Heidi Cramm

Assistive Technology and Mental HealthMay 12, 2009

M.A., M.Sc. (O.T.—Post-Professional), Doctoral Candidate

Occupational TherapistProprietor, Compass Occupational Therapist Solutions,

Kingston, ON

Heidi Cramm

Heidi Cramm, May 12 2009

Objectives

To discuss the significance of mental health issues for students

To become familiar with executive functioning skill deficits and how they relate to mental health disorders

To describe assistive technology features and applications that may benefit students who have mental health disorders and experience executive dysfunction


Students and Mental Health

1 in 5 children and adolescents in Canada are affected by mental health issues.

80% NEVER get help Seventy per cent of adults living with a

mental health problem developed symptoms before they were 18.

(http://www.thespec.com/article/559061)


http://www.thespec.com/article/559061

Students and Mental Health By the time many students enter post-

secondary institutions, their mental health status has already been affected Major life changes such as leaving home or

beginning post-secondary studies can place these students at further risk


Executive Functions

Capacities related to successful engagement in productive, independent, and constructive behaviours

Relate to: Planning tasks Initiating activity Self-monitoring of task performance Self-correcting of behaviour Anticipating outcomes Levels of motivation


Executive Functions are distinct from Cognitive Functions

How do you do something?

How do you do things?

PROCESS

How much do you know?

What can you do?

KNOWLEDGE

Executive Functions Cognitive Functions


…knowing what you need, how long it will take, how to start, how to keep going, how to know when you are finished, where you need to be, etc.

The executive assistant to your brain

EXECUTIVE FUNCTIONS


Executive Dysfunctions

Manifested in difficulties in Initiation

Identifying needs and wants Planning

Identifying the components of the task Sequencing the steps in an organized way

Purposive action Translating intentions into actions Requires maintaining efforts and switching between

steps Monitoring effectiveness of performance

Being able to monitor and adjust one’s performance


Executive Dysfunction Simulations Writing Reading


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Rce Nt bisOVeriEshave strnthnb Al8ERTS ruPUtatOIn as the

“DnoSUar CaptolOF THE Wrolb” sCIentISTtsatthe ROyel Tyrell

Musseum in DruMHeller, Al8RtA, ar eExAMnin9 the frist 8uCk-Dillb binsoaRSkelTOn to 8e

recOVRrb in nrTHern Alberta. The

SKlEtn culb RreprsNT a new species of DinoSor.

The habROsaur, or bUC8illebbiNOSoaur, lvb a8out 73 miiliion YEarSa9o, whENMuch

Of AlbRTA was cVoreb 8y aVaSt inlanbsea. HreD of DUck/DiillEb creturs MOVED acroosthelsushly

Vee9eETGteb lo Wlanbs, foloW in tMIe8ySUch prEDtRs as the Tyrannosaursus rex.


Executive Dysfunction Simulations Attention:

http://www.pbs.org/wgbh/misunderstoodminds/experiences/attexp1a.html

Memory: http://www.pbs.org/wgbh/misunderstoodmi

nds/experiences/readexp2a.html




http://www.pbs.org/wgbh/misunderstoodminds/experiences/readexp2a.html

http://www.pbs.org/wgbh/misunderstoodminds/experiences/readexp2a.html

Relating Executive Functions to Mental Health


Learning Disability

Processing information can take longer, so individuals may persist at tasks and miss other information Individuals may also avoid tasks due to the

effort and energy required The mechanics of reading, writing,

spelling, and memorizing can hog cognitive resources, making it difficult to sequence and plan larger tasks


Attention Deficit Disorders

Inattention is a common difficulty Impulsivity associated with difficulties

with self-monitoring and self-regulation is common

Distractibility also occurs, and individuals may shift attention to novel stimuli as they are introduced


Comorbidity with LDs and ADHD LD and AHDH often comorbid May be comorbid with

Anxiety Mood Behavioural disorders


Bottom line:

If you are working with students with LD and/or ADHD, be prepared to see anxiety or mood issues


Anxiety Disorders

Difficulties with Maintaining concentration

Recurrent and persistent thoughts, images, and behaviours that create an experience of distress

Trying to control the worry Keeping oneself regulated in emotion,

thinking, and behaviour


Mood Disorders

Mood disorders can have powerful impacts on initiation of goal-directed behaviours

Sequencing tasks places a heavy demand on executive functions to prioritize, organize, and anticipate, posing a challenge for those with mood disorders


Asperger’s Syndrome

Shifting between tasks is difficult Can become “stuck” cognitively in rigid thought

patterns Shifting perspectives to see big picture and how

details are connected is extremely difficult “connecting the dots” problematic

Initiation of goal-directed behaviour may be difficult as identification of needs and wants may prove challenging

Decoding single constructs into an organized sequence is very difficult


Psychotic Disorders

Intrusive thoughts and sensations can impair an individual’s ability to maintain concentration

Vigilance required to maintain focus and actively disregard those intrusions is very energy demanding


Other factors

Pain Fatigue Medication effects


How can assistive technology help?


How?

Mechanical burden mitigated Expectation that student read, write, and memorize

to learn realized through the use of AT Lack of automatization accommodated for Discrete chunks of information more accessible in

clear sequence See how the pieces of information are linked, can

alternate between big picture and little picture Inefficiencies shored up through study skill tools Organizational supports provided Difficulty in switching between tasks supported


Kurzweil 3000

Reading features supports attention Study skill features can allow for effective and

efficient note taking Highlight and extract Extract to column notes Extract column notes to outline

Writing features allow for integration of reading and writing into one task

Supports for Commonly confused words Revision learning strategies Word lists


Dragon 10

Significantly improved from earlier versions

Those with experience using Dragon dictation software from 3 or 4 years ago or longer will not recognize the program as it currently works

Dictation that works well can be an incredible to support to individuals who can lose their train of thought or who would benefit from the efficiencies it offers doing written work

Integrates with the other AT for synergistic results


Inspiration

An incredible process support Visually allows individuals to

See the sequence Prioritize and sort the information Monitor their performance

Comprehension checking Connect big picture and details without losing

the thread Hyperlink series of documents


Microsoft OneNote

Acts like an electronic binder Customizable to suit need Automatically saves Offers a visible index of the material so it

can be found quickly


Email contact information

Please feel free to contact me at: [email protected]@queensu.ca


mailto:[email protected]

mailto:[email protected]

Documents

Heidi Cramm