Week 12/2 ID

Question 0

Terminology
 Historically, whatever term has been used to define this
condition has shifted to become an insult and offensive called the

Answer 0

 “Euphemism treadmill” – terms intended to be neutral slowly acquire negative meanings

Question 1

Do you know rainbow acronym for bipolar treatment ?

Answer 1

B be a good friend

Question 2

Idiot, imbecile, moron were all once neutral terms used to describe individuals experiencing developmental delays
 These terms were phased out in favour of

Answer 2

mental retardation (DSM-IV)
 Mental retardation is also now seen as offensive

 Advocates prefer intellectually disability or
developmental disability
 DSM-5 uses the term “intellectual disability” or “intellectual development disorder”

Aside on person with x disorder :)

Question 3

What is intelligence?

Answer 3

Composed of many sub-processes
 Verbal ability
 Spatial skills
 Reasoning
 Working memory and control of attention



Question 4

Is iq (part of intelligence) stable?

Answer 4

Trait or state?
 IQ stable but CAN change
 Environment and testing situation

Question 5

Core Features: DSM-5 for ID

Answer 5

Deficits in intellectual functioning including reasoning, problem solving, planning, abstract thinking, judgment as confirmed by both clinical assessment and individualized, standardized intelligence testing
 IQ < 70 or equivalent assessment

 Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility; functioning is limited in one more activities of daily life such as communication, social participation, and independent living, across multiple environments

 Onset during developmental period

Question 6

Subtypes by Degree of Impairment

Answer 6

 Mild (IQ of 55 to 70)
 applies to about 85% of persons with ID
 typically not identified until elementary school years
 overrepresentation of minority group / low SES members

 Moderate (IQ of 40 to 54)
 applies to about 10% of persons with ID
 usually identified during preschool years
 applies to many people with Down syndrome

Severe (IQ of 20 to 39)
 applies to about 3%-4% of persons with ID
 often associated with clear organic cause
 usually identified at a very young age

 Profound (IQ below 20 or 25)
 applies to about 1%-2% of persons with ID
 usually identified in infancy
 almost always associated with clear organic cause and often co-occurs with severe medical conditions

Question 7

Mild (IQ of 55 to 70)

Answer 7

 applies to about 85% of persons with ID
 typically not identified until elementary school years
 overrepresentation of minority group / low SES members

Question 8

Moderate (IQ of 40 to 54) characteristics

Answer 8

 applies to about 10% of persons with ID
 usually identified during preschool years
 applies to many people with Down syndrome

Question 9

Severe (IQ of 20 to 39)

Answer 9

 applies to about 3%-4% of persons with ID
 often associated with clear organic cause
 usually identified at a very young age

Question 10

 Profound (IQ below 20 or 25)

Answer 10

 applies to about 1%-2% of persons with ID
 usually identified in infancy
 almost always associated with clear organic cause and often co-occurs with severe medical conditions

Question 11

Assessment of ID requires?

Answer 11

 IQ
 Adaptive Functioning

Question 12

IQ Assessment

Answer 12

 A series of tasks designed to assess different types of intelligence
 Weschler Intelligence Scale for Children (WISC)
 Children aged 6 to 17 years
 Also a preschool version

Question 13

IQ Assessment (training)

Answer 13

 WISC is standardized (picture, block and matrix)
 Procedures for administering the tasks on the WISC are highly
 Where you are supposed to sit
 How you are supposed to interact with the child, do not visa higher.

Question 14

Norms for the WISC have been established, and they are?

Answer 14

 Performance can be compared to other children of the same
age and gender
 Average performance on the WISC is 100
 Standard deviation is 15

Question 15

Criticisms of IQ Tests

Answer 15

 Test knowledge associated with the cultural majority
 Focus on speed of processing
 Children with behavior difficulties are likely to underperform

Good discriminate of Id down to 60.
Floor effect, 20-60 poor discrimination. Not good.

