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  • 10/27/2014

    1

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Integrated Health and Wellness Approaches to Challenging Behavior in Persons with IDD

    Joan B. Beasley, Ph.D. Jarrett Barnhill, MD Anne D. Hurley, Ph.D. Beth Marks, RN, Ph.D.

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Public Health Model of Intervention

    Primary: Capacity building; promoting wellness, improved quality of life; better outcomes

    Secondary: Expertise, access to appropriate care, cross systems communication; crisis prevention; accountability

    Tertiary: Expertise, appropriate response, stabilization, intervention; accountability

    2

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D. Numbers Benefitting from

    Intervention

    Effective Strategies Changing the odds

    Accurate Response

    Facing the

    odds

    Improved Supports Beating the odds

    Potential

    impact of intervention

    Required

    intensity of intervention

    Primary Intervention: Improved access to services, treatment planning, integration of health and wellness, and development

    of service linkages

    Secondary Intervention: Identification of individual/family stressors, crisis

    planning/prevention, health and medication monitoring and crisis

    intervention services

    Tertiary Intervention: Emergency room services,

    hospitalizations and law enforcement interventions

    3

  • 10/27/2014

    2

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Medical and Genetic Conditions : Key Players for IDD and Mental Health

    Assessments

    Anne Desnoyers Hurley, Ph.D.

    Research Associate Professor

    University of New Hampshire- Institute on Disability

    4

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Initial Psychiatric Diagnostic Interview

    General Population ID Population

    Establish relationship Relationship with a Team

    Conversation, detailed questions & answers

    Verbal ability limited

    3rd party information

    Evaluate overall presentation Atypical presentation Behavioral phenotypes

    Discuss diagnosis and treatment plan

    Team treatment negotiation

    5

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Chief Complaint N= 100 each Hurley et al. 2003 OPD

    NIQ Mild M-P

    Aggression* 6 45 37 Mood* 38 9 3 Anxiety* 24 8 1 Suicidality* 14 6 0 Physical* 5 6 18 SIB * 0 2 9 Cognitive* 2 5 11 Psychotic 2 5 12 Other 9 14 19

    6

  • 10/27/2014

    3

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    7

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    How Can We Improve Assessment?

    Send for all medical and educational records Integrating instrumentation into our

    assessment process Assessment of adaptive skills and

    neuropsychological testing and projective testing

    Specific tools to assess symptoms or areas, at initiation and regular follow-up

    Careful integration of psychosocial stressors and medical conditions

    8

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    START Formal Assessments

    ABC (Aberrant Behavior Checklist)

    RSQ (Recent Stressors Questionnaire)

    MEDS (Matson Evaluation of Medication Side Effects)

    Obtain all medical and educational records

    Case Conference Seminar for select individuals CET Clinical Education Team

    9

  • 10/27/2014

    4

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    What do we Mean by Medical?

    Any condition that causes pain, illness, or impairments

    Chronic illness

    Disability extra burden

    Medical problems that are intermittent

    ALL OF THE ABOVE CAUSES PSYCHOLOGICAL DIFFICULITES

    10

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    What about Genetics

    Many people with intellectual disability have that condition because it is genetic in nature

    Genetic conditions cause physical characteristics to be different, usually several

    Many genetic conditions also are the cause of intellectual disability

    Behavioral phenotype is that part of a genetic condition that influences intellectual ability and/or behavior and psychological / psychiatric functioning

    11

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Why are Genetics Important?

    Because if we are trying to help someone who has a specific known genetic condition, we must find out as much as possible about how it may cause medical problems, what types of medical services the person may need, and we will understand psychiatric difficulties and/or challenging behavior associated with the condition better.

    12

  • 10/27/2014

    5

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Case #1

    Down Syndrome

    13

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Oscar 17 yo Down syndrome

    Referred due to severe physical aggression

    q 2-3 months, female staff or community

    members, incontinent, fecal smearing

    2006 psychiatric eval suggested he was

    manipulative

    Axis I current: mental disorder due to

    medical problems; r/o autism spectrum

    disorder, r/o ODD

    14

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Oscar 17 yo Down syndrome

    ADHD age 5

    Surgical procedure, complications, psychological reactions?

    Hearing impairment

    Vision severe nearsighted, legally blind

    Psychiatric medications with no evidence of response- adverse events documented previously

    Morbid obesity, hyperlipidemia, HTN, sleep apnea, hypothyroidism

    15

  • 10/27/2014

    6

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Oscar Age 17 Down syndrome

    Prevacid- 30 mg, 1x/day

    Perphenazine- 2 mg, 2 tabs 2x/day

    Levothyroxine- 150 mg 1x/day

    Clonidine- 0.1 mg in AM, 0.05 mg in PM, 0.1mg @ HS

    Abilify- 5 mg @ HS

    Clonazepam- 0.5 mg 1x/day @ HS

    Allegra - 90mg (1/2 tab) @ HS

    Melatonin 3 mg @ HS 16

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Types of Down Syndrome

    95% of people with Down syndrome have trisomy 21 3 copies of chromosome #21

    4% have Robertsonian translocation because part of #21 attached to another chromosome, e.g., #14

    1% have mosaicism because only some cells have 3 copies of #21: they may have milder features

    17

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Epidemiology

    >60% spontaneously aborted

    20% stillborn

    1983: 9.5 in 10,000 live births

    2003: 11.8 in 10,000 live births

    18

  • 10/27/2014

    7

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Down Syndrome Phenotype

    Short stature Broad neck

    Small hands

    Epicanthal folds on eyes

    Upslanting palpebral fissures

    Flat nasal bridge

    Small mouth

    Brachicephaly

    19

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Down Syndrome Behavioral Phenotype

    Intellectual Disability mild-moderate

    Extroverted, highly social

    Impulsive, insistent

    Ability in reading, math, daily living skills

    outstrips predictions based on IQ testing

    More than 10% have Autism

    Ambitious

    20

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Scottish award-winning film & TV actress Paula Sage receives award with Brian Cox-- Wikipedia BAFTA Scotland

    21

  • 10/27/2014

    8

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Anxiety Disorders Internalizers

    Panic dx

    Agorophobia

    OCD

    Obsessional slowness

    22

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Active/Inattentive-Extroverted Externalizers

    ADHD

    May be linked to problems in

    expressive-receptive language

    frustration and perception of

    being stubborn

    23

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    Common Medical Problems

    Hearing impairment

    Visual limitations

    Fine & gross motor

    Congenital heart disease

    Depression

    Anxiety disorders

    Early aging

    Celiac disease

    Hypothyroidism

    Osteoarthritis

    Eczema

    Seizures

    Obesity

    Sleep apnea

    Diabetes

    Alzheimers disease

    Constipation

    GERD

    24

  • 10/27/2014

    9

    University of New Hampshire Institute on Disability/UCED

    Joan B. Beasley, Ph.D.

    normal vision

    25

    University of New