Transcript Document

Models of Development
and Mental Health
Lecture 3:
Behavioural Model: Autistic
Spectrum Disorders
Autistic Spectrum
Disorders
• Subcategory of Pervasive
Developmental Disorders
• Spectrum
– Asperger’s, Autistic, Childhood
Disintegrative Disorder
• Described by Kanner (1943)
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– communication deficits, atypical
cognitive potential, repetitious actions &
unimaginative play
absorption in the self or subjective mental
Rosaleen McElvaney, Phd
activities’
Diagnosis
DSM IV TR
• Qualitative Impairment in Social Interaction
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nonverbal behaviours
age-appropriate peer relationships
Spontaneous sharing, interests
Social or emotional reciprocity
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Language
Initiating or sustaining conversation
Stereotyped, repetitive, idiosyncratic language
Age appropriate make believe or initiative play
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Preoccupation with stereotyped restrictive interests
Inflexible adherence to non-functional routines or rituals
Stereotyped repetitive motor mannerisms
Persistent preoccupation with parts of objects
• Qualitative Impairment in Communication
• Restrictive, Repetitive Behaviours and Interests
Rosaleen McElvaney, Phd
Referencing DSM-IV-TR
American Psychiatric Association
(2000). Diagnostic and Statistical
Manual of Mental Disorders, (4th
Edition), Text Revision. Washington,
DC: APA
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Characteristics
Prevalence
Discrepant claims: 4.5 – 4.8 per 10,000
or much higher?
ERHA study 5 per 10,000 – closer to 20
(Fitzgerald et al, 2000)
Age
Typically early onset
Gender
Boys > Girls 3-5:1 (APA, 1994)
Socio-economic
status
No differences
Race/ethnicity
Little information
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Related problems (not diagnostic
criteria)
Intelligence: at least 75% of children with autism
have learning disabilities; minority have special
cognitive abilities e.g. excellent memory
Behaviour problems: aggression, outbursts,
temper tantrums and hyperactivity. Moods
shifts, excessive fears. Self-injurious
behaviour
Motor skills: may be poor, normal or very good
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Course of Autism
• Variations in onset, typically before age 3
• Diagnosis possible at age 3, but often occurs
later
• Developmental course is variable (improvement
& deterioration)
• In about 30% of cases adolescence brings
serious deterioration
• May be less favourable outcomes for girls
• Poorer prognosis if language absent and IQ low
• Some cases improve in adulthood but typically
outcomes not good
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(Atwood, 1998, cited in Molloy &
Vasil, 2002)
• Lack of empathy
• Naieve, inappropriate, one-sided
interaction
• Little ability to form and sustain
friendships
• Pedantic repetitive speech
• Poor non-verbal communication
• Intense interest in certain objects
• Clumsy ill co-ordinated movements & odd
posture
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Aetiological Theories
(Carr, 1999)
• Psychogenic theories
– Inadequate parenting: psychodynamic therapy
– Neurobiological: cognitive Vs emotional:
behaviour therapy
• Biogenic theories
– Neuroanatomy, neurochemistry &
psychophysiology
• Cognitive theories
– Emphasis on cognitive deficits
• Theory of mind; information processing deficits.
• Memory deficits; executive function deficits
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Behavioural Model
How helpful?
• Emergence, Maintenance, Treatment?
• Continuum between normal &
abnormal behaviour?
• Emphasis on behavioural
manifestation of difficulties
• Socially constructed? (Molloy & Vasil,
2002)
Rosaleen McElvaney, Phd
Behavioural Model
• Key principles
– Operant & classical conditioning (Pavlov
& Skinner)
– Concerned with behaviour alone
– Behaviour is learned
– Behaviour is reinforced
– It can be ‘unlearned’
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Components of Programmes
(Carr, 1999, 2003)
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Psychoeducation
Educational placement
Family based approach
Structured teaching method
Behaviour modification
Self care and skills training
Communication skills training
Management of challenging behaviour
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Critique of Behavioural
Model
• Underlying assumptions may not be
correct
• May be effective intervention not
explanation for aetiology
• Focus on behaviour – too narrow?
• Evidence for short term gain –
sustained over longer term?
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Therapeutic Interventions
• Applied Behavioural Analysis - ABA (Lovaas,
1987)
– uses operant conditioning, preferably beginning
before age 4
• TEACCH (The Treatment and Education of
Autistic and Communication Handicapped
Children) (Schopler, 1987)
– Structured learning activities
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Additional References
• Eikeseth, S., Smith, T., Jahr, E and
Eldevik, S. (2002). Intensive
behaviouraltreatments at school for
4-to-7 year-old children with autism.
Behaviour Modification, 26, 49-68
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Report of Task force on
Autism (2001)
• http://www.education.ie/servlet/blobservlet/sped
_autism.pdf
• Curriculum to include:
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Programme access guidelines
Individualised ASD programme guidelines
Use of NCCA guidelines
General ASD strategies
Personal and social programme for all pupils highlighting
the differing needs of sub groups on the ASD spectrum
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Task Force – curriculum
contd
• Support strategies, circle of friends,
buddying (with parental permission)
• Behavioural strategies/guidance (if
behavioural difficulties have been
identified)
• Resource implications
• Vocational and training guidelines
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Info
• Guest lecture – working with
adolescents, Feb 2nd
• Essay deadline – Thursday 2nd April
• Next week – Anxiety & cognitive
therapy model
Rosaleen McElvaney, Phd