REC365 TR & Medical Conditions
September 7th, 2020
Class #3
Happy Labor Day!
Section 1 Presentations :)
AFFECTIVE DOMAIN
Chapter 2: Attention-Deficit/Hyperactivity Disorder
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According the the DSM-5, clients with ADHD have:
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Markedly decreased attention (not due to defiance or comprehension deficits)
And/or an age-inappropriate level of hyperactivity/impulsivity
Symptoms must be present before the age of 12 and have lasted for at least
six months
Depending on symptoms, an ADHD presentation is identified as
predominantly hyperactive/impulsive presentation, a predominantly
inattentive presentation, or a combined presentation
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
AFFECTIVE DOMAIN, cont.
Chapter 2: Attention-Deficit/Hyperactivity Disorder, cont.
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Secondary problems include:
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Emotional impairment (anger, aggression, frustration, reduced empathy, decreased arousal to
stimulation, emotion dysregulation)
Social impairment (including dislike for school and impaired sense of self)
Physical activity deficits (perceptual motor deficits and general coordination deficits can make
it difficult for children with ADHD to participate in sports and other high-level physical
activities, while also increasing risk for injuries)
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
AFFECTIVE DOMAIN, cont.
Chapter 2: Attention-Deficit/Hyperactivity Disorder, cont.
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Prognosis
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ADHD symptoms during elementary school years can continue or change throughout
developmental years
During adolescence, about 50-60% of the diagnosed population continue to experience
problematic symptoms
It is estimated that 50-70% of the diagnosed population continue to have problems into
adulthood
Hyperactivity is usually the first impairment to decline with age, while attention span and
impulse control impairments may linger
It is believed that throughout the developmental years, brain function
continually
improves, resulting in a reduction of ADHD symptoms
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
AFFECTIVE DOMAIN, cont.
Chapter 3: Autism Spectrum Disorder
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Includes Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative
Disorder, and Pervasive Developmental Disorder Not Otherwise Specified
Criteria for ASD can be found in the DSM-5 and includes:
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Deficits in social communication and social interaction
Restricted, repetitive patterns of behavior, interests, or activities
The DSM-5 divides ASD into three severity levels depending on support
required:
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Level 1 requires support
Level 2 requires substantial support
Level 3 requires very substantial support
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
AFFECTIVE DOMAIN, cont.
Chapter 3: Autism Spectrum Disorder
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Secondary problems include:
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Epilepsy
Sleep disorders
Hyperactivity
Anxiety and depression
Sensory processing dysfunctions
Cognitive impairment
Self-injuring behaviors
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
AFFECTIVE DOMAIN, cont.
Chapter 3: Autism Spectrum Disorder
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Prognosis:
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Most children greatly improve with both treatment and age.
There is no single best treatment package for all children with ASD
Early intervention is important, and those with ASD respond well to highly structured,
specialized programs
Prognosis may be affected by the presence or absence of associated intellectual disability,
language impairment and additional mental health problems
Functional consequences of ASD for young children are impacted by rate or effectiveness of
learning, especially in setting where social interaction with peers
is part of the process
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
AFFECTIVE DOMAIN, cont.
Chapter 5: Borderline Personality Disorder
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Serious psychiatric illness most often characterized by pervasive instability in
interpersonal relationships, moods, and self-image combined with marked
impulsivity and difficulty with mood regulation
Episodic mood instability tends to disrupt work and family life and the individual’s
ability to make long-term plans
Reckless behaviors (substance abuse, gambling, unsafe sex, reckless driving,
binge eating) and impulsive aggression
May exhibit self-injuring behavior or threats
Recurrent suicide attempts and self-injury often occur when the
individual fears rejection or separation, whether real or imagined.
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
AFFECTIVE DOMAIN, cont.
Chapter 5: Borderline Personality Disorder, cont.
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Affects roughly 2% of the general population according to the American
Psychiatric Association
○ 20% of the inpatient mental health population
○ 10% of the outpatient mental health population
70-75% of those diagnosed are women, and is more highly associated with single,
young females who are likely of lower economic status and reside in urban areas
Most commonly diagnosed in young adulthood, although a BPD diagnosis is
generally not recommended during adolescence because young
adolescent behaviors often mimic BPD symptoms
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
AFFECTIVE DOMAIN, cont.
Chapter 5: Borderline Personality Disorder, cont.
