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How Are Psychological Disorders Treated?

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During the latter half of the Middle Ages, people with psychological disorders were placed in overcrowded institutions called asylums. People in asylums were often chained up and lived in incredibly filthy conditions. The "treatments" they received included starvation, beatings, and isolation. In 1793, Philippe Pinel, a French physician, argued that treatments should be based on what actually works to reduce psychopathology. Moral treatment involves close contact with, and careful observation of, patients.

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Three main approaches are used to treat disorders

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1.Psychotherapy 2.Psychotropic medications 3.Alternative treatments

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Psychotherapy

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Treatment for psychological disorders in which a therapist works with clients to help them understand their problems and work toward solutions. Therapists generally use psychotherapy to change their clients' patterns of thought or behavior.

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Psychodynamic therapy

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One of the first people to develop treatments for psychological disorders was Sigmund Freud .

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Along with Josef Breuer, Freud pioneered the method of psychoanalysis.

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Psychoanalytic treatment involved identifying unconscious conflicts in feelings and drives. Freud's techniques included free association and dream analysis.

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Psychodynamic therapy:

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Treatment for psychological disorders in which a therapist works with clients to help them become aware of how their unconscious processes may be causing conflict and impairing daily functioning There is only weak evidence, however, for its effectiveness in treating most psychological disorders.

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Humanistic therapy

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Treatment for psychological disorders in which a therapist works with clients to help them develop their full potential for personal growth through greater self-understanding. One of the best-known humanistic therapies is client-centered therapy, which includes A safe and comforting setting for clients Active listening Unconditional positive regard.

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Behavior therapy:

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Treatment for psychological disorders in which a therapist works with clients to help them unlearn behaviors that negatively affect their functioning Treatment often centers around the use of token economies, social skills training, and modeling.

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Cognitive therapy:

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Treatment for psychological disorders in which a therapist works with clients to help them change distorted thought patterns that produce maladaptive behaviors and emotions. Aaron Beck has advocated cognitive restructuring. Albert Ellis introduced rational-emotive therapy.

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Cognitive-behavioral therapy (CBT):

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Treatment for psychological disorders in which a therapist incorporates techniques from cognitive therapy and behavior therapy to correct faulty thinking and maladaptive behaviors. CBT is one of the most effective therapies for many types of psychological disorders, especially anxiety disorders and mood disorders.

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Group therapy

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The most obvious benefit is cost Group therapies vary widely in the types of clients enrolled in the group, the duration of treatment, the theoretical perspective of the therapist running the group, and the group size. Many groups are organized around a particular type of problem (e.g., sexual abuse) or a particular type of client (e.g., adolescents).

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Family therapy

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According to a systems approach, an individual is part of a larger context. Any change in individual behavior will affect the whole system. This effect is often easiest to see within families.

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Biological therapy

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Treatment for psychological disorders that is based on medical approaches to illness and disease.

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Psychotropic medications

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Drugs that affect mental processes and that can be used to treat psychological disorders. Psychotropic medications act by changing brain neurochemistry.

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Most psychotropic medications fall into five categories

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Anti-anxiety drugs Antidepressants Mood stabilizers Antipsychotics Stimulants

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Electroconvulsive therapy (ECT):

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Treatment for psychological disorders that involves administering a strong electrical current to the client's brain to produce a seizure; ECT is effective in some cases of severe depression. The general public has a very negative view of ECT Film, One Flew over the Cuckoo's Nest.

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Transcranial magnetic stimulation (TMS):

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Treatment for psychological disorders that uses a magnetic field to interrupt function in specific regions of the brain. When rapidly switched on and off, this magnetic field creates an electrical current in the brain region directly below the coil, thereby interrupting the activity of neurons in that region.

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Deep brain stimulation (DBS):

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Treatment for psychological disorders that involves passing electricity through electrodes planted in the client's brain to stimulate the brain at a certain frequency and intensity. DBS may be especially valuable for treating severe obsessive-compulsive disorder (OCD) and depression.

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Some treatments widely believed to be effective not only lack scientific support, but are actually counterproductive.

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It is important to recognize the difference between evidence-based psychotherapies and "fringe" therapies. The only way to determine whether a treatment is valid is to conduct empirical research using randomized clinical trials.

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Three features characterize evidence-based psychological treatments

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1.Treatments vary according to the particular psychological disorder and the client's specific symptoms. 2.The techniques used in these treatments have been developed in the laboratory by psychologists, especially behavioral, cognitive, and social psychologists. 3.No overall grand theory guides treatment. Instead, adoption of a specific treatment is based on the evidence of its effectiveness.

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Nearly half of all Americans meet Diagnostic and Statistical Manual (DSM) criteria for a psychological disorder at some point in their lives.

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In any given year, 25 percent of the population meets these criteria.

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Choosing the right treatment provider is extremely important for ensuring successful treatment

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The professional must have the appropriate training and experience for the specific psychological disorder or life problem, and the person seeking help must believe the therapist is trustworthy and caring.

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Various Providers Assist in Treatment for Psychological Disorders .

