INTRODUCTION
DIFFERENCES BETWEEN
o sychiatrist: controls and treats somatic symptoms,prescribes medication, duties at night and during the weekend
P
SPECIALISTS o Clinical psychologist: psychological assessment andpsychotherapy treatment
o At LUMC Curium - Psychologist-specialist vs Psychaitrist => same responsibilities for except for medical duties
Atypical development–most common disorders:
o Learning disabilities (such as dyslexia)
CHILD AND ADOLESCENT o Speech-language disorders
DEVELOPMENT AND o Intellectual disabilities
DISORDERS o Neurodevelopmental disorders, such as ADHD and autism
Complex disorders– and comorbidity
o Anxiety
o Depression
o Eating disorders
o Attachment disorders/trauma
o Stressor-related disorders
o Personality disorders
o Psychotic disorders
ORGANIZATION OF . C
1 hild Healthcare / Youth and Family Centre
PSYCHOLOGICAL SERVICES IN 2. Basic mental healthcare(Basis GGZ)
THE NETHERLANDS 3. Specialized mental healthcare(Specialistische GGZ):LUMC Curium (Referral needed & Most complex cases)
Divided into four areas
o E xtra-therapeutic factors
TREATMENT o Expectancy effects
OUTCOME o Specific therapy techniques
o Common factors:empathy,warmth, and thetherapeuticrelationship
Interpersonal skills
o erbal fluency
V
o Interpersonal perception
TREATMENT o Affective modulation and expressiveness
RELATIONSHIP o Warmth and acceptance
o Empathy
o Focus on other
T herapist/ Team
o T rusting and understanding
treatment climate o Aware: client’s age, characteristics, cultural background and context
,
o F lexible & will adjust therapy
o Communicates hope and optimism
o Aware of their own psychological process
I ndividually planned
o s short as possible - as intensive as necessary
A
treatment program o Outpatient treatment, home treatment, day clinic, clinic inpatient etc
Clinical treatment
o F ocused individualized treatment
o Treatment climate
o Short inpatient treatment + outpatient treatment + home training
LUMC o Familties in control
CURIUM o Outpatient pre and post treatment programs
Attitide towards Families
o arents are competent and experts on their child
P
o Building on competencies of the child and famil
o Goal is to foster functioning & find a new balance between child and family (not to cure)
o Non-violentresistance:parentalpresenceinthechildsmindtoreducehelplessnessandgainauthoritybysupporting
parents
Intake & Treatment
o iagnostic process: history, psychological assessment, info from school
D
o Multidisciplimary meeting with specialist, family therapist (or social worker) and student when reviewing
psychological assessment with psychologist => descriptive diagnosis + treatment plan
o Meeting with parents and children for advice
o Treatment: 3 monthly multidisciplinary evaluation
, WEEK 1. AUTISM SPECTRUM DISORDER
CATEGORY A Persistent deficits in social communication and social interactions across multiple contexts
Deficitsin
ASD DSM-5 o Socialand emotional reciprocity
o Non-verbal communication behaviors that are used in social interactions
o Development of relationships, maintaining relationships, and understanding relationships
CATEGORY B Restricted, repetitive patterns of behavior, interests or activities, as manifested by at least two of the following
S tereotyped or repetitive motor movements, use of objects or speech
Having a strict routine or ritualized patterns of behavior
Fixed interests that are abnormally intense or focused
Sensory input or unusual interest in sensory aspects of the environment leads to hyper or hypo activity
CATEGORY C Symptoms must have been present in early development
CATEGORY D Mentioned symptoms cause clinically significant impairment
CATEGORY E Impairment cannot be better explained by other mental disorders or through global development delay
Level 1: Requiring support Social communication
SEVERITY SPECIFIERS o Without supports in place, deficits in social communication cause noticeable impairments
o May appear to have decreased interest in social interactions
o Example: person able to speak fullsentencesandengageincommunicationbutwhosetoandfromconversations
with other fails, and whose attempts to make friends are odd and typically unsuccessful
Restricted, repetitive behaviors
o Inflexibility of behavior causes significant interference with functioning in one or more contexts
o Problems of organization and planning hamper independence
L evel 2: Requiring Social communication
substantial support o Marked deficits in verbal & nonverbal social communication skills
o Limited initiation of social interactions
o Example:personwhospeakssimplesentences,whoseinteractionislimitedtonarrowspecialinterests,andwhohas
markedly odd nonverbal communication
Restricted, repetitive behaviors
o Inflexibility of behavior
