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’s area Pars opercularis Motor cortex Somatosensory cortex Sensory associative cortex Primary Auditory cortex Wernicke’s area Visual associative cortex Visual cortex

Pre Frontal Cortex To overcome Habituated responses To stay goal directed To compete with stronger established patterns To establish newer Responses In the face of Interference and distractions Overcome stronger task-irrelevant responses Select (weaker) task-relevant responses

Situation requiring Cognitive Control Look Left Look Right

Process 1.Awareness that context is different 2.Retrieving Cognitive Representations of Correct action in circumstance 3.Selecting correct motor response 4.Inhibiting INCORRECT response 5.Active Maintenance (of Task / Goal related information) 6.Update any new information 7.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 Functions Inhibit Shift Emotional Control Monitor

Working Memory Plan/ organize Organization of Materials Task Completion

Dysfunction ADAPTIVE FUNCTIONING Emotional Interpersonal environmental Intrapersonal

Perceptions are never PURE or Absolute Perceptions are influenced by one’s “knowledge of the Perceived” Perceptions may be modified by the experience of consequences

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 pain Self injury OPIOIDS Released ANXIETY REDUCED Self Injury - Opioid Dynamics Stress Adaptation Fails