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Medication is normally prescribed only by psychiatrists, who hold an MD. Efforts are under way to give more practitioners, such as clinical psychologists, the ability to prescribe medications. The most important features to look for in a provider are empathy and experience in the methods known to be effective in treating specific psychological disorders.

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There is accumulated evidence that most adult anxiety disorders are best treated with a combination of cognitive and behavior therapies.

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Anti-anxiety drugs are also beneficial in some cases because they have a sedative effect that makes people feel calmer. The effects of cognitive-behavioral therapy (CBT) persist long after treatment; this remains the best treatment in general for anxiety disorders.

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Specific phobia

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Learning theory suggests that specific phobias are acquired either by experiencing a trauma or by observing similar fear in others. Behavior techniques are the treatment of choice, along with approaches to changing the client's thoughts about the fearful stimulus.

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Exposure:

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Therapy technique that involves repeatedly exposing clients to an anxiety-producing stimulus or situation, with the goal of reducing fear.

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Systematic desensitization:

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Therapy technique that involves exposing clients to increasingly anxiety-producing stimuli or situations while coaching them to relax.

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Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy

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A recent alternative is to expose clients to fearful situations without putting them in danger by using computers to simulate the environments and the feared objects. Psychotropic medication treatments for phobias often include anti-anxiety drugs that are calming. CBTs are the treatments of choice for phobia Antidepressants may be useful for social phobia (social anxiety disorder).

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Panic disorder

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It has multiple components and each symptom may require a different treatment. Cognitive restructuring is a technique used in cognitive therapy to address ways of reacting to the symptoms of a panic attack. In the treatment of panic attacks, CBT appears to be as or more effective than medication.

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Exposure and response prevention:

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Therapy technique that teaches clients to relax as they are gradually exposed to increasingly fear-inducing stimuli or situations. The goal of treatment is to reduce fear.

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continued...

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Exposure and response prevention proved superior to the use of a specific tricyclic antidepressant, and both were better than placebos CBT may be more effective at treating OCD than medication, especially over the long term Deep brain stimulation (DBS) may be an effective treatment for people with OCD

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Psychotropic drug treatment

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Researchers have attempted to determine how particular types of people will respond to antidepressants. Since selective serotonin reuptake inhibitors (SSRIs) have the fewest serious side effects, they tend to be used as the first-line medication.

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The use of antidepressants is based on the belief that depression is caused by an imbalance in neurotransmitters or problems with neural receptors

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Approximately 60 to 70 percent of clients who take antidepressants experience relief from their symptoms, as compared with about 30 percent who respond to placebos.

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Cognitive-behavioral treatment

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Research has shown that cognitive-behavioral therapy (CBT) is just as effective as antidepressants at treating depression. The CBT approach helps the client think more adaptively and eliminate the cognitive triad of negative thoughts. CBT can be effective on its own, but combining it with antidepressant medication may be more effective than either approach alone.

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Phototherapy:

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Treatment for seasonal affective disorder (SAD) through which the client is exposed to high-intensity light each day. Treatment that alters the brain's electrical function, such as electroconvulsive therapy (ECT), may be very effective for some people who are severely depressed and do not respond to conventional treatments. A series of studies have demonstrated that changing brain function by using transcranial magnetic stimulation (TMS) over the left frontal regions of the brain also reduces depression significantly.

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DBS may be valuable for treating severe depression when all other treatments have failed.

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Several studies have been done using DBS for treatment-resistant depression, and each time at least half the clients benefited from the treatment.

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Bipolar disorders are one of the few psychological disorders for which there is a clear optimal treatment.

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The best practice is to use psychotropic medications, especially the mood stabilizer lithium The process by which lithium stabilizes mood is not well understood, but the drug seems to modulate neurotransmitter levels. Lithium has unpleasant side effects, including thirst, hand tremors, excessive urination, and memory problems.

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Psychotropic Medications Are Most Effective for Bipolar Disorders

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The drug quetiapine (better known as Seroquel) is an antipsychotic and is now the most commonly prescribed drug for bipolar disorders, as combining lithium with quetiapine improves treatment outcomes. As with all psychological disorders, compliance with drug therapy can be a problem for various reasons.

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Psychotropic drug treatments

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Early antipsychotic drugs called conventional antipsychotics reduced the positive symptoms of schizophrenia, such as delusions, hallucinations, and disorganized speech and behavior These medications have little to no effect on the negative symptoms.

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Tardive dyskinesia:

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involuntary movement of body parts—is another devastating side effect of these medications and is irreversible once it appears

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Atypical antipsychotics act on different neurotransmitters. They are beneficial in treating both the positive symptoms of schizophrenia and some of the negative symptoms.

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Atypical antipsychotics can have serious side effects including seizures, heart rate problems, and substantial weight gain. Some of these drugs can cause a fatal reduction in white blood cells.

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Behavior therapy

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Can include social skills training to elicit desired behavior, such as appropriate ways to act in specific social situations. If a client's self-care skills are poor, behavioral interventions can focus on areas such as grooming and bathing, managing medications, and financial planning.

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Prognosis in schizophrenia

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Most clients diagnosed with schizophrenia experience multiple psychotic episodes over the course of the disorder. Most clients with schizophrenia also experience a reduction in symptoms as they get older.

