Intellectual Disability

mental retardation (MR)

term often used in schools and social service agencies

(outdated term)

*usually IQ driven

(below 70-75)

**disability must originate before age 18

intellectual disability (ID)

preferred term

(interchangeable with MR)

*still includes IQ cut-offs

**ALL will have developmental disability

developmental disability

defined by Developmental Disabilities Assistance and Bill of Rights Act (2000)

*NO IQ cut-off

**often used in context of IDEA eligibility

conditions associated with intellectual disability

- fetal alcohol syndrome

- down syndrome

- autism

- prader-willi syndrome

- cri du chat syndrome

- corenlia delange syndrome

- fragile X

- hurler syndrome

- lesch-nyhan syndrome

- ardt syndrome

- williams syndrome

- angelman syndrome

cri du chat syndrome

rare chromosomal disorder due to loss of material from 5p

- initially present with hypotonia

- facial abnormalities

- minor UE abnormalities

- scoliosis/congenital heart disease is common

*high pitched cry (like a kitten)

cornelia deLange syndrome

genetic mutation characterized by:

- limb abnormalities

- microcephaly

- severe growth retardation

- spasticity

- intention tremor

- seizures

- clinodactyly of the fifth fingers

- respiratory and GI problems, congenital heart disease

fragile x syndrome

most common form of inherited ID

genetic abnormality characterized by:

- poor coordination & motor planning

- tremor/ataxia

- ADD

- anxiety

- seizures

- connective tissue abnormalities

(DDH, scoliosis, pes planus)

- mitral valve prolapse

- autism

hurler syndrome

autosomal recessive storage disorder

(unable to break down long chains of sugar molecules)

CHARACTERIZED BY:

- hydrocephalus

- joint contractures

- visual defects

- kyphosis

- shallow acetabular and glenoid fossae

- cardiac deformities

(R ventricular hypertension common)

*death frequently due to cardiac failure

lesch-nyhan syndrome

genetic deficiency of the HPRT enzyme

CHARACTERIZED BY:

- spasticity

- chorea

- athetosis

- dystonia

- compulsive self-injurious behavior

(ex. extreme biting--> some have teeth pulled)

rett syndrome

caused by mutation in X chromosome

(almost always seen in GIRLS)

*often misdiagnosed as autism

CHARACTERIZED BY:

- deceleration of head growth

- loss of skills after 6-18 months

- scoliosis

- growth failure

- hyperventilation and breath holding

williams syndrome

mutation or deletion of the elastin gene at 7q11.23

CHARACTERIZED BY:

- hypersocialability

- mild neurologic dysfunction

- hypotonia

- cerebellar dysfunction

- facial abnormalities

- slow growth

- connective tissue abnormalities

- scoliosis/kyphosis

- aortic stenosis

- hypertension

- mitral valve prolapse

angelman syndrome

genetic disorder characterized by:

- hypotonicity

- seizures

- developmental delay

- ataxia/balance problems

- lack of speech

- behavior problems

*often fascinated by water

poor head control, poor trunk control, disinterest in movement

What are the 3 common early motor signs in children with ID?

assessment of intellect in children

- Stanford-Binet Intelligence Scale IV

(used to identify giftedness)

- Weschler Intelligence Scale for Children III (WISC)

- The Columbia Mental Maturity Scale

(designed specifically for children w/ CP - NO oral response)

infant assessment is unreliable

- developmental assessments

- poor predictors on intelligence

*Fagan Test of Infant Intelligence*

low IQ expected skills

important for PROGNOSIS

REFER TO IMAGE

variety

PT goals can encompass a wide range of skills from expectations of typical development at a slower pace to physical support for posture and mobility (AD use)

establishing goals

Normalization vs Compensation

1. bottom up approach

- identify strengths & weaknesses

- determine goal

- intervention plan and strategies

- assessment

(NORMALIZATION)

2. top down approach

- desired outcome (goal)

- identify obstacles & strengths

- strategies to bypass obstacles and to improve performance

- intervention plan

- assessment

(COMPENSATION)

common learning characteristics (intellectual impairments)

1. capability to learn a fewer number of things

- careful selection of high value skills

- TEAM APPROACH BEST

2. need for greater number of repetitions

- routines-based mindset

(increase frequency)

3. greater difficulty generalizing skills

- need to practice skills in context

(ex. specific stairwell at school)

4. greater difficulty maintaining skills not practiced

- increase number of reps

(imbed practice in daily routine)

5. slower response times

- consider speed & frequency of cuing

(SLOW DOWN)

6. limited repertoire of responses

- be "ok" w/ lack of variability & variation

*adapt environment to person, NOT person to environment

assistive technology

CONSIDER:

- early switch introduction

- adaptive equipment & developmental planning model

- compensation vs normalization

ADHD (Attention-Deficit Hyperactivity Disorder)

persistent pattern of inattention and/or hyperactivity impulsivity

- present before 7 y/o

- impairments in at least two settings

- clear evidence of interference with social, academic or occupational functioning

RULE OUT--> Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder

SUBTYPES:

- inattentive type

(focus issues)

- hyperactive-impulsive type

(physical manifestations)

- combined type

(most common)

inattentive type, hyperactive-impulsive type, combined type

What are the 3 subtypes of ADHD?

ADHD PT implications

- fidgeting should NOT be discouraged or punished

- regular physical activity can reduce the symptoms of ADHD

- meditation/yoga may help with focusing

*link btwn ADHD, sensory overresponsivity, anxiety disorder

identifying PT need

1. norm-referenced tests

- help to identify

- must include "high level" balance and coordination tasks (BOT-2)

- program eligibility requirements

(older age = greater delay needed)

2. school-based therapy

- building relationships w/ teachers