Intellectual Developmental Disorder

Page 33 - 41

Intellectual Disability (Intellectual developmental disorder) is a disorder with onset during the Developmental period that includes both

Intellectual and adaptive functioning deficits in conceptual, social, and practical domains.

There are three criteria that must be met for this Disorder. The first one is:

Deficits in intellectual functioning, such as reasoning, problem solving, planning, abstract thinking, judgement, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing.

There are three criteria that must be met for this Disorder. The second one is:

Deficits in adaptive functioning that result in failure to meet developmental and socio-cultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community.

There are three criteria that must be met for this Disorder. The third one is:

Onset of intellectual and adaptive deficits during the developmental period.

The various levels of severity are defined on the basis of adaptive functioning, and not IQ scores, because it is adaptive functioning that determine the level of support required. Moreover, IQ measures are less valid in the lower end of the IQ range. Because of this, the level of severity is as followed.

(F70) Mild

(F71) Moderate

(F72) Severe

(F73) Profound

When the severity level is mild, it can effect the Conceptual Domain in the following ways.

For preschool children, there may be no obvious conceptual differences. For school-age children and adults, there are difficulties in learning academic skills involving reading, writing, arithmetic, time, or money, with support needed in one or more areas to meet age-related expectations.

In adults, abstract thinking, executive functioning (i.e., planning, strategizing, priority setting, and cognitive flexibility), and short-term memory, as well as functional use of academic skills (e.g., reading, money management), are impaired. There is somewhat concrete approach to problems and solutions compared with age-mates.

When the severity level is mild, it can effect the Social Domain in the following ways.

Compared with typically developing age-mates, the individual is immature in social interactions.

There may be difficulty in accurately perceiving peers social cues. Communication, converations, and language are concrete or immature than expected for age. There may be difficulties regulating emotions and behaviour in age-appropriate fashion; these difficulties are noticed by peers in social situations.

This is an example of mild Social Domain

There is limited understanding of risk in social situations; social judgment is immature for age, and the person is at risk of being manipulated by others (gullibility)

This is talking about mild Social Domain

When the severity level is mild, it can effect the Practical Domain in the following ways.

The individual may function age-appropriately in personal care. Individuals need some support with complex daily living tasks in comparison to peers. In adulthood, supports typically involve grocery shopping, transportation, home and child-care organizing, nutritious food preparation, and banking and money management.

Recreational skills resemble those of age-mates, although judgement related to well-being and organization around recreation requires support. In adulthood, competitive employment is often seen in jobs that do not emphasize conceptual skills. Individuals generally need support to make health care decisions and legal decisions, and to learn to perform a skilled vocation competently. Support is typically needed to rise a family.

This is talking about being mild in the Practical Domain

When the severity level is moderate, it can effect the conceptual Domain in the following ways.

All through development, the individual’s conceptual skills lag markedly behind those of peers.

When the severity level is moderate, it can effect the conceptual Domain in the following ways. (Preschoolers)

Language and pre-academic skills develop slowly.

When the severity level is moderate, it can effect the conceptual Domain in the following ways. (School Age Children)

-Progress in reading, writing, mathematics, and understanding of time and money occurs slowly across the school years and is markedly limited compared with that of peers.

When the severity level is moderate, it can effect the conceptual Domain in the following ways. (Adults)

-Academic skills development is typically at an elementary level, and support is required for all use of academic skills in work and personal life. Ongoing assistance on a daily basis is needed to complete conceptual tasks of day-to-day life, and others may take over these responsibilities fully for the individual.

When the severity level is moderate, it can effect the Social Domain in day to day interactions

-The individual shows marked differences from peers in social and communicative behavior across development.

When the severity level is moderate, it can effect the Social Domain in day to day interactions (Language)

-Spoken language is typically a primary tool for social communication but is much less complex than that of peers.

When the severity level is moderate, it can effect the Social Domain in day to day interactions (Relationships)

-Capacity for relationships is evident in ties to family and friends, and the individual may have successful friendships across life and sometimes romantic relationships in adulthood.

-However, individuals may not perceive or interpret social cues accurately. Social judgement and decision making abilities are limited, and caretakers must assist the person with life decisions.

