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IntroductionIntroduction
Brief overview of the four major categories of impairment with an emphasis on the affective and cognitive areas.
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Physical ImpairmentsPhysical Impairments
Cerebral PalsySpinal Cord InjuryHead InjuryAmputationMultiple SclerosisArthritisSeizure Disorders
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Cognitive ImpairmentsCognitive Impairments
Learning DisabilitiesAttention Deficit Hyperactivity DisorderMental RetardationTraumatic Brain InjuryRehabilitation from Substance Abuse
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Affective ImpairmentsAffective Impairments
Psychotic DisordersMood DisordersAnxiety DisordersPersonality Disorders
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What is the most common What is the most common disability among our Job disability among our Job
Corps population?Corps population?
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Learning Disabilities Learning Disabilities Definition-Education for All Handicapped Definition-Education for All Handicapped
Children Act of 1975Children Act of 1975
A disorder in one or more of the basic psychological processes involved in understanding or using language, spoken, or written, in which the disorder may manifest itself in an imperfect ability to listen, think, speak, read, write, spell or do mathematical calculations, despite at least average intelligence. The term does not include children who having learning problems which are primarily the result of visual, hearing, or motor disabilities; mental retardation; emotional disturbance;or of environmental, cultural, or economic disadvantage.
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Types of Learning DisabilitiesTypes of Learning Disabilities Dyslexia
– Problems reading, letter or word reversals, confused by pages crowded with print
Listening Comprehension– Able to hear words, but have difficulty understanding
their meaning when combined to express a complete thought. Trouble following spoken instructions
Expressive Language Disorders (spoken/written)– Written Expression– Motor difficulties. Difficulty learning to write. Poor
written expression. Avoids writing.– Difficulty putting thoughts into words. Refuses to
speak (usually to a group)
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Types of Learning Disabilities Types of Learning Disabilities (continued)(continued)
Mathematics– Problems doing Math despite given adequate
instruction. Math Skills Below Grade Level
Visual-perceptual/Visual Motor– Difficulty interpreting what is seen. Problems
copying designs;putting together puzzles.
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Types of Learning Disabilities Types of Learning Disabilities (continued)(continued)
Auditory Processing Disorders– Difficulty hearing the sounds within words. Focus
is on individual words not sentences. Poor speller. Memory
– Problems with short-term or long-term memory Abstract Reasoning, Organization, and
Problem Solving– Average or better cognitive skills. Difficulty
understanding the relationship among things (i.e. analogies)
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Examples of General Accommodations Examples of General Accommodations for Learning Disabilitiesfor Learning Disabilities
Taped Examinations Large Print Examinations Large Print Answer Sheets Transcribers Interpreters Taped Texts Videotaped Lectures Cassettes Prepared Notes
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Attention Deficit Hyperactivity Attention Deficit Hyperactivity Disorder (ADHD)Disorder (ADHD)
Persistent pattern of inattention or hyperactivity— impulsivity
More frequent in males (4:1) than females (9:1)
Symptoms tend to attenuate during late adolescence and adulthood
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ADHD Students in Job CorpsADHD Students in Job Corps
Inattention– Low frustration tolerance– Mind is somewhere else– Disorganized work habits
Hyperactivity– Feelings of restlessness– Difficulty engaging in sedentary activities
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Impulsivity– Fails to listen to directions– Interrupts others frequently– Engages in potentially dangerous activities
Behavioral– Impairments in the classroom and in the
dorms– Temper outbursts, frequent insistence that
requests be met, poor self- esteem
ADHD Students in Job CorpsADHD Students in Job Corps (continued)(continued)
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Examples of ADHD AccommodationsExamples of ADHD Accommodations
Minimize distractions during class Allow extra time to finish work Peer Assistance Short work periods Break long tasks into smaller ones Recommend training program of high interest
to student Praise appropriate behaviors - Reinforcement Pair oral assignments with written instruction Checklists Buddy System during unstructured time
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What are the most common What are the most common affective impairments among affective impairments among our Job Corps population?our Job Corps population?