Question 16

Assessment of Adaptive Functioning for ID

Answer 16

 Vineland Adaptive Behavior Scales

 Assesses children’s functioning in several domains

Question 17

Vineland Adaptive Behavior Scales  Assesses children’s functioning in several domains
 Communication

Answer 17

 Receptive
 Listening
 Following instructions

 Expressive
 Pointing when offered a choice
 Uses phrases with a noun and a verb

 Written
 Recognizes own name
 Prints more than 20 words from memory

Question 18

Vineland living skills

Answer 18

Living Skills
 Personal
 Drinks from a cup
 Asks to use toilet!
 Puts shoes on correct feet

 Domestic
 Is careful using sharp objects
 Is careful around hot objects

 Community
 Demonstrates understanding of function of telephone
 Demonstrates understanding of function of a clock
 Can identify pennies, nickels, dimes

Question 19

Socialization of Vineland

Answer 19

 Interpersonal Relationship
 Looks at face of parent or caregiver
 Shows two or more emotions
 Demonstrates friendship seeking behavior with others of the same age

Play and Leisure Time
 Responds when a caregiver is playful
 Plays simple interaction games (peek-a-boo)
 Shares toys or possession

 Coping Skills
 Controls angry feelings
 Changes easily from one activity to the next

Question 20

Vineland Adaptive Behavior Scales structure?

Answer 20

 Semistructured Interview
 Interviewer has a lot of latitude when asking questions
 Differs from a structured interview where the interviewer is given a very specific set of a questions to ask

 Excellent for building rapport as it is like having a conversation
 Interview given a number of general questions (prompts) and a set of more specific probes if needed, clarifications and laddering. Wow efficient and satisfying.
 Interviewer checks off items on a list as they obtain the information

Question 21

Prevalence of ID

Answer 21

Low income and minority.
1% to 403% prevalence.
Ses differences only apparent for less severe.
Not for severe,

Effects slightly more males than females.

Question 22

Etiology of ID.

Organic causes

Answer 22

Chromosome,me
Genetic
Neurobiological.
Associated with moderate to severe/profound,

Do not see more in

Question 23

Prevalence (All subtypes)

Answer 23

 Prevalence
 Community prevalence estimates range from 1% to 3%
 Cultural and contextual differences  More prevalent in lower SES groups
 More prevalent in minority groups
 Differences only apparent for less severe ID
 Gender differences
 Slightly more males than females

Question 24

Etiology

Answer 24

 Organic
 includes chromosome abnormalities, single gene conditions,
and neurobiological influences
 tend to be moderate, severe, and profound cases  Prevalence comparable across SES groups

Cultural / Familial
 Does not have a clear cause
 Includes family history of intellectual disability, economic deprivation, inadequate child care, poor nutrition, and parental psychopathology
 tend to be mild cases (most cases!)
 Higher rates in lower SES and minority group

Question 25

Specific Organic Syndromes for ID

Answer 25

 Chromosomal abnormalities
 Most common cause of severe MR
 Fragile-X syndrome (X chromosome, inherited)
 Down syndrome (chromosome 21, most cases are random event)
 Prader-Willi and Angelman (chromosome 15, most cases are random events) need to eat

 Single-gene problems
 Phenylketonuria (PKU; inherited), special diet needed
 Cannot metabolize amino acid phenylalanine, rising levels are toxic and impact intellectual development

 Neurobiological injury
 Prenatal (e.g., Fetal Alcohol Syndrome)
 Perinatal (e.g., anoxia at birth)
 Postnatal (e.g., head injury)

Question 26

Summary of Causes of ID
note mr mental retardation = ID

Answer 26

 Genetic factors
 General heritability of intelligence is approximately 50%
 Rare conditions associated with ID also inherited

 Neurobiological influences
 Prenatal, perinatal, and postnatal injury

 Environmental influences
 deprivation of physical and emotional care, social stimulation, and early learning environment

Question 27

Prevention of ID

Answer 27

 Available test for Down’s syndrome, other specific single-gene
EthicL issue

 Prenatal care
 Reduce prenatal neurobiological injury
 Increase gestation time
 Plan for uncomplicated delivery

Question 28

Early childhood care and education prevention strategy for ID?

