THE MANAGEMENT OF BEHAVIOR DISORDERS

Drug Therapy: Drugs have to be prescribed by a psychiatrist. Combinations of the following may be used:

• Antipsychotic drugs

• Antianxiety drugs

• Antidepressant drugs.

Group Therapy: When the patient is in a group he gets to interact with others like him. This visual feedback gives him information of what others are going through. He sees that there are others worse off than him, and decides that life is worth living after all.

Family Therapy: Sometimes the family members in all good intention end up by doing more harm. They discourage rehabilitation -appropriate behavior by doing all functions for the patient, or by giving them unwanted sympathy.

Giving a concrete job to the patient and family member can prevent day dreaming and negative attitudes.

Behavior Therapy

Whenever called up on to correct a deviant behavior, psychologists use behavior therapy which lays emphasis on current individual behavior rather than the historical origins of its problems.

First, the behavior to increase or decrease is identified. It is also noted how often this behavior occurs and reinforcers are identified. Reinforcers are nothing

but stimuli that increase or decrease the frequency of a behavior. Positive reinforcers (carrot) increase the frequency while negative reinforcers (stick) decrease its frequency.

For example a child not co-operating to therapy can be offered a sweet, or the therapy can be converted into a game. An adult can be given the option of listening to music while doing therapy. It is not enough to reduce unwanted behavior it is equally important to provide alternate behavior.

For complicated tasks which do not find approval or cooperation with the patient, the tasks are broken down into smaller steps and the patient is instructed on what he can do. Encouragement increases performance

Leisure and prevocational activities have to be given. We must remember that the patient has a lot of time on his hands. An idle mind is the devils workshop. Hence he must have something to occupy his mind throughout his tenure.

Behavioral modification techniques are classified as:

Techniques for reducing anxiety including relaxation training

Graded exposure treatment involves exposing the subject to the feared stimulus one step at a time. Aversion therapy aims to reduce maladaptive behavior by associating it with an unpleasant experience, such as pain or a noxious smell.

Summary of contingency management techniques is shown in Table 6.1.

Table 6.1: Summary of contingency management techniques

Techniques Main features Applications

Negative reinforcement A known negative stimulus This stimulus can suppress (Punishment) is given to reduce the behaviors likely to interfere with

frequency or intensity of therapeutic programs. This undesirable behavior. technique is not recommended This is maintained till the as it encourages avoidance.

behavior becomes desirable and then stopped. For example the person can be suspended from work till he gives up alcoholism and reinstated when he has given up the habit.

Fading Reinforcement of a desirable Used as a special feature in behavior is gradually with- programs with children who drawn to bring it under have frequent bedwetting at naturally occurring rein- night.

forcement

Attention to dis- The environment of the This technique is helpful when criminative stimuli setting is changed to give negative behavior is predictable

positive cues, for example in a particular scenario, like a a rehab center for children doctor’s clinic.

can be decorated brightly with lots of toys and games.

Techniques to Increase Desired Behavior

• Rewards

• Behavioral contracts—written agreements between people who desire a change in behavior

• Shaping—gradual development of complex pieces of behavior by reinforcement of the constituent parts. This technique is used to develop basic skills (such as eating and dressing) in cases of mental retardation.

• Psychological treatment—hypnosis MENTAL RETARDATION

Mental retardation is a term applied to a condition where the mental development is retarded at birth or in early childhood. The child has limited intelligence with difficulty in adaptation. Mental retardation is an educational, psychological and social problem.

It may influence all aspects of human functioning including speech, language development, hearing and visual functioning as well as muscular co-ordination.

Prevalence

A study conducted by the National Sample Survey of India in 1991 said that 3 percent of our children have developed mental delays often associated with mental retardation. Several non-official studies have also suggested that 2 to 2.5 percent children have mental retardation. India has about 300 million children less than 16 years of age. This means that the country has a huge young population with retardation.

Definition

“Mental retardation means a condition of arrested or incomplete development of mind of a person which is specially characterized by sub-normal intelligence.”

• Intelligence should be significantly sub-average

• This should have occurred in the developmental period, i.e. up to 18 years of age

• Behavior should be significantly inappropriate.

Classification

1. According to gross physical characteristics

• Familial types

• Microcephaly

• Hydrocephalus

• Cretinism

• Mongolism

2. Classification according to American Association of Mental Retardation (AAMR)

Degree of Retardation IQ Range

Profound 0 – 24

Severely retarded 25 – 39

Moderately retarded 40 – 54

Mildly retarded 55 – 69

Borderline 70 – 84

IQ Scores, percentile ranges, and classifications for the Wechsler adult intelligence scale are shown in Table 6.2.

Table 6.2: IQ Scores, percentile ranges, and classifications for the Wechsler adult intelligence scale

IQ Score Percentile range Classification

130 and above 98 or greater Very superior

120-129 91 to 97 Superior

110-119 74 to 89 High average

90-109 25 to 73 Average

80-90 9 to 23 Low average

70-79 2 to 8 Borderline

50-69 < 2 Mild mental retardation

35-49 < 1 Moderate mental retardation

20-34 < 1 Severe mental retardation

Below 20 < 1 Profound mental retardation

Prevention of Cerebral Palsy and Mental Retardation

• Public education

• Maternal and child health services

• Genetic counseling

• Consanguinity

• Malnutrition.