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Transcript
11/2/15
Intellectual Disability
&
Mental Health:
A Different Kind of
Dual Diagnosis
Allisha Berendts, MS, LPCC
The Ohio State University Counselor Education Doctoral Candidate
The Ohio State University Nisonger Center Child Behavior Support Specialist
Facts
•  About 4.6 million Americans have ID
•  Can be caused before or during birth or during “developmental
period”
•  25% from genetic disorders
•  25-33% unknown
•  May or may not be co-occurring with another developmental
disability
•  92% live independently or with family
•  ~40% have a co-occurring psychiatric disorder
•  2x general population
•  Full range of psychopathology
Property of Allisha Berendts, MS, LPCC
Intellectual
Disability (ID)
•  A developmental disability
•  Impairments in mental abilities that affect three
adaptive functioning domains
•  Conceptual Domain
•  Social Domain
•  Practical Domain
•  Communicate, interact, behave and learn differently
•  Name change in DSM-5 from Mental Retardation
•  Under Neurodevelopmental Disorders
Property of Allisha Berendts, MS, LPCC
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11/2/15
DSM 5
•  319. Intellectual Disability (Intellectual
Developmental Disorder) is a disorder with onset
during the developmental period that includes both
intellectual and adaptive functioning deficits in
conceptual, social, and practical domains.
•  Specifiers:
•  Age of onset
•  Associated with medical or genetic condition or
environmental factors
•  Severity
Property of Allisha Berendts, MS, LPCC
Severity levels
•  Based on adaptive functioning NOT IQ
Conceptual
Social
Practical
Mild
Moderate
Severe
Profound
•  85% mild, 9% moderate, 4% severe, 2% profound
Property of Allisha Berendts, MS, LPCC
Conceptual domain
•  Language
•  Reading
•  Writing
•  Math
•  Reasoning
•  Knowledge
•  Memory
Property of Allisha Berendts, MS, LPCC
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Social domain
•  Empathy
•  Social judgment
•  Interpersonal communication skills
•  The ability to make and retain friendships
Property of Allisha Berendts, MS, LPCC
Practical domain
•  Self-management in areas such as:
•  Personal care
•  Job
•  Responsibilities
•  Money management
•  Recreation
•  Organizing school and work tasks
Property of Allisha Berendts, MS, LPCC
Psychopathology
•  This population is especially vulnerable to psychiatric
disorders
•  Psychological burdens of ID
•  Poor problem solving, coping skills, and emotional
control
•  Poor environmental and/or social support
•  Can suffer from all psychiatric conditions, though may
not present “typically”
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Differential
Diagnosis
•  Since presentation may not be typical, you may have to
weed out what is part of the ID and what is mental
health symptomology
•  Diagnostic overshadowing
•  Clinicians downplay or ignore mental health
symptomology when they are working with a client with
an intellectual disability
•  ID is more noticeable
•  May be seen as more substantial
•  Behavioral vs. mental health symptomology
Property of Allisha Berendts, MS, LPCC
Assessment
•  Bio-psycho-social interview with client and perhaps caregivers, if
warranted
•  Psychological Assessment Schedule for Adults with Developmental
Disabilities
•  Reiss Screen for Maladaptive Behavior
•  Aberrant Behavior Checklist (ABC)
•  Assessment of Dual Diagnosis (ADD)
•  Anxiety, Depression and Mood Scale (ADAMS)
•  Social Performance Survey Schedule (SPSS)
•  Modified versions of “typical” scales
Property of Allisha Berendts, MS, LPCC
Dual Diagnosis
•  The co-existence of the symptoms of both intellectual
or developmental disabilities and mental health
problems
•  ID and Major Depressive Disorder
•  Cerebral Palsy and Generalized Anxiety Disorder
•  Autism and Bipolar Disorder
•  Traumatic Brain Injury and Borderline Personality
Disorder
•  May present differently than clients without ID
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11/2/15
Why is your client
seeking treatment?
•  Family or school request?
•  Treat ID behavioral symptomology?
•  Diagnosis and treatment of a comorbid mental health
issue?