Answer 28

 Safe and stimulating environments
 Safe
Lead paint

 Stimulating
 Educational programs
 Major focus on speech and communication

 Early intervention (preschool) optimal brain is growing
 Educational enrichment for low-SES youth

Question 29

Rich vs poor kids exposure to words

Answer 29

Rich get considerably more,
45m vs 10 over 3y

No tv or radio

Low ses lower vocab

Question 30

Carolina Abecedarian Project
 Low-income families
 Four cohorts of children recruited from 1972 and
1977
 Randomly assigned as infants to receive a full-time educational intervention at a project-run childcare center OR to be cared for at home or in another child care center
 Offered enriched environments from infancy through preschool (lasted 5 years)
 Individualized educational program
 Focus on language
 Games
findings

Answer 30

By age two, children who are receiving the program have higher test scores than children in control group, and these differences were maintained over time
 IQ scores
 Mathematics and reading achievement scores
 Their scores stay higher over a prolonged period of time – still saw differences at 21 years of age
 A larger percentage of children in the intervention group went to colle

Question 31

Treatment

Answer 31

 Behavioral Treatments

 Family Strategies
 Residential Care

Question 32

Preschools good for

Answer 32

Learning for low ses,

Immunology for high ses and low ses

Question 33

Cost benefit, like Mst, for abecedarian

Answer 33

Earn more contribute more,m

Is expensive, but more than regain in your investment.

Question 34

Residential Treatment

Answer 34

 Serious and dangerous behaviors such that the child requires full-time supervision
 Intensive treatment programs
 Full or part-time
 Research has shown that family involvement is critical
 Home visits, parental involvement

Question 35

Family-Oriented Strategies

Answer 35

 Individual services are more effective when the family is involved
 Parent-management training
 Parents serving as behavior therapists
 Skill acquisition, rather than problem behavior reduction

Question 36

Behavioral Treatment
I’d

Answer 36

 Shaping procedure
 Rewarding successive approximations
 Receive a reward when you imitate the sound made by the speech therapist
 Once that sound is mastered, only receive a reward for the next sound on the list
 Modeling behavior you want to see
 Break into component parts
 Rewards for behaviors you want to see, consequences for behaviors you do not want to see
 Social skills
 Self-injurious behaviors and pica

Question 37

Behavioral Treatment I’d
 Basic principles of behavioral treatment

Answer 37

 Positively or negatively reinforce behaviors you want to see
 Administer consequences or remove rewards for behaviors you do not want to see

Start small break it down, like just touching spoon rewarded first, working to getting it to the mouth

Question 38

Treatment
For ID

Answer 38

 Behavioral Treatments  Family Strategies
 Residential Care

Question 39

Two ways to approach prevention of psychopathology

Answer 39

Prevention
 Can we stop children’s mental health problems before they
start?

 Identify risk factors and target those

 Identify high risk populations and intervene before problems
start?

Notes on dissemination

Question 40

Risk factors identified in class for children to de. Psychopathology.

Answer 40

 Poverty
 Child Abuse
 Parental Psychopatholog

Question 41

Poverty evidence correlate

Answer 41

W Low SES is a risk factor for many psychological problems
 Particularly behavioral problems

 Casino study

So change poverty change behvairour problems?

Question 42

Recall that there is evidence that low SES causes behavior problems
 If we change conditions associated with poverty, can we change behavior problems?
 Neighborhood
 Violence, deviant peers, few adult role models, poorer schools

Answer 42

Moving to Opportunity (MTO)
 Operated from 1994 to 1998
 Baltimore, Boston, Chicago, Los Angeles, and New
 Eligible families with children living in:
 public housing
 high-poverty neighborhoods (poverty rate >= 40%)
MTO: Random Assignment
4608 eligible families in public housing
Low-Poverty Voucher Group (LPV)
(N = 1,800)
Section 8 Group (S8)
(N = 1,350)
Control Group (C) (N = 1,400)

Offered restricted Section 8 voucher + mobility counseling
Offered conventional Section 8 voucher
No voucher, existing programs
47% used voucher to move
(N = 864)
68% used voucher to move
(N = 918)

Selected Characteristics of Sample

22 percent of household heads were employed at baseline
87 percent single-parent female-headed households
Baltimore and Chicago samples are almost 100 percent African-American
LA, and NY are roughly 50 percent African- American, 50 percent Hispanic.
About 20 percent of the sample in Boston is nh- white or Asian

