* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download IDD and Mental Health: Communicating
Survey
Document related concepts
History of psychiatry wikipedia , lookup
Major depressive disorder wikipedia , lookup
Child psychopathology wikipedia , lookup
Autism therapies wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
Developmental disability wikipedia , lookup
Classification of mental disorders wikipedia , lookup
History of mental disorders wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Mental status examination wikipedia , lookup
Labeling theory wikipedia , lookup
Asperger syndrome wikipedia , lookup
Transcript
Communicating Through Behavior: Becoming Better “Listeners” Michael J. Parker, PhD Clinical Director IDD Eligibility, MHMR Tarrant Medical, Behavioral, Psychiatric Webinar March 9, 2016 [email protected] 1 Communicating Through Behavior Learning Objectives Attendees will: 1. Learn how people with limited language constitute a diversity population 2. Identify meanings and functions of behaviors 3. Learn to identify mental health diagnoses based on behavior 2 Communicating Through Behavior # 1: Behavioral communication is characteristic of a limited language diversity population. 3 Communicating Through Behavior Language is far more than communication. 4 Communicating Through Behavior Language regulates emotion. 5 Communicating Through Behavior Limitations in oral language leaves people prone to use nonverbal means of expression – possibly with less inhibitory control 6 Communicating Through Behavior Language is bound in culture. Culture is a form of community. 7 Communicating Through Behavior Being nonverbal is not the same as lacking language. 8 Communicating Through Behavior Things to Remember: People who have limitations speaking tend to act out. Acting out is not a substitution for language; it is a language. Language is a form of interpersonal relatedness. Behavior is an expression of preferences. 9 Communicating Through Behavior Objective 2: Identify meanings and functions of behaviors 10 Communicating Through Behavior What was your first behavior? 11 Communicating Through Behavior Examples of Common Reasons We Act: • Catharsis • Rejuvenation • Social Acceptance • Pleasure • Satiation • Nurturance 12 Communicating Through Behavior Just as there are multiple influences upon how and why we act, there are various schools of thought about how and why we act. Alfred Adler: Mental Health approach People are “discouraged” rather than ill. 13 Communicating Through Behavior Alder’s 4 Motives They can be either productive or “mistaken”. Attention Power Revenge Escape / Avoidance 14 Communicating Through Behavior - Attention Attention The desire for attention is natural and normal. People often mistake Attention as the motive for a “misbehavior” because: All challenging behavior draws attention. The way to extinguish attention-seeking behavior is to ignore it. 15 Help! 16 Communicating Through Behavior – Power Power The purpose of power is to get what you want. When a person uses power to dominate others, to control them to gratify their own wants at the expense of others, then it becomes socially unacceptable. 17 Communicating Through Behavior – Revenge Revenge Revenge is retaliation after being hurt. While revenge is normally directed at the perceived perpetrator, vengeance can be displaced. 18 Communicating Through Behavior – Escape Escape / Avoidance Escape is not about leaving a place or a task. The intent is to avoid noxious feelings. A person does not have to physically run away to escape. A person can “tune out” or forget to show up. Examples of noxious feelings include fear [“Run away!”], anxiety, worry, and discouragement. A person can also push others away as a means of escape. 19 Communicating Through Behavior – Escape Avoidance In some models, Avoidance is viewed as Inadequacy or Worthlessness. Form this perspective, the person actively pursues failure. 20 Communicating Through Behavior Activity Imagine you’re sitting in a presentation. A member of the audience stands up and makes very critical remarks about the presentation. He tells the speaker why his presentation is so weak. By showing his “superior knowledge” is the person’s intent: • • • • to shift the focus of attention to himself? to gain control of the session? to get revenge for the agony he has endured? to avoid being bored further? As stated earlier, behaviors and their motives can be complex. A behavior can fill more than one purpose. 21 Communicating Through Behavior Objective 3: Identify mental health diagnoses based on behavior 22 Prevalence of Mental Health Issues Approximately one-third of persons with IDD will be identified with a comorbid mental health disorders during their lifetime, and as many as 50% of children with IDD will experience emotional problems. NADD position paper. 2014. • Accurate diagnosis is the foundation of effective treatment. • Symptoms of mental health disorders are often displayed in different formats by persons with limited ability for verbal self-report. • With proper training, behaviors that otherwise impress as aberrant may be recognized as ordinary in the context of IDD and limited verbal language. 23 Without proper training, diagnostic overshadowing can result in important behavioral expressions, which are actually reports of symptomology, being attributed to a cause other than the true precipitating disorder. Behavioral expressions of Major Depression, Bipolar Disorder, Autism Spectrum Disorder and psychotic features will be considered in order to facilitate accurate diagnosis and case conceptualization. 