-Friendships with typically developing peers are often affected by communication or social limitations. Significant social and communicative support is needed in work settings for success.

When the severity level is moderate, it can effect the Practical Domain in the following ways. (Taking Care of Self).

-The individual can car for personal needs involving eating, dressing, elimination, and hygiene as an adult, although an extended period of teaching and time is needed for the individual to become independent in these areas, and reminders may be needed.

When the severity level is moderate, it can effect the Practical Domain in the following ways. (Household tasks).

-Participation in all household tasks can be achieved by adulthood, although an extended period of teaching is needed, and ongoing supports will typically occur for adult-level performance.

When the severity level is moderate, it can effect the Practical Domain in the following ways. (Jobs).

-Independent employment in jobs that require limited conceptual and communication skills can be achieved, but considerable support from co-workers, supervisors, and others is needed to manage social expectations, job complexities, and ancillary responsibilities such as scheduling, transportation, health benefits, and money management.

When the severity level is moderate, it can effect the Practical Domain in the following ways. (Recreational Skills).

-A variety of recreational skills can be developed. These typically require additional support and learning opportunities over an extended period of time.

-Maladaptive behavior is presented in a significant minority and causes social problems.

When the severity level is Severe, it can effect the Conceptual Domain in the following ways.

-Attainment of conceptual skills is limited.

-The individual generally has little understanding of written language or of concepts involving numbers, quantity, time, and money.

-Caretakers provide extensive support for problem solving throughout life.

When the severity level is Severe, it can effect the Social Domain in the following ways.

-Spoken language is quite limited in terms of vocabulary and grammar.

-Speech may be single words or phrases and may be supplemented through augmentative means.Speech and communication are focused on the here and now within everyday events.

-Language is used for social communication more than for explication.

-Individuals understand simple speech and gestural communication. Relationships with family members and familiar others are a source of pleasure and help.

When the severity level is Severe, it can effect the Practical Domain in the following ways. (daily tasks)

-The individual requires support for all activities of daily living, including meals, dressing, bathing, and elimination.

When the severity level is Severe, it can effect the Practical Domain in the following ways. (Self - Autonomy)

-The individual requires supervision at all times.

-The individual cannot make responsible decisions regarding well-being of self or others.

When the severity level is Severe, it can effect the Practical Domain in the following ways. (Adult)

-Participation in tasks at home, recreation, and work requires ongoing support and assistance.

-Sill acquisition in all domains involves longterm teaching and ongoing support.

-Maladaptive behavior, including self-injury, is presented in a significant minority.

When the severity level is Profound, it can effect the Conceptual Domain in the following ways. (Conceptual Skills)

-Conceptual skills generally involve the physical world rather than symbolic processes.-The individual may use objects in goal-directed fashion for self-care, work, and recreation.

When the severity level is Profound, it can effect the Conceptual Domain in the following ways. (Visual)

-Certain visuospatial skills, such as matching and sorting based on physical characteristics, may be acquired.

-However, co-occurring motor and sensory impairments may prevent functional use of objects.

When the severity level is Profound, it can effect the Social Domain in the following ways. (verbal)

-The individual has very limited understanding of symbolic communication in speech or gesture.

-They may understand some simple instructions or gestures.

-They express their own desires and emotions largely through nonverbal, non-symbolic communication

When the severity level is Profound, it can effect the Social Domain in the following ways. (Relationships)

-The individual enjoys relationships with well-known family members, caretakers, and familiar others, and initiates and responds to social interactions through gestural and emotional cues.

-Co - occurring sensory and physical impairments may prevent many social activities.

When the severity level is Profound, it can effect the Practical Domain in the following ways. (Self Care)

-The individual is dependent on others for all aspects of daily physical care, health, and safety, although they may be able to participate in some of these activities as well.

When the severity level is Profound, it can effect the Practical Domain in the following ways. (Home Life)

-Individuals without severe physical impairments may assist with some daily work tasks at home, like carrying dishes to the table.

-Simple actions with objects may be the basis of participation in some vocational activities with high levels of ongoing support.

