THEMA’S UIT ORTHOPEDAGOGIEK: HANDICAP
EN ONTWIKKELINGSSTROORNISSEN
INHOUDSOPGAVE
OMGAAN MET GEDRAGS- EN PSYCHISCHE PROBLEMEN BIJ PERSONEN MET EEN VERSTANDELIJKE BEPERKING
EN/OF ASS .................................................................................................................................................... 12
1. Probleemgedrag ............................................................................................................................ 12
1.1. Definitie en prevalentie.............................................................................................................. 12
1.1.1. Definitie ..................................................................................................................................... 12
Types van probleemgedrag ....................................................................................................... 12
1.1.2. Prevalentie ................................................................................................................................ 13
Populatiestudies – prevalentie.................................................................................................. 13
Populatiestudies – samenhangende factoren (Bowring et al., 2017) ...................................... 13
1.1.3. Gevolgen.................................................................................................................................... 13
1.1.4. Multifactoriële analyse van probleemgedrag............................................................................ 13
1.2. Analyse kader ............................................................................................................................ 14
Stap 1: herkenning en defiënering van het probleemgedrag ................................................................. 14
Stap 2: leren van voorgeschiedenis......................................................................................................... 14
Proces .................................................................................................................................................. 14
Gedrags – en emotionele problemen (Došen et al., 2008) ................................................................. 14
1. Probleemgedrag .......................................................................................................................... 15
Beschrijven ................................................................................................................................ 15
Diagnostiek................................................................................................................................ 15
2. Psychiatrische stoornissen ......................................................................................................... 15
Prevalentie ................................................................................................................................ 15
Probleemgedrag & psychiatrische stoornissen ......................................................................... 16
Aard van psychiatrische stoornis (DSM-5) ................................................................................ 16
Diagnostiek................................................................................................................................ 16
Aandachtspunten (Wieland, Kapitein, Otter & Baas, 2014) .................................................. 17
Screeningsvragenlijst algmeen .............................................................................................. 17
Screeningsvragenlijst specfiek .............................................................................................. 17
Alternatieven voor DSM ........................................................................................................ 18
3. Ontwikkelingsfactoren ................................................................................................................ 18
Eerste component: voorgeschiedenis ......................................................................................... 18
Tweede component: huidig functioneren ................................................................................... 19
Ontwikkelingsprofiel ............................................................................................................... 19
1. Cognitieve ontwikkeling .................................................................................................. 19
2. Communicatieve ontwikkeling ........................................................................................ 19
3. Sociaal-emotionele ontwikkeling .................................................................................... 19
5. Motoriek .......................................................................................................................... 20
6. Adaptief gedrag ............................................................................................................... 20
7. Sensorische prikkelverwerking ........................................................................................ 20
Belang van ontwikkelingsprofiel ............................................................................................. 20
1. Preventie ......................................................................................................................... 20
2. Begrijpen/verklaren ......................................................................................................... 21
3. Behandeling en aanpak ................................................................................................... 21
4. Valkuilen .......................................................................................................................... 21
Pagina 1 van 154
, 4. Biologische en medische factoren ......................................................................................... 22
Diagnostiek ............................................................................................................................ 23
5. Pyschologische factoren ........................................................................................................ 23
Verhoogde kwetsbaarheid voor stress (Schuengel & Janssen, 2005) ................................... 23
6. Omgevings-(sociale) factoren ................................................................................................ 24
Voorbeeldstudie: Robertson, J. et al. (2007)............................................................................. 24
Belang van omgevingsfactoren ................................................................................................. 24
Omgeving .............................................................................................................................. 24
1. Kenmerken van de leefsituatie...................................................................................... 24
2. kenmerken van de begeleiders (model Hastings, 2005) ............................................... 25
3. Gezins- en opvoedingssituatie ...................................................................................... 26
4. Belang Sociale steun...................................................................................................... 27
Stap 3: Analyse van factoren dat probleemgedrag instand houdt.......................................................... 27
7. Condities: oorzakelijk, verwerking, instandhoudend ............................................................ 27
Mogelijke bekrachtigers van probleemgedrag (Didden, Duker, Seys, 2003) ............................ 27
Functionele gedragsanalyse ...................................................................................................... 28
Patroonanalyse ......................................................................................................................... 28
ABC -analyse .............................................................................................................................. 28
Experimentele analyse .............................................................................................................. 28