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Sadness, irritability, loss of pleasure or interest, appetite changes, sleep changes, psychomotor changes, fatigue
Onset—no particular age—highest in 25-44 age group
Gender differences—twice as common for adolescent and adult women than men
The lifetime risk for major depression is 10 -25% for women and 5 -12% for men
DepressionDepression
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Mood Disorders Hall of FameMood Disorders Hall of Fame
Barbara Bush
Ray Charles
Dick Clark
Robin Williams
Charles Dickens
Vincent Van Gogh
Joan Rivers
Ernest Hemingway
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Students with Depression Students with Depression in Job Corpsin Job Corps
Irritability in the dormsObsessive rumination—relationshipsFrequent visits to health services—
excessive worry over physical healthComplaints of pain (headaches, joint
pain, etc.)Alcohol useSuicide threats or attempt
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Accommodation SuggestionsAccommodation Suggestions
Acute stages of major depression, probably not appropriate for Job Corps.– MSWR or Medical Leave for Treatment
Students who are in remission or stabilized on medication are more appropriate– Adjust schedule to allow for treatment with CMHC
or off center– Adjust vocational/educational load to account for
low energy level
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Accommodation Suggestions Accommodation Suggestions (continued)(continued)
Depression– Encourage participation in recreational
activities– Develop support system– Monitor nutrition and personal care with
CMHC
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Personality DisordersPersonality DisordersWho Am I?Who Am I?
Conduct Disorder/Antisocial Personality Disorder
Borderline Personality Histrionic Personality Obsessive-Compulsive Personality Narcissistic Personality Several Others
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On Center—CharacteristicsOn Center—Characteristics
Conduct Disorder Before age 15
Little empathy
Blames others
Image of toughness
Aggressive style
Difficulty with GED
Antisocial Personality 18 or older
Lack of empathy
Superficial charm
Inflated ego
Excessively opinionated
Dysphoria
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Borderline PersonalityBorderline Personality
On Center—CharacteristicsOn Center—Characteristics Extreme attention seeking Manipulative—gaining the concern of staff
– Will share most intimate details easily Constant anger—recurring verbal fights
– When staff or friends are seen as neglectful, withholding, uncaring
Promiscuous behavior Sudden and dramatic shifts in their view of
others and Job Corps
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Histrionic PersonalityHistrionic Personality
Pervasive and excessive emotionality and attention seeking behavior
Center of attention Theatrical Sexually
provocative 2-3% of population
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On Center—CharacteristicsOn Center—Characteristics
Very Macho or Extremely FeminineRole of “Victim” or “Princess”Demands Constant Attention Becomes Bored Easily—Needs Novelty Initiates Job or Project—Loses Interest
FastCannot Delay GratificationDistorted Intimate Relationships
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Examples of Examples of AccommodationsAccommodations
Place in vocations with low interpersonal demands and low risk of injury to self and others
Provide frequent feedback to student about progress and how staff and other students view them
Place with supportive teachers/vocational instructors who are skilled at working with volatile students
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Anxiety DisordersAnxiety Disorders
Panic DisordersSpecific PhobiasAcute Stress DisorderPost-traumatic Stress DisorderGeneralized Anxiety
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Examples of Examples of AccommodationsAccommodations
Depending upon severity, medical leave or MSWR for treatment
Modifications in schedules for treatment with CMHC or off center
Vocational placement in areas that avoid the “feared situation/object – indoor work to avoid snakes, bugs – outdoor trade to avoid confined spaces
Identify areas of concerns and provide training, buddy system, alternative learning method, etc.
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Psychotic DisorderPsychotic Disorder
Most Common Form is Schizophrenia
Description of Schizophrenia– Emotional Turmoil – Overwhelming Confusion– Changes in Speech and Behavior– Loss of Reality Testing
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Students with Schizophrenia Students with Schizophrenia in Job Corpsin Job Corps
Can be abrupt or insidiousSocial withdrawalLoss of interest in class and workDeterioration in hygiene and groomingUnusual behavior—inappropriate affectAnger outbursts
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Examples of Examples of AccommodationsAccommodations
Most students in the acute stages of a psychotic disorder will need to be separated, however those with a history and stabilized on medication can be successful in Job Corps– Some of the ones listed for LD and ADHD– Monitoring of meds and general functioning by
the CMHC and center physician– RA to monitor self care– Recommend vocational trades of low risk –
business/computer
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Who Suffers from Cognitive and Who Suffers from Cognitive and Affective Impairments?Affective Impairments?
Approximately 1 out of 4 people will suffer some form of cognitive or affective impairment during their
lifetime.
American Psychiatric Association, 1998