Question 43

Outcomes: Interim (4 to 7 years) of MTO STUDY

Answer 43

 Neighborhoodoutcomes
 Assignment to either of the MTO mobility groups led participating adults to feel safer and more satisfied with their housing and neighborhoods.
 Improved outcomes for female youth
 Low poverty voucher group – less psychological distress, fewer behavior problems
 Section 8 group – less depression
 Both moving groups – less GAD
 Deleterious effects on male youth risky behavior
 Low poverty voucher group – More likely to be arrested
 MTO had no detectable effects on the math and reading achievement of children

Question 44

MTO

 Final analyses are underway

Answer 44

 Suggests benefits for girls
 Neighborhood wealth can effect children in different ways
 Access to more resources might be helpful
 But, makes them aware of their relative deprivation
 Safety may mean different things to boys and girls
Feel less threat of sexual assault.

Question 45

Child Abuse
 Risk factor for many types of disorders  Conduct problems
 Can we reduce incidence of child abuse?

Nurse-Family Partnership Program (NFP; David Olds)

Answer 45

Support for mothers “at risk”
 Low income
 Single
 Young (under age 19)

 Treatment model
 Structured home visits
 Education and social support
 High intensity during pregnancy
 High intensity immediately post-pregnancy (6 weeks)
 Lower intensity through age 2 1⁄2

Question 46

NFP Target Outcomes

Answer 46

 Pregnancy
 reduce Smoking and substance use
 Premature births reduce, instead full term.

Caregiving, abuse
 Neglect (e.g., accidents)

 Maternal “life course”
 Education and employment, life planning I guess
 Number and spacing of additional births

 Long-term youth behavior

Question 47

NFP Elmira Outcomes
 Participants
– 400 pregnant women
– 62% unmarried
– 47% younger than 19
– 61% “working poor”
– 89% Caucasian

Design
– Random assignment 3 groups
– “Usual services” (e.g., developmental screening)
– NFP – two groups – one receiving visitation during pregnancy only and the second receiving visitation both during and after pregnancy

Answer 47

 Pregnancy outcomes
– 25% less smoking
– Fewer infections
– Fewer pre-term deliveries

Dysfunctional caregiving
– 27% fewer ER visits
– 56% fewer accidents
– 80% less abuse (verified)
– Effects strongest for women with least resources

Mom income was moderator, worse off biggest effects

Question 48

NFP outcomes later on 15yr later

Answer 48

Less likely to run away, arrested, or convicted.
Significant later improvement too!

NFP Outcomes
 Significant effects on pregnancy outcomes, parental behavior
 Also saw effects on children’s behavior 15 years later

Shows importance of early intervention for kids

Question 49

MacMillan et al. 2005
 In Olds’ program, women are visited during pregnancy
 Can a similar program when children are older stop child abuse?
 MacMillan et al. designed a nurse-home visitation program targeting stopping recurrence of child abuse

MacMillan et al. 2005
 Families recruited from child protection agencies
 Physical abuse/neglect had occurred in the previous
three months
 Child was still living with families

Answer 49

MacMillan et al. 2005
 Families randomly assigned to the treatment group or the control group
 Control group:
 Standard services provided by child protection agency
 E.g., Follow up by social workers, education
 Treatment group
 Standard services
 Home visits (1.5 hours) by a public-health nurse every week for six months, then every two weeks for six months, and then monthly for twelve months
 Nurse visits focused on family support, parent education, and helping families get services needed (e.g., special education, employment services)
 Goal was to reduce stressors and increase support

Question 50

MacMillan et al. 2005
 Primary outcome was reports of child abuse/neglect made to CPA
 Research assistants went through CPA records and identified cases of abuse or neglect

Answer 50

Found that the intervention had no effect
 No differences between intervention and control group
 Were not seeing lower rates of recurrence in the intervention group
 Incidences in the intervention group were as severe as incidences in the control group

Suggests once involved with cap, hard to change things.

Prevention necessary. Think olds group.

