PSYC3102 [Final]

Aging Population Changes

• Less kids

• Better elderly care

• Improved sanitation

• More importance to care about invesitgating dementia

Cognitive functioning best viewed as….

function of lifespan

Most prevalent type of dementia

Alzheimer’s Disease

Protective and risk factors are in main…

modifiable, but not accessible for all

T/F Dementia is not automatically a cause for lacking capacity

TRUE

Dementia is extremely…

heterogenous; interventions best when coordinated among healthcare professionals; people often wait years for a diagnosis

Dementia [Umbrella Cateogry] definition

a term for broad class of neurological disorders associated with cognitive, personality, and behaivoural changes in later life; IS A DISEASE, NOT PART OF PRIMARY AGEING

Dementia Proper Definition

An acquired syndrome of intellectual impairment produced by brain dysfunction

Dementia Process

Neurons in brain accumulate plaques or tangles (tau proteins) that deposit on cells → leads to cell death , no way of slowing or stopping process atm

Heterogenous disease meaning

Condition that has diverse range of underlying causes and symptoms; people with same diagnosis may experience condition in different ways

Dementia Vs Normal Ageing

• Memory loss that disrupts daily life vs sometimes forgetting but remembering later

• Problems with words [aphasia] vs trouble finding right word

• Changes in mood or personliaty vs irritation at having routine disrupted

• Difficulty completing familiar tasks vs help needed with new tasks

Factors for Developing Dementia

Socioeconomic factors and resources matter, if big gaps → results in unhealthy ageing

When testing cognitive decline….

Motor Declines can precede cognitive decline

Dementia Prevalence and Frequency

• Prevalence:

  • between 65-69 is around 1%

  • between 75-79 is around 6%

• Over 90 years of age:

  • around 40% of people exhibit symptoms of moderate or severe dementia

Types of dementia

• Huntington’s disease

• Dementia with Lewy Bodies

• Alcohol related dementia

• Frontotemporal dementia

• AD (Alzheimer’s disease)

• VaD (Vascular dementia)

• Other

Preclinical Phase of Dementia

• Silent phase: brain changes without measurable symptoms

  • individual may notice changes, but not detectable on tests

MCI phase of Dementia

• Cognitive changes are of concern to individual and family

  • one or more cognitive domains impaired significantly

  • preserved activities of daily living

Final Dementia Phase

• Cognitive impairment Severe enough to interfere with everyday abilties

• Not every single person end up in this phase, may only end on MCI and not face severe cognitive decline

Younger Onset Dementia

• Can affect people in their 30s and 40s

• No cure to slow down, but psychosocial interventions effective

• Usually succumb to other illnesses such as stroke or pneumonia

  • due to neuron loss impacting memory, and then affecting other areas like breathing and swallowing

  • requires sensitive and individualised care

Alzheimer vs Vascular Dementia

• Gradual/Insidious vs Abrupt/Stopwise

• Early/Prominent vs Variable/Mild Early

• Later in course vs Early/Prominent

• Common in moderate/late stages vs present visuospatial deficits

• Word-finding difficulty vs mild language impairment

• Behaviour changes at any stagr vs apathy and depression

• Late gait changes vs gait disturbances and motor failures

• Uncommon to have hallucinations early vs uncommon to have hallucinations

Alzheimer’s Disease History

• Alois Alzheimer (1964-1915)

  • Had 51-year old patient (August Dieter) with strange disease of cerebral cortex

  • Ahead of time by reccomending shift away from institutional practices such as isolation rooms or restrictions

  • Promoted individualised hands on care (“treatment next to bed of patient and into day room”)

Burdekin Report (Human Rights and Mental Illness)

• Elderly more likely to receive drugs and less likely to receive psychotherapy

• Worst images associated with old mental instituions is still the case for many elderly sick people (being physically restrained or sedated)

• Prejudice that old people are disposable and not worth spending money or energy on - that natural parts of getting old

Dementia Diagnosis

• Need to take good clinical history

• Take a medical exam (by geriatrician/geropsychiatrists)

• Neuropsychological testing (not just screening)

• Neuroimaging (MRI)

• Ruling out other causes (depression, anxiety, medication, vitamin deficiency, etc.)