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Exact cause is unknown, but numerous theories exist
○ Childhood hx of neglect, abuse, or separation increases risk of developing
BPD and environmental stressors may trigger the onset of the disorder
○ BPD may also have a genetic component--the disorder has been reported to
be almost 5x more common among first-degree biological relatives
○ Biological irregularities might impair the neural circuits that regulate emotion
○ Characterized as having biological abnormalities that potentially interact with
psychosocial stressors
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
AFFECTIVE DOMAIN, cont.
Chapter 5: Borderline Personality Disorder, cont.
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BPD affects the brain as indicated by detection of abnormalities of the frontal lobe
by MRI and PET scans
Observation of behavior often indicates the individual’s inability to regulate
emotion or mood
Individuals with BPD often have unstable relationships with family, friends, and
co-workers. They have difficulty with mood stability, aggression, and fear of loss
that makes it challenging to engage in and maintain healthy relationships
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
AFFECTIVE DOMAIN, cont.
Chapter 5: Borderline Personality Disorder, cont.
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Secondary problems include:
○ Suicide attempts and threats, self destruction, self mutilation
○ Substance dependence and/or abuse
○ Other psychiatric illnesses (bipolar disorder, depression, anxiety,
schizophrenia)
○ Treatment can become complex and requires a combination of therapeutic
approaches and interventions
○ Psychiatric hospitalizations are often necessary
○ Long-term, intensive psychotherapy is also recommended
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
AFFECTIVE DOMAIN, cont.
Chapter 5: Borderline Personality Disorder, cont.
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Prognosis:
○ Persons with BPD are at high risk for suicide and self-harm
○ Mood stability may improve with active participation in one or more long-term
psychotherapy treatments
○ With age, they may experience less instability in social and occupational
functioning
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
AFFECTIVE DOMAIN, cont.
Chapter 5: Borderline Personality Disorder, cont.
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Assessment
○ The diagnostic criteria in the the DSM-5 includes presenting with five or more of these nine
criterion:
■ Frantic efforts to avoid real or imagined abandonment
■ Unstable and intense interpersonal relationships alternating between idealization and
devaluation
■ Identity disturbance that leads to unstable self-image
■ Impulsivity that is potentially self-damaging
■ Suicidal behavior or threats, or self-mutilating behavior
■ Affective instability that comes from over-reacting
■ Chronic feelings of emptiness
■ Anger problems
■ Paranoid ideation or dissociative symptoms
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
AFFECTIVE DOMAIN, cont.
Chapter 5: Borderline Personality Disorder, cont.
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Assessment, cont.
○ Comprehensive Evaluation in Recreational Therapy: Psych/Behavioral, Revised (CERT Psych/R)
○ Leisure Assessment Inventory (LAI)
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
AFFECTIVE DOMAIN, cont.
Chapter 5: Borderline Personality Disorder, cont.
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RT Areas of Concern
○ Emotional instability
○ Safety precautions for the individual and others
○ Difficulty controlling anger
○ Impulsivity
○ Problematic social functioning
○ Interpersonal relationship difficulty and/or losing self in relationships
○ Recurring suicide attempts or ideation
○ Manipulation
○ Depression
AFFECTIVE DOMAIN, cont.
Chapter 5: Borderline Personality Disorder, cont.
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Treatment
○ Evidence-based psychotherapeutic interventions (dialectical behavior therapy
and family therapy) are identified as successful interventions when
supplemented with medication
○ RT treatment focuses on:
■ Improving functional skills, social behaviors and social skills, coping
skills, stress and anger management
■ Education and training, community integration, health promotion
Source: Porter, Heather R., Ph.D., CTRS, “Recreational Therapy for Specific Diagnoses and Conditions”
REVIEW FOR QUIZ #1 ON 9/14
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Quiz will be posted to Canvas on Sunday, 9/13
Will send out Canvas announcement when posted
Completed quiz is due by midnight on 9/14
Worth 20 points
True/False, multiple choice, matching questions, etc.
Content will include:
○ Assigned textbook readings--focus on class PowerPoints located on Canvas
○ Guest speaker topics--focus on Jeff’s handout uploaded to Canvas
○ Section 1 presentations--located in Canvas assignments
NEXT CLASS
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Read chapters 13, 15, 16
Quiz #1
Guest speakers
Affective domain
Assessments
Overview of expectations for Section 2