o Difficultycopingwithchangeorotherrestricted/repetitivebehaviorsappearfrequentlyenoughandinterferewith
functioning in a variety of contexts
, L evel 3: Requiring very Social communication
substantial support o Severe deficits in verbal and nonverbal social communication skills cause server impairments in functioning
o Very limited initiation of social interactions - Minimal response to social overtures from others
o Example: person with few words of intelligible speech who rarely initiates interaction and when they do, makes
unusual approaches to meet needs only and responds to only very direct social approaches
Restricted, repetitive behaviors
o Inflexibility of behavior
o Extreme difficultly coping with change
o Other restricted/ repetitive behaviors markedly interfere with functioning in all spheres
Phenotypes: observable characteristics of individuals(in autism, they are the behavioral aspects) - RESEARCH: male dominated
PHENOTYPES Females with autism Show deficits in different ways than males
o More social attention
o Less face fixationcompared to typical women
o “Camouflaging” =>higher social motivation
o Less externalizing behavior,more internalizing issues
Autism is a neurodevelopmental disorder and isbiasedtowards males
GENES “Female Protective Effect” F emales are biologically shielded from autism
Females need more genes to be able to identify if they have the disorder (less for males)
Behavioral differences between genders may relate to genes and their expressions
“Extreme Male Brain” ifferent patterns of connectivity in the brain => Males have more connectivity
D
BIOLOGICAL "Empathy" is associated with the female end, while "systemizing" is linked to the male end.
IFFERENCES
D Individuals with autism are often positioned towards the systemizing end, termed the "extreme male brain."
Girls with autism with similar developed brain areas as boys show similar symptoms
Boys often externalize symptoms due to inpatients in motor brain areas and language areas => more noticeable and quicker diagnosed
Differing social environments for boys and girls with ASD
SOCIAL CULTURAL Peer relationship study
o T ypically developing children and children with ASDprimarily socialized with same-gender peers
INFLUENCES o Boyswith ASD wererejectedmore frequently
o Girlswith ASD wereoverlookedor“mothered”
Need to navigate distinct gender-specific demands of same-gender relationships => poses different challenges
DIFFERENCES BETWEEN
o sychiatrist: controls and treats somatic symptoms,prescribes medication, duties at night and during the weekend
P
SPECIALISTS o Clinical psychologist: psychological assessment andpsychotherapy treatment
o At LUMC Curium - Psychologist-specialist vs Psychaitrist => same responsibilities for except for medical duties
Atypical development–most common disorders:
o Learning disabilities (such as dyslexia)
CHILD AND ADOLESCENT o Speech-language disorders
DEVELOPMENT AND o Intellectual disabilities
DISORDERS o Neurodevelopmental disorders, such as ADHD and autism
Complex disorders– and comorbidity
o Anxiety
o Depression
o Eating disorders
o Attachment disorders/trauma
o Stressor-related disorders
o Personality disorders
o Psychotic disorders
ORGANIZATION OF . C
1 hild Healthcare / Youth and Family Centre
PSYCHOLOGICAL SERVICES IN 2. Basic mental healthcare(Basis GGZ)
THE NETHERLANDS 3. Specialized mental healthcare(Specialistische GGZ):LUMC Curium (Referral needed & Most complex cases)
Divided into four areas
o E xtra-therapeutic factors
TREATMENT o Expectancy effects
OUTCOME o Specific therapy techniques
o Common factors:empathy,warmth, and thetherapeuticrelationship
Interpersonal skills
o erbal fluency
V
o Interpersonal perception
TREATMENT o Affective modulation and expressiveness
RELATIONSHIP o Warmth and acceptance
o Empathy
o Focus on other
T herapist/ Team
o T rusting and understanding
treatment climate o Aware: client’s age, characteristics, cultural background and context
,
o F lexible & will adjust therapy
o Communicates hope and optimism
o Aware of their own psychological process
I ndividually planned
o s short as possible - as intensive as necessary
A
treatment program o Outpatient treatment, home treatment, day clinic, clinic inpatient etc
Clinical treatment
o F ocused individualized treatment
o Treatment climate
o Short inpatient treatment + outpatient treatment + home training
LUMC o Familties in control
CURIUM o Outpatient pre and post treatment programs
Attitide towards Families
o arents are competent and experts on their child
P
o Building on competencies of the child and famil
o Goal is to foster functioning & find a new balance between child and family (not to cure)
o Non-violentresistance:parentalpresenceinthechildsmindtoreducehelplessnessandgainauthoritybysupporting
parents
Intake & Treatment
