Exam 3: Intellectual Disability

intellectual disability used to be referred to as

retardation

the terminology change reflects the shift from a vire that classifies "mental retardation" as a personal trait residing solely within the individual to a holistic perspective that includes the capabilities of the person within the context of the environment.

ID is characterized by

significant limitations in both intellectual functioning and adaptive behavior as expressed in conceptual, social, and practical adaptive skills

ID originates before what age

18

define intellectual functioning (intelligence)

the general mental capability of an individual

includes the ability to: reason, plan, problem solve, think abstractly, comprehend complex ideas, and learn from experience

what do we use to measure intelligence?

IQ scores - standardized test

IQ of a person with ID

70

"significant limitation in intellectual functioning" was defined as two standard deviations below the mean (IQ test)

an IQ score must be considered in the context of

adaptive behavior, health, participation, and context

what is the most related domain of concern among OTs when it comes to ID?

adaptive behavior

it is our