Stap 4: Analyse omzetten naar interventies ........................................................................................... 29
Meta-analyse (Heyvaert et al., 2010) .......................................................................................... 29
Groepsstudies.......................................................................................................................... 29
Single casestudies.................................................................................................................... 29
Begeleidingsplan ......................................................................................................................... 30
Soorten interventies.................................................................................................................... 30
1. Medicatie............................................................................................................................. 30
2. Gedragstherapeutische interventies (Minshawi, Hurwitz, Morriss, & McDougle, 2015).... 31
3. Omgevingsgerichte interventies.......................................................................................... 31
Verandering in de omgeving (Embregts et al., 2009; McAtee, 2004; McGill et al., 2005) .. 31
Interventies t.a.v. ouders .................................................................................................... 32
Interventies t.a.v. begeleiders ............................................................................................. 32
4. Individugerichte interventies .............................................................................................. 32
Probleemgedrag interventies (Heyvaert, Maes, Van den Noortgate, Kuppens & Onghena, 2012)
..................................................................................................................................................... 33
1.3. Probleemgedrag: casussen ......................................................................................................... 34
1.3.1. Casus Luuk..................................................................................................................................... 34
Analyse kader ............................................................................................................................ 34
Interventies: waarop inzetten? ................................................................................................. 35
Resultaten ................................................................................................................................. 35
1.3.2. Casus Carla ................................................................................................................................ 36
Analyse kader ............................................................................................................................ 36
Interventies: waarop inzetten? ................................................................................................. 37
Resultaten ................................................................................................................................. 37
Pagina 2 van 154
,SOCIALE INCLUSIE ......................................................................................................................................... 38
2. Strategiëen om te werken aan inclusie........................................................................................... 38
2.1. Bredere context ......................................................................................................................... 38
2.2. Conceptualisering ...................................................................................................................... 38
2.2.1. Sociale inclusie .......................................................................................................................... 38
2.2.2. Community participation (bigby, 2008)..................................................................................... 39
2.2.3. Belonging ................................................................................................................................... 39
2.2.4. Vijf waardevolle ervaringen (John ‘O’brien) .............................................................................. 40
2.2.5. Inclusie vanuit perspectief persoon .......................................................................................... 40
2.2.6. Inclusie vanuit perspectief samenleving ................................................................................... 40
2.2.7. Voor iedereen hetzelfde? .......................................................................................................... 40
2.3. Beleving & beïnvloedende factoren ........................................................................................... 41
2.3.1. Wonen in samenleving (review bredewold et al., 2020) ........................................................... 41
2.3.2. Complexe realiteit (simplican et al., 2015) ................................................................................ 41
2.4. Interventies ............................................................................................................................... 42
2.4.1. Stratetegieën ............................................................................................................................. 42
Persoongerichte strategie ......................................................................................................... 42
Netwerkversterking ............................................................................................................... 42
Persoonsgerichte planningsmethodieken ............................................................................. 43
Rolversterkend werken ......................................................................................................... 43
Samenlevingsgericht.................................................................................................................. 44
Inclusief wonen, werken en vrije tijd besteden..................................................................... 44
Woonmatrix (Bertrands, 2020).......................................................................................... 44
Inclusief wonen met ondersteuning .................................................................................. 45
Inclusief werken ................................................................................................................ 45
Inclusief werken met ondersteuning ................................................................................. 45
Activiteiten in en met de buurt ......................................................................................... 45
Communicty building............................................................................................................. 46
‘Van buiten naar binnen’ ....................................................................................................... 46
2.5. Inclusie, ook in onderzoek .......................................................................................................... 47
2.5.1. Nothing about us, without us .................................................................................................... 47
2.5.2. Mogelijke redenen (Nind, 2014)................................................................................................ 47
2.5.3. 5 principes (Sergeant, 2021) ...................................................................................................... 47
3. Sociale netwerken.......................................................................................................................... 48
3.1. Conceptualisering ...................................................................................................................... 48
3.1.1. Sociale netwerken .................................................................................................................... 48
