Developmental Disabilities

what kind of terminology should we use?

people-first

intellectual developmental disability (IDD)

limitation in the individual's ability to learn at a level needed to engage in activities of daily life

when does IDD start?

before age 18

what problems characterize IDD?

intellectual functioning or intelligence--ability to learn, think, reason, problem solve, plan ahead, social life, skills

signs and symptoms of IDD

learn to talk later or have trouble speaking, have trouble thinking logically

diagnosis for IDD

the purpose of establishing a diagnosis for IDD is to determine eligibility and support in life

diagnostic adaptive behavior scale (DABS)

skills test that analyzes someone's strengths and weaknesses across conceptual, social, and practical skills for daily life

mild IDD IQ

55-70

moderate IDD IQ

36-55

severe IDD IQ

20-35

profound IDD IQ

0-19

characteristics of mild IDD

slow development of skills, looks normal, functions to work and have family, may need help under stress

characteristics of moderate IDD

bathes, dresses, can do chores, impaired learning, nondriver, relies on support for family living

characteristics of severe IDD

feeds and bathes with supervision, toilet trained, low communication, may look different, relies on 24 h support

characteristics of profound IDD

self feed w spillage, nonverbal, limited mobility, looks different, relies of 24 h support

characteristics of provisional IDD (dont know where they fall)

evidence of IDD, younger than 4, not possible to conduct assessment

conceptual skills

receptive and expressive language, read and write, money concepts, self direction

practical skills

activities of daily life, make meals, take meds, have a job

social skills

interpersonal, responsibility, follows rules, obeys laws

causes of IDD

abnormalities of genes, error when genes combined, disorder of genes during pregnancy due to xrays or infections

problems during pregnancy

use of alcohol and drugs, malnutrition, illness during pregnancy, environmental toxins

leading preventable cause of IDD

alcohol

perinatal causes

prematuraty and low birth weight, difficulties in birthing process

postnatal causes

childhood diseases (chicken pox), head injuries, A&N, environmental toxins

post natal poverty causes

children growing up in poverty are at higher risk and may be deprived of many cultural and educational experiences

prevention of IDD

car seats and helmets, early prenatal care, early intervention programs

medical management

dependent on associated systemic disease

behavioral management

adapt to functional level, adapt patient education, involve caregiver

increased caries risk

recommend preventative measure, tell side effects of medications, nutrition counseling, SDF

increased periodontal risk

oral hygiene issues, bruxism, tongue thrust, effects of medications, stress importance of hygiene and frequent recalls

variations and teeth in malocclusion

very common, delayed eruption, underdevelopment of maxilla, variation in number of teeth, damaging oral habits

down syndrome

extra number 21 chromosome

down syndrome physical characteristics

small head and mouth, upward slant to eyes, flattened facial profile

down syndrome development characteristics

varied IQ, short attention span, slow learning, delayed speech, impulsive behavior

down syndrome diagnosis before birth

prenatal screening, prenatal blood test (risk), amniotic fluid test (definitive diagnosis)

down syndrome diagnosis after birth

identify physical characteristics, take sample of babys blood

down syndrome associated health issues

cardiac disorders, higher susceptibility to infectious diseases, hypotonia, seizures, hearing impairment

down syndrome oral health issues

high susceptibility to PD, increased risk for caries, tongue thrusting, delayed eruptions, large tongue, mouth breathing

down syndrome ASA

ASA II-III

down syndrome treatment considerations

tell show do, pre med, OHI counseling, caries and PD prevention

fragile X syndrome

most common genetic cause of inherited IDD, boys have higher risk

fragile X characteristics

prominent forehead, long face, slow language processing, IDD

fragile X oral findings

more frequent recalls, high arched palate, malocclusion, gingivitis, poor oral hygiene

autism spectrum disorder (ASD)

umbrella diagnosis, multifactorial etiology

ASD deficits

social interaction and communication, repetitive behaviors or interests, typical lifespan, self-sufficient adults

ASD social impairment

difficulty with verbal/nonverbal, not paying attention to others, not responding to others, not sharing toys or play

ASD physical signs

stimming, handwriting, self injury, meltdowns, social withdraw

ASD causes

no known cause; some theories- brain development in utero, born with susceptibility

asperger's syndrome (high functioning)

sometimes extremely intelligent, poor social skills, cannot understand sarcasm, unable to show sympathy

ASD therapy

early intervention instruction should begin with diagnosis; medications for behaviors that interfere such as OCD or depression

ASD "they wish you knew"

please be patient with my limited vocabulary, i interpret language very literally, show me, please focus on what i can do

ASD oral manifestations

3x more likely to exhibit class II occlusion, bruxism, tongue thrust, poor oral hygiene

pica

crave/eat non food objects and substances such as gravel, cigarette butts, or pens

ASD access to care

low priority, cost of treatment, unpleasant experiences

ASD oral health

increased caries risk, biofilm control, debridement, fluoride varnish, sealants

appt modifications for IDD or ASD appts

accept suggestions from parent, allow pts to bring comfort items, gradual exposure to office and staff, talk calmly and short, tell show do, praise and reinforce good behavior

home care considerations

show them how to do home care, strategies for home care, increased recalls, dental first aid