of NDL
-social skills training
-behavioral modification
-assertiveness training
case study for learning disabilities
-14 yr old F, oldest kid
-difficult birth with possibility of ischemic/anoxic event raised
-difficulties with sensory, fine motor, social development
-long standing difficulties in school with arithmetic (otherwise gets As)
-has anxiety (gets treatment and meds)
-wexler test showed low symbol search, low visual logic, low arithmetic, low copy and recall (visual memory)
-MMPI showed pretty normal profile
strengths of Brian-Kid 12
-worked occasionally picking up drywall
-same gives him birthday gifts
-best friend carl
-one of best students in school, enjoys science
-sex ed in 5th grade
-mom won’t let him receive free lunches
-both AI anon therapist and teacher impressed with him
-12 outfits in closet
weaknesses of Brian - kid 12
-63% of students are poverty stricken in elementary school
-parents abused drugs and alc until he was 6
-father reported him for cheating
-not very disciplined in his studies
-math most problematic
-loans his mothe rmoney
-only 3 “cake birthdays”
penny– kid 12
-5’7”, overweight since teen
-history of alc and drug abuse
-quit when pregnant with brian
-relapsed 2 years ago
-has sisters and neighbor for social support
-works as machine operator full time earning 18K per year
nathan– kid 12
-5’9”, 135 lbs
-diagnosed with Hep C 2 years ago, has fever and chills, recieves interferon therapy through TennCare
-hx of alc and drug use (including IV drugs)
-quit after DUI through jail rehab program (attends AA 3x weekly)
-relapse 2 years ago
-has temper and moodiness, including breaking objects
-worked for Sam, now unemployed, gets 4K per year from disability
Assessment for Brian kid 12
-WISC
-WRAT and WJ, particularly in area of math
-CBCL
-Harter self concept scale
-MOOS family environment scale
assessment for Penny and nathan kid 12
-WAIS
-Memory testing
-MMPI-2
-TAT
family assessments kid 12
-parent-child interaction task
-family interaction task
brian now – kid 12
has kids but tried to rob home in TN, cops found a van full of drugs and stolen stuff, not doing well