3.1.2. Reflectietool: om even stil te staan ........................................................................................... 48
3.1.3. Reflectietool voor proffesionals en voor cliënten ..................................................................... 48
3.2. Belang en beleving van sociale relaties....................................................................................... 49
3.2.1. Belang sociale netwerk .............................................................................................................. 49
Vanuit personen met een beperking ........................................................................................ 49
Maar .......................................................................................................................................... 49
3.2.2. Kwaliteit en beleving ................................................................................................................. 50
Kwaliteit .................................................................................................................................... 50
Beleving ..................................................................................................................................... 50
3.2.3. Beinvloedende factoren van sociale netwerken en en sociale inclusie .................................... 51
Review (Overmars-Marx et al., 2014, Harrison et al.,2021) ...................................................... 51
Pagina 3 van 154
, 3.3. Analyse en beeldvorming ........................................................................................................... 52
3.3.1. Analyse van het netwerk ........................................................................................................... 52
Wat? .......................................................................................................................................... 52
Hoe? .......................................................................................................................................... 52
Netwerk cirkel Lensink .......................................................................................................... 53
Ecogram ................................................................................................................................ 53
In kaart brengen van steun ................................................................................................... 53
Breder (onverwacht) netwerk (lUS) ...................................................................................... 54
3.3.2. Interpretatie van de analyse ..................................................................................................... 54
3.3.3. Voorbeeld interventie ............................................................................................................... 54
Dynamische persoonlijke netwerverhalen................................................................................ 54
Invulposter ................................................................................................................................ 55
Leidraad voor gesprek(ken) met de persoon ........................................................................ 55
Leidraad voor gesprek met netwerklid ................................................................................. 55
Reflectietool proffesionals ........................................................................................................ 55
3.4. Interventies ............................................................................................................................... 56
3.4.1. Interventies niveau sociaal netwerkvorming (Bigby, anderson, cameron, 2017) ..................... 56
3.4.2. Kenmerken van interventies ..................................................................................................... 56
3.4.3. Werkzame mechanismen .......................................................................................................... 56
3.4.4. Begeleider.................................................................................................................................. 57
Rol van de begeleider................................................................................................................ 57
Praktijken van de begeleiders ................................................................................................... 57
Beinvloedende factoren op rol begeleider ............................................................................... 58
3.5. Effectiviteit van interventies ...................................................................................................... 58
3.5.1. Onderzoek naar sociale netwerekn ........................................................................................... 58
3.5.2. Onderzoek naar interventies (Meys, Hermans, Maes, In review) ............................................. 58
Discussiepunten en uitdagingen ............................................................................................... 58
SPECIFIEKE WERKVORMEN EN THEMA’S DOORHEEN DE LEVENSLOOP .......................................................... 59
4. Personen met ernstig meervoudige beperkingen ........................................................................... 59
4.1. Inova .......................................................................................................................................... 59
4.1.1. Missie en visie ........................................................................................................................... 59
Nauwe banden met ................................................................................................................... 59
4.1.2. Personen met EMB .................................................................................................................... 60
Definitie ..................................................................................................................................... 60
Assen verstandelijke – motorische ontwikkeling ...................................................................... 60
Uitdagingen bij onderzoek ........................................................................................................ 60
Heterogene groep ..................................................................................................................... 60
4.2. Gezinsleven (Ines Van Keer) ....................................................................................................... 60
4.2.1. Gezinsinteractiepatronen .......................................................................................................... 61
4.2.2. Model van Guralnick (2011) ...................................................................................................... 61
Gezinsinteractiepatronen .......................................................................................................... 61
1. Basiszorg ............................................................................................................................ 61
2. Ouder – kind interactie ...................................................................................................... 61
3.Dagelijks leven .................................................................................................................... 63
Balans zoeken in het gezinsleven .............................................................................................. 63
4.3. Delen van zorg (Sien Vandezande) ............................................................................................. 64
4.3.1. The art of balancing ................................................................................................................... 64
4.3.2. Achtergrond van de studie ........................................................................................................ 64
4.3.3. Hoe beleven ouders van kinderen met ernstig tot diep VB dit beslissingsproces? Hoe
verbinden ouders dit met hun rol als gehechtheidsfiguur voor het kind? ................................................ 65