24 Communicating Through Behavior Caution! 25 What’s not Mental Illness Things that are not Mental Illness Always rule out medical causes. 26 DSM vs. DM-ID: Mood Disorders Factors Complicating Diagnosis in the IDD Population: “Internal” symptom criteria for diagnosis Difficulty relating abstract concepts with limited or nonexistent expressive speech Limited skills providing history Similarity between problematic behaviors and external symptoms of mental illness 27 Communicating Through Behavior Diagnostic Overshadowing • Diagnostic overshadowing happens when a person attributes behavioral, emotional and social issues to one particular diagnosis while not considering other possible reasons or issues that might be the cause. 28 Communicating Through Behavior Diagnostic Overshadowing • Diagnostic overshadowing occurs when a professional allows one condition to "overshadow" other aspects of the person and thus fails to recognize symptoms or diagnoses due to other conditions. 29 Mental Health & IDD Three Major Mental Illnesses frequently experienced by persons with IDD: Major Depression Bipolar Disorder Psychoses / Schizophrenia Symptoms may present differently by people with IDD compared to neurotypical people. 30 Depression as Behavior Depression Depression is a mood, not a feeling. It can be unipolar or bipolar; mild or major. It has a global toxic impact on functioning. Aaron Beck identified depression as characterized by a negative view of: • Self • The world • The future 31 Depression as Behavior “The 3 H’s” Helpless * Hapless * Hopeless Doesn’t believe s/he can make things better. Life is miserable and there’s nothing good. Cannot see that things will ever get better. 32 DSM vs. DM-ID: Major Depressive Episode DSM-5 Criteria for Major Depressive Disorder: 1. Depressed mood most of the day, nearly every day 2. Markedly diminished interest or pleasure 3. Significant weight loss or decrease or increase in appetite 4. Insomnia or hypersomnia nearly every day 5. Psychomotor agitation or retardation 6. Fatigue or loss of energy 7. Feelings of worthlessness or inappropriate guilt 8. Diminished ability to think or concentrate 9. Recurrent thoughts of death / suicidal ideation 33 DSM vs. DM-ID: Major Depressive Episode DM-ID Adapted Criteria: Must include at least FOUR of the following for a two week period: Mood may be irritable OR depressed for persons with IDD: Depressed mood or irritable mood *required* Diminished interest or pleasure in almost all activities *required* Significant weight loss or gain without dieting, or failure to gain weight in children 34 DSM vs. DM-ID: Major Depressive Episode DM-ID Adapted Criteria (cont.): Mood may be irritable OR depressed for persons with IDD: Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or excessive guilt Diminished ability to think or concentrate Recurrent thoughts of death or suicide, or a suicide attempt 35 DSM vs. DM-ID: Manic Episode DSM-IV Criteria for Manic Episode: Mood must be elevated, expansive, or irritable for at least 1 week (No duration is required if hospitalization is necessary): Plus three of the following (or four if mood is only irritable): Inflated self-esteem or grandiosity More talkative than usual or pressure to keep talking Flight of ideas or racing thoughts 36 DSM vs. DM-ID: Manic Episode DSM-IV Criteria (cont.): Plus three of the following (or four if mood is only irritable) (cont.): Easily distracted Increase in goal-directed behavior Excessive involvement in pleasurable, but risky behaviors 37 DSM vs. DM-ID: Manic Episode DM-ID Adapted Criteria: Mood must be elevated, expansive, or irritable for at least 1 week (No duration is required if hospitalization is necessary): Plus TWO of the following for persons with limited expressive language (or THREE if mood is only irritable): Inflated self-esteem or grandiosity More talkative than usual or pressure to keep talking Flight of ideas or racing thoughts 38 DSM vs. DM-ID: Manic Episode DM-ID Adapted Criteria (cont.): Plus TWO of the following for persons with limited expressive language (or THREE if mood is only irritable) (cont.): Easily distracted Increase in goal-directed behavior Excessive involvement in pleasurable, but risky behaviors 39 IDD and Mood Disorders Persons with IDD and a Mood Disorder are more likely to: Display obsessive-compulsive behaviors Experience psychotic symptoms during mood disturbances Display anxiety with the mood disturbance Demonstrate aggressive behaviors during a mood disturbance 40 Diagnoses Comorbid with IDD Mental Status Examination addresses: oAppearance oMotor oSpeech oAffect oThought Content oThought Process oPerception oIntellect oInsight oInterpersonal Relatedness oSleep & Appetite 41 Diagnoses Comorbid with IDD Mental Status Exam: Items as Behavior oAppearance oIntellect oSpeech oEmotional Expression oThinking & Perception oInterpersonal Relatedness 42 Diagnoses Comorbid with IDD Depression Mood may be depressed or irritable for persons with IDD: Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or excessive guilt Diminished ability to think or concentrate Recurrent thoughts of death or suicide, or a suicide attempt 43 Depression as Behavior Appearance • Neglect of appearance • Decrease in