organic brain syndromes in the developmentally disabled a new way of conceptualizing dysfunction and...
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Organic Brain Syndromes in the Developmentally Disabled
A new way of conceptualizing Dysfunction
and Cognitive Restructuring
Dr. Jay Rao
M.B.,B.S., D.P.M., M.R.C.Psych(U.K.), F.R.C.P©
Associate Professor/ Director, Post Graduate Education
University of Western Ontario, London
Signs and Symptoms
• Perseveration
• Organic Sameness
• Inflexibility
• Catastrophic Anxiety
• Emotional Dysregulation
• Working Memory Deficits
• Poor judgement
Signs and Symptoms
• Low threshold for frustration
• Impulse control difficulties
• Dyspraxia --Speech / motor
• difficulty in postponing gratification
• emotional ‘incontinence’
The Process of Adaptation
INVOLVES
• Obtaining information
• Evaluating information
• Processing information ( taking decisions)
• Acting
• Evaluating results
• Storing patterns
Factors Influencing Obtaining of Information
PERCEPTION
• require context of past experience
• require a personal * meaning
* need
* emotional state
* predictive value
• require some sort of reasoning process
In a Developmentally disabled individual;
•Perceiving/Integrating:
* Selective or poor attention
* Sensory deficits
* Absence of prior knowledge/
Experience
Input affected by problems in:
Processing of Information
•DEPENDENT also ON such filters as:
• Varied experience
• Problem solving skills
• Ability to predict personal outcomes
Processing in the developmentally disabled
• Faulty : given the faulty input
• Can not base on prior knowledge
• Not Flexible
• Problems with sequencing and Logical operations
• Linked to basic ‘ survival’ emotions.
Typical Responses in OBS
Rapid cycling mood changes
aimless energy
High Anxiety
Irritability
Impulsivity
Disinhibition
perseveration
How is Behavior Controlled
• Simple Behaviors
Reflexive Automatic Inflexible
• Complex Behaviors
Cognitive control purposeful flexible
•
Broca’sarea
Parsopercularis
Motor cortexSomatosensory cortex
Sensory associativecortex
Primary
Auditory cortexWernicke’s
area
Visual associativecortex
Visualcortex
Pre Frontal Cortex
Situation requiring Cognitive Control
Look Left Look Right
Process
1. Awareness that context is different2. Retrieving Cognitive Representations of Correct action in circumstance3. Selecting correct motor response4. Inhibiting INCORRECT response5. Active Maintenance (of Task / Goal related information)6. Update any new information7. Learn (transfer through Working Memory Short Long term Memory
Without Pre Frontal Function
The most frequently used neural pathway pre-dominates
In a NOVEL situation:
Haphazard behavior occurs:
IMPULSIVE, Inappropriate, Disorganized
Executive FunctionsInhibit
Shift
Emotional Control
Monitor
Working Memory
Plan/ organize
Organization of Materials
Task Completion
Dysfunction
ADAPTIVE FUNCTIONING
Emotional
Interpersonalenvironmental
Intrapersonal
PROCESSING INFORMATION
• Information is processed highly individually.
• Processing is influenced by many motives.
• Avoiding pain, discomfort, distress.
• Manipulation to gain results.
• Activation of past patterns.
Results in
• High anxiety
Disorganized behavior
Perseveration
Jo
Inability to process information efficiently
•Inability to dampen unnecessary inflow
•Inability to focus on what is essential
•Bombarded by stimuli, fragmented experiencing of the world
•Inability to handle the resulting chaos
• Wanting to withdraw, “turn off” the sensory inflow.
• Anxiety Self injury (Endorphin response)
Stress
conflict
helplessness High CRH
High ACTH
High NE, Cortisol
High Anxiety
High Metenkephalin
Impervious to painSelf injury
OPIOIDS Released
ANXIETY REDUCED
Self Injury - Opioid Dynamics
Stress Adaptation Fails
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