Pagina 4 van 154
EN ONTWIKKELINGSSTROORNISSEN
INHOUDSOPGAVE
OMGAAN MET GEDRAGS- EN PSYCHISCHE PROBLEMEN BIJ PERSONEN MET EEN VERSTANDELIJKE BEPERKING
EN/OF ASS .................................................................................................................................................... 12
1. Probleemgedrag ............................................................................................................................ 12
1.1. Definitie en prevalentie.............................................................................................................. 12
1.1.1. Definitie ..................................................................................................................................... 12
Types van probleemgedrag ....................................................................................................... 12
1.1.2. Prevalentie ................................................................................................................................ 13
Populatiestudies – prevalentie.................................................................................................. 13
Populatiestudies – samenhangende factoren (Bowring et al., 2017) ...................................... 13
1.1.3. Gevolgen.................................................................................................................................... 13
1.1.4. Multifactoriële analyse van probleemgedrag............................................................................ 13
1.2. Analyse kader ............................................................................................................................ 14
Stap 1: herkenning en defiënering van het probleemgedrag ................................................................. 14
Stap 2: leren van voorgeschiedenis......................................................................................................... 14
Proces .................................................................................................................................................. 14
Gedrags – en emotionele problemen (Došen et al., 2008) ................................................................. 14
1. Probleemgedrag .......................................................................................................................... 15
Beschrijven ................................................................................................................................ 15
Diagnostiek................................................................................................................................ 15
2. Psychiatrische stoornissen ......................................................................................................... 15
Prevalentie ................................................................................................................................ 15
Probleemgedrag & psychiatrische stoornissen ......................................................................... 16
Aard van psychiatrische stoornis (DSM-5) ................................................................................ 16
Diagnostiek................................................................................................................................ 16
Aandachtspunten (Wieland, Kapitein, Otter & Baas, 2014) .................................................. 17
Screeningsvragenlijst algmeen .............................................................................................. 17
Screeningsvragenlijst specfiek .............................................................................................. 17
Alternatieven voor DSM ........................................................................................................ 18
3. Ontwikkelingsfactoren ................................................................................................................ 18
Eerste component: voorgeschiedenis ......................................................................................... 18
Tweede component: huidig functioneren ................................................................................... 19
Ontwikkelingsprofiel ............................................................................................................... 19
1. Cognitieve ontwikkeling .................................................................................................. 19
2. Communicatieve ontwikkeling ........................................................................................ 19
3. Sociaal-emotionele ontwikkeling .................................................................................... 19
5. Motoriek .......................................................................................................................... 20
6. Adaptief gedrag ............................................................................................................... 20
7. Sensorische prikkelverwerking ........................................................................................ 20
Belang van ontwikkelingsprofiel ............................................................................................. 20
1. Preventie ......................................................................................................................... 20
2. Begrijpen/verklaren ......................................................................................................... 21
3. Behandeling en aanpak ................................................................................................... 21
4. Valkuilen .......................................................................................................................... 21
Pagina 1 van 154
, 4. Biologische en medische factoren ......................................................................................... 22
Diagnostiek ............................................................................................................................ 23
5. Pyschologische factoren ........................................................................................................ 23
Verhoogde kwetsbaarheid voor stress (Schuengel & Janssen, 2005) ................................... 23
6. Omgevings-(sociale) factoren ................................................................................................ 24
Voorbeeldstudie: Robertson, J. et al. (2007)............................................................................. 24
Belang van omgevingsfactoren ................................................................................................. 24
Omgeving .............................................................................................................................. 24
1. Kenmerken van de leefsituatie...................................................................................... 24
2. kenmerken van de begeleiders (model Hastings, 2005) ............................................... 25
3. Gezins- en opvoedingssituatie ...................................................................................... 26
4. Belang Sociale steun...................................................................................................... 27
Stap 3: Analyse van factoren dat probleemgedrag instand houdt.......................................................... 27
7. Condities: oorzakelijk, verwerking, instandhoudend ............................................................ 27
Mogelijke bekrachtigers van probleemgedrag (Didden, Duker, Seys, 2003) ............................ 27
Functionele gedragsanalyse ...................................................................................................... 28
Patroonanalyse ......................................................................................................................... 28
ABC -analyse .............................................................................................................................. 28
Experimentele analyse .............................................................................................................. 28