o iagnostic process: history, psychological assessment, info from school
D
o Multidisciplimary meeting with specialist, family therapist (or social worker) and student when reviewing
psychological assessment with psychologist => descriptive diagnosis + treatment plan
o Meeting with parents and children for advice
o Treatment: 3 monthly multidisciplinary evaluation
, WEEK 1. AUTISM SPECTRUM DISORDER
CATEGORY A Persistent deficits in social communication and social interactions across multiple contexts
Deficitsin
ASD DSM-5 o Socialand emotional reciprocity
o Non-verbal communication behaviors that are used in social interactions
o Development of relationships, maintaining relationships, and understanding relationships
CATEGORY B Restricted, repetitive patterns of behavior, interests or activities, as manifested by at least two of the following
S tereotyped or repetitive motor movements, use of objects or speech
Having a strict routine or ritualized patterns of behavior
Fixed interests that are abnormally intense or focused
Sensory input or unusual interest in sensory aspects of the environment leads to hyper or hypo activity
CATEGORY C Symptoms must have been present in early development
CATEGORY D Mentioned symptoms cause clinically significant impairment
CATEGORY E Impairment cannot be better explained by other mental disorders or through global development delay
Level 1: Requiring support Social communication
SEVERITY SPECIFIERS o Without supports in place, deficits in social communication cause noticeable impairments
o May appear to have decreased interest in social interactions
o Example: person able to speak fullsentencesandengageincommunicationbutwhosetoandfromconversations
with other fails, and whose attempts to make friends are odd and typically unsuccessful
Restricted, repetitive behaviors
o Inflexibility of behavior causes significant interference with functioning in one or more contexts
o Problems of organization and planning hamper independence
L evel 2: Requiring Social communication
substantial support o Marked deficits in verbal & nonverbal social communication skills
o Limited initiation of social interactions
o Example:personwhospeakssimplesentences,whoseinteractionislimitedtonarrowspecialinterests,andwhohas
markedly odd nonverbal communication
Restricted, repetitive behaviors
o Inflexibility of behavior
o Difficultycopingwithchangeorotherrestricted/repetitivebehaviorsappearfrequentlyenoughandinterferewith
functioning in a variety of contexts
, L evel 3: Requiring very Social communication
substantial support o Severe deficits in verbal and nonverbal social communication skills cause server impairments in functioning
o Very limited initiation of social interactions - Minimal response to social overtures from others
o Example: person with few words of intelligible speech who rarely initiates interaction and when they do, makes
unusual approaches to meet needs only and responds to only very direct social approaches
Restricted, repetitive behaviors
o Inflexibility of behavior
o Extreme difficultly coping with change
o Other restricted/ repetitive behaviors markedly interfere with functioning in all spheres
Phenotypes: observable characteristics of individuals(in autism, they are the behavioral aspects) - RESEARCH: male dominated
PHENOTYPES Females with autism Show deficits in different ways than males
o More social attention
o Less face fixationcompared to typical women
o “Camouflaging” =>higher social motivation
o Less externalizing behavior,more internalizing issues
Autism is a neurodevelopmental disorder and isbiasedtowards males
GENES “Female Protective Effect” F emales are biologically shielded from autism
Females need more genes to be able to identify if they have the disorder (less for males)
Behavioral differences between genders may relate to genes and their expressions
“Extreme Male Brain” ifferent patterns of connectivity in the brain => Males have more connectivity
D
BIOLOGICAL "Empathy" is associated with the female end, while "systemizing" is linked to the male end.
IFFERENCES
D Individuals with autism are often positioned towards the systemizing end, termed the "extreme male brain."
Girls with autism with similar developed brain areas as boys show similar symptoms
Boys often externalize symptoms due to inpatients in motor brain areas and language areas => more noticeable and quicker diagnosed
Differing social environments for boys and girls with ASD
SOCIAL CULTURAL Peer relationship study
o T ypically developing children and children with ASDprimarily socialized with same-gender peers
INFLUENCES o Boyswith ASD wererejectedmore frequently
o Girlswith ASD wereoverlookedor“mothered”
Need to navigate distinct gender-specific demands of same-gender relationships => poses different challenges
