Exam Review: INTELLECTUAL DISABILITY (ID)

AAIDD approach to ID?

• IQ 2 standard deviations below the mean 70 or below

• Adaptive behavior deficits - 2 standard deviations below mean

• before age 18

• assessed by levels of needed support

DSM Approach To ID

• IQ 70 OR BELOW

• Adaptive Behavior deficits in at AT LEAST 2 AREAS

• onset before age 18

• CATEGORIZED IN LEVELS OF MILD, MODERATE, SEVERE, PROFOUND

• 85% of all cases are mild form

What are the 4 AAIDD Categories of Risk / Etiology to iD

(1) Biomedical

(2) Social

(3) Behavioral

(4) Education

Flynn Effect

finding IQ scores in populations have increased / improved over time

Levels of needed support according to the AAIDD

• Positive Behavioral Support: aiming to increase skills alter environmental contingencies

AAIDD: PRENATAL Biomedical Risk to ID

1. chromosomal disorders / single gene disorders

2. syndroms

3. metabolic disorders

4. cerebral dysgenesis

5. maternal illnesses

6. parental age

AAIDD: PERINATAL Biomedical Risk to ID

1. prematurity

2. birth injury

3. neonatal disorders

AAIDD: POSTNATAL Biomedical Risk to ID

1. Traumatic brain injury

2. malnutrition

3. seizures disorders

4. degenerative disorders

AAIDD: PRENATAL SOCIAL RISK/ETIOLOGY TO ID

1. Poverty / lack of access to prenatal care

2. Maternal malnutrition

3. Domestic Violence

AAIDD: PERINATAL SOCIAL ETIOLOGY TO ID

1. Lack of access to birth care

AAIDD: POSTNATAL Social Etiology to ID

1. Impaired child-caregiver interaction

2. lack of adequate stimulation

3. family poverty

4. chronic illness in the family

AAIDD: PRENATAL Behavioral Etiology to ID

1. Parental drug / alcohol / smoking use

2. Parental Immaturity

AAIDD: PERINATAL Behavioral Etiology to ID

1. Parental rejection of caretaking

2. Parental abandonment of child

AAIDD: POSTNATAL Behavioral Etiology to ID

1. Child abuse and neglect / DV

2. Inadequate safety measures

3. social deprivation

4. difficult child behaviors

AAIDD: PRENATAL Educational Etiology to ID

1. Parental cognitive disability without supports

2. lack of preparation for parenthood

AAIDD: PERINATAL Educational Etiology to ID

1. Lack of medical referral for intervention services at discharge

AAIDD: POSTNATAL Educational risk to ID

1. Impaired parenting

2. delayed diagnosis

3. inadequate early intervention

4. inadequate family support / special educational services

Intelligence

is viewed as consisting of a general ability called g and many specific abilities

[ex. motor / verbal abilities]

What is central in defining ID?

Measures of intelligence / assessments of adaptive behavior is central to defining intellectual disorders

Measured Intelligence involves….

involves the knowledge possessed by a person, the ability to learn or think, OR the capacity to adapt to new situations.

Intelligence is measured to…

to how well a person performs on processing tasks! both general & specific abilities

Mental Age (MA)

the age corresponding to the chronological age (CA).

Average Child: MA = CA

IQ (ratio)

Intelligence Quotient; the ratio of an individual’s mental age to chronological age multiplied by 100

• IQ = MA/CA x 100

IQ (deviation)

a standard score shows how much a persons performance is different from the average score for their age group.

• it tells us if they did better or worse than most people their age

IQ score can..

• can be used to try to predict a persons performance in class / work / other life tasks

• can tell us about a variety of social behaviors (social adjustment)

• relatively stable scores but not cast in stone! caution is necessary

What is central to the concept of Intellectual Disability?

the failure to adapt socially to ones environment has been central to the concept of [ID].

What are the adaptive behaviors that children/adolescents with ID adopt?