Stap 4: Analyse omzetten naar interventies ........................................................................................... 29
Meta-analyse (Heyvaert et al., 2010) .......................................................................................... 29
Groepsstudies.......................................................................................................................... 29
Single casestudies.................................................................................................................... 29
Begeleidingsplan ......................................................................................................................... 30
Soorten interventies.................................................................................................................... 30
1. Medicatie............................................................................................................................. 30
2. Gedragstherapeutische interventies (Minshawi, Hurwitz, Morriss, & McDougle, 2015).... 31
3. Omgevingsgerichte interventies.......................................................................................... 31
Verandering in de omgeving (Embregts et al., 2009; McAtee, 2004; McGill et al., 2005) .. 31
Interventies t.a.v. ouders .................................................................................................... 32
Interventies t.a.v. begeleiders ............................................................................................. 32
4. Individugerichte interventies .............................................................................................. 32
Probleemgedrag interventies (Heyvaert, Maes, Van den Noortgate, Kuppens & Onghena, 2012)
..................................................................................................................................................... 33
1.3. Probleemgedrag: casussen ......................................................................................................... 34
1.3.1. Casus Luuk..................................................................................................................................... 34
Analyse kader ............................................................................................................................ 34
Interventies: waarop inzetten? ................................................................................................. 35
Resultaten ................................................................................................................................. 35
1.3.2. Casus Carla ................................................................................................................................ 36
Analyse kader ............................................................................................................................ 36
Interventies: waarop inzetten? ................................................................................................. 37
Resultaten ................................................................................................................................. 37
Pagina 2 van 154
,SOCIALE INCLUSIE ......................................................................................................................................... 38
2. Strategiëen om te werken aan inclusie........................................................................................... 38
2.1. Bredere context ......................................................................................................................... 38
2.2. Conceptualisering ...................................................................................................................... 38
2.2.1. Sociale inclusie .......................................................................................................................... 38
2.2.2. Community participation (bigby, 2008)..................................................................................... 39
2.2.3. Belonging ................................................................................................................................... 39
2.2.4. Vijf waardevolle ervaringen (John ‘O’brien) .............................................................................. 40
2.2.5. Inclusie vanuit perspectief persoon .......................................................................................... 40
2.2.6. Inclusie vanuit perspectief samenleving ................................................................................... 40
2.2.7. Voor iedereen hetzelfde? .......................................................................................................... 40
2.3. Beleving & beïnvloedende factoren ........................................................................................... 41
2.3.1. Wonen in samenleving (review bredewold et al., 2020) ........................................................... 41
2.3.2. Complexe realiteit (simplican et al., 2015) ................................................................................ 41
2.4. Interventies ............................................................................................................................... 42
2.4.1. Stratetegieën ............................................................................................................................. 42
Persoongerichte strategie ......................................................................................................... 42
Netwerkversterking ............................................................................................................... 42
Persoonsgerichte planningsmethodieken ............................................................................. 43
Rolversterkend werken ......................................................................................................... 43
Samenlevingsgericht.................................................................................................................. 44
Inclusief wonen, werken en vrije tijd besteden..................................................................... 44
Woonmatrix (Bertrands, 2020).......................................................................................... 44
Inclusief wonen met ondersteuning .................................................................................. 45
Inclusief werken ................................................................................................................ 45
Inclusief werken met ondersteuning ................................................................................. 45
Activiteiten in en met de buurt ......................................................................................... 45
Communicty building............................................................................................................. 46
‘Van buiten naar binnen’ ....................................................................................................... 46
2.5. Inclusie, ook in onderzoek .......................................................................................................... 47
2.5.1. Nothing about us, without us .................................................................................................... 47
2.5.2. Mogelijke redenen (Nind, 2014)................................................................................................ 47
2.5.3. 5 principes (Sergeant, 2021) ...................................................................................................... 47
3. Sociale netwerken.......................................................................................................................... 48
3.1. Conceptualisering ...................................................................................................................... 48
3.1.1. Sociale netwerken .................................................................................................................... 48
