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samenvatting kwaliteit van leven bij mensen met gedrags- en emotionele problemen
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KWALITEIT VAN MENSENMET GEDRAGS EN
EMOTIONELE PROBLEMEN
Emmy Govaert
,HOOFDSTUK 1: TERMINOLOGIE, CLASSIFICATIE EN DIAGNOSTIEK ........................................................................ 5
1 INLEIDING .................................................................................................................................................... 5
1.1 meer gedragsproblemen? .................................................................................................................... 5
2 TERMINOLOGIE EN DEFINIËRING ................................................................................................................ 5
2.1 what’s in a name .................................................................................................................................. 5
2.2 gedrags- en emotionele stoornis.......................................................................................................... 7
2.3 vijf aandachtspunten bij het definiëren van probleemgedrag ............................................................. 7
2.4 definitie probleemgedrag..................................................................................................................... 8
2.5 twee soorten probleemgedrag ............................................................................................................ 8
3 CLASSIFICATIE .............................................................................................................................................. 8
3.1 klinisch -psychiatrische classificatiesystemen ...................................................................................... 9
3.2 empirisch – statistische classificatiesystemen ..................................................................................... 9
4 DIAGNOSTIEK............................................................................................................................................. 10
4.1 diagnostiek in de enge of ruime zin ................................................................................................... 10
4.2 aandachtspunten met betrekking tot het stellen van een diagnose.................................................. 10
4.3 voor-en nadelen van het stellen van een diagnose............................................................................ 10
HOOFDSTUK 2: personen met gedragsstoornissen .............................................................................................. 11
1 inleiding ..................................................................................................................................................... 11
2 gedragsstoornissen in de DSM-5 ............................................................................................................... 11
2.1 DSM5 .................................................................................................................................................. 11
2.2 oppositionele-opstandige stoornis (ODD) .......................................................................................... 13
2.3 normoverschrijdend-gedragsstoornis (CD) ........................................................................................ 14
3 gedragsstoornissen in de DSM-5 ............................................................................................................... 15
4 prevalentie en comorbiditeit ..................................................................................................................... 15
5 diagnostiek ................................................................................................................................................ 15
5.1 onderkennende / classificerende diagnostiek ................................................................................... 15
5.2 handelingsgerichte diagnostiek.......................................................................................................... 15
6 etiologie ..................................................................................................................................................... 15
6.1 monocausaal ...................................................................................................................................... 15
6.1.1 biologische verklaringsmodellen .............................................................................................. 16
6.1.2 psychodynamisch model .......................................................................................................... 16
6.1.3 leertheorie ................................................................................................................................ 16
6.1.4 leertheorie ................................................................................................................................ 17
6.1.5 systeemtheoretische benadering ............................................................................................. 17
orthopedagogiek ....................................................................................................................................... 18
6.2 multicausaal ....................................................................................................................................... 18
6.2.1 etiologie van gedragsproblemen .............................................................................................. 18
1
, 6.2.2 risio- en protectieve factoren ................................................................................................... 19
7 ondersteuning ........................................................................................................................................... 20
7.1 drie doelen voor actuele ondersteuning ............................................................................................ 20
7.1.1 het vergroten van disciplinaire en affectieve opvoedingsvaardigheden van ouders ............... 20
7.1.2 het vergroten van zelfregulerende en prosociale vaardigheden van kind/jongere ................. 20
7.1.3 het verbeteren van het gezinsfunctioneren vanuit een systematische benadering ................ 20
7.2 netwerkondersteuning ....................................................................................................................... 20
HOOFDSTUK 3: personen met hechtingsproblemen of stoornissen ..................................................................... 21
1 pioniers in de wetenschap over hechting.................................................................................................. 21
1.1 lorenz.................................................................................................................................................. 21
1.2 Harlow & Zimmerman ........................................................................................................................ 21
1.3 bowlby ................................................................................................................................................ 21
2 definitie hechting ...................................................................................................................................... 21
3 ontwikkeling van hechting......................................................................................................................... 22
3.1 psychodynamische benadering van hechting .................................................................................... 22
4 onderzoek naar kwaliteit van hechting ..................................................................................................... 23
4.1 the strange situation (ainsworth & bell) ............................................................................................ 23