• conceptual, social, practical

Conceptual

memory, language, reading and writing, reasoning, problem solving, time, number concepts

Social

awareness of others’ thoughts and feelings, interpersonal skills, social responsibility, self-esteem, gullibility, rule following, avoidance of being victimized, social problem solving, friendship abilities

Practical

activities and personal care of daily living (bathing / cooking / dressing), use of money, safety, health care, travel, routines, use of phone, occupational skills.

What is the relationship between the conceptual domain and intellectual functioning?

the conceptual domain is closely linked to intellectual abilities, focusing on memory, reasoning, and problem solving.

What is in the range of a positive correlation?

in the range of 0.3 to 0.6 between scores on adaptive behavior tests and Intelligence tests.

How does measured intelligence affect everyday functioning?

as measured intelligence decreases, individuals are more likely to struggle with everyday tasks and functioning

How do developmental skills change from early life to adolescence?

• early life: focuses on sensorimotor, communication, self-help, and social skills.

• adolescence: reasoning and social judgment become more important.

What should be considered when judging adaptation?

consider community expectations and the sociocultural context where the person lives

ex. a child may have social deficits in a school setting and still meet the expectations of the neighborhood.

Why is adaptive behavior important for individuals with ID?

adaptive behavior helps identify the resources needed to support individuals with Intellectual Disabilities

What are the levels / severity of ID?

1. mild

2. moderate

3. severe

4. profound

What is the Conceptual Domain Description with Mild severity of ID?

• no obvious early conceptual differences

• difficulties in learning core school subjects / managing time & money

• difficulties in executive function skills (planning, setting priorities)

What is the Conceptual Domain Description with Moderate level of ID?

• delays in language and pre-academic skills

• unlikely to progress beyond elementary level mastery of academic skills

• support required for tasks of daily life (managing money) and work

What is the Conceptual Domain Description with Severe level of ID?

• limited conceptual skills

• little understanding of written language or concepts involving numbers / quantity / time / money

• requires extensive supports for problem solving

What is the Conceptual Domain Description with Profound level of ID?

• conceptual skills limited to understanding objects and physical world

• some skills may be acquired (matching or sorting) may be acquired

• co-occurring sensory and physical impairments likely present

• likely neurological impairments

What is the Social Domain Description with Mild level of ID?

• Develops social / communication skills but can be more concrete or immature than expected for age

• difficulties in perceiving social cues & regulating emotions

• may be at risk for being manipulated by others (gullible)

What is the Social Domain Description with Moderate level of ID?

• Usually develops communication skills but may be much less complex than that of peers

• may establish friendships & romantic relationships but limited by communication / social deficits

• adapts to supervised community living with supports

What is the Social Domain Description with Severe level of ID?

• spoken language limited in vocabulary & grammar

• may understand simple speech and gestures ; communication aids help

• communication focused on present moment and everyday events

• relationships with family members and familiar others provides pleasure and assistance

the Social Domain Description with Profound level of ID?

• Very limited understanding & use of communication in speech or gesture

• desire & emotions largely expressed through nonverbal communication

• enjoys relationships with well-known family members, caretakers, & familiar others

What is the Practical domain with Mild Level of ID?

• May function age-appropriately in personal care but need guidance & assistance in daily living tasks

• may live successfully in the community with supports

What is the Practical domain with Moderate level of ID?

• can care of age- appropriate personal needs with extended period of teaching & time

• participation in adult household tasks can be achieved with supports

• can benefit from occupational training & support to perform unskilled or semiskilled work

What is the Practical domain with Severe level of ID?

• Requires support for all activities of daily living (meals, dressing bathing, elimination)

• requires supervision & assistance at all times

• most cases, can adapt to community living with family or in group homes

• maladaptive behavior, including self injury may be present in significant minority

What is the Practical domain with Profound level of ID?

• dependent on others for all aspects of daily physical care, health, safety

• may do simple supervised tasks

• requires structure & constant supervision for optimal development

• maladaptive behavior, including self injury can be present

Most youth with ID: mild

• no unusual physical traits

• blend into general population

factors especially associated with most severe levels of ID?