3.1.2. Reflectietool: om even stil te staan ........................................................................................... 48
3.1.3. Reflectietool voor proffesionals en voor cliënten ..................................................................... 48
3.2. Belang en beleving van sociale relaties....................................................................................... 49
3.2.1. Belang sociale netwerk .............................................................................................................. 49
Vanuit personen met een beperking ........................................................................................ 49
Maar .......................................................................................................................................... 49
3.2.2. Kwaliteit en beleving ................................................................................................................. 50
Kwaliteit .................................................................................................................................... 50
Beleving ..................................................................................................................................... 50
3.2.3. Beinvloedende factoren van sociale netwerken en en sociale inclusie .................................... 51
Review (Overmars-Marx et al., 2014, Harrison et al.,2021) ...................................................... 51
Pagina 3 van 154
, 3.3. Analyse en beeldvorming ........................................................................................................... 52
3.3.1. Analyse van het netwerk ........................................................................................................... 52
Wat? .......................................................................................................................................... 52
Hoe? .......................................................................................................................................... 52
Netwerk cirkel Lensink .......................................................................................................... 53
Ecogram ................................................................................................................................ 53
In kaart brengen van steun ................................................................................................... 53
Breder (onverwacht) netwerk (lUS) ...................................................................................... 54
3.3.2. Interpretatie van de analyse ..................................................................................................... 54
3.3.3. Voorbeeld interventie ............................................................................................................... 54
Dynamische persoonlijke netwerverhalen................................................................................ 54
Invulposter ................................................................................................................................ 55
Leidraad voor gesprek(ken) met de persoon ........................................................................ 55
Leidraad voor gesprek met netwerklid ................................................................................. 55
Reflectietool proffesionals ........................................................................................................ 55
3.4. Interventies ............................................................................................................................... 56
3.4.1. Interventies niveau sociaal netwerkvorming (Bigby, anderson, cameron, 2017) ..................... 56
3.4.2. Kenmerken van interventies ..................................................................................................... 56
3.4.3. Werkzame mechanismen .......................................................................................................... 56
3.4.4. Begeleider.................................................................................................................................. 57
Rol van de begeleider................................................................................................................ 57
Praktijken van de begeleiders ................................................................................................... 57
Beinvloedende factoren op rol begeleider ............................................................................... 58
3.5. Effectiviteit van interventies ...................................................................................................... 58
3.5.1. Onderzoek naar sociale netwerekn ........................................................................................... 58
3.5.2. Onderzoek naar interventies (Meys, Hermans, Maes, In review) ............................................. 58
Discussiepunten en uitdagingen ............................................................................................... 58
SPECIFIEKE WERKVORMEN EN THEMA’S DOORHEEN DE LEVENSLOOP .......................................................... 59
4. Personen met ernstig meervoudige beperkingen ........................................................................... 59
4.1. Inova .......................................................................................................................................... 59
4.1.1. Missie en visie ........................................................................................................................... 59
Nauwe banden met ................................................................................................................... 59
4.1.2. Personen met EMB .................................................................................................................... 60
Definitie ..................................................................................................................................... 60
Assen verstandelijke – motorische ontwikkeling ...................................................................... 60
Uitdagingen bij onderzoek ........................................................................................................ 60
Heterogene groep ..................................................................................................................... 60
4.2. Gezinsleven (Ines Van Keer) ....................................................................................................... 60
4.2.1. Gezinsinteractiepatronen .......................................................................................................... 61
4.2.2. Model van Guralnick (2011) ...................................................................................................... 61
Gezinsinteractiepatronen .......................................................................................................... 61
1. Basiszorg ............................................................................................................................ 61
2. Ouder – kind interactie ...................................................................................................... 61
3.Dagelijks leven .................................................................................................................... 63
Balans zoeken in het gezinsleven .............................................................................................. 63
4.3. Delen van zorg (Sien Vandezande) ............................................................................................. 64
4.3.1. The art of balancing ................................................................................................................... 64
4.3.2. Achtergrond van de studie ........................................................................................................ 64
4.3.3. Hoe beleven ouders van kinderen met ernstig tot diep VB dit beslissingsproces? Hoe
verbinden ouders dit met hun rol als gehechtheidsfiguur voor het kind? ................................................ 65
Pagina 4 van 154