Differential Diagnosis: Delirium

• Altered state of consciousness that have underlying cause

• Symptoms unclude waxing, limited attention span, behavioural/psychiatric changes

• Seen in older adults with UTIs or infections from surgical procedures/placement of catheters; also from medicatin SE

• When treated, cognitive faculties regained

• But usually unrecognised and untreated, and fatal if person self-harms

• Need to reduce excess stimulation and educating family about situation

Risk Factors for dementia

• Vascular damage (diabteses, smoking, obesity, air pollution, head injury, etc.)

• Dementia neuropathology (depression, physical activity, alcohol intake)

• Stress and inflammation (visual loss, social contact, hearing loss)

• Cognitive and brain reserve (continue cognitive activity consistently)

Protective factors for Dementia

• Physical Activity: regular training to improve blood flow

• Nutritious diet: mediterranean-style high in veggies, fruits, nuts, and healthy fats

• Social connection: 3 good friends, maintain social interaction

• Cognitive stimulation: consistently engage in mentally stimulating activities

• Good sleep: consistent routine

Neuropsychological Assessment

• Cognitive

• Behaviour

• Emotion

• Social

Dementia in Indigeous Context

• Over 45 years is 12.4% and 26.8% for those over 65 years old

  • 5.2 times higher than overall Aussie population

• Need to adapt Western methods to be culturally sensitive

  • correct language, notions of time/space, appropriateness of discussing family matters

  • KICA tool has cultural;ly suitable items (ex: what season is it vs what year is it)

Assessment of Capacity/Competence

• Important to see if people is legally capable unless determined otherwise

• Presence of neurologic or psychiatric diagnosis/disability does not mean person is incapable

• Refusal to cooperate does not mean person is incapable

Why is diagnosis hard for many?

• Hesitant to recognise decline

  • Can result in lengthy delay as time goes on from having to see sympton onset → family recognition → general physician → specialist evaluation

• GPs reluctant refer/not well-trained

• Functional things become challenging (ex: driving)

• Misinformation on dementia online

  • Dementia Australia best contact point for all

Dementia Medication Treatment

• Acetylcholine levels are reduced - medications target this

  • Donepezil (Aricept) treatment which modifies symptoms but does not interfere with progression

  • Medications usually most effective earlier in progression

Dementia Psychologcial Treatment

• Early - psychotherapy, CBT if depression main focus

• Boost physical/mental/social activity

• Managging heart health helps manage dementia

• Develop routines to scaffold daily activities

Caregivers

• Most are females, especially daughters

• around 450,000 people live with dementia in Australia

  • around 1.6 million care for person with dementia

• Self-care critical

  • respite single out as most desired by caregivers

  • help with understanding evolving needs

  • address fears with unpredicable nature of psychosis or aggression

Assessment tools for family carers

• Burden scale for caregivers (10 items)

• Zarit Burden Interviews (22, 12, 4 items)

Psychosocial approaches for caregivers

• ABC

  • activating event, behaviour, consequences

• faciliating effective communication (less shouting, more giving space/non-verbals)

• Environmental modificationss

  • all aspects + creative activity planning

Active coping strategies

• Recruit more supporters

• Changing appraisals of stressors

• Develop new skills, revive oldones

• Cultivate sense of humor/forgive self and others

• Look for positive moments to share with person with dementia

Environmental manipulations for dementia patients

• PUT

  • Gardens

  • Pets

  • Children

• DONT PUT

  • Distracting stimuli (TV, radio…)

