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IGNOU BPCE 011 Solved Assignment 2022-23
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Submission Date :
- 31st March 2033 (if enrolled in the July 2033 Session)
- 30th Sept, 2033 (if enrolled in the January 2033 session).
All questions are compulsory.
Answer the following questions in 1000 words each. 3 x 15 = 45 marks
1. Explain the classification and causes of intellectual disability.
Introduction Other Section
Deficits in cognitive and adaptive functioning are the hallmarks of intellectual disability. With advances in scientific research and our understanding of how societal and cultural factors impact a person’s cognitive and adaptive functioning, the terminology has evolved from idiocy to mental retardation to intellectual disability or intellectual developmental disorder (1-3). By the definitional criteria, intellectual disability must be identified during developmental years (childhood through adolescence). However, intellectual disability has life-long implications for an individual’s growth and development in all functional domains. Persons with intellectual disability require a variable degree of life-long support in education, ability to live independently, access health care, employment, and community participation and integration. The physician plays an essential role in the diagnostic assessment and medical treatment of intellectual disability. The physician is also directly involved in facilitating and coordinating ongoing and life-long management of various non-medical aspects of management for persons who have intellectual disability.
The setting within which services are delivered to persons with intellectual disability, the cost of caring for persons with intellectual disability and how the services and healthcare are funded vary across countries because of differences in healthcare systems. In the United States, services for persons with intellectual disability are delivered by a combination of resources that include both public and private agencies and funding mechanisms. The public funding for the evaluation, educational and other support services to persons with intellectual disability is regulated by various Federal and State regulations.
Methods Other Section
We conducted a literature search (2005-2020) using online database PubMed, specifically for studies related to the clinical aspects of intellectual disability as they apply to practice, with specific relevant to children and adolescents. Our search was limited to English language publications. In addition to PubMed, we also consulted standard textbooks. We included original research as well as systematic reviews and meta-analysis type of articles. The key search terms included intellectual disability, neurodevelopmental disability, tests for cognitive function, tests for adaptive function, genetics of intellectual disability, and treatment of intellectual disability.
Definition Other Section
Intellectual disability (intellectual developmental disorder) as defined by the World Health Organization (WHO), the American Association for Intellectual and Developmental Disabilities (AAIDD), and the Diagnostic and Statistical Manual of Mental Disorders, all include as criteria, a significant impairment in general cognitive functioning, social skills, and adaptive behavior (1-6). Significant impairment is characterized as performance that is 2 or more standard deviations below the mean based on normed, individually administered standardized tests of cognitive and adaptive function. Scores on the standardized tests should not be the sole criteria to determine the severity of intellectual disability. Clinical judgment is integral to the delineation of the severity of impairment in the cognitive and adaptive function (1,2).
According to the International Classification of Disorders, 11th edition (ICD11), disorders of intellectual development are considered as a group of conditions with different causes that begin during developmental period (6). According to the American Association on Intellectual and Developmental Disabilities (AAIDD), intellectual disability “is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills” (1). The administration and interpretation of standardized, individually administered psychometric testing for cognitive and adaptive functioning should take into account a person’s age and cultural background (2). Other factors, including a person’s sensory, motor, and communication ability may also modulate the administration and interpretation of such testing (1,2,4).
In the United States a widely used definition of intellectual disability is the one from the Individuals with Disabilities Education Act that defines intellectual disability as “significantly sub-average general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period that adversely affects a child’s educational performance” (7).
The Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) classifies Intellectual Disabilities under the category of Neurodevelopmental Disorders and describes three diagnoses, (I) Intellectual Disability (Mild, Moderate, Severe, and Profound), (II) Global Developmental Delay, and (III) Unspecified Intellectual Disability (2). Global Developmental Delay is a diagnosis given to children under the age of 5 who are not able to participate in standardized assessment procedures due to typical developmental limitations for the age or delays in development (2). Unspecified intellectual disability is a diagnosis reserved for children over 5 years of age who could not be assessed due to multiple factors, such as a physical disability or co-occurring mental illness. These two diagnoses require reassessment at a later date (1). The DSM-5 diagnostic criteria include deficits in intellectual functions such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience (2). Deficits in adaptive function affect communication, social participation, and independent living activities (1-4).