• Abnormalities of physical appearance / function

• medical conditions such as: cerebral palsy, epilepsy, cardiac problems, kidney disease.

Atypical appearance range from?

ranges from minor to obvious

includes: seizures, motor difficulties, impaired vision, deafness

social functioning

relates to a persons social skills / social understanding

• the way they interact with those around them

• behavioral skills include : eye contact / facial expression / social greeting / reciprocal interaction / expressing wants & needs

What social challenges do youth with mild and moderate ID face?

• understanding social cues

• navigating social situations

• seeing others perspectives

what may cause some social problems in children with intellectual disorders?

1. intellectual impairments

2. language deficits

3. physical / medical issues

What social challenge do youth with ID face?

greater social isolation

the developmental dimension….

emphasizes that functioning in each domain varies at each developmental level.

ex. a child may lag behind in peers in language / motor / academic / emotional / and social skills at one point in development, but this can change with time & support !

psychological dimension of functioning…

includes psychosocial and emotional functioning of the individual

Intellectual disability display varying degrees of

challenging behaviors such as verbal / physical aggression, tantrums, self-injury, other disruptive behaviors

behavioral phenotypes

specific disorder predisposes individuals to certain behaviors

most common single disorder of ID?

Down syndrome; a condition described in 1866 by John Langdon Down

What are some physical, behavioral, cognitive attributes associated with syndromes of ID?

1. down syndrome

2. fragile X

3. williams

4. prader-willi

Down syndrome: Physical

• upward slant & folds at corner of eyes

• flat facial features

• fissured tongue

• broad hands / feet

• poor muscle tone

• short stature

Fragile X: Physical

• long face / large ears / soft skin

• high arched palate

• double jointed thumbs

• oversized testicles in boys ; features less likely in girls

Williams: Physical

• “elfnlike” face ( small lower jaw, prominent cheeks)

• growth deficiency ; aged appearance in late adolescence or early adulthood

Prader-Willi: Physical

• almond shaped eyes / downturned mouth / short stature

• small hands / feet

• poor muscle tone

• underdeveloped gonads

• obesity

Down syndrome: behavioral/cognitive features

• wide IQ variation; mild to moderate IQ

• wide array of behavior problems: noncompliance, stubbornness, argumentativeness, inattention, social withdrawal, depression in adolescence

• relative strength in social communication

Fragile X: behavioral/cognitive features

• moderate to severe; variable level of IQ

• variable behavioral difficulties: inattention, hyperactivity, poor eye contact, shyness, anxiety, autism related features

Williams: behavioral/cognitive features

• moderate intellectual disability

• delayed in language acquisition but relative strength in language

• indiscriminate & overly friendly social interaction

• poor social judgment / anxiety/ perseverative thinking

Prader-Willi: behavioral/cognitive features

• mild IQ

• excessive eating & food-seeking/ hoarding

• excessive daytime sleepiness

• delayed motor milestones & speech difficulties

• obsessions & compulsions

• stubbornness / tantrums / aggression / disobedience / anxiety / impulsivity

Parents of children with ID…

• worry about child, realize that expectations will never be fulfilled, and can lead to experiencing a stressful / frustrating diagnostic process

• unusual amount of attention must be given to the intellectual / psychological / physical needs of kids.

• parents face decisions, unique or uncommon in typical families concerning

mothers of children with ID are….

more likely to experience stress, anxiety, depression, other negative reactions

siblings can be….

challenged by the need to accommodate the child with ID & the impact having a child with disability has on family functioning

What is correlated with child’s behavioral problems?

with parental reports of stress, depression, anxiety, and mothers are more affected than fathers

transformation

significant positive changes set into motion by a traumatic / challenging event

Potential rewards?

parents learning to speak out, becoming stronger, seeing life from a new perspective, & having greater compassion

Positive consequences of experience?

increased empathy, patience, acceptance of differences, ability to help others, appreciation for health & family.