MDFT. working with adolescents with intellectual disabilities. Brenda Cooiman, psychologist and MDFT supervisor Reinaerde Utrecht, the Netherlands

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1 MDFT working with adolescents with intellectual disabilities Brenda Cooiman, psychologist and MDFT supervisor Reinaerde Utrecht, the Netherlands 8th of may

2 2 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

3 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 3

4 understanding

5 memory

6 Speaking

7 Tuning

8 Generalization

9 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

10 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

11 For Example: 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

12 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

13 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?

14 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 14

15 Tension thermometer ~ ik ga vechten 5 KWAAD 4 ~ mijn hele lichaam gaat trillen ~ mijn hele lichaam wordt strak ~ het gevoel dat ik door mijn benen zak ~ ik wil eigenlijk terug duwen Dingen die ik kan doen om minder boos te worden: - Zeggen dat ik het niet leuk vind - Andere activiteit gaan doen - Weglopen - Mijn ouders bellen - Naar: ~ meneer van Willegen ~ mevrouw van Beringen - Uitpraten Dingen die anderen kunnen doen: 3 ~ er komt boze adrenaline ~ spieren nog strakker ~ ik ga trillen ~ ik ga schelden, dingen terug zeggen - Weggaan - Leraar / lerares gaat mij helpen - Eerlijk uitpraten 2 ~ Ik ga anders kijken (strakker / bozer) ~ er komt woede in mijn lichaam ~ spieren worden strak: mijn benen, armen, ellebogen en knieën. een schot in mijn hart 1 0 RELAX Grapjes, grapjes maken, niets doen, mezelf zijn Dingen die anderen kunnen doen: Dingen die ik kan doen om minder boos te worden: - Op di en do boksen - Gaan hardlopen naar Benschop - Koken - Uit gaan - Musical / dansen - Praten Dingen die anderen kunnen doen: - Met papa hardlopen - Praten met mij 15

16 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 16

17 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 17

18 Empowerment 18

19 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!! 19