Severity classification Other Section
The classification of intellectual disability is based on a person’s intellectual and adaptive functioning, and the intensity of supports needed (Table 1) (1-5,8). It is often not possible to assess the severity of intellectual disability in many cases solely based on standardized testing. In these instances, a diagnosis of intellectual disability is made based on clinical findings and judgment (1-3). It is also not always possible to determine the severity of intellectual disability or the severity may evolve over time. In such cases a diagnosis of intellectual disability is made without specifying the level of severity (1-3).
The variability in the reported prevalence of intellectual disability is explained on the basis of the differences in the definitions used in different surveys, how data was collected, and the characteristics of the populations studied. The distribution of the measured intellectual quotient (IQ) in a given population follows the typical bell shaped curve. Based on the typical distribution of the measured IQ in the population and applying 2 standard deviations below the mean as the cut-off, intellectual disability is identified in 2.5% of the general population (1,2,4,5,9-11).
According to DSM 5, the prevalence of intellectual disability is 1% of the general population; with 6 per 1,000 persons reported to have severe intellectual disability (2). Most epidemiological surveys generally categorize the severity of intellectual disability as mild (IQ ≥50) or severe (IQ ≤50), with 75% of individuals recognized to have mild intellectual disability (1,2,4,9-11). In the United States, the prevalence of severe intellectual disability has been reported to be between 0.3% and 0.5% of the population, which has remained unchanged for past several decades (4).
The worldwide reported prevalence of intellectual disability is 16.41 per 1,000 persons in low income countries; 15.41 per 1,000 persons in middle income countries; and, 9.21 per 1,000 persons in high income countries (4,10,11).
The male to female ratio for intellectual disability is 2:1 (1,2,4,9-11). In a family with one child affected with severe intellectual disability, the recurrence risk for subsequent child to have intellectual disability is between 3% and 9% (1,4,9-11).
Causes Other Section
A specific etiology is likely to be identified in less than 50% of cases with mild intellectual disability; whereas, an underlying biologic etiology is likely to be identified in more than 75% of cases with severe intellectual disability (1,9,11-26). Chromosomal disorders, genetic syndromes, congenital brain malformations, neurodegenerative diseases, congenital infections, inborn errors of metabolism, and birth injury are the most common identified causes of severe intellectual disability (1,9,11-17).
Clinical presentation Other Section
The initial symptoms and signs seen in children who have intellectual disability vary depending on the age at presentation, the severity of functional deficits, and the underlying biologic cause especially in cases of severe intellectual disability (1-5,9). In children who have severe intellectual disability, the symptoms and signs are recognized at an early age and may suggest an underlying cause. Children with profound to severe intellectual disability may be recognized clinically during the first 3 years of life (4,5,9). In children who have mild intellectual disability, symptoms and signs are recognized at a later age and are not suggestive of any specific underlying cause; rather, developmental delay or atypical behavior are common presenting clinical features. Children with mild to moderate intellectual disability may not be recognized until 4–6 years of age and new cases are identified up to 9 years of age (4,5,9,18).
A newborn with intellectual disability may have feeding or breathing difficulty, microcephaly, macrocephaly, dysmorphic facial features, or other congenital anomalies (3-5,9). During infancy, caregivers may notice that infant fails to engage and interact with environmental stimuli. Vision deficits and hearing deficits also become first apparent during infancy (4). A common concern for parents to seek medical attention during infancy is a delay in attaining age expected gross motor skills (3-5,9).
Between 3 and 5 years of age, a delay or difficulty with language acquisition is a more common clinical presentation and a reason for parents to seek medical attention (4,5). There may be deficits in early social play, and fine motor skills, such as, cutting or drawing may be delayed (4,5). As the child enters the early school years, difficulty with school work and concerns about behavior, such as difficulty sustaining attention, become more apparent as presenting symptoms (4,5).
Children and adolescents with intellectual disability may manifest associated behavioral symptoms such as self-injurious behavior, aggression, self-induced vomiting, and difficulty with sleep. Associated or co-morbid mental health conditions are also common in children and adolescents with intellectual disability. These include attention deficit hyperactivity disorder, mood disorders, autism spectrum disorder, anxiety disorders, and obsessive compulsive disorder (1-4,9,12). It is important to recognize behavioral symptoms of co-morbid conditions as part of clinical evaluation of intellectual disability. Children and adolescents who have intellectual disability are 3–4 times more likely to also have associated other mental health conditions when compared to those who do not have intellectual disability (19). In children and adolescents who have symptoms and signs of both intellectual disability and associated other mental health disorder, a dual diagnosis of intellectual disability and co-morbid mental health disorder is appropriate if the diagnostic criteria are met for both.
