Organic Brain Syndromes in the Developmentally Disabled

A new way of conceptualizing Dysfunction

and Cognitive Restructuring

Dr. Jay Rao

M.B.,B.S., D.P.M., M.R.C.Psych(U.K.), F.R.C.P©

Associate Professor/ Director, Post Graduate Education

University of Western Ontario, London

Signs and Symptoms

• Perseveration

• Organic Sameness

• Inflexibility

• Catastrophic Anxiety

• Emotional Dysregulation

• Working Memory Deficits

• Poor judgement

Signs and Symptoms

• Low threshold for frustration

• Impulse control difficulties

• Dyspraxia --Speech / motor

• difficulty in postponing gratification

• emotional ‘incontinence’

The Process of Adaptation

INVOLVES

• Obtaining information

• Evaluating information

• Processing information ( taking decisions)

• Acting

• Evaluating results

• Storing patterns

Factors Influencing Obtaining of Information

PERCEPTION

• require context of past experience

• require a personal * meaning

* need

* emotional state

* predictive value

• require some sort of reasoning process

In a Developmentally disabled individual;

•Perceiving/Integrating:

* Selective or poor attention

* Sensory deficits

* Absence of prior knowledge/

Experience

Input affected by problems in:

Processing of Information

•DEPENDENT also ON such filters as:

• Varied experience

• Problem solving skills

• Ability to predict personal outcomes

Processing in the developmentally disabled

• Faulty : given the faulty input

• Can not base on prior knowledge

• Not Flexible

• Problems with sequencing and Logical operations

• Linked to basic ‘ survival’ emotions.

Typical Responses in OBS

Rapid cycling mood changes

aimless energy

High Anxiety

Irritability

Impulsivity

Disinhibition

perseveration

How is Behavior Controlled

• Simple Behaviors

Reflexive Automatic Inflexible

• Complex Behaviors

Cognitive control purposeful flexible

•

Broca’sarea

Parsopercularis

Motor cortexSomatosensory cortex

Sensory associativecortex

Primary

Auditory cortexWernicke’s

area

Visual associativecortex

Visualcortex

Pre Frontal Cortex

Situation requiring Cognitive Control

Look Left Look Right

Process

1. Awareness that context is different2. Retrieving Cognitive Representations of Correct action in circumstance3. Selecting correct motor response4. Inhibiting INCORRECT response5. Active Maintenance (of Task / Goal related information)6. Update any new information7. Learn (transfer through Working Memory Short Long term Memory

Without Pre Frontal Function

The most frequently used neural pathway pre-dominates

In a NOVEL situation:

Haphazard behavior occurs:

IMPULSIVE, Inappropriate, Disorganized

Executive FunctionsInhibit

Shift

Emotional Control

Monitor

Working Memory

Plan/ organize

Organization of Materials

Task Completion

Dysfunction

ADAPTIVE FUNCTIONING

Emotional

Interpersonalenvironmental

Intrapersonal

PROCESSING INFORMATION

• Information is processed highly individually.

• Processing is influenced by many motives.

• Avoiding pain, discomfort, distress.

• Manipulation to gain results.

• Activation of past patterns.

Results in

• High anxiety

Disorganized behavior

Perseveration

Jo

Inability to process information efficiently

•Inability to dampen unnecessary inflow

•Inability to focus on what is essential

•Bombarded by stimuli, fragmented experiencing of the world

•Inability to handle the resulting chaos

• Wanting to withdraw, “turn off” the sensory inflow.

• Anxiety Self injury (Endorphin response)

Stress

conflict

helplessness High CRH

High ACTH

High NE, Cortisol

High Anxiety

High Metenkephalin

Impervious to painSelf injury

OPIOIDS Released

ANXIETY REDUCED

Self Injury - Opioid Dynamics

Stress Adaptation Fails