Property of Allisha Berendts, MS, LPCC
Treating ID Behavior
Symptomology
•  Behavioral Therapy
•  Behavioral assessment—Why is the behavior occurring?
•  Make sure the behavior you are treating isn’t caused by a
mental health dx
•  Aggression, self-injury, property destruction are impulsive
behaviors that may be from ADHD, Bipolar Disorder or
from anxiety
•  Non-compliance may be due to depression
•  Social Skills Training
Property of Allisha Berendts, MS, LPCC
Treating Mental
health issues
•  ADHD
•  Depression
•  Anxiety
•  Bipolar Disorder
•  OCD
•  PTSD
•  Can use the same evidenced based treatment but slightly
modified to meet the client’s needs (pace, language use, etc.)
Property of Allisha Berendts, MS, LPCC
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11/2/15
Cognitive Behavioral
Therapy
•  Increasing skills
•  Social skills
•  Coping skills
•  Identify and respond to dysfunctional automatic
thoughts and cognitive distortions
•  Recognize and modify maladaptive intermediate
beliefs
•  Modify maladaptive schemas
Property of Allisha Berendts, MS, LPCC
Dialectical
Behavioral Therapy
•  Distress Tolerance
•  Emotional Regulation
•  Interpersonal Effectiveness
Property of Allisha Berendts, MS, LPCC
Distress Tolerance
•  Crisis Survival Strategies
•  ACCEPCTS skill
•  Activities
•  Contributing
• 
• 
• 
• 
Comparisons
Emotions
Pushing away
Thoughts
•  Sensations
n 
IMPROVE skill
n 
n 
n 
n 
n 
n 
n 
Imagery
Meaning
Prayer
Relaxation
One thing at a time
Vacation
Encouragement
•  Self Soothe
•  Pros and Cons
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•  Accepting Reality
•  Radical Acceptance
•  Turning the mind
•  Willingness vs. Willfulness
•  Awareness
•  Observe your breath
•  Half smile
•  Awareness of body
Property of Allisha Berendts, MS, LPCC
Emotional
Regulation
•  Challenge thoughts
•  Label emotions
•  Understand function
•  Decrease vulnerability
•  Increase positive emotions
•  Decrease emotional suffering
•  Mindfulness
•  Opposite action
Property of Allisha Berendts, MS, LPCC
Interpersonal
effectiveness
Getting Objective Met
DEAR
MAN
Challenge
Challenge
Thoughts
Thoughts
Maintaining
Relationship
GIVE
Property of Allisha Berendts, MS, LPCC
FAST
Maintaining
Self-Respect
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DEAR MAN
•  Describe
•  Express
•  Assert
•  Reinforce
•  Mindfully
•  Broken record
•  Ignore
•  Appear Confident
•  Negotiate
Property of Allisha Berendts, MS, LPCC
GIVE
•  Gentle
•  Interested
•  Validate
•  Easy going manner
Property of Allisha Berendts, MS, LPCC
FAST
•  Fair
•  To self and others
•  no Apologies
•  Stick to values
•  Truthful
Property of Allisha Berendts, MS, LPCC
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Positive Psychology
•  Shift identification of deficits and focus on the person’s
strengths and interests
•  Self Determination
•  Shift from the negative to positive
•  Identify and use a personal strength each day
•  Balance the negative and positive
•  Promote feelings of hopefulness
Property of Allisha Berendts, MS, LPCC
Behavioral
relaxation Therapy
•  Proactive in decreasing anxiety, agitation, pain, and
stress through progressive muscle relaxation and
biofeedback
•  Shown to be effective with clients in reducing
disruptive behaviors, phobias, ritualistic behavior, and
aggression
Property of Allisha Berendts, MS, LPCC
Small Group Activity
•  How would you go about assessing and treating this
client?
Property of Allisha Berendts, MS, LPCC
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Questions?
Property of Allisha Berendts, MS, LPCC
Thank you!
•  Allisha Berendts, MS, LPCC
•  The Ohio State University Counselor Education
Doctoral Candidate
•  Child Behavior Support Specialist OSU Nisonger
Center
•  [email protected]
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