Models of Development and Mental Health

1. Models of Development and Mental Health Lecture 3: Behavioural Model: Autistic Spectrum Disorders

2. Autistic Spectrum Disorders • Subcategory of Pervasive Developmental Disorders • Spectrum • Asperger’s, Autistic, Childhood Disintegrative Disorder • Described by Kanner (1943) • communication deficits, atypical cognitive potential, repetitious actions & unimaginative play • absorption in the self or subjective mental activities’ Rosaleen McElvaney, Phd

3. Diagnosis DSM IV TR • Qualitative Impairment in Social Interaction • nonverbal behaviours • age-appropriate peer relationships • Spontaneous sharing, interests • Social or emotional reciprocity • Qualitative Impairment in Communication • Language • Initiating or sustaining conversation • Stereotyped, repetitive, idiosyncratic language • Age appropriate make believe or initiative play • Restrictive, Repetitive Behaviours and Interests • Preoccupation with stereotyped restrictive interests • Inflexible adherence to non-functional routines or rituals • Stereotyped repetitive motor mannerisms • Persistent preoccupation with parts of objects Rosaleen McElvaney, Phd

4. Referencing DSM-IV-TR American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, (4th Edition), Text Revision. Washington, DC: APA Rosaleen McElvaney, Phd

5. Characteristics Rosaleen McElvaney, Phd

6. 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 Rosaleen McElvaney, Phd

7. 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 Rosaleen McElvaney, Phd

8. Asperger’s Syndrome(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 Rosaleen McElvaney, Phd

9. 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 Rosaleen McElvaney, Phd

10. Behavioural ModelHow helpful? • Emergence, Maintenance, Treatment? • Continuum between normal & abnormal behaviour? • Emphasis on behavioural manifestation of difficulties • Socially constructed? (Molloy & Vasil, 2002) Rosaleen McElvaney, Phd

11. Behavioural Model • Key principles • Operant & classical conditioning (Pavlov & Skinner) • Concerned with behaviour alone • Behaviour is learned • Behaviour is reinforced • It can be ‘unlearned’ Rosaleen McElvaney, Phd

12. Components of Programmes(Carr, 1999, 2003) • Psychoeducation • Educational placement • Family based approach • Structured teaching method • Behaviour modification • Self care and skills training • Communication skills training • Management of challenging behaviour Rosaleen McElvaney, Phd

13. 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? Rosaleen McElvaney, Phd

14. 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 Rosaleen McElvaney, Phd

15. 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 Rosaleen McElvaney, Phd

16. Report of Task force on Autism (2001) • http://www.education.ie/servlet/blobservlet/sped_autism.pdf • Curriculum to include: • 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 Rosaleen McElvaney, Phd

17. 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 Rosaleen McElvaney, Phd

18. Info • Guest lecture – working with adolescents, Feb 2nd • Essay deadline – Thursday 2nd April • Next week – Anxiety & cognitive therapy model Rosaleen McElvaney, Phd