SW 644: Issues in Developmental Disabilities Autism and Aging Lecture Presenter: Mary Pearlman, M.D....
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Transcript of SW 644: Issues in Developmental Disabilities Autism and Aging Lecture Presenter: Mary Pearlman, M.D....
SW 644: Issues in Developmental DisabilitiesAutism and Aging
Lecture Presenter:
Mary Pearlman, M.D.
04/18/23 Mary Pearlman, M.D. 1
Adolescent Development
Puberty: Definition Period of rapid physical growth and
sexual maturation that ends childhood and begins adolescence
04/18/23 Mary Pearlman, M.D. 2
Adolescence
Adolescence: Definition The period of biological, cognitive,
and psychosocial transition from childhood to adulthood usually lasting a decade or so.
04/18/23 Mary Pearlman, M.D. 3
Hormonal Changes
Are hormonal changes responsible for the emotional changes in puberty?
Hormonal changes can cause: More rapid arousal of emotions Quick shifts in extremes of emotions More thoughts about sex Girls: cyclical mood shifts and
physical function
04/18/23 Mary Pearlman, M.D. 4
Newness Examples
Breast Changes Height and Weight Physical Strength
04/18/23 Mary Pearlman, M.D. 5
Newness
Task; integrating with peers Girl needs poodle skirt “now” Or life is ruined Everyone will hate me I hate you, mother
04/18/23 Mary Pearlman, M.D. 6
Newness Hysteria Is Fixed By…
Learning new skills Experiencing how peers react Experiencing how time works
emotionally
04/18/23 Mary Pearlman, M.D. 7
Hormones
Hormones are responsible for emotional changes because they stimulate brain cell growth.
04/18/23 Mary Pearlman, M.D. 8
Synaptogenesis and Arborization Synaptogenesis and arborization: Under the influence of increased
hormones in adolescence there is rapid synaptogenesis and arborization.
04/18/23 Mary Pearlman, M.D. 9
Synaptogenesis
Synaptogenesis:Definition Synapse: the functional membrane to
membrane contact of the nerve cell with another cell
Genesis: beginning
04/18/23 Mary Pearlman, M.D. 10
Arborization
Arborization: Definition The terminal branching of nerve
fibers in a tree-like fashion
04/18/23 Mary Pearlman, M.D. 11
Pre- and Post- Pubertal Nerve and Fibers
Post pubertal nerve fibers have branching at end. Diagram of pre and post pubertal nerve and fibers.
04/18/23 Mary Pearlman, M.D. 12
Arborization and Synaptogenesis Arborization and synaptogenesis
occur randomly, without a pattern Learning and experience strengthens
some paths and lets some paths die
04/18/23 Mary Pearlman, M.D. 13
Synaptogenesis and Arborization (cont.)
Cognitive response is confusion Emotionally the adolescent has
increased excitability
04/18/23 Mary Pearlman, M.D. 14
Apoptosis
Apoptosis: definition Cell death. An important result of
learning. Cellular pathways that are not useful, die.
04/18/23 Mary Pearlman, M.D. 15
Apoptosis (cont.)
Selective Attention Expanded memory skills Growing knowledge base Metacognition Continued Language Mastery Formal Operational Thought
04/18/23 Mary Pearlman, M.D. 16
Formal Operational Thought
With formal operational thought a person can imagine and process possibility not just concrete things that are taken in exactly as sensed
04/18/23 Mary Pearlman, M.D. 17
New Attributes
All the New Attributes lead to typical beliefs and attitudes that most adolescents experience.
These ameliorate, with experience.
04/18/23 Mary Pearlman, M.D. 18
Adolescent Development: Autism Qualitative impairment in social
interaction Qualitative impairment in
communication Restricted repetitive and stereotyped
patterns of behavior, interests
04/18/23 Mary Pearlman, M.D. 19
Adolescent Development: Autism (cont.)
Sexuality
04/18/23 Mary Pearlman, M.D. 20
Sexuality
Teaching appropriate self care and social mores
Support family and staff to provide this teaching
Autism lack of social understanding
04/18/23 Mary Pearlman, M.D. 21
Sexual Aggression
Normal phase of development Need to teach specific behaviors to
those who can’t figure it out
04/18/23 Mary Pearlman, M.D. 22
Cognitive and Emotional Development
Cognitive and emotional development relates to conscience development
Conscience may never get beyond that of a young person
04/18/23 Mary Pearlman, M.D. 23
A Tale of Learning Control
Age 9 - Young man touching himself in public
Age 13 – Grabbed peer around neck and kissed her
Helpful intervention is to point out appropriate ways and times, and firm rule of always asking permission
04/18/23 Mary Pearlman, M.D. 24
A Tale of Learning Control (2)
Age 18 – Approaches young aide and asks her to marry him
Young man hasn’t internalized the rule; moral age is 7
People around him have to be taught how to set limits neutrally
04/18/23 Mary Pearlman, M.D. 25
A Tale of Learning Control (3)
Age 22 – Uses money to buy fancy women’s underwear
Age 24 – Refuses to go to work Age 25 – Caught kissing a willing peer Age 32 – No longer interested in
picture collection
04/18/23 Mary Pearlman, M.D. 26
Adolescent Development: Autism As time goes on, competition relates
more to friendship Sexuality has not worked out well Most are uninterested in children Some may have been victimized Important to look at cognitive, social
and conscience age of person with DD
04/18/23 Mary Pearlman, M.D. 27
Adolescent Development: Autism (cont.) Are 7 year-olds responsible for their
behavior? We don’t negotiate rules with people with
inadequate or immature conscience formation
There are situations where a person always has to have some kind of monitoring
Conscience formation, which goes along with social development, is not going to get any further than seven or thirteen
Role Modeling
Powerful tool for learning behaviorCreates possible self definitionsCreates motivation for behavior
04/18/23 Mary Pearlman, M.D. 29
Role Modeling (cont.)