  • Rigid rules

  • Lack of structure

Practical things to do with Dementia person

• Update will with enduring guardian

• Appoint enduring power of attorney

• Make plan to manage driving

• Get info and connect to relevant orgs

• Build formal + informal support team

Healthy Ageing

• Functional ability compromises health-related attributes that enable people to be and do

• Made up of intrinsic capacity of individual, relevant env characeristics and interactions between two

Factors for Succesful Ageing

• Minimise risk of disease and disability

• Continue engagement with life

• Maintain physical and cognitive function

Six factors model of well-being

• Environmental Mastery

• Autonomy

• Self Acceptance

• Purpose in life

• Personal growth

• Positive relationships with others

Hierarchy of flourishing

• Base: identity and connectedness

• Security and autonomy

• Meaning and growth

• Top: Joy

  • increases wellbeing with every step

Externalising disorders meaning

• create problems for external world

• breaking age-appropriate social rules/disobeying authority

• anger and aggression

• impulsivity

Internalising disorders

• create problems for internal world

• anxiety

• sadness

Attention-Deficit/Hyperactivity Disorder (ADHD) Criteria

• Persistent pattern of inattention and/or hyperactivity impulsivity

  • inattention (6 or more symptoms for at least 6 months)

  • Hyperactiivty and impulsivity (6 or more symptoms for at least 6 months)

• Several symptoms present before 12 years old

• Symptoms present in two or more settings (home, school, etc.)

• Interfere with quality of social, academic, occupational functioning

• No other explanations

ADHD Inattentive symptoms

• Often fails to give close attention to details

• Often has difficulty sustaining attention

• Often does not seem to listen when spoken to directly

• Often does not follow through on instructions and fails to finish

• Often has difficulty organising

• Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort

• Often loses necessary things

• Often easily distracted by external stimuli

• Often forgetful in ddaily activities

ADHD Hyperactivity/Impulsivity Symptoms

• Often fidgit with hands/feet

• Often leaves seat in classroom/seated situations

• Often runs about/climbs excessively

• Often has difficulty playing quietly

• Often on the go

• Often talks excessively

• Often blurts out

• Often has difficulty waiting turn

• Often interrupts or intrudes

Types of ADHD

• combined presentation (ADHD-C): if both inattention and hyperactivity-impulsitivty are met for past 6 months

• Predominantly inattentive presentation (ADHD-PI): if inattention met, but not hyperactivity-impulsivity

• Predominanly hyperactive-impulsive presentation (ADHD-HI): if hyperactivity-impulsivity met, but not inattention

Oppositional Defiant Disorder (ODD) Criteria

• Pattern of angry mood, argumentative behaviour lasting at least 6 months, evidenced by at least 4 symptoms, exhibited during interaction with at least one individual who is not a sibling

  • Angry/Irritiable mood

    • losing temper, touchy/easily annoyed, resentful

  • Argumentative behaviour

    • arguing with authority, defying rules/requests, annoys others, blames others

  • Vindicativeness

    • spiteful at least twice within past 6 months

  • Behaviour associated with distress in individual/others in their immediate social context/impacts social, educational, occupational areas of functioning

  • Behaviour does not exlclusively occur during course of psychotic, substance use, deressive, or bipolar

  • Specify if mild (symptoms confined to one setting), moderate (at least in two settings), severe (three or more settings)

Conduct Disorder (CD) criteria

• Repetitive and persistent pattern of behaviour which basic rights/societal norms are violated, manifested by presence of three of following 15 criteria in past 12 months, at least one criterion present in past 6 months

  • Aggression to people/animals

    • bullies others, physical fights, uses weapon, physically cruel, stolen things (confrontational), forced sexual activity

  • Destruction of property

    • engaged in fire setting, destroyed others’ property

  • Theft/Deceitfulness

    • broken into things, lies to obtain goods, stolen items (unconfrontational)

  • Serious violation of rules

    • stays out at night, run away from home, truant from school

• Disturbance in behaviour causing impairment in social, academic, occupational functioning

• If older 18, and criteria not met for antisocial personality disorder

• Specify if with limited prosocial emotions, lack of remose, callous - lack of empathy, unconcerned about performance, shallow or deficient affect

Adolescent Disorder Prevalence

• Most common disorder in children + adolescent

  • in australia, 7.4% of all children and adolescents

  • more common in boys (12.9% of boys, 5.6% of girls)

  • ratio of 4:1 in children (1:6:1 in adults)

    • not necesarilly that girls less susceptible, but symptoms present differently in girls

• In Australia

  • 5.1% diagnosed with ODD; 2.1% with CD

  • higher prevalence in males than females

Adolescent Disorder Course

• For ADHD, prevalence declines in adolescence

  • ADHD persists from childhood to adulthood in 50-65% of individuals

• ODD onset usually 2-3 years, CD late childhood or early adolescence

  • Half of children with ODD/CD continue into problematic adulthood

Aetiology of Externalising Disorders

• Genetic risk

  • High heritability

  • Genes contribute less to ODD than ADHD, some indication in CD

• Temperamental Risk

  • Difficult temperament (emotion regulation - high reactivity)

• Neurobiological risk

  • ADHD

    • structure: delayed brain maturation, less activity

    • Function: selective deficiency in neurotransmitters

  • CD: structural and functional differences in areas associated with affect regulation and affect processing

• Parenting factors

  • ADHD: smoking, neurotoxin, or alcohol exposure in utero

  • ODD: harsh, inconsistent, or neglectful parenting

  • CD: as above, maltreatment, lack of supervision, psychopathology

• Psychological factors

  • Lack of self-control

  • Delay of gratification

• Peers, neighbourhoods, and media

Treatment of ADHD (Per age group)

• Preschool (4-5 years)

  • first line treatment = behavioural interventions

  • only prescribe stimulants if no significant improvements + moderate-severe impairment

• Primary school (6-11 years)

  • apprroved medication and/or behavioural interventions - preferably both - stimulant medication usually tied first

• Adolescence (12-18 years)

  • first line treatment = approved medication

  • may include behavioural interventions

Pharmocolgical Treatment of ADHD

• Psychostimulants

  • increase norepinephrine and dopamine levels in brain

  • side effects: decreased appetite, increase HR, sleeping difficulties, unmask motor tics

• Non-stimulants

  • SSRI - antidepressants

  • SNRI - slective norepinephrine reuptake inhibitor

  • Alpha-agonists

    • increase serotonin levels in brain

Behavioural Treatment of ADHD

• Parent education, training and support to manage ADHD symptoms

  • Triple P - positive parenting program, PCIT, incredible years

    • streategies to strengthen relationship, improve communication, promote development

  • Classroom accomodations

  • Organisational supports

Personal Treatment of ADHD

• Learn coping skills

  • make mental info physical bc of lack of working memory (reminders, to-do)

  • Make time physical (clocks, alarm, etc.)

  • break up lengthy tasks

  • Make motivation external (immediate reinforcements/consequences, rewards)

  • Moke problem solving manual (no mental manipulation, ex math tasks)

  • Refill self-regulation fuel task (rewards), self-statement, regular breaks, relaxation, meditation, physical exercise, sugar

Behavioural Treatment of ODD/CD

• Evidence-based parenting support (triple P, incredible years, PCIT)

  • focus on family interactions

  • build parent-self regulations

  • develop relationships

  • clear expectation

  • increase appropriate prosocial behaviours

  • reduce inappropriate behaviours

• Individual skills development (ex: anger management)

• Multisystemic therapy (family, schools, peers, etc.)

• Residential programs

Tailoring evidence-based parent support with First Nations communities

• Pilot RCT

  • decrease in child behaviour concerns

  • improve parenting

  • reduction in barriers to mainstream services

• National think tank

  • training to increase confidence via pre-accreditation workshops

  • dealing with logistical barriers + workplace support

  • peer networking

• Practitioner support evluation

  • peer networking _ coaching → program sustainment 3 years later

  • implementaion consultants + first indigenous trainer

• Remote community trial

  • 38 local workers trained → positive training outcomes → positive family outcomes

• Tailoring

  • community survey regarding parenting concerns → dvlp project scope

  • localise adaptations: names, images, delivery, locations, etc

Internalising Disorders Definition

• Defines depressive and anxiety disorders same for children as adults

• Depressive symptoms

  • show as irritability in children

  • in children/adolescents comorbid with externalising problems and anxiety

    • children have difficulty identifying anxiety, but aware of fears (age-appropriate usually)

Internalising Disorders Criteria [Depresive Symptoms]

Depressive Symptoms (5 or more during same 2-week period)

• depressed mood (irritability)

• diminished interest/pleasure

• significant weight loss/gain

• insomnia

• psychomotor agitation/retardation

• fatigue

• feeling of worthlessness/inappropriate guilt

• diminished ability to concentrate

• recurrent thoughts of suicide

Internalising Disorders Criteria [Separation Anxiety Disorder]

Separation Anxiety Disorder

• Developmentally inappropriate fear/anxiety concerning separation from home

• Distress when anticipating seprations

• Worry about losing/harm to attachment figure

• Worry about experiencing untoward events (getting lost, being kidnapped, etc.)

• Refusal to go out/sleep away from home/without attachment figure

• Fear/reluctance about being alone

• Nightmares with seperation themes

Internalising Disorders Criteria [Selective Mutism]

Selective Mutism

• Consistent failure to speak in certain social situations

• Speak to only a small number of people

Internalising Disorders Prevalence

• In australia, among 6-17 year olds

  • 3.2% diagnosed with MDD

  • 6.9% diagnosed with anxiety disorders

  • Similar rates between males and females until age 12

  • Higher prevalence found in females than males between 12-17 years old

Internalising Disorders Course

• Some internalising problems persist into adulthood

• Linked to relationship difficulties, other anxiety disorders + mental health problems

• Functional impairment in social and personal life

• Childhood depression predicts six-fold increase in risk for suicide in young adults

Aetiology of interlising disorders

• Biological Factors

  • few behavioural genetic studies conducted

    • some indication of heritability

    • predisposition to anxiousness

• Social factors

  • experience of life stress, loss, or trauma / attachment issues

  • Parental overprotectiveness

  • maltreatment

• Psychological factors

  • emotion regulation

  • rumination → future depression

  • caretaking children of depressed parents happy

Internalising Disorders Treatment

• Depression

  • Psychotherapy

  • CBT

  • Family therapy

  • Antidepressent meds not effective as with adults

• Anxiety

  • child focused CBT

  • family therapy interventions (ex: Fear-Less Triple P)

  • medication - SSRIs most common

  • CBT components - psychoeducation, emotion regulation, positive self-talk, in vivo exposure, contingency manegement

Neurodevelopmenta Disorder Definition

group of disorders with onset in developmental period, manifest early in development (before entering school); characteristics by developmnetal deficits in brain processes that produce impairments of personal, academic, or occupational functioning

Social Model Definition

Interaction between individual’s characteristics and an environment that creates physical, systemic, attitudinal, and social barriers for the individual

• people disabled by environmnets not designed for them

• shift towards changing systems, policies, and environments

Medical model definition

• Deficit framing

• Disability seen to be problem in indiivdual, not problem of society

  • that person needs to be fixed or cured

Social Model Definition

Group of neruodevelopmental differences that emerge during developmental period

• differences typically become recognised early in development

• characterised by diverse brain processes that may result in support needs, across personal, social, academic, or occupational contexts

  • particularly in environments that are not designed to accomodate the differences in the ways of thinking, learning, perceiving, and engaging with the world

Use of Language in Autism

• Identify-first languge: autism is an integral part of their identity and who they are and consistently preferred by most autistic people

• Shifts from medical model

  • supports should focus on environmnetal changes and on upskilling non-autistic, allistic, or neurotypical people

  • shift from terms like “disorder”, “imapirment”, “cure”, and “high/low functioning” pathologise autistic experiences

Neuroneutrality - Needs Focused Language

Moves away from deficit-based language on one end and superpower or romanticising language on other end

• needs focused language allows meaningful conversations about access

Sharper Minds

has three SSPs (Student Staff partnerships) to co-produce and adapt components of the package

University simplified

co-designed with UQ neurodivergent student partners in 2025

Autism Criteria

• Persistent deficits in social communication + social interaction across multiple contexts, manifested by all of the followig:

  • social-emotional reciprocity

  • nonverbal communicative behaviours

  • developing, maintaining, and understanding relationships

• Restrictive, repetitive patterns of behaviour, interests or activities as manifested by at least two of the following:

  • stereotyped or repetitive motor movements

  • insistence on sameness (routines)

  • highly restricted, fixated interests

  • hyper or hypo-reactivity to sensory input

• Must be present in early developmental period (may be masked/not fully manifested)

• Symptoms cause clinically sig impairment on social, occupational, or important areas of current functioning

• Not better explained by Intellectual disability or Global developmental delay

• Specify if: with/without accompanying intellectual/language impairment, associated with known genetic/medical condition/severity of social commu impairments (requiring substantial support/substantial support/support)

Autism and Co-occuring neurodivergence

Most autistic people have one or more co-occuring conditions - these are not part of autism, but frequently present alongside it

Autism prevalence

• Estimates 1 in 31 children aged 8 years are autistic

  • 1 in 44 (2018) and 1 in 36 (2020)

  • Autism reported to occur in racial, ethnic, and socioeconomic groups

    • more prevalent among males, although debated

• highest rates in 5-14 age group

  • 20-24 age group more than doubled from 1.2% in 2015 and 2018 2.7% in 2022

  • youngest children are being identified

    • 0-4 age group more than doubled from 0.4% in 2015 to 0.9% in 2022

Gender Differences in Autism

Autistic women more likely to be diagnosed at later stage

• under-representation of autistic girls and women in research

• interests towards topics relational in nature compared to males, who tend to be more mechanical in their interests

• internalising difficulties (present as shy or anxious)

  • camouflaging

  • masking/double masking

Neurodiversity-affirming Pillars

• Professional competency

  • three pillars:

    • social inclusion

    • economic inclusion

    • support services

      • ensure inclusion, safety, equitable access to opportunities, appropriate neurodiversity-affirming supports that recognise needs, strengths, and aspirations

Neurodiversity-addirming practices

• Supports autistic identity

• Adapts environment to suit their needs

• incorporates autistic perspectives and therapeutic goals

• aligns with their preferences and values

• enhances autonomy

• includes diagnostic assessment process

• facilitates knowledge and self-acceptance

Neurodiversity-affirming Therapy

• Emotion regulation is transdiagnostic → burnout prevention

  • modified CBT: big focus on affective education

  • energy banking: burnout management

    • withdrawal - energy depletion

    • deposit - energy boosters

• Mindfulness-based therapy

• Trauma-informed therapy

• Parenting support and parents as co-therapists

• Supports and/or medication for co-occuring mental health, medical health conditions, and disabilities

Intellectual Disability Criteria

• Identified by significant limitations in both intellectual functioning and adaptive functioning

• Intellectual and cognitive functioning required for diagnosis

• Adaptive functioning required for classification

  • collection of conceptual, social, and practical skills

• Age of onset is third element for diagnosis of ID

• Explicit moved away from IQ scores alone to determine severity levels

• Specify: severity in three domains based on behaviour (mild, moderate, severe, profund)

Intellectual Disability Specific Criteria

• Intellectual functioning

  • IQ approximately 2 SD below mean (around 70), assessed using standardised tools

• Adaptive behaviour

  • challenges in conceptual, social, and practical skills in everyday life

  • AB composite approximately 2 SD below mean

• Developmental onset

  • Must originate before age 22

Intellectual Disability Prevalence

that about 450,000 people have an intellectual disability in Australia

• Australian government released national roadmap for improving health of people with intellectual disability

Five assumptions (AAIDD)

Essential to applying the AAIDD definition in practice:

• Limitations must be considered within context of community environments typical of the individual’s age peers and culture

• Valid assessment considers cultural and linguistic diversity, and differences in communication, sensory, motor, and behavioural factors

• Within an individual, limitations often coexist with strengths

• Important purpose of describing limitations is to develop a profile of needed supports

• With appropriated personalised supports over a sustained period, the life functioning of the person will generally improve

Intellectual Disability Aetiology

• Chromosomal

  • Down syndrome - most common chromosomal cause

• Genetic

  • Fragile X syndrome - commom inherited cause of ID

  • Phenylketonuria (PKU) - metabolic disorder, problems with eating high-protein, phenylalanine-rich foods

  • Prenatal infections

    • Rubella (German Measles)

    • HIV

    • Syphillis

    • Herpes simplex virus

  • Prenatal Toxin Exposure

    • Fetal alcohol syndrome - leading cause of ID

    • Environmental exposure: lead, mercury

  • Biological & Perinatal factors

    • Rh incompatibility between mother and infant

    • Premature birth

    • Low birth weight

    • anoxia/oxygen deprivation during birth

    • Pregnancy and birth complications

  • Postnatal infections

    • encephalitis - inflammation of brain

    • meningitis - inflammation of brain membranes

    • whooping cough

    • measles — cause brain damage if complicated

  • traumatic brain injury/neurological

    • head injuries

    • epilepsy and uncontrolled seizures

  • environmental toxin exposure

    • lead exposure

    • mercury expore

  • psychosocial and environmental

    • poverty + socioeconomic disadvantage

    • severe malnutrition in early infancy

    • environment lacking stimulation and responsiveness

    • early childhood neglect

    • limited access to intervention and healthcare

AAIIDD take on classifying ID (trad vs modern)

• Traditional vs Modern approach

  • IQ score as primary classifier vs Support needs as primary focus

    • IQ: mild (50/55-70), moderate (35/40-50/55), severe (20/25-35/40), profound (<20-25)

      • deficit-focused and static, limited contextual consideration, heavily reliant on single test score

    • support: multidimensional - iq, adaptive behaviour, health, participation, context

      • adaptive behaviour composite score preferred for classification as it reflects real world functioning

      • purposeful and person-centred, aligned with social model of disability

ID Medical vs Social Model

• Medical Model vs Social Model

  • Focus: deficit/impairment vs human functioning/env context

  • Language: disorder/cure/severity/impairment vs difference/support/needs/strengths

  • Classification: IQ Bands (mild, moderate, severe, profound) vs Support levels (requiring, substantial, very substantial support)

  • Goal: fix/normalise ind vs enhance QoL thru tailored supports

  • Env: individual adapt to env vs enc adapt to individual

AAIDD Five Dimensions

• Intellectual Abilities: reasoning, problem-solving, learning, abstract thinking

• Adaptive Behavior: conceptual, social, practical everyday skills

• Health: physical, mental, and social well-being

• Participation: involvement in home, work, school, leisure, community

• Context: personal and env factors including culture and opportunities

AAIDD Systems of Supports

• Resources and strategies that promote development and interests of person and enhance individual functioning and personal well0being

  • Person-centred, comprehensive, coordinated, outcome-oriented

  • Values and support relationships

  • Promote autonomy and choice (incorporate choice and inclusivity)

  • Align to personal goals and support needs (built aroundd individual goals, preferences)

• Examples:

  • Family, friends, support workers

  • Professional support

  • Technological

  • Easy Read Info Guide

  • Adapt env to meet needs

  • Opportunities

Assessment process: intellectual functioning

• Typically measured with individually administered and psychometrically valid, comprehensive, and culturally approrpiate tests of intelligence

• Wechsler Intelligence Scale for Children Indices

  • Verbal Comprehension

  • Visual spatial

  • Fluid reasoning

  • Working memory

  • Processing speed

• Testing identifies areas of relative strengths and weaknesses: ssist academic and vocational planning

• IQ test scores, may be insufficient to assess reasoning in real-life situations and mastery of life skills

Factors affecting IQ scores

• Practice effect (learning from repeated testing)

• Flynn effect (overly high scores due to out of date norms)

• Use of brief intelligence screening tests or group tests

• Discrepant individual subtest score makes overall IQ score invalid

• May not be normed for individual’s sociocultural background or native language

• Co-occuring conditions that affect communication, language, and or motor function

Assessment process: Adaptive Functioning

• Confirmed by both standardised measures (ABAS, VABS)

  • require additional sources of info

    • educational

    • dvlp

    • medical history

    • parent report

Factors affecting AD composite scores

• Respondent related bias (who provides info)

• Behavior may vary across home, school, community

• Opportunity to perform the skills or level of support provided

• Cultural context

Supportive and Effective engagement practices

• Accessible communication (short, simple sentences, avoid jargon, one question at a time)

• Respect & Dignity (speak directly, ensure inclusivity and respect)

• Time & Patience (time for processing and responsing)

• Visual Supports (use images, diagrams, etc)

• Build Rapport (schedule consistent times for interaction)

• Environmental Considerations (minimise distractions and noise)

Working with Adults with ID

• Language needs to be adapted, reduce anxiety and put person at ease (humor)

  • provide more encouragement and more direct teaching of the tasks where needed

    • aim to facilitate person doing their best

• Therapy

  • provide respect and listen well

  • common referral reasons (feeling sad and not being able to process that emotion)

  • important considerations (level of language that person hs both when talking to them and providing information/handouts)

Picture Exchange Communiation Systems (PECS)

• Each card can be stuck on with velcro dots

• Can create cards with FIRST and THEN

Eating Disorder Prevalence

• Any ED

  • 0.74-2.2% of males

  • 2.58-8.4% of females

    • peak age of onet 15-17

• Study found

  • Many ED risk factors present by early adolescence

    • Body dissatisfaction (13/15 → predict ED at 21)

    • Perceived pressure to be thin (14 → predict ED at 21)

    • Thin-ideal internalisation (14 → predict ED at 21)

    • Dieting (14 → predict ED at 21)

    • Negative Affect (14 → predict EF at 21)

      • suggests 14 as ideal age to do prevention

• In austrlia, 4-16% of australian popul have eating disorder

  • by 14, 1.2% of males, 8.5% of females

  • by 20, 2.9% of males and 15.2% of females

    • binge eating disorder most common (esp with females)

  • anorexia typical onset 19-19 years more common with females

  • bulimia onset late adolescence/early 20s, more common with females

Eating Disorder Comorbidities

If have eating disorder, also have chances of

• Anxiety disorders up to 62%

  • generalised anxiety - genetic link + excessive exercise/low BMI

  • social anxiety - highest BN, then BED, then AN-BP

  • OCD - rates are variable amongst ED

• Mood disorders up to 54%

  • MDD has strong relationship

  • Bipolar has mixed reports from 1.9% up to 35.8%

  • Personality disorder sig higher in ED

• Substance use or PTSD up to 27%

  • Substance use higher in ED

  • Psychosis + Schizophrenia has limited research

  • Body dysmophia have vairable prevalence

  • ADHD twice greater with ED

  • Autism higher prevalence

  • PTSD around 16-32% across all eating disorders

  • Suicide leading causes of death for those with ED

  • self-harm common with 1/3 of those with EDs