Mild intellectual disability in adolescents can be difficult to recognize. Although adolescents with mild intellectual disability can engage without limitation in who, what and where discussions, intellectual limitations are more noticeable with why or how discussions (4). Adolescents are quite cognizant of how others view them and of peer pressure. They do not want to be identified as having intellectual deficits and find different ways to compensate for any deficits (4). This further complicates identification of adolescents with mild intellectual disability (4).
Evaluation Other Section
The breadth and depth of evaluation of children and adolescents for intellectual disability will be guided by the age of the child at presentation, severity of symptoms, and the need to pursue an etiological diagnosis. Such an evaluation comprises clinical assessment, psychological testing, genetic and metabolic testing and imaging studies (1,9,18,20-40).
Psychological assessment of intellectual disability involves conducting a clinical interview, administration of standardized intellectual and adaptive assessment measures, and additional assessments to take into account differential diagnoses (1,2,22-32). The psychologist administering the assessments should have training in reliable and valid assessment procedures to help ensure the quality of the results. The psychologist should have sufficient experience working with individuals with intellectual disability to help with accurate identification of severity levels. It is important to consider the impact of culture, gender, stigma, and socio-economic status on intellectual functioning (1,2,23,26,27).
2. Discuss the therapeutic techniques in solution focused therapy.
What Is Solution-Focused Brief Therapy?
Solution-focused brief therapy (SFBT) is a strength-based approach to psychotherapy based on solution-building rather than problem-solving. Unlike other forms of psychotherapy that focus on present problems and past causes, SFBT concentrates on how your current circumstances and future hopes.
SFBT was developed in the 1970s and 1980s by husband and wife Steve de Shazer and Insoo Kim Berg at the Brief Family Therapy Center in Milwaukee, Wisconsin.
SFBT is an approach that falls under the umbrella of constructive therapies. Constructivism posits that people are meaning makers and are ultimately the creators of their own realities. The SFBT therapist believes that change in life is inevitable. Because someone creates their own reality, they may as well change for the better.
In SFBT, the therapist is a skilled conversation facilitator. They do not present themselves as an expert but instead comes from a “not-knowing” point of view.1
Drawing upon the client’s expertise in themselves, the therapist uses a variety of techniques and questions to demonstrate their strengths, resources, and desires. With the focus shifted to what is already working in a client’s life, and how things will look when they are better, more room opens up for the solutions to arrive.
The miracle question is a technique that therapists use to assist clients to think “outside the square.” It asks the client to consider life without the problem by setting up a scene where a miracle happens and the problem is gone. The exact language may vary, but the basic wording is this:2
“Suppose that while you are sleeping tonight and the entire house is quiet, a miracle happens. The miracle is that the problem which brought you here is solved. But because you are sleeping, you don’t know that the miracle has happened. So, when you wake up tomorrow morning, what might be the small change that will make you say to yourself, ‘Wow, something must have happened—the problem is gone!'”
Asked this way, miracle questions help clients open up to future possibilities.
Exception questions allow clients to identify times when things have been different for them. Finding times when the problem wasn’t so much of a problem.
Examples of exception questions include:
- “Tell me about times when you felt happiest.”
- “What was it about that day that made it a better day?”
- “Can you think of a time when the problem was not present in your life?”
By exploring how these exceptions happened, a therapist can empower clients to find a solution.
Scaling questions invite clients to perceive their problems on a continuum. They’re also a helpful way to track progress toward goals and monitor change.
Generally, scales are from 1 to 10. When working with a client who is dealing with anxiety, for example, a therapist might say:
“If 10 is the most anxious and 1 is the most relaxed, what number would you put yourself on right now?”
Questions like these are usually followed with questions related to scaling, such as asking the client to explain why they chose the number they did and why their number is not one lower. They’ll likely also ask the client how they will know they are moving up the scale.
What SFBT Can Help With?
SFBT is best when a client is trying to reach a goal or overcome a particular problem. It can stand alone as a therapeutic intervention, or it can be used along with other therapy styles. It’s used to treat people of all ages and a wide range of issues including addiction, child behavioral problems, and relationship problems.
