MDFT working with adolescents with intellectual disabilities Brenda Cooiman, psychologist and MDFT supervisor Reinaerde Utrecht, the Netherlands 8th of may 2014
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MDFT: working with adolescents with intellectual disabilities
Effectiveness of treatment for adolescents with intellectual disabilities is enlarged as it involves family and friends. The involvement of this social system gives them a stronger position and increases the transfer of what has been learned
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Previous experience of CBT treatment of adolescents with intellectual disabilities • • • •
resistance Takes a long time Effects don’t persist Success in the therapy room is no guarantee of success beyond • youngster has no more opportunities to learn • Little view on content or relation, tendency to react on content
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understanding
memory
Speaking
Tuning
Generalization
A professionals guide to success Uit: De Wit, Moonen en Douma 2011
•Difficulty in prioritizing •Slower •Smaller working memory •Trouble with verbal input •Inhibition problems •Negative interpretation social information •Overestimate possibilities •Negative self-image •Difficulty with self-regulation •Difficulty with generalization
•Make choices together •Take more time •Do less •Visualize more •Take small steps • Explain, discuss, give clues and subtitles •Ask to show it •Reward and encourage •Skirt behavior, give boundaries •Practice very often and involve the social network
Program for adolescents with intellectual disabilities • ‘Reinaerde’ and ‘Stichting Jeugdinterventies’ have developed a program for the application of MDFT in young people with intellectual disabilities • The adjustments are not on content but on form in terms of implementation
For Example:
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Language use: 5-7 words per sentence Specific subjects Visual support Session diary Shorter sessions (30 minutes instead of 60 minutes) • repetition • Linking (connecting sessions) • Treatment duration 9 months instead of 6 months
a case study • Jayden 16 years old, a boy with severe aggressive acting out and suspended sentence because of violent offences • TIQ 67, PIQ 63, VIQ 72 • School drop-outs for last 18 months • Problems in family • Problems in peer group • Problems at school
Interventions • Tension thermometer and make a transfer to solution strategies • Together with the social system, parents, brother and friend to make the transfer • Parents as co-therapist, they wanted but didn’t know how • What things of the past are relevant for the present • Relabeling behavior, why is he doing it?
Interventions • Parents learned to look at the underlying question • Investigate if it’s about content or relations • Social information processing: at first it was trigger → act • Now: trigger→ thinking → make a plan→ act • Psycho education to Jayden, his parents, brother, friends, teachers
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Tension thermometer 5
KWAAD
~ ik ga vechten
Dingen die ik kan doen om minder boos te worden:
4 ~ mijn hele lichaam gaat trillen ~ mijn hele lichaam wordt strak ~ het gevoel dat ik door mijn benen zak ~ ik wil eigenlijk terug duwen
Zeggen dat ik het niet leuk vind Andere activiteit gaan doen Weglopen Mijn ouders bellen Naar: ~ meneer van Willegen ~ mevrouw van Beringen Uitpraten
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Dingen die anderen kunnen doen: 3 ~ er komt boze adrenaline ~ spieren nog strakker ~ ik ga trillen ~ ik ga schelden, dingen terug zeggen 2 ~ Ik ga anders kijken (strakker / bozer) ~ er komt woede in mijn lichaam ~ spieren worden strak: mijn benen, armen, ellebogen en knieën.
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Weggaan Leraar / lerares gaat mij helpen Eerlijk uitpraten
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Dingen die anderen kunnen doen:
Dingen die ik kan doen om minder boos te worden:
1 “een schot in mijn hart”
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RELAX
Grapjes, grapjes maken, niets doen, mezelf zijn
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Op di en do boksen Gaan hardlopen naar Benschop Koken Uit gaan Musical / dansen Praten
Dingen die anderen kunnen doen:
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Met papa hardlopen Praten met mij
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Jaydens cognitions • • • • • •
Most of the people can not be trusted My parents don’t love me, I’m to difficult for them I have to take good care for my self nobody does it other wise People gonna take advantage of me any way I cant make it on my own, but I don’t want help If I do something stupid I don’t care, I have trouble any way, doing the right way or doing the wrong way. • I’m just a pain in the ass • Negative attention is also attention • I’ve lost the person who understood me
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Goals
• Jayden gets grip on his life in a good way, is feeling in control doing the right things • Parents work together as a team and know how to support Jayden • Friends and teachers understand him, help and support Jayden • Pain from the past is processed • Family is reconnected
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Empowerment
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Ticket for in the pocket Things I can do to be less angry -say I don’t like it -tell them to stop -run away -call my parents -at school go to mr. Burges or mrs. Spaan -do other activities -As I calmed down, resolve conflicts I’m OK!!
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