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10/27/2014
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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
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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
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10/27/2014
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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
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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
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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
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10/27/2014
3
University of New Hampshire Institute on Disability/UCED
Joan B. Beasley, Ph.D.
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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
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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
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10/27/2014
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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
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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
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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.
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10/27/2014
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University of New Hampshire Institute on Disability/UCED
Joan B. Beasley, Ph.D.
Case #1
Down Syndrome
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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
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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
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10/27/2014
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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
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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
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10/27/2014
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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
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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
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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
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10/27/2014
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University of New Hampshire Institute on Disability/UCED
Joan B. Beasley, Ph.D.
Anxiety Disorders Internalizers
Panic dx
Agorophobia
OCD
Obsessional slowness
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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
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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
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10/27/2014
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University of New Hampshire Institute on Disability/UCED
Joan B. Beasley, Ph.D.
normal vision
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University of New