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Prognosis:

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A prediction of the likely course of a psychological (or physical) disorder. People with later onset tend to have a more favorable prognosis. Women tend to have a better prognosis than men In developing countries, schizophrenia often is less severe than in developed countries.

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Most therapists agree that personality disorders are very difficult to treat.

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Some therapies have proven to be helpful for two of the most disruptive personality disorders. Borderline personality disorder. Antisocial personality disorder.

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Traditional psychotherapy approaches have been largely unsuccessful.

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Dialectical behavior therapy (DBT): Form of therapy used to treat borderline personality disorder. DBT combines elements of behavior, cognitive, and psychodynamic therapies with a mindfulness approach based on Eastern meditative practices.

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Treating people with antisocial personality disorder (APD) often seems impossible.

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Individuals with APD apparently have diminished cortical arousal, so stimulants have been prescribed to normalize arousal levels Most psychotherapies seem ineffective in treating APD. Behavior therapy approaches using operant procedures have had some success. Individuals with APD typically improve after age 40 with or without treatment. Criminal acts and imprisonment decrease among those with APD after age 40.

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In the United States, an estimated 12 to 20 percent of children and adolescents experience psychological disorders.

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Problems not addressed during childhood or adolescence may persist into adulthood.

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Approximately 8 percent of 12- to 17-year-olds in the United States have reported experiencing a major depressive episode.

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Untreated adolescent depression is associated with drug abuse, dropping out of school, and suicide.

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Risk of antidepressants for adolescents.

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Shortly after SSRIs were introduced as treatments for adolescent depression, some mental health researchers raised concerns that the drugs might cause some adolescents to become suicidal. Many questions about the effects of SSRIs on young people remain to be answered.

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Treatment for Adolescents with Depression Study (TADS)

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Provided clear evidence that SSRIs are effective in treating adolescent depression. Of participants taking an SSRI, 61 percent showed improvement in symptoms, compared with 43 percent receiving cognitive-behavioral therapy (CBT) and 35 percent taking a placebo. The group that received both an SSRI antidepressant and therapy did best (71 percent improved).

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Further thoughts on treatment approaches

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It is relatively easy for pediatricians and family physicians to prescribe drugs. In the TADS report, suicide attempts were quite uncommon. Among adolescents, higher doses of SSRIs are more likely to trigger suicide attempts. According to some researchers the relative success of psychotherapy for teenage depression makes it a better treatment choice.

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Is attention-deficit/hyperactivity disorder (ADHD) a psychological disorder that should be treated, or is it simply a troublesome behavior pattern that children eventually outgrow?

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Some individuals diagnosed with ADHD as children do grow out of it, but many more continue to experience the disorder throughout adolescence and adulthood.

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Psychotropic medication treatment of ADHD

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The most common treatment for ADHD is a central nervous system stimulant, such as methylphenidate (Ritalin) or Adderall, The actions of these drugs are not fully understood, but they may affect multiple neurotransmitters, particularly dopamine.

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Children With ADHD Can Benefit From Various Approaches

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Side effects include sleep problems, reduced appetite, body twitches, and temporary slowing of growth. Some children on medication may see their problems as beyond their control. Most therapists believe medication should be supplemented by psychological therapies, such as behavior modification.

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Behavior therapy for ADHD

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Many therapists advocate combining behavioral approaches with medication. Some suggest that medication should be used only if behavioral techniques fail to reduce inappropriate behaviors.

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The core symptoms of autism spectrum disorder are impaired communication, restricted interests, and deficits in social interaction

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Changing these behaviors is difficult to do because effective reinforcers are hard to find. The tendency to focus on specific details while ignoring others interferes with generalizing learned behavior to other stimuli and situations.

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Behavior therapy for autism, Applied behavioral analysis:

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An intensive behavior therapy for autism, this treatment is based on operant conditioning. There is evidence that this method can be used successfully to treat autism spectrum disorder. This intensive approach requires a minimum of 40 hours of treatment per week.

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Lovaas's applied behavioral analysis program has some drawbacks.

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The most obvious is the time commitment. Parents of children with autism essentially become full-time teachers for years. The financial and emotional drains on the family can be substantial.

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Biological treatments for autism spectrum disorder

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There is good evidence that autism spectrum disorder is caused by brain dysfunction. The neurobiology of autism spectrum disorder is not well understood.

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Prognosis

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Despite a few reports of remarkable recovery from autism spectrum disorder, the long-term prognosis is poor. Early diagnosis clearly allows for more effective treatments. Early language ability is associated with a better outcome. Higher IQ is also associated with a better outcome.

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Case study of childhood autism spectrum disorder

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John O'Neil, a deputy editor at the New York Times O'Neil's son James had been an easy baby. James's behavior started to deteriorate when he was a toddler and really started to deteriorate at age 2½. Treatment is expensive, difficult, and time consuming. James started school with the assistance of one of his full-time instructors, who attended class with him. With support, James was able to start talking, attend school, and make a friend. This success story and many others show that psychological research can help us discover effective treatments for many psychological disorders.

Psychology Ch. 15 – Flashcards

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