When the severity level is Profound, it can effect the Practical Domain in the following ways. (Recreational)

-Recreational activities may involve, for example, enjoyment in listening to music, watching movies, going out for walks, or participating in water activities, all with the support of others.

-Co - occurring physical and sensory impairments are frequent barriers to participate (beyond watching) in home, recreational, the vocational activities.

-Maladaptive behavior is present in a significant minority.

The essential features of intellectual disability (intellectual developmental disorder) are deficits in general mental abilities. This is

Criteria A

Impairment in everyday adaptive functioning, in comparison to an individuals age, gender, and sociocultural matched peers. This is

Criteria B

Onset is during the developmental period. This is

Criteria C

Individuals with Intellectual Disabilities have scores of approximately

Two standard deviations or more below the population mean, including a margin for measurement error (generally +5points).

On tests with standard deviations of 15 and a mean of 100, this individual would have a score of

65 - 75 (70 ± 5).

Adaptive functioning may be difficult to assess in controlled settings like

Prisons, detention centers. If possible, corroborative information reflecting outside those settings should be obtained.

Criteria B is met when at least one domain of

Adaptive functioning (Conceptual, Social, or practical) is sufficiently impaired that ongoing support is needed in order for the person to perform adequately in one or more life settings at school, at work, at home, or in the community.

To meet diagnostic criteria for intellectual disability, the deficits in adaptive functioning must

Be directly related to the intellectual impairments described in Criteria A

Criteria C, onset during the developmental period refers to

Recognition that intellectual and adaptive deficits are present during childhood or adolescents

There may be associated difficulties with social judgement, assessment of risk, self-management of behaviors, emotions, and interpersonal skills. Because of this, a lack of communication skills may predispose to disruptive and aggressive behaviors like,

-Gullibility and lack of awareness of risks that may result in exploitation by others and possibly victimization, fraud, unintentional criminal involvement, false confessions, and risk for physical and sexual abuse.

Individuals with a diagnosis of intellectual disability with co - occurring mental disorders are at risk for

Suicide. They think about suicide, make suicide attempts, and may die from them. Thus, screening for suicidal thoughts is essential in the assessment process. Because of a lack of awareness of risk and danger, accidental injury rates may be increased.

Intellectual disability has an overall general population prevalence of approximately 1%, and prevalence rates vary by age. Prevalence for severe intellectual disability is

approximately 6 per 1,000.

Onset of intellectual disability is in the

Developmental age. The age and characteristic features at onset depend on the etiology and severity of brain dysfunction.

Delayed motor, language, and social milestones may be identifiable within the first 2 years of life among those with more severe intellectual disabilities, while

mild levels may not be identifiable until school age when difficulty with academic learning becomes apparent.

When intellectual disability is associated with a genetic syndrome, there may be a characteristic physical appearance (e.g., Down Syndrome). Some syndromes have a behavioral phenotype, which

refers to specific behaviors that are characteristic of particular genetic disorders (e.g., Lesch - Nyhan Syndrome).

In acquired forms, the onset may be abrupt following an illness such as

meningits or encephalitis or head trauma occurring during the developmental period.

Meningitis and encephalitis are both serious inflammatory conditions that affect the central nervous system, but

but they involve different areas of the brain and spinal cord

Meningitis is the

inflammation of the meninges—the protective layers of tissue that surround and cushion the brain and spinal cord

Encephalitis is the

inflammation of the brain parenchyma (the actual functional tissue or meat of the brain itself).

When intellectual disabilities result from a loss of previously acquired cognitive skills, as in severe traumatic brain injury, the

Diagnoses of intellectual disability and of a neurocognitive disorder may both be assigned.

Although intellectual disability is generally non-progressive, in certain genetic disorders (e.g., Rett Syndrome) there are periods of worsening, followed by stabilization, and in others (e.g., San Phillippo syndrome)

Progressive worsening of intellectual function.

After early childhood, the disorder is

generally lifelong, although severity levels may change over time. This course may be influenced by underlying medical or genetic conditions and co - occurring conditions (e.g., hearing or visual impairments, epilepsy).