Question 51

MacMillan et al. 2005
 Findings suggest that once a family is involved with Child Protective Services

Answer 51

it may be hard to help
 Importance of intervening before the problem starts

Question 52

Parental Psychopathology
 Parental psychopathology associated with a number of problematic outcomes in childhood
 Disorders often “run in families”  Genetics
 Environment

Answer 52

Includes depression,

Question 53

Parental Depression
 Primary prevention (i.e., targeting children in general) has

Answer 53

not been very effective
 Programs targeting high-risk samples
 Children of parents with depression are at higher risk for developing a depressive disorder

Question 54

Group CBT (Clarke et al. 1995)
 Coping with Stress course

Answer 54

 15, 45 minute group sessions
 Taught cognitive techniques
 E.g., identifying and challenging negative thoughts
 Reduce negative thoughts before sub-clinical symptoms become more significant
 Can we:
 Reduce symptoms?
 Prevent depressive episodes?

Question 55

Clark et al. 2001

Initial recruitment letters sent by physicians to parents with depression and teenage children (N = 3374)
Youth categorized as subsyndromal and agreed to randomization (N = 94)
Usual Care (N = 49)

Answer 55

Clark et al. 2001
 Youth in experimental group 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

But at two years converge almost, may need booster sessions!

Question 56

Garber et al. 2009
 Generalizability
 Basically the same intervention
 Slight format changes
 8 weekly 90 minute sessions
 6 monthly continuation sessions
 316 adolescents in 4 sites
 Randomized to CBT intervention or usual care

Results replicated?

Answer 56

Rate of depressive episodes lower for the intervention group
 Symptoms declined at a greater rate for youth in intervention group
 Demonstrates that this intervention can be delivered by clinicians other than those who designed the intervention!

Question 57

Summary: Prevention

Answer 57

 Prevention programs can have a significant impact, even many years after the intervention takes place, think abcedarian and aba autism too.
 Demonstrates importance of sound theoretical model and understanding of more basic processes

Question 58

Dissemination
 Many youth will experience significant mental health problems
 We have treatments of demonstrated efficacy for a number of these issues

Answer 58

What do we know about treating psychological disorders in youth?
Disorder
Evidence-Based Psychosocial Treatments
ADHD
Behavior therapy – peer interventions, classroom management, parent training
ODD and CD
Anger control training (e.g., Anger Coping Program), parent management training, MST
Anorexia/Bulimia
Family therapy (AN); CBT (Bulimia)
Anxiety
CBT, trauma-focused CBT (PTSD)
Depression
CBT, Interpersonal therapy (not discussed in class)
Autism
ABA (Lovaas’ Method)

KNOW THIS,

Question 59

Treatment Efficacy versus Effectiveness

Answer 59

 Treatments have demonstrated efficacy
 Efficacy: Can this treatment work?
 Tested in RCTs
 Patients recruited for studies who often do not represent “real world” presentation
 Therapists who are highly trained to administer an intervention
 Different conditions then we see in practice

Effectiveness
 Does this treatment work? In rel world
 Tested in the “real world”
 Patients and therapists
 Far less evidence about effectiveness relative to efficacy

Question 60

Are Evidence-Based Interventions Being Used in Usual Care?

Answer 60

 Not widely
 Treatment in community is much more eclectic and
based upon therapist’s personal preferences  E.g., Weersing & Weisz 2002
 Therapists in community-mental health clinic report using more psychodynamic techniques during treatment of depression than cognitive and behavioral techniques

Question 61

Why Not?
 Efficacy versus effectiveness

Answer 61

 Concerns about treatments in the real world

 Complex case presentations
 Rapport
 Manuals too inflexible

Question 62

The Critical Issue in Youth Mental Health

Answer 62

 Bridging the gap between research and practice
 Disseminating evidence-based treatments and
assessments
 Recall that evidence-based assessments (e.g., structured and semi-structured interviews) perform better than unstructured interviews
 Will be significant advantages to incorporating those in treatment

Question 63

The Critical Issue in Mental Health
 Is evidence-based practice associated with greater improvement in treatment?

Weersing & Weisz 2002
Includes tads

Plotting deprsion meta.

EBT versus Usual Care
 Weisz et al. (2006)

Answer 63

 Meta-analysis
 Studies comparing evidence-based treatments to treatment as usual (usual care)
 E.g., MST versus care as usual
 Found that children receiving EBTs did better!
 Note that differences were not due to symptom severity or co-morbidity

Question 64

Conclusions of the course

Answer 64

 Many youth will experience psychological problems
 Basic research is ongoing to try to understand
etiology and maintenance of those problems
 Apply research to developing more effective interventions
 Dissemination of evidence-based interventions