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i am sam
Transcript of i am sam
Movie Project Presentation Who is Sam Dawson? Through an Abnormal Psych Lens... Directed by Jessie Nelson, 2001. With Sean Penn, Michelle Pfeiffer, Dakota Fanning, Dianne Wiest.
Carla Archuletta, Amy Austin, Sarah Grove, Brianna Velazquez 5-Axis Diagnosis Axis I: V71.09 No Diagnosis on Axis I
Axis II: 317 Mild Mental Retardation*
Axis III: None Reported
Axis IV: None
Axis V: GAF = 70 // Very Mild Impairment Sam is a man living in Los Angeles, CA in the 1990s.
He is a single father to one daughter, Lucy Diamond.
Sam works at Starbucks, and he is an avid Beatles fan.
He is a caring friend and neighbor.
Sam also has an intellectual disability. *Note that in the DSM-5, the term "Mental Retardation" will be changed to "Intellectual Disability." When Sam finds himself as a single father to Lucy after her mother, a homeless woman, abandons them at the hospital, he relies upon his group of friends with various developmental disabilities and his kind, agoraphobic neighbor Annie for support. Though Sam provides a loving and caring environment for precocious Lucy, she soon surpasses his mental ability. Other children tease her for having a "retard" as a father, and she becomes too embarrassed to accept that she is more intellectually advanced than Sam. In preparation for a custody case, a social worker turns up at Lucy's birthday party. Lucy is removed from Sam's care, and Sam is allowed only two supervised visits per week with his daughter.
On the advice of his friends, Sam approaches a high-powered lawyer, Rita Harrison, whose fast-paced schedule and difficult personal life have earned her a reputation as cold and unfeeling. In an attempt to prove to others that she is not heartless, Rita surprisingly agrees to take on Sam's case pro bono. As they work together to secure Sam's parental rights, Sam unwittingly helps Rita with her family problems, including encouraging her to leave her cheating husband and repairing her relationship with her son.
At the trial, Sam breaks down after opposing counsel convinces him that he is not capable of being a father. After the trial, Lucy resides in a foster home, but she continually escapes in the middle of the night to go to Sam's apartment, whereupon he immediately returns her. Ultimately, the foster family who planned to adopt Lucy decide to return her to Sam, with an arrangement that they will help him raise her.
The final scene depicts a soccer game, refereed by Sam, in which Lucy participates as a player. In attendance are the foster family, Sam's friendship group, and a newly-single Rita with her son. References A look at the criteria... Differential Diagnosis Mini Mental Health Status Etiology & Predisposing Factors Factors are biological, psychosocial, or a combination of both.
No clear etiology can be determined for 30%-40% of individuals with Mental Retardation.
Specific etiologies are more likely to be identified in individuals with Severe or Profound Mental Retardation
Major predisposing factors include:
heredity (fragile X syndrome, Down syndrome, PKU)
early alterations of embryonic development (chromosomal changes, teratogens, infections, cranial anomalies)
environmental influences (deprivation of nurturance and social, linguistic, and other stimulation)
pregnancy and perinatal problems (fetal malnutrition, prematurity, hypoxia, viral and other infections, trauma) Client was alert and fully oriented.
Appearance was appropriate.
Mood was reported as sad and hurt; affect was mood-congruent.
Thought processes were logical and linear, though abstract thought and complex reasoning skills were limited.
No delusional, paranoid, and/or otherwise unusual thought content noted.
Client did not display perceptual distortions, and did not appear to respond to internal stimuli.
Client did not express thoughts of harm to self and/or others. Diagnostic Criteria A. Significantly subaverage intellectual functioning: an IQ of approx. 70 or below.
B. Concurrent deficits or impairments in present adaptive functioning in at least two of the following areas:
C. Onset is before age 18 years. [Mental Retardation falls under the DSM section of "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence."] Criteria for Adjustment Disorder with Depressed Mood Diagnostic and Statistical Manual of Mental Disorders, (Fourth Edition, Text Revision). (2000). Arlington, VA: American Psychiatric Association. Wedding, D., Boyd, M. & Niemiec, R. Movies and Mental Illness. (2005). Cambridge, MA: Hogrefe & Huber Publishers. "...autistic tendencies, mental retardation..." "The diagnostic criteria for Mental Retardation do not include an exclusive criterion; therefore, the diagnosis should be made whenever the diagnostic criteria are met, regardless of and in addition to the presence of another disorder."
It is important to consider...
Pervasive Developmental Disorders
Borderline Intellectual Functioning
Also, we ruled out 299.00 Autistic Disorder, since Sam's social interactions do not meet the impaired criteria for Autistic Disorder. 5-Axis Diagnosis Axis I: 309.0 Adjustment Disorder with Depressed Mood
Axis II: 317 Mild Mental Retardation*
Axis III: None Reported
Axis IV: Daughter removed from home
Axis V: GAF = 60 (during stressor)
GAF = 71 (at termination of stressor)
No Impairment *Note that in the DSM-5, the term "Mental Retardation" will be changed to "Intellectual Disability." Degrees of Severity of Mental Retardation 317 Mild Mental Retardation 318.0 Moderate Mental Retardation 318.1 Severe Mental Retardation 318.2 Profound Mental Retardation 319 Mental Retardation, Severity Unspecified IQ level 50-55 to approx. 70
This group represents about 85% of those with Mental Retardation
Age 0-5: develop social and communication skills
Late teens: acquire academic skills up to about a 6th grade level.