4.2 3 vormen van hechting ....................................................................................................................... 23
4.2.1 veilige gehechtheid ................................................................................................................... 24
4.2.2 onveilige gehechtheid ............................................................................................................... 24
5 klinisch-psychiatrische classificatie ........................................................................................................... 24
5.1 DSM (2013)......................................................................................................................................... 24
5.1.1 REACTIEVE HECHTINGSSTOORNIS. (RAD) ................................................................................. 25
5.1.2 ONTREMD-SOCIAALCONTACTSTOORNIS (DSED) ...................................................................... 25
6 prevalentie ................................................................................................................................................ 26
7 etiologie van hechtingsstoornissen ........................................................................................................... 26
7.1 BESCHERMENDE FACTOREN IN DE OUDERKINDRELATIE ................................................................... 26
7.2 BESCHERMENDE FACTOREN ALS DERDE (HULPVERLENER, LEERKRACHT, …) à niet te kennen,
illustratief ...................................................................................................................................................... 27
7.3 RISICOFACTOREN IN DE OUDER-KINDRELATIE ................................................................................... 27
8 prognose van hechtingsstoornissen .......................................................................................................... 28
9 comorbiditeit en differentiaaldiagnostiek ................................................................................................. 29
10 ondersteuning .................................................................................................................................... 29
HOOFDSTUK 4: gezinnen met meervoudige en complexe problemen ................................................................. 30
1 inleiding ..................................................................................................................................................... 30
2 terminologie .............................................................................................................................................. 30
oorsprong ...................................................................................................................................................... 30
2
, 2.1 het begrip ‘multiprobleemgezin’ ........................................................................................................ 30
2.1.1 INHOUDELIJKE TYPERING: SOORTEN PROBLEMEN EN BIJHOREND FUNCTIONEREN ............... 30
inhoudelijke problemen gezin ................................................................................................................... 31
problemen met hulpverleningssysteem .................................................................................................... 32
conclusie .................................................................................................................................................... 33
2.2 kansarmoede ...................................................................................................................................... 33
2.2.1 MULTIDIMENSIONALITEIT (MUTLI-ASPECTUEEL) VAN KANSARMOEDE ................................... 33
KANSARMOEDE IN CIJFERS ........................................................................................................................ 34
KANSARMOEDE INDEX (KA-INDEX) ........................................................................................................... 34
3 verbintenisproblematiek bij kansarmoede (prof. dr. Tine van Regelmortel) ............................................ 36
3.1 verbintenisproblematiek als centraal kenmerk.................................................................................. 36
4 gevolgen van kansarmoede ....................................................................................................................... 37
5 hoe kijken naar gezinnen met meervoudige en complexe problemen ..................................................... 37
5.1 er is nood aan multiperspectiviteit .................................................................................................... 40
6 hulpverlening............................................................................................................................................. 40
6.1 kansarmoede kent vele gezichten en wordt op verschillende manieren beleefd.............................. 41
6.2 principes van de hulpverlening aan gezinnen met meervoudige en complexe problemen............... 42
HOOFDSTUK 5: interpersoonlijk geweld ............................................................................................................... 43
1 inleiding ..................................................................................................................................................... 43
2 wat is kindermishandeling ......................................................................................................................... 43
overkoepelende definitie .............................................................................................................................. 43
2.1 lichamelijke mishandeling en verwaarlozing ...................................................................................... 43
2.2 emotionele mishandeling. en verwaarlozing ..................................................................................... 43
2.3 seskueel misbruik ............................................................................................................................... 44
2.4 specifieke vormen van kindermishandeling ....................................................................................... 44
1) factitious disorder imposed by another ........................................................................................ 44
2) Shaken baby syndrome ................................................................................................................. 44
3) Institutionele en structurele kindermishandeling ......................................................................... 44
4) Psychogene dwerggroei ................................................................................................................ 44
5) Sibling mishandeling ...................................................................................................................... 44
3 prevalentie van kindermishandeling ......................................................................................................... 45
4 gevolgen van kindermishandeling ............................................................................................................. 45
4.1 lichamelijke gevolgen ......................................................................................................................... 45
4.2 psychische gevolgen ........................................................................................................................... 45
4.3 intergenerationele tranmissie ............................................................................................................ 45
risicofactoren voor intergenerationele transmissie ...................................................................................... 45
invloed van psychotrauma: ........................................................................................................................... 46
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