This form of therapy is typically not used to treat major psychiatric conditions such as psychosis and schizophrenia.
Benefits of SFBT
The major advantage of SFBT is its brevity. SFBT is a form of “brief therapy,” typically lasting between 5–8 sessions. Because of this, it is often less costly than other forms of therapy.
Instead of digging into old wounds, more time is spent focusing on resolutions, which makes SFBT great for people who have a specific goal in mind and just need a little help reaching it.
Research shows that SFBT can effectively:
- Decrease addiction severity and trauma symptoms3
- Decrease marital issues and marital burnout in women4
- Improve classroom behavioral problems in children with special education needs5
- Reduce externalizing behavioral problems, including conduct disorder, and conflict management6
- Reduce internalizing behavioral problems, such as depression, anxiety, and self-esteem7
SFBT can be just as effective (sometimes even more so) than other evidence-based practices, such as cognitive behavioral therapy (CBT) and interpersonal psychotherapy.
Things to Consider
If you are looking to dissect your childhood or come upon a great deal of insight about your life’s trajectory, SFBT may not be the kind of therapy you are looking for. If, however, you want laser-focused help to move into a new area of your life without getting lost in the details, SFBT may be a good fit for you.
How to Get Started
If you have an issue you can’t seem to solve and think you might benefit from SFBT, you can start by asking your physician for a recommendation. If you’re seeing a mental health practitioner for other reasons, they may be able to provide a recommendation as well. Local and state mental health agencies also often have resources you can turn to.
Once you have found a qualified professional, make an appointment and ensure they accept your insurance. Your first appointment will probably involve filling out the necessary paperwork, which can include details regarding your symptoms, medical history, and insurance plan.
3. Explain the psychological factors of abnormality.
Psychology deals with the study of emotional and mental disorders that hinder an affected individual’s day-to-day activity. The emotional and mental disorders may lead to a series of very unusual activities, which can be termed as abnormal behaviour. The peculiar behaviour trait not only affects the distressed individual but also significantly messes with others around them. The factors underlying abnormal behaviours are essential, which can unravel the concept of deviant behaviour. Abnormal behaviour can develop because of different factors, for example, abuse. It has been extensively studied that abuse can contribute highly to abnormal behaviours not only in humans but also in animals.
Concept of Normal and Abnormal Behaviour
A particular behaviour can be accepted as usual in one culture but may not be accepted in another culture and is therefore termed as abnormal behaviour, which signifies that culture plays an important role psychologically in understanding a particular behaviour. The expected behaviour in an individual is said to be normal behaviour. For example, a person shouting and cheering for their favourite team is entirely normal behaviour. Our society has an expected norm or value that is the code of conduct, and unless and until an individual is following it, they have normal behaviour. If an individual goes against the code of conduct, they are said to have abnormal behaviour. This may be because of various life experiences faced by that very individual. Some examples of abnormal behaviours are dysfunction when an individual cannot control emotions and actions, deviance where the abnormal behaviour is deviant to the social norms and OCD or obsessive-compulsive and related disease, which is a type of anxiety disorder. Some effects minor behaviour while others can become a part of their day to day behaviour.
Factors Underlying Abnormal Behaviour
Abnormal behaviour is mainly caused by three known factors :
Biological factor: Genes comprise 90% of our personality traits, and we acquire them from our parents, or we can say some sets of genes are passed on and on from one generation to the other. The traits of abnormal behaviour can also be genetic and can be passed on from one generation to the other. Schizophrenia is an example of abnormal behaviour; a specific pattern of genes in a person makes them more vulnerable to the mentioned disease than others. This pattern of genes can be genetically passed on from one generation to another. Other than genes, further biological factors that contribute efficiently to the abnormality of one’s behaviour are neurotransmitters and hormones. Imbalance in neurotransmitters like GABA, norepinephrine, etc., causes abnormal neural plasticity or brain dysfunction. Again imbalance of hormones like dopamine serotonin can cause mood and anxiety disorder which can affect all together health of an individual.
Psychological factor: Psychological factors mainly interfere with how an individual deals with external and internal stress. The reflection of his behaviour shows how well they can control their emotions or illogical fear and can have a huge impact on their life experiences and learnings. The incoherent development of the superego or even lack of superego can slowly develop into irrational and abnormal behaviour. The feeling of inferior or superior can attack a persons’ subconscious and then their conscious mind leading to very unusual behaviour and thoughts which are contrary to the norm of society. This type of behaviour is not entirely abnormal but may need a diagnosis to resolve the debate.
