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Introduction

Research states that individuals with intellectual disabilities have a high risk of obesity (Murray & Ryan-Krause, 2010). Specifically, approximately 30% – 50% of individuals with intellectual disabilities have been diagnosed with obesity, which is significantly higher than the general population. Specifically, individuals with Down Syndrome exhibit a higher risk of Type II Diabetes due to their higher propensity for obesity.

Specific physiological and behavioral mechanisms that individuals with Down Syndrome may have a tendency for are associated with increased risk of obesity. Specifically, a higher propensity for hypothyroidism, decreased basal metabolic rate, increased leptin, and poor mastication may react a higher tendency towards obesity. Furthermore, behavioral tendencies, such as impulsivity, inattention, and noncompliance may negatively impact overall wellness, healthy eating, and regular physical exercise (Murray & Ryan-Krause, 2010).

Theory

Cognitive behavioral therapy (CBT) is a common type of talk therapy (psychotherapy). CBT helps clients become aware of inaccurate or negative thinking in the midst of challenging situations and respond or cope in a more effective way. CBT is a helpful tool in treating mental health disorders, such as depression, post-traumatic stress disorder (PTSD) or an eating disorder. Cognitive behavioral therapy may not cure your condition or make an unpleasant situation go away. But it can give you the power to cope with your situation in a healthy way and to feel better about yourself and your life (Mayo Clinic Staff, 2017).

In CBT, individuals learn to be their own therapists. Through exercises in/outside of sessions, clients can practice coping skills to change their own thinking, problematic emotions and behavior. CBT takes into consideration what is going on in the person’s current life, rather than what has led up to their difficulties. A certain amount of information about one’s history is needed, but the focus is primarily on moving forward in time to develop more effective ways of coping with life (American Psychological Association).

Case Study

Rosa is a 52-year-old woman with Down Syndrome and type II diabetes (Cypress, 1999). She weighs 265 lbs. She lives in a group home and she is expected to prepare her meals. Her nutritionist wants her to make better meal choices to regulate her glucose levels and to also lose weight. Rosa admits to eating lots of sandwiches and sodas for meals. She reports not knowing how to plan healthier meals other than sandwiches (Cypress, 1999).

Evidence

There is empirical evidence about the use and effectiveness of cognitive remediation therapy to treat people with mental illness and or with obesity issues. A recent study by Raman et al., 2017 suggest that cognitive remediation therapy increases cognitive functions such as cognitive flexibility, which is the ability to think in new ways, and maintained weight loss in a three months follow up. In addition, Qing et al., 2017 concluded that cognitive remediation therapy is highly used and effective to improve cognitive impairments such as poor planning skills, in patients with mental illness. Furthermore, empirical research indicates that cognitive impairment is associated with obesity, especially in executive functions such as planning, thus the use of cognitive interventions to improve executive functions may potentially lead to weight control (Bissels et al., 2008).

Intervention Plan

Problem Statement

• Client has difficulty with meal planning secondary to poor organizational skills.

Long Term Goals

• Client will select five healthy foods for a meal at her local grocery market to demonstrate meal planning skills in 2 weeks.
• Client will plan a healthy meal using a Co-op strategy to demonstrate meal planning skills in 4 weeks.

Short Term Goals

• Client will be able to categorize healthy and unhealthy foods using a grocery store catalogue in 1 session to demonstrate adequate food choices skills for meal planning.
• Client will select 4 healthy foods from her home refrigerator she can use to plan a meal in 1 session.
• Client will create a list of pros and cons of healthy eating habits in 2 sessions, to identify maladaptive ways of thinking about meal planning.

Intervention format:

• Cognitive remediation therapy

Setting

• Home health

Supplies

• Loose leaf paper
• Writing utensil

Agenda

• Meet client develop rapport (5 min)
• Client will identify goals using co-op strategy (5 min)
• Review Co-op strategy with client (5 min)
• Client will categorize foods in a grocery store catalogue as either healthy or unhealthy (15 min)
• Client will use the identified healthy foods from the catalogue to provide a healthy meal. (10 min)

Documentation

S: Client said “I am  excited about learning the difference between healthy and unhealthy foods”.

O: Client identified that one of her goals was to improve her ability to categorize foods. Client failed to identify 7/10 healthy foods  when completing activity. Client took 15 minutes to browse 4 pages of a grocery ad while identifying healthy and unhealthy foods within those pages.

A: Client demonstrates difficulty with identifying healthy foods, but remained motivated to improve her performance at the next session. Client’s poor insight skills promote continued maladaptive appraisal, and contributes to meal planning difficulties.

P: The client will benefit from a home health and local supermarket visit to address meal planning skills using cognitive remediation interventions.

References

Biessels GJ, Deary IJ, Ryan CM: Cognition and diabetes: a lifespan perspective. Lancet Neurol 2008, 7:184–190.

Cypress, M. (1999). Case Study: A 52- year old woman with obesity, poorly controlled type 2 diabetes, and  symptoms of depression. Clinical Diabetes, 17(3),143.

Cognitive Retraining. (n.d.). Retrieved March 9, 2015, from http://www.minddisorders.com/Br-Del/Cognitive-retraining.html

Krajnik, S. (2015). Week 2: Neurological impairments & approaches in neuro OT practice [PowerPoint slides].

Murray, J., & Ryan-Krause, P. (2010). Obesity in children with down syndrome: Background and recommendations for management.Pediatric Nursing, 36(6), 314. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21291048

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Qing, F., Liwei, L., & Guihua, P. (2017). The Application of Cognitive Remediation Therapy in The Treatment of Mental Disorders. Shanghai Archives Of Psychiatry, 29(6), 367-369. doi:10.11919/j.issn.1002-0829.217079

Raman, J., Hay, P., Tchanturia, K., & Smith, E. (2018). A randomised controlled trial of manualized cognitive remediation therapy in adult obesity. Appetite, 123269-279. doi:10.1016/j.appet.2017.12.023