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Differences between Developmental
Disorders & Mental Disorders
and
What Do We Do in Cefn
Carnau ?!
Dr khalid Mansour
Priory Cefn Carnau
Development
Development
1- Adult Brain Abilities / Skills
3- Nurturing
(Environmental Stimulation)
2- Biological Development
(Maturity)
1- Child Brain Abilities / Skills
Basic Brain Abilities / Skills
• Major Systems:
• Object related (physical) intelligence.
• Emotional intelligence.
• Social intelligence.
• Subsystems:
• Temperament
• Resilience
• Problem Solving
• Self-sufficiency
• Self-stimulation
• Central Coherence
Object-Related (Physical) Intelligence
• Managing objects
and/or physical
environment.
• Budgeting, Travelling,
Cleaning, Cooking,
etc.
• Usually measured by
IQ.
Emotional Intelligence
•Ability to appreciate and
treat oneself and others
as individuals:
•Insight (self awareness /
self observation)
•Empathy (theory of
mind)
•> positive personal
relationships
Social Intelligence
Ability to interact with
abstract parts of society >
fitting well in the wider
society :
•Law, Social Norms.
•Government, Police,
Social Services.
•Society, Country,
Nation, humanity.
Brother, friend,
mate, partner:
Emotional
Intelligence
People in society
not known
personally: Social
Intelligence
Basic Brain Functions: Subsystems:
• Positive Temperament vs Negative
Temperament
• Resilience vs Despondence
• Problem Solving vs Vulnerability
• Self Sufficiency vs Dependence
• Self Stimulation vs Irritability
• Central Coherence vs Awkwardness
2- Maturity
3- Nurture
•Family
•Environment
•Neglect /
Deprivation
•Abuse
•Culture
•Trauma
Patterns of Development
NOT Adult Brain Systems / Subsystems
XNurturing
(Environmental Stimulation)
XBiological Development
(Maturity)
Child Brain Systems / Subsystems
Normal Development
Adult Functioning
illness develop
ment
illness develop
ment
illness develop
ment
Child
Functioning
MaturityRegression
Consistent / Pervasive Developmental Disorders
Adult functioning
Childish Functioning
Irregular Developmental Disorders
Differences between Developmental
Disorders & Mental Disorders
4- Developmental Dis. & Acquired Mental Illness
Developmental Dis. &
Acquired Mental Illness
Differences:
•Baseline.
•Functionality
•Saved parts
•Potential for recovery
•Speed of recovery
•Rehabilitation
What do we do in Cefn Carnau
1. Assessment
2. Admission
3. Care
4. Treatment
5. Risk
management
6. Discharge
Assessment
Developmental
Disorders (Mental):
• Two main categories:
•Specific DD (e.g. dyslexia,
dyscalculia, speech
disorders, etc.
•Pervasive DD (e.g. Mental
Retardation (Learning
Difficulties) or Autistic
Spectrum Disorders)
• All frequently seen in chronic
mental health services
Developmental Disorders in
Cefn Caranu
•Primary Developmental
Disorders > Challenging
Behaviour (Secondary Mental
Disorders) + High Risk (to
others).
•Atypical presentations from
mental illnesses without
developmental disorders.
Diagnosis:
•History taking (client and
carers).
• Cross-sectional mental and
behavioural assessment
• Observation / Monitoring
•Psychometric tests
• Investigations.
• Formulations
• Therapeutic Trials.
Clinical Assessments:
• Still the main systems in use >
• Diagnostic criterial and
classifications > vague
• Open to Disagreement
• Subjective / Elective
methods unavoidable.
• Funding issues.
• Need multiple professional
agreement
Psychometric Assessment
• Expensive, time consuming and hard
to find
• Heavily dependent on client
cooperation
• Relatively of limited specificity and low
sensitivity (↑ False +ve and False –
ve)
• Limited in scope (Not as good in
suggesting differential diagnosis)
• Most services demand confirmations
via clinical assessment especially by
a doctor
Causes of Challenging
Behaviour:
Higher sensitivity to:
•Physical health factors.
•Environmental factors.
•Abuse / Neglect
•Vulnerability factors
•Communication
problems
Admission
Criteria for Admission:
•A Section of MHA.
•Pose significant risk to others
(not to oneself).
•Similar level of functioning
•Primarily problem >
Developmental Disorders
•Main need > structured care >
protective environment
Management: Care
Principles of Care:
Multi-dimensional
principle:
•Physical,
•Emotional,
•Social.
Maturity - Regression Principle:
• Based on levels
of development.
• Prevention of
regression
principle.
• Reaching the
maximum of
one’s potential.
• Individualisation
of care
• Normalisation of
care
Principles of Care:
•The Family Principle:
•Human factor
•Unconditional care
•High Predictability
& Consistency.
•Clear structure.
•High Promotion of
development
• Group work:
• Multidimensional:
• Behavioural, medical, physical,
psychological, social,
occupational, educational
• Not easy:
• Communication.
• Leadership.
• Internal structure.
• Support system.
Principles of Care: the
Multidisciplinary Team
Management: Treatment
Treatments:
Traditional but Comprehensive:
• Physical Medicine: GP, Neurologist, Dentist
• Mental Health Medications
• Behavioural
• Relational
• Psychotherapy
• Occupational
• Educational
• Social work
• SALT
• Physiotherapy
• Genetic Counselling
Treatments General:
Packages:
•Syndromic
•Non-syndromic.
Not as specific:
•Less RCTs on medications
in Developmental
Disorders > More side
effects.
•Other TTs similar
Treatments:
• Tailored
• Individualistic
• Multidimensional
• Strong non-
chemical
component
• Experimental
• Slower
• More expensive
Risk Management
Risk Management:
Internal factors:
• Insight: functional is enough
• Coping:
• Internal: coping with weaknesses.
• External: ability to use external help.
• Life-style:
• Structure: learning, structured activity, work,
etc
• Fulfilment: Personal choices, Hobbies,
qualifications, etc
Risk Management:
External factors:
• Environment:
• Physical environment: e.g.
housing, travelling, finance,
etc.
• Personal / practical: carers
• Socio-emotional: family,
friends, relationships.
• Supervision
• Support
• Boundaries: e.g. Sections MHA,
CTO, etc
Discharge
Discharge:
General Considerations
•Secure setting is not
normal > exceptional
setting.
•We can not continue
without providing the
justification.
•Discharge from secure
setting is not discharge
from treatment or care.
Discharge:
General Considerations
•high vulnerability to relapses.
•Behavioural Improvement does
not always means
dischargeable
•None-transferable
improvement vs transferable
improvement
• Less vulnerability
• Effective external care/ttt.
• Real target > stop patients
coming back
Additional Tasks
• Working with families.
• Engagement of the
Public.
• Working with the media.
• Complaints and
litigations.
• Departmental and non-
departmental regulatory
and inspection bodies.
• HIW
• NHS
• Commissioners
• Tribunals
Comments

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Difference between mental disabilities and mental disorders 8