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  1. 1. COMMUNICATION, COGNITIVE DEVELOPMENT AND BEHAVIOR IN CHILDREN WITH PWS Violeta Stan University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania Juan Carre de Miranda
  2. 2. “ Loving means respecting the other” Erich Fromm , The Art of Loving <ul><li>“ the respect means the capacity to perceive the person as she/ he is in his/her uniqueness , to care for the development in the direction that is chosen by it self, starting from his/her capacity on her own strenghts …respect is not possible without my own autonomy if I’m able to walk alone without crutches without the need for domination or exploit the other ” </li></ul>
  3. 3. The Interactive Psychological Model <ul><li>Cognition Behavior Affect </li></ul>
  4. 4. The attitude of the medical staff Importance of initial impact <ul><li>The family “discover the different child”- the cascade of emotional reactions- acceptance or rejection = inclusion or neglect </li></ul><ul><li>Early reactions may settle on a path the abandonment </li></ul><ul><li>Holistic systematic understanding of the family and the community’s values and reactions - based on scientific data </li></ul>
  5. 5. Characteristics of persons with PWS <ul><li>Cognitive rigidity </li></ul><ul><li>Emotional dysregulation </li></ul><ul><li>Disruptive behavior </li></ul><ul><li>Stress sensitivity </li></ul><ul><li>Will challenge the mental health of the family unit and the enviromment. How much can we prevent? </li></ul>
  6. 6. Severe Behavior Disorders in Persons with Mental Retardation: Multimodal Behavioral Diagnostic Model <ul><li>“ The need for a multidimensional and uniquely individualized assessment, one person’s episodes of aggression may reflect the absence of effective alternative means of communicating his/her fearfulness or frustation” (Durand,1990) </li></ul><ul><li>“ Aggression may be a functional behavior and may reflect a learned mode of obtaining desired consequences (social attention, potentially painful condition)” (Mace,1986) </li></ul>
  7. 7. Severe Behavior Disorders in Persons with Mental Retardation: Multimodal Behavioral Diagnostic Model <ul><li>“ The heuristic value of a comprehensive individualized diagnostic assessment reflects the reality that is no single or simple physical or psychological cause and thus no single or specific effective treatment, psychological or medical, for most abberant behaviors of those with mental retardation” (Gardner, Graeber,1983) </li></ul>
  8. 8. Symptoms of depresion on severely mentally retarded persons (Menolascino,Weiler,1990) <ul><li>mood disorder, in wich sadness, apathy, withdrawal, agitation, and crying spells may predominate </li></ul><ul><li>property destruction and temper tantrums </li></ul><ul><li>sleeping disorders </li></ul><ul><li>appetite disorder and weight loss </li></ul><ul><li>onset of or incrase in self-injurious behavior </li></ul><ul><li>motoric retardation and decrease of activity </li></ul><ul><li>catatonic stupor </li></ul><ul><li>hallucinations </li></ul><ul><li>anxiety </li></ul><ul><li>suicidal actions or ideations </li></ul>
  9. 9. Constant symptoms in depressed mentally retarded children (Dosen,1990) <ul><li>Disphoria and sadness (observed or verbalized) </li></ul><ul><li>Disorders of sleeping, eating </li></ul><ul><li>Changes in motoric activity </li></ul><ul><li>Irritability </li></ul><ul><li>Market affective hunger </li></ul>
  10. 10. Symptoms among depressed mentally retarded persons <ul><li>Behavioral disorders like hyperactivity, aggression/autoaggression and inhibition </li></ul><ul><li>Fear of failure </li></ul><ul><li>Stereotypy </li></ul><ul><li>Sleeping and appetite disorders, constipation, encopresis and enuresis </li></ul><ul><li>Somatic complain </li></ul>
  11. 11. Developmentally Oriented Diagnostics <ul><li>Anaclitic depression (Spitz,1946) </li></ul><ul><li>Loss of the previous state of the self precondition for early onset of depression (Sandler&Jofee,1965) </li></ul><ul><li>Negative consequence of the repeted frustrations stemming from the separation-individuation phase (Bowlby,1952) . Unconditional availability and appraisal by the significant other-a prerequisite for the sense of self experienced </li></ul><ul><li>Strong dependency risking a strong “devaluing of the self” (Gaedt&Gartner,1990) </li></ul>
  12. 12. Developmentally Oriented Diagnostics <ul><li>Clownish behavior are defense mechanisms when the subject experiences helpnessness and impotence </li></ul><ul><li>Aggression/autoaggression when protesting against separation </li></ul><ul><li>Moving the body and obsessional rituals are defenses against depressive affect accompanied by feeling of self-worthlessness and being unworthy of love </li></ul><ul><li>Clinging behavior-attempt to restore symbiotic attachment (Gaedt&Gartner,1990) </li></ul>
  13. 13. Assessment <ul><li>1. A detailed developmental history/ anamnesis </li></ul><ul><li>2. Medical examinations (general somatic, genetic, neurological, biochemical) </li></ul><ul><li>3. A psychological examination (cognitive, social and personality development, analysis of behavioral problem, a neuropsychological examination) </li></ul><ul><li>4. A detailed psychiatric examination (level of emotional development, psychosocial homeostasis, psychopathology, psychiatric diagnosis) </li></ul>
  14. 14. Assessment <ul><li>5. A milieu examination (parental and family, current residential) </li></ul><ul><li>6. Pedagogical assessment (analysis with surroundings, adaptation abilities, enviromental characteristics) </li></ul><ul><li>7. Physiotherapeutic assessment </li></ul><ul><li>8. Speech examination </li></ul>
  15. 15. An Integrative Developmental Psychiatric Look at Self-Injurious Behavior <ul><li>Developmental imapairments </li></ul><ul><li>The effects of stress </li></ul><ul><li>Anxiety and SIB </li></ul><ul><li>The relationship between psychiatric disorders and SIB </li></ul>
  16. 16. Developmental Impairments <ul><li>Disturbed maturation of cerebral tissue </li></ul><ul><li>Disturbances at the biological and neurobiochemical levels </li></ul><ul><li>Primitive reaction types at the lower developmental levels </li></ul><ul><li>Disturbances in phasic socio-emotional development </li></ul><ul><li>Adaptive (learned) behavior </li></ul>
  17. 17. An Integrative Developmental Model (Pyramid and SIB) <ul><li>Biological disorders </li></ul><ul><li>Enviromental disturbances </li></ul><ul><li>Motric disorders </li></ul><ul><li>Sensoric intergation disorders </li></ul><ul><li>Adaptive behavior </li></ul><ul><li>Disorders in socio-emotional development </li></ul><ul><li>Anxiety </li></ul><ul><li>Psychiatric disorders </li></ul><ul><li>Stress </li></ul>
  18. 18. Menthal Health Issues <ul><li>Prevention of “burnout syndrome” in family and profesionals need holistic understanding and approach </li></ul><ul><li>Training and supervision is needed on specific methods to adress specific issues at different life stages acording with the level of International knowledge </li></ul><ul><li>Is imperative to develop an algorithm and systemic strategies centered on child rights </li></ul>
  19. 19. Attachment related concepts <ul><li>Security of attachment across life span </li></ul><ul><li>Security/insecurity in adolescence mean: </li></ul><ul><li>1 characteristic strategy </li></ul><ul><li>2 specific memories and representation of interactions </li></ul><ul><li>3 ongoing relationships </li></ul><ul><li>Managing conflicting systems recall the parents to remain available when truly needed </li></ul><ul><li>Family nurturance basis for resilience/community integration/share pleasures </li></ul>
  20. 20. <ul><li>THANK YOU! </li></ul>