Adults: achieve social and vocational skills adequate for self-support IQ level 35-40 to 50-55
This group represents about 10% of those with Mental Retardation
Early childhood: develop communication skills
Profit from vocational training, can attend to personal care
Unlikely to progress beyond the 2nd grade level in academics
May learn to travel independently in familiar places IQ level 20-25 to 35-40
This group represents about 3%-4% of those with Mental Retardation
Early childhood: develop little or no communicative speech
School-age: may learn to talk, and can be trained in elementary self-care skills
May learn alphabet, counting, sight reading "survival" words.
Adults: may be able to perform simple tasks, and adapt well to community living. IQ level below 20
This group represents about 1%-2% of those with Mental Retardation
Most have identified neurological condition that accounts for mental retardation
Childhood: considerable impairments in sensorimotor functioning
Optimal environment for development is highly structured, with constant aid from and individualized relationship with a caregiver Can be used when there is a strong presumption of Mental Retardation but the person's intelligence is untestable by standard tests
For example, if the individual is too impaired, uncooperative, or an infant Mental Retardation occurs among children around the world.
Prevalence rate of diagnosed cases in the U.S. is approx. 1% (2.6 million people)
CBT (like social problem-solving therapy), educational and training programs
Resources like group homes, employment services, in-home care
Institutionalization (most agree this should be a last resort) Communication
Use of community resources
Functional academic skills
Safety Prevalence & Treatment Butcher, J., Mineka, S., and Hooley, J. Abnormal Psychology 15th Edition (2013). Boston: Pearson Education, Inc. Hartley, S. L. & MacLean, W. E. (2005). Perceptions of stress and coping strategies among adults with mild mental retardation: Insight into psychological distress. American Journal on Mental Retardation. 110:4, 295-297. Chaney, R. H. (1996). Psychological stress in people with profound mental retardation. Journal of Intellectual Disability Research. 40:4, 305-310. Nucci, M. & Reiss, S. (1987). Mental retardation and emotional disorders: A test for increased vulnerability to stress. Journal of Developmental Disabilities. 13:3, 161-166. Nezu, C. M., Nezu, A. M., & Arean, P. (1991). Assertiveness and problem-solving training for mildly mentally retarded persons with dual diagnoses. Research in Developmental Disabilities. 12, 371-386. "...cognitive disorder may make a person more vulnerable to stress." Vulnerability to Stress A specific stressor enters the picture... A. Development of emotional/behavioral symptoms in response to identifiable stressor occurring within 3 months of the onset of the stressor.
B. Symptoms are clinically significant in that:
1) marked distress is in excess of what would be expected from exposure to stressor
2) significant impairment in social or occupational functioning
C. Stress-related disturbance does not meet criteria for another Axis I disorder and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.
D. Symptoms do not represent bereavement.
E. Once stressor has terminated, the symptoms do not persist for more than an additional 6 months.
Acute: if disturbance lasts less than 6 months
Chronic: if disturbance lasts for 6 months or longer
With Depressed Mood: predominant manifestations are symptoms such as depressed mood, tearfulness, or feelings of hopelessness Important Resources
Family and Children's Service, Screening Services:
http://www.fcsnashville.org/family.html Progress Residential & Day Disability Services:
http://www.progress-inc.org/disability_services.html Parent Support Groups for Children with Disabilities or Special Needs:
http://www.childrensdisabilities.info/parenting/groups-childrensdisabilities.html "...perceptions of stress among people with mental retardation has only recently been documented" (Hartley & MacLean 2005).
"Persons with dual diagnoses of mental retardation and mental illness are repeatedly cited as one of the most underserved populations with respect to mental health care despite data indicating that persons with mental retardation exhibit higher psychiatric prevalency rates and are more at risk for developing behavioral and emotional disorders" (Nezu, Nezu, & Arean 1991). Underserved and Understudied "The idea that mentally retarded people readily fall apart when frustrated or stressed [is]...an invalid, stereotypic conception. Although some mentally retarded people might have great difficulty handling stress, others might be able to cope very well, so that overall there is little or no association between intelligence and the capacity to handle stress" (Nucci & Reiss 1987).
"One reason for the increased vulnerability of mentally retarded individuals for psychopathology may involve the lack of opportunities to learn adaptive ways of coping with stress" (Nezu, Nezu, & Arean 1991). Stress and Mental Retardation Active Coping Types of Coping Strategies Distraction Coping Avoidant Coping efforts aimed at gaining control over the stressful situation or over one's emotions efforts aimed to distract from the stressful situation through positive thoughts and positive activities efforts aimed at avoiding or disengaging from the stressful situation or one's emotional experience (Hartley & MacLean 2005) "...individuals with mild mental retardation may have particular difficulty coping adaptively with Negative Interpersonal Relation stressors." (Hartley & MacLean 2005)
They have high rates of avoidant coping and low rates of active coping.
Fortunately, coping skills can be taught via CBT and appropriate psychoeducation. This approach follows the trend of seeing stress and frustration not as a symptom of mental retardation, but as an indicator of additional psychopathology. CBT and Teaching Coping Skills Lynch, P.S. Kellow, J.T., & Willson, V.L. (1997), The impact of deinstitutionalization on the adaptive behavior of adults with mental retardation. Education & Training in Mental Retardation & Developmental Disabilities. 32(3), 255-61.