Early and ongoing interventions may improve adaptive functioning throughout childhood and adulthood. In some cases, these

result in significant improvement of intellectual functioning, such that the diagnosis of intellectual disability is no longer appropriate. Thus, it is common practice when assessing infants and young children to delay diagnosing of intellectual disability until after an appropriate course of intervention is provided.

For older children and adults, the extent of support provided may allow for full participation in all activities of daily living and improved adaptive functioning. Diagnostic assessment must determine whether

Improved adaptive skills are the result of a stable, generalized new skill acquisition (in which case the diagnosis of intellectual disability may no longer be appropriate) or whether the improvement is contingent on the presence of support and ongoing interventions (in which case the diagnosis of intellectual disability may still be appropriate).

In regards to Genetic and Physiological, Prenatal etiologies include genetic symptoms (e.g.,

sequence variations or copy number variants involving one or more genes; chromosomal disorders), inborn errors of metabolism, brain malformations, maternal disease (including placental disease), and environmental influences (e.g., alcohol, other drugs, toxins, teratogens).

Perinatal causes include a variety of labor and delivery-related events leading to neonatal encephalopathy While Postnatal

Hypoxic ischemic injury, traumatic brain injury, infections, demyelinating disorders, seizure disorders (e.g., infantile spasms), severe and chronic social deprivation, and toxic metabolic syndromes and intoxications (e.g., lead, mercury),

Perinatal is

The entire period surrounding birth, stretching from the time you become pregnant through the first year after giving birth.

Postnatal is

The period occurring strictly after birth (often used interchangeably with postpartum, though postpartum sometimes focuses specifically on the mother's physical recovery while postnatal can apply to both mother and baby)

Overall, males are more likely than females to be diagnosed with both

Mild (average male:female ratio 1.6:1) and severe (average male:female 1.2:1) forms of intellectual disability.

The Diagnostic Markers include the

Basic pre - and perinatal medical history, three generational family pedigree, physical examination, genetic evaluation (e.g., karyotype ot chromosomal microarray analysis and testing foe specific genetic syndromes), and metabolic screening and neuroimaging assessment.

A genetic syndrome linked to intellectual disability should be

Noted as a concurrent diagnosis with the intellectual disability.

Intellectual disability is categorized as a neurodevelopment disorder and is distinct from the neurocogitive disorders, which are

Characterized by a loss of cognitive functioning.

Major neurocognitive disorder may co - occur with intellectual disability (e.g., an individual with Down Syndrome who develops Alzheimer’s disease, or an individual with intellectual disability who loses further cognitive capacity following a head injurt). In such cases,

The diagnoses of intellectual disability and neurocognitive disorder may both be given.

Communication disorders and specific learning disorders are neurodevelopmental disorders and are specific to the communication and learning domains and do not show deficits in intellectual and adaptive behaviors. Because of this,

They may co - occur with intellectual disability. Both diagnoses are made if full criteria are met for intellectual disability and a communication disorder or specific learning disorder.

Intellectual disability is common among those with Autism Spectrum Disorder. Assessment of intellectual ability may be complicated by

So many interfere with understanding and complying with test procedures. Appropriate assessment across the developmental period, because IQ scores in Autism Spectrum Disorder may be unstable, particularly in early childhood.

Comorbidity is the

Medical and psychological term for when a person has two or more mental illnesses or disorders present at the same time

Co - occurring mental, neurodevelopmental, medical, and physical conditions are frequent in

Intellectual Disability, with rates of some conditions (e.g., mental disorders, cerebral palsy, and epilepsy) three to four times higher than in the general population.

The prognosis and outcome of co - occurring diagnoses may be influenced by the presence of Intellectual Disability. Because of this,

assessment procedures may require modifications because of associated disorders, including communication disorders, autism spectrum disorder, and motor, sensory, or other disorders.

The most common co - occurring mental and neurocognitive disorders are:

Attention - deficit / hyperactivity disorder, depressive and bipolar disorders, anxiety disorders, autism spectrum disorder, stereotypical movement disorder (with or without self - injuries behavior), impulse - control disorder, and major neurocogitive disorder.

Individuals with intellectual disability, particularly those with more severe intellectual disability, may also exhibit

Aggression and disruptive behaviors, including harm to others or property destruction.