COMMUNICATION, COGNITIVE COMMUNICATION, COGNITIVE DEVELOPMENT AND BEHAVIOR IN DEVELOPMENT AND BEHAVIOR IN

CHILDREN WITH PWSCHILDREN WITH PWS

Violeta StanVioleta StanUniversity of Medicine and Pharmacy “Victor University of Medicine and Pharmacy “Victor

Babes” Timisoara, RomaniaBabes” Timisoara, Romania

Juan Carre de MirandaJuan Carre de Miranda

““Loving means respecting the other”Loving means respecting the other”Erich FrommErich Fromm, The Art of Loving, The Art of Loving

““the respect means the capacity tothe respect means the capacity to perceive perceive the the person as she/ he is in his/her person as she/ he is in his/her uniquenessuniqueness, to care , to care for the for the development in the directiondevelopment in the direction that is chosen that is chosen by it self, starting from his/her by it self, starting from his/her capacity capacity on her on her own own strenghtsstrenghts…respect is not possible without my …respect is not possible without my own own autonomyautonomy if I’m able to walk alone without if I’m able to walk alone without crutches crutches without the need for domination or without the need for domination or exploit the otherexploit the other””

The Interactive Psychological ModelThe Interactive Psychological Model

Cognition Behavior AffectCognition Behavior Affect

The attitude of the medical staffThe attitude of the medical staffImportance of initial impactImportance of initial impact

The family “discover the different child”- the The family “discover the different child”- the cascade of emotional reactions- acceptance or cascade of emotional reactions- acceptance or rejection = inclusion or neglectrejection = inclusion or neglect

Early reactions may settle on a path the Early reactions may settle on a path the abandonmentabandonment

Holistic systematic understanding of the Holistic systematic understanding of the family and the community’s values and family and the community’s values and reactions - based on scientific datareactions - based on scientific data

Characteristics of persons with PWSCharacteristics of persons with PWS

Cognitive rigidityCognitive rigidity Emotional dysregulationEmotional dysregulation Disruptive behaviorDisruptive behavior Stress sensitivityStress sensitivity

Will challenge the mental health of the Will challenge the mental health of the

family unit and the enviromment.family unit and the enviromment. How How much can we prevent?much can we prevent?

Severe Behavior Disorders in Persons with Severe Behavior Disorders in Persons with Mental Retardation: Multimodal Behavioral Mental Retardation: Multimodal Behavioral

Diagnostic ModelDiagnostic Model

““The need for a multidimensional and uniquely The need for a multidimensional and uniquely individualized assessment, one person’s episodes individualized assessment, one person’s episodes of aggression may reflect the absence of of aggression may reflect the absence of effective alternative means of communicating effective alternative means of communicating

his/her fearfulness or frustation”his/her fearfulness or frustation” (Durand,1990)(Durand,1990)

““Aggression may be a functional behavior and Aggression may be a functional behavior and may reflect a learned mode of obtaining desired may reflect a learned mode of obtaining desired consequences (social attention, potentially consequences (social attention, potentially painful condition)” painful condition)” (Mace,1986)(Mace,1986)

Severe Behavior Disorders in Persons with Severe Behavior Disorders in Persons with Mental Retardation: Multimodal Behavioral Mental Retardation: Multimodal Behavioral

Diagnostic ModelDiagnostic Model

“ “The heuristic value of a comprehensive The heuristic value of a comprehensive individualized diagnostic assessment reflects the individualized diagnostic assessment reflects the reality that is no single or simple physical or reality that is no single or simple physical or psychological cause and thus no single or specific psychological cause and thus no single or specific effective treatment, psychological or medical, for effective treatment, psychological or medical, for most abberant behaviors of those with mental most abberant behaviors of those with mental retardation” retardation” (Gardner, Graeber,1983)(Gardner, Graeber,1983)

Symptoms of depresion on severely mentally Symptoms of depresion on severely mentally retarded persons retarded persons (Menolascino,Weiler,1990)(Menolascino,Weiler,1990)

mood disorder, in wich sadness, apathy, mood disorder, in wich sadness, apathy, withdrawal, agitation, and crying spells may withdrawal, agitation, and crying spells may predominatepredominate

property destruction and temper tantrumsproperty destruction and temper tantrums sleeping disorderssleeping disorders appetite disorder and weight lossappetite disorder and weight loss onset of or incrase in self-injurious behavioronset of or incrase in self-injurious behavior motoric retardation and decrease of activitymotoric retardation and decrease of activity catatonic stuporcatatonic stupor hallucinationshallucinations anxietyanxiety suicidal actions or ideationssuicidal actions or ideations

Constant symptoms in depressed mentally Constant symptoms in depressed mentally

retarded childrenretarded children (Dosen,1990)(Dosen,1990)

Disphoria and sadness (observed or verbalized)Disphoria and sadness (observed or verbalized) Disorders of sleeping, eatingDisorders of sleeping, eating Changes in motoric activityChanges in motoric activity Irritability Irritability Market affective hungerMarket affective hunger

Symptoms among depressed mentally Symptoms among depressed mentally retarded personsretarded persons

Behavioral disorders like hyperactivity, Behavioral disorders like hyperactivity, aggression/autoaggression and inhibitionaggression/autoaggression and inhibition

Fear of failureFear of failure StereotypyStereotypy Sleeping and appetite disorders, constipation, Sleeping and appetite disorders, constipation,

encopresis and enuresisencopresis and enuresis Somatic complainSomatic complain

Developmentally Oriented DiagnosticsDevelopmentally Oriented Diagnostics

Anaclitic depressionAnaclitic depression (Spitz,1946)(Spitz,1946)

Loss of the previous state of the self precondition Loss of the previous state of the self precondition for early onset of depression for early onset of depression (Sandler&Jofee,1965)(Sandler&Jofee,1965)

Negative consequence of the repeted frustrations Negative consequence of the repeted frustrations stemming from the separation-individuation phase stemming from the separation-individuation phase (Bowlby,1952)(Bowlby,1952). Unconditional availability and appraisal . Unconditional availability and appraisal by the significant other-a prerequisite for the sense by the significant other-a prerequisite for the sense of self experiencedof self experienced

Strong dependency risking a strong “devaluing of Strong dependency risking a strong “devaluing of the self” the self” (Gaedt&Gartner,1990)(Gaedt&Gartner,1990)

Developmentally Oriented DiagnosticsDevelopmentally Oriented Diagnostics

Clownish behavior are defense mechanisms Clownish behavior are defense mechanisms when the subject experiences helpnessness when the subject experiences helpnessness and impotenceand impotence

Aggression/autoaggression when protesting Aggression/autoaggression when protesting against separationagainst separation

Moving the body and obsessional rituals Moving the body and obsessional rituals are defenses against depressive affect are defenses against depressive affect accompanied by feeling of self-accompanied by feeling of self-worthlessness and being unworthy of loveworthlessness and being unworthy of love

Clinging behavior-attempt to restore Clinging behavior-attempt to restore symbiotic attachment symbiotic attachment (Gaedt&Gartner,1990)(Gaedt&Gartner,1990)

AssessmentAssessment

1. A detailed developmental history/ 1. A detailed developmental history/ anamnesisanamnesis

2. 2. Medical examinationsMedical examinations (general somatic, (general somatic, genetic, neurological, biochemical)genetic, neurological, biochemical)

3. A 3. A psychological examinationpsychological examination (cognitive, (cognitive, social and personality development, social and personality development, analysis of behavioral problem, a analysis of behavioral problem, a neuropsychological examination)neuropsychological examination)

4. A detailed 4. A detailed psychiatric examinationpsychiatric examination (level (level of emotional development, psychosocial of emotional development, psychosocial homeostasis, psychopathology, psychiatric homeostasis, psychopathology, psychiatric diagnosis)diagnosis)

AssessmentAssessment

5. 5. A milieu examinationA milieu examination (parental and family, (parental and family, current residential)current residential)

6. 6. Pedagogical assessment Pedagogical assessment (analysis with (analysis with surroundings, adaptation abilities, enviromental surroundings, adaptation abilities, enviromental characteristics)characteristics)

7. Physiotherapeutic assessment7. Physiotherapeutic assessment

8. Speech examination8. Speech examination

An Integrative Developmental Psychiatric An Integrative Developmental Psychiatric Look at Self-Injurious BehaviorLook at Self-Injurious Behavior

1.1. Developmental imapairmentsDevelopmental imapairments

2.2. The effects of stressThe effects of stress

3.3. Anxiety and SIBAnxiety and SIB

4.4. The relationship between psychiatric disorders The relationship between psychiatric disorders and SIBand SIB

Developmental ImpairmentsDevelopmental Impairments

Disturbed maturation of cerebral tissueDisturbed maturation of cerebral tissue Disturbances at the biological and Disturbances at the biological and

neurobiochemical levelsneurobiochemical levels Primitive reaction types at the lower developmental Primitive reaction types at the lower developmental

levelslevels Disturbances in phasic socio-emotional Disturbances in phasic socio-emotional

developmentdevelopment Adaptive (learned) behaviorAdaptive (learned) behavior

An Integrative Developmental Model An Integrative Developmental Model (Pyramid and SIB)(Pyramid and SIB)

Biological disordersBiological disorders Enviromental disturbancesEnviromental disturbances Motric disordersMotric disorders Sensoric intergation disordersSensoric intergation disorders Adaptive behaviorAdaptive behavior Disorders in socio-emotional developmentDisorders in socio-emotional development AnxietyAnxiety Psychiatric disordersPsychiatric disorders Stress Stress

Menthal Health IssuesMenthal Health Issues

Prevention of “burnout syndrome” in family and Prevention of “burnout syndrome” in family and profesionals need holistic understanding and profesionals need holistic understanding and approachapproach

Training and supervision is needed on specific Training and supervision is needed on specific methods to adress specific issues at different life methods to adress specific issues at different life stages acording with the level of International stages acording with the level of International knowledgeknowledge

Is imperative to develop an algorithm and systemic Is imperative to develop an algorithm and systemic strategies centered on child rights strategies centered on child rights

Attachment related conceptsAttachment related concepts

Security of attachment across life span Security of attachment across life span Security/insecurity in adolescence mean:Security/insecurity in adolescence mean: 1 characteristic 1 characteristic strategy strategy 2 2 specific memoriesspecific memories and representation of and representation of

interactions interactions 3 3 ongoing relationshipsongoing relationships Managing conflicting systems recall the Managing conflicting systems recall the

parents to remain available when truly needed parents to remain available when truly needed Family nurturance basis for Family nurturance basis for

resilience/community integration/share resilience/community integration/share pleasures pleasures

THANK YOU!THANK YOU!