Socio-cultural factor: The term socio-cultural refers to various institutions with different radii, for example, family and friends or neighbourhood or even the policies of a particular country. Comparison and discrimination remain the top factors influencing socio-cultural factors for abnormal behaviour. The comparison between IQ or wealth or even looks can result in psychological disorders. The person becomes more conscious about their existence leading to deviant behaviours. Discrimination based on gender, race, nationality, religion, marital status, colour, etc., can affect the mental state of an individual, leaving them mentally disrupted or may even develop an illogical fear. Abuse can also leave a mental scar and develop abnormal behaviour in an individual. Toxic parenting, where parents discriminate or compare their children or abuse them physically or verbally, can deteriorate the mental well-being of those children. Children start to show abnormal behaviour like losing interest in studies, developing trust issues and even being scared of stating their opinions, which begin to compromise their mental development.
Approaches to Abnormal Behaviour
Research has shown that to control and explain abnormal behaviour. Three main approaches have been used generation after generation. The bio-psycho-social model of illness usually focuses on what is the actual reason for the abnormal behaviour, is it biological, where genes have contributed or hormonal imbalance due to lifestyle and socio-cultural stress. Here three main approaches historically used through ages to control and understand unusual behaviour are biological, supernatural and psychological traditions. When taking into account abnormal behaviour, one must consider several theoretical perspectives or multiple casualties. Diathesis is another model which interacts with a person’s stress response. The diathesis model explains beautifully how a person with a high-stress level or low stress coping capacity is more prone to disorders like abnormal behaviour. When the factors are accessed, it becomes easy for a doctor or therapist.
Psychological Causes of Mental Health Problems
In some instances, previous issues in a person’s background can have a snowball effect and lead to worsening psychological conditions. Post-traumatic stress disorder (PTSD) is one prominent example. A past history of painful experiences, whether physical or mental, can leave an individual scarred and struggling. For instance, Joey was verbally abused by his mother when she wasn’t neglecting him altogether to spend time with serial boyfriends. Even after he was grown, Joey was defensive and prone to anxiety or outbursts of anger.
As the name PTSD implies, stress of all kinds leaves its mark. Carol was a teacher caught in the middle of a school shooting. For years thereafter, she had panic attacks when she heard a fire alarm, even if she knew it was only a drill.
Social Causes of Mental Health Disorders
You may have noticed that stress and trauma, while considered psychological factors, come from a person’s environment; they are not purely mental. You are correct! Remember what we said at the start of the lesson: psychological conditions rarely if ever have a single cause.
Stresses and traumas arise from what happens to and around a person. Some social stresses include financial hardships, family and relationship issues, job instability, and cultural differences. Here’s an example: after Mei’s best friend died, she became very depressed. However, her family did not deal with emotions or teach their children how to deal with psychological issues. She learned to pretend everything was fine, but her depression only deepened.
Abnormal behaviour develops slowly, feeding upon the mental wellness of an individual. Initially, abnormal behaviour remains overlooked and undiagnosed and slowly develops into different psychological disorders. The first step toward treatment or control of any abnormal behaviour is to understand the factors responsible for abnormal behaviour and also the concept of abnormal behaviour and how it differs from the culture or society. Once the underlying factors are disclosed, the person can be treated accordingly. Now an individual may recover on their own after a short period without any treatment. This may be because of the environment or their mental willingness, but others may need proper treatment.
Answer the following questions in 400 words each. 5 x 5 = 25 marks
4. Explain the process of narrative therapy.
5. Discuss counselling approaches for children with attention deficit/ hyperactivity disorder.
6. Explain sibling training and parent training approaches for the treatment of behaviour
problems in children.
7.Elucidate the forces that influence human development.
8. Discuss the effectiveness of play therapy.
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Answer the following questions in 50 words each. 10 x 3 = 30 marks
9. Humanistic approach to art therapy
10. Meaning of problem behaviour
11. Conduct disorder
12. Causes of learning disability
13. Check list for assessment of children
14. Longitudinal vs cross-sectional method
15. Concept of life span development
16. Characteristics of slow learner
17. Special education
18. Observation method as an assessment technique for behaviour problems
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