for Asperger Syndrome and Other Related Disorders Practical Strategies for Assessment Practical Strategies and for Treatment Assessment and Treatment Illustrated by Laura S. Kowalski A Simple Technique to Help Someone with Social Difficulties Illustrated by Laura S. Kowalski Illustrated by Laura S. Kowalski Psych Grand Rounds, M.A., C.C.C. Professional Communication Services, Inc. 1401-A Edgewater Dr. Orlando, FL 32804 407-245-1026 www.socialpragmatics.com In the efforts to comply with the appropriate boards/associations, I declare that I do not have any affiliations with or financial interest in a commercial organization that could pose a conflict of interest with my presentation. Speaker Disclosure My books I declare that aside from materials I have authored, I, or my family, do not have any financial relationship in any amount with a commercial interest whose products or services are discussed in my presentation. Additionally all Planner s involved in today s presentation do not have any financial relationship. Non-Financial: Florida Assoc. of Sp-Lang. Path. & Aud.: VP Professional Practices in SLP Social-Pragmatic Success Asperger Syndrome explained Are you In The Zone? Me, Myself, and You Financial: Professional Communication Services, Inc.: President AS Works: Co-owner Author 3 4
DSM-5 Diagnostic Codes Neurodevelopmental disorders Schizophrenia spectrum & other psychotic disorders Bipolar and related disorders Depressive disorders Anxiety disorders Obsessive-compulsive and related disorders Trauma- and stressor-related disorders Dissociative disorders Disruptive, Impulse-control, and conduct disorders 5 Personality disorders Just What is the DSM? 300 different psychiatric disorders fluid - some are added & deleted as we learn more about the issue lists known causes stats in terms of gender, age at onset & prognosis the Bible for psych 6 Diagnosing Categories & Disorders lots of overlap with diagnoses rarely is one dx exclusive of another one dx often leads to another anxiety can lead to depression categorized according to predominant features phobias, social anxiety, & PTSD all have anxiety as a main feature and as such are categorized under Anxiety Disorders 7 8
Axis I: Clinical Syndromes it s what most people think of as the diagnostic label examples would be depression schizophrenia phobias Axis II: Developmental Disorders & Personality Disorders Developmental disorders: often evident in childhood examples are PDD & autism Personality disorders: more long lasting symptoms encompass the individual s way of interacting with the world examples are paranoia, antisocial, and borderline personality disorder 9 10 Axis III: Physical Conditions Axis IV: Severity of Psychosocial Stressors specific conditions that can result in the development, continuance, or exacerbation of Axis I and II disorders examples include brain injury, HIV/AIDS events in a person s life that can impact disorders listed in Axis I and II examples: death of loved one, starting new job, college, unemployment, marriage 11 12
Axis V: Highest Level of Functioning a rating of an individual s level of functioning at the present time and within the previous year helps understanding how the previous 4 axes are affecting a person and what type of change could be expected Categories of Mental Health 13 Categories of Mental Health Adjustment Disorders Adjustment Disorders Anxiety Disorders Dissociative Disorders Eating Disorders Impulse-Control Disorders Mood Disorders Sexual Disorders Sleep Disorders Psychotic Disorders Sexual Dysfunctions Somatoform Disorders Substance Disorders Personality Disorders 15 common characteristics relate to a difficult adjustment to a life situation above that typically seen in most individuals typical labels: adjustment disorder unspecified adjustment disorder with... (anxiety, depressed mood, disturbance of conduct) adjustment disorder with mixed anxiety and depressed mood adjustment disorder with mixed disturbance of emotions and conduct 16
Anxiety Disorders primary feature is abnormal or inappropriate anxiety become a problem when they occur without any stimulus or the stimulus doesn t warrant such a reaction typical labels acute stress disorder agoraphobia obsessive-compulsive disorder panic disorder phobias posttraumatic stress disorder 17 a. Generalized Anxiety Disorder Etiology: Anxiety becomes generalized to other situations and then becomes overwhelming. Develops over long period of time and often not noticed until it impacts ADLs Symptoms: heart palpitations, dizziness, excessive worry Treatment: medication & therapy Prognosis: good underlying fears more difficult childhood issues often get distorted in adulthod 18 b. OCD (Obsessive Compulsive Disorder) Etiology: biological & psychological Symptoms: obsessions: persistent, often irrational, and uncontrollable compulsions: actions used to neutralize obsessions Treatment: medication & therapy Prognosis: wide range depending upon how the individual reacts to medication and how deep rooted the underlying issues are 20
c. Panic Disorder Etiology: subtle underlying causes that produce rapid symptoms without an identifiable stressor Symptoms: sudden attacks of intense fear with physical symptoms (hear palpitations, shortness of breath, racing thoughts...). Often mistaken for heart attack in hospital ER Treatment: medication & therapy Prognosis: good if treated if untreated agoriphobia can result 22 d. Phobias Etiology: often a traumatic event is the precurser (may not be at conscious level) Symptoms: extreme anxiety and fear that disrupt everyday functioning Treatment: behavioral desensitization training Prognosis: very good if treated effectively 24
e. PTSD (Post-traumatic Stress Disorder) Etiology: always follows traumatic event that causes intense fear and/or helplessness Symptoms: re-experiencing the trauma via nightmares, obsessive thoughts & flashbacks. Avoidance component is common. Increased anxiety and startle response Treatment: psychological treatment, sometimes medications (anti-anxiety) Prognosis: moderate to very good. Better for those whose event was acute or occurred only once 25 Dissociative Disorders disruption in consciousness, memory, identity, or perception typical labels dissociative amnesia dissociative fugue dissociative identity (multiple personality) depersonalization disorder 26 Eating Disorders a. Anorexia Nervosa disturbances in eating behavior typical labels anorexia nervosa bulimia nervosa 27 Etiology: strong familial tendency, often from controlling families, sexual abuse survivors more prone Symptoms: 90% female. Fear of losing control over one s weight or becoming fat. Body dysmorphism common Treatment: restore health and then focus on normal eating patterns and explore underlying issues Prognosis: treatable if caught in time but can be fatal if left untreated 28
b. Bulimia Nervosa Etiology: often from controlling families, sexual abuse survivors more prone Symptoms: bingeing and purging Treatment: restore health and then focus on normal eating patterns and explore underlying issues Prognosis: good but often negatively impacted by individual s reluctance to get treatment due to recognition of obvious symptoms Impulse Control Disorders failure or difficulty in controlling impulses despite negative consequences typical labels intermittent explosive disorder kleptomania pathological gambling pyromania trichotillomania 29 30 Mood Disorders inappropriate, exaggerated, or limited range of feelings can be lows or highs typical labels bipolar disorder cyclothymic disorder dysthymic disorder major depressive disorder a. Bipolar Disorder Etiology: strong biological component environmental factors exacerbate symptoms Symptoms: 2 types Bipolar I: mania followed by depression Bipolar II: same but mania is hypo-manic (similar symptoms but not as severe) Treatment: medication and therapy Prognosis: no cure, manic episodes often slow down due to aging. Medication necessary to keep illness at minimum level 31 32
b. Dysthymia Etiology: some support for biological undertone Symptoms: ongoing depression of at least 2 years Treatment: medication and therapy Prognosis: more chronic than Major Depression but less severe in terms of symptoms 34 c. Major Depressive Disorder Etiology: biological & environmental Symptoms: depressed mood, reduced interests, reduced energy, poor concentration, suicidal thoughts or intentions Treatment: medication and/or therapy Prognosis: good when medication and psychotherapy are used. Often episodic in nature. As such, wise to maintain a relationship with a mental health professional 35 Sexual Disorders fantasies, urges, or behaviors that interfere with satisfactory relations distress is present due to feelings of uncontrollable need Typical Labels: exhibitionism fetishism frotteruism pedophilia sexual masochism sexual sadism transvestic fetishism voyeurism 36
Sleep Disorders 2 categories dyssomnias: relate to amount, quality & timing of sleep parasomnias: relate to abnormal behavior occurring during sleep Typical Labels: Dyssomnias: primary insomnia primary hypersomnia narcolepsy Parasomnias nightmare disorder sleep terror disorder sleepwalking disorder 37 Psychotic Disorders psychosis to include: delusions: false beliefs that hinder ADLs hallucinations: false perceptions impacting the 5 senses - visual, auditory, olfactory, tactile and/or taste Typical Labels: brief psychotic disorder delusional disorder schizoaffective disorder schizophrenia schizophreniform shared psychotic disorder 38 a. Schizoaffective Disorder Etiology: biological Symptoms: combination of schizophrenia and affective (mood) disorder Treatment: medication and therapy Prognosis: poor as there is no cure intervention helps with coping and social functioning a. Schizophrenia Etiology: physiological brought out by life stressor Symptoms: delusions and hallucinations disorganized behavior and/or speech Treatment: medication and case management Prognosis: poor as there is no cure intervention helps with coping and social functioning 39 40
Illustrated by Laura S. Kowalski for Asperger Syndrome and Other Related Disorders Practical Strategies for Assessment Practical Strategies and for Treatment Assessment and Treatment A Simple Technique to Help Someone with Social Difficulties Illustrated by Laura S. Kowalski What are we to do? SLPs do not treat the psychiatric diagnosis treat the underlying social-pragmatic communication deficit refer for appropriate medical management 42 My books! Hope you found your time worthwhile. Now, before you leave... Asperger Syndrome explained Social-Pragmatic Success Are you In The Zone? 43 44
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