SW 644: Issues in Developmental Disabilities Autism and Aging

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SW 644 Issues in Developmental
DisabilitiesAutism and Aging

• Lecture Presenter
• Mary Pearlman, M.D. 

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Adolescent Development

• Puberty Definition
• Period of rapid physical growth and sexual
  maturation that ends childhood and begins
  adolescence

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Adolescence

• Adolescence Definition
• The period of biological, cognitive, and
  psychosocial transition from childhood to
  adulthood usually lasting a decade or so.

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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

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Newness Examples

• Breast Changes
• Height and Weight
• Physical Strength

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Newness

• Task integrating with peers
• Girl needs poodle skirt now
• Or life is ruined
• Everyone will hate me
• I hate you, mother

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Newness Hysteria Is Fixed By

• Learning new skills
• Experiencing how peers react
• Experiencing how time works emotionally

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Hormones

• Hormones are responsible for emotional changes
  because they stimulate brain cell growth.

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Synaptogenesis and Arborization

• Synaptogenesis and arborization
• Under the influence of increased hormones in
  adolescence there is rapid synaptogenesis and
  arborization.

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Synaptogenesis

• SynaptogenesisDefinition
• Synapse the functional membrane to membrane
  contact of the nerve cell with another cell
• Genesis beginning

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Arborization

• Arborization Definition
• The terminal branching of nerve fibers in a
  tree-like fashion

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Pre- and Post- Pubertal Nerve and Fibers

• Post pubertal nerve fibers have branching at end.
  Diagram of pre and post pubertal nerve and
  fibers.

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Arborization and Synaptogenesis

• Arborization and synaptogenesis occur randomly,
  without a pattern
• Learning and experience strengthens some paths
  and lets some paths die

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Synaptogenesis and Arborization (cont.)

• Cognitive response is confusion
• Emotionally the adolescent has increased
  excitability

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Apoptosis

• Apoptosis definition
• Cell death. An important result of learning.
  Cellular pathways that are not useful, die.

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Apoptosis (cont.)

• Selective Attention
• Expanded memory skills
• Growing knowledge base
• Metacognition
• Continued Language Mastery
• Formal Operational Thought

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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

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New Attributes

• All the New Attributes lead to typical beliefs
  and attitudes that most adolescents experience.
• These ameliorate, with experience.

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Adolescent Development Autism

• Qualitative impairment in social interaction
• Qualitative impairment in communication
• Restricted repetitive and stereotyped patterns of
  behavior, interests

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Adolescent Development Autism (cont.)

• Sexuality

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Sexuality

• Teaching appropriate self care and social mores
• Support family and staff to provide this
  teaching
• Autism lack of social understanding

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Sexual Aggression

• Normal phase of development
• Need to teach specific behaviors to those who
  cant figure it out

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Cognitive and Emotional Development

• Cognitive and emotional development relates to
  conscience development
• Conscience may never get beyond that of a young
  person

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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

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A Tale of Learning Control (2)

• Age 18 Approaches young aide and asks her to
  marry him
• Young man hasnt internalized the rule moral age
  is 7
• People around him have to be taught how to set
  limits neutrally

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A Tale of Learning Control (3)

• Age 22 Uses money to buy fancy womens
  underwear
• Age 24 Refuses to go to work
• Age 25 Caught kissing a willing peer
• Age 32 No longer interested in picture
  collection

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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

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Adolescent Development Autism (cont.)

• Are 7 year-olds responsible for their behavior?
• We dont 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

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Role Modeling

• Powerful tool for learning behavior
• Creates possible self definitions
• Creates motivation for behavior

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Role Modeling (cont.)

• What an adult is what an adult does
• Work
• Social relationships
• Play

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The Personal Fable

• One is destined for greatness
• Greatness? Defined by society or self
• Greatness? reality or fantasy

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Adulthood Normal Development

• Adulthood Definition
• The time after adolescence and before death
• A period of ongoing Senescence

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Senescence

• Senescence Definition
• The state of physical decline, in which the body
  gradually becomes less strong and efficient with
  age.

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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

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Homeostasis

• Homeostasis the adjustment of the bodys systems
  to keep physiological and emotional functions in
  a state of equilibrium

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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

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Some Characteristics

• Mature commitment
• Post formal thought
• Dialectical thought
• Cognitive flexibility
• synthesis

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Some Characteristics (cont.)

• Faith can be an important part of life
• Socialization
• Resource
• Managing behavior
• Sooth feelings
• Have a community

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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 increases
• Abuse increases as child cannot defend themselves

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Relationship with Police

• Dangerous Encounters, Avoiding perilous
  Situations with Autism. Davis, Bill and
  Schunick, Wendy. Jessica Kingsley Publishers.
  2002. Philadelphia.

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Adulthood Autism (cont.)

• Health Habits
• Eating
• Exercise

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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?

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Caretaker Concerns (cont.)

• Language attached to experience
• Familial and cultural ritual
• Maintaining attachment after death
• Language of self feelings

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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

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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

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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

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Adulthood Autism, Caretaker Concerns

• Is my child too dependent on me?
• Resource function model

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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

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Autism and aging Bibliography

• The Developing Person Through the Life Span.
  Berger, 5th edition Worth Publishers
• Stedmans 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.