grooming – uncombed hair, used to like to have a fresh shirt on, now unclean clothes, wearing the same thing, face not washed • Decreased eye contact • Staring off into space • Staring down • Also, no longer caring for belongings 44 Depression as Behavior Speech • Limited [Reduced verbalizations or vocalizations] • Shrugs instead of talking • Low volume • Monotone • Slow to respond 45 Depression as Behavior Interpersonal • Withdrawn – avoids interacting • Seems “aloof” • Pushes people away – literally or with angry words or acts • Covers eyes or ears • You may also see avoidance in the form of hitting, pinching, shoving, etc. 46 Depression as Behavior Emotional Expression • Sad Mood (This may present as Agitation or Irritability.) • Flat Affect – monotone voice & lack of facial expression • Loss of pleasure – Loss of ability to experience pleasure [Anhedonia] • Indifference – Does not want to do favorite activities • Statements of lowered Self-worth: “I bad.” “I no good.” 47 Depression as Behavior Thinking & Perception • Thoughts (acts) of harming self. • World is a less interesting place. • Lacks motivation. [Avolition] “Get up!” • Decreased Self-Esteem [affects interpersonal relationships] UNIQUE to Depression: “I am not worthy of being loved.” 48 Depression as Behavior Intellect • Less able to figure things out (problem-solve) • Impaired Memory • Less able to Concentrate (stay on task) • Poor memory & decreased concentration, further reduce existing Low Frustration Tolerance • You may see it as “opposition” to complying with requests. 49 Depression as Behavior Intellect Less able to problem-solve: Agitation (Pain) + low self-worth + reduced frustration tolerance + decreased problem-solving can lead to suicidal acts. 50 Mental Health & IDD Bipolar Disorder is frequently experienced by persons with IDD. What does Mania look like when a person has ID? 51 Mania as Behavior Appearance • Continued self-care BUT in a haphazard way • Sloppy make-up • “Weird” disheveled Hair & Clothing 52 Mania as Behavior Speech • • • • Pressured – very rapid Boundless speech, cannot get to the point Stream of thought inconsistent “Flight of ideas” 53 Mania as Behavior Emotional Expression Elated, Expansive Mood (may be irritable) Intense “manic” Boundless energy Facial Expressions are extreme Labile emotions – Rapid changes – sudden Crying or Laughing – seemingly no reason. • “Hair Trigger” Very easily annoyed or upset • Irritable / Angry behavior • Inflated Self-esteem “I’m the best in the world!” • • • • • 54 Mania as Behavior Thinking & Perception • Grandiose Ideas / Plans – relative to life experience • Pleasure-seeking (Hedonistic Behavior) & Risk-taking e.g., Binge Eating, Sexualized Behavior – “Streaking” • Acts as if invincible • Confusion 55 Mania as Behavior Intellect • Internally Distractible • Cannot attend or concentrate to complete tasks, even preferred activities. 56 Mania as Behavior • • • • • Interpersonal No one is a stranger Immediate best friends Unprotected sex Gullible – take drugs May object to you “rescuing” them. 57 Autism Autism “Spectrum” Disorder DSM-5 Criteria: • Deficits in communication and social interaction • Poor back and forth conversation; fails to initiate or respond to social interaction • Impaired nonverbal communication (poor eye contact, lack of gestures and facial expressions, limited range or misuse of tone of voice, etc.) • Deficits in developing and maintaining relationships (lack of interest in others, cannot adjust behavior to changing social contexts, lack of imaginative play) 58 Autism Limited and repetitive patterns of behavior, interests and activities • must have at least two of the following… • Repetitive movements, speech, or use of objects • Insistence on sameness; inflexible adherence to routines and rituals • Fixated interests that are very intense and overly focused • Unusually high or low sensitivity to the senses (lighting, odors, textures, etc.) 59 Autism Things to consider when working with people with Autism: Poor eye contact, limited or odd speech, and lack of interest in others is typical and does not necessarily indicate noncompliance or avoidance. Invasion of personal space usually does not indicate attempts at aggression. Socially inappropriate behavior typically does not suggest attempts at attention or manipulation. People with Autism are easily stressed and overstimulated. Despite their limited speech, persons with Autism generally understand a lot more than they are able to express. 60 Communicating Through Behavior Schizophrenia and Other Psychotic Disorders (Unfortunately the time allotted did not allow presentation of this section during the webinar.) 61 Communicating Through Behavior What Can We Do? 62 What Can Be Done Get to know the person. Understand what behaviors communicate. Teach additional ways to communicate. Share information across providers, staff, and shifts. Ask people what they want. Offer people more opportunity – not just forced choices. Meet social needs and the need for fun! 63 What Can Be Done Schedule regular Dental and Physical exams. Accompany the person to appointments. Report significant changes to medication managers, after ruling out situational factors. Treat your clients like people and not just “consumers.” Prior planning – Focus on fixing the system and not just the individual. 64 Communicating Through Behavior Thank you for your attention and participation! 65