What an adult is what an adult does Work Social relationships Play
04/18/23 Mary Pearlman, M.D. 30
The Personal Fable
One is destined for greatness Greatness? Defined by society or self Greatness? reality or fantasy
04/18/23 Mary Pearlman, M.D. 31
Adulthood: Normal Development Adulthood: Definition The time after adolescence and
before death A period of ongoing Senescence
04/18/23 Mary Pearlman, M.D. 32
Senescence
Senescence: Definition The state of physical decline, in which
the body gradually becomes less strong and efficient with age.
04/18/23 Mary Pearlman, M.D. 33
Senescence (cont.)
Because of senescence, any chronic vulnerability we have worsens with each decade.
Vulnerabilities in persons with DD show the same progression
Associated with some specific DD there appears to be more rapid progression
04/18/23 Mary Pearlman, M.D. 34
Homeostasis
Homeostasis: the adjustment of the body’s systems to keep physiological and emotional functions in a state of equilibrium
04/18/23 Mary Pearlman, M.D. 35
Tasks Specific to Various Phases Young is learning or setting up the
conditions for work, love, play The mid-adult is settled in and has to
figure out how to maintain these conditions in the face of change
The late adult has to figure out how to make things better for the future
04/18/23 Mary Pearlman, M.D. 36
Some Characteristics
Mature commitment Post formal thought Dialectical thought Cognitive flexibility synthesis
04/18/23 Mary Pearlman, M.D. 37
Some Characteristics (cont.)
Faith can be an important part of life Socialization Resource Managing behavior Sooth feelings Have a community
04/18/23 Mary Pearlman, M.D. 38
Adulthood: Autism
Abuse is increased by any characteristic that makes the child harder to care for
Abuse is increased by any characteristic that promotes a negative identification with the child
Abuse is increased as stress increasesAbuse increases as child cannot defend
themselves
04/18/23 Mary Pearlman, M.D. 39
Relationship with Police
Dangerous Encounters, Avoiding perilous Situations with Autism. Davis, Bill and Schunick, Wendy. Jessica Kingsley Publishers. 2002. Philadelphia.
04/18/23 Mary Pearlman, M.D. 40
Adulthood: Autism (cont.)
Health Habits Eating Exercise
04/18/23 Mary Pearlman, M.D. 41
Caretakers Concerns
Social skills related to illness and death
Who will care for my child after I die? How much should I protect my child
from the dangers of the world? Is my child too dependent on me?
04/18/23 Mary Pearlman, M.D. 42
Caretaker Concerns (cont.)
Language attached to experience Familial and cultural ritual Maintaining attachment after death Language of self feelings
04/18/23 Mary Pearlman, M.D. 43
Who Will Care for My Child After I Die?
Appoint a caretaker for attachment, finances, case coordination
Memory books-keeping soothing past attachments and behavioral models
People with DD survive change very well if attachment and individualizing needs tended to
04/18/23 Mary Pearlman, M.D. 44
How Much Should I Protect My Child from the Dangers of the World?
No risk and the person cannot grow or experience life
No safety and the person is hurt and gives up going out
Balance and safety nets
04/18/23 Mary Pearlman, M.D. 45
Autism and aging: Conclusion
Changing demographics and increased participation in community living are exposing us all to more issues of adolescence and aging
Remember development Remember individualization Remember the need for a variety of social
supports Listen
04/18/23 Mary Pearlman, M.D. 46
Adulthood: Autism, Caretaker Concerns
Is my child too dependent on me? Resource function model
04/18/23 Mary Pearlman, M.D. 47
Autism and aging
How do you figure out causes of behavior?
Usually behavior serves the function of meeting a primary need
Skills, tasks, concerns and challenges help determine primary need and how it is expressed
Patient and caretakers drop clues if you listen
04/18/23 Mary Pearlman, M.D. 48
Autism and aging: Bibliography
The Developing Person Through the Life Span. Berger, 5th edition Worth Publishers
Stedman’s Medical Dictionary: 26th Edition, Williams and Wilkins 1995
Seltzer, Marsha. Mother-Child Relationship Quality Among Adolescents and Adults with Autism. Am. Journal on Mental Retardation. Vol111, Number 2: 121-137/ March 2006.
04/18/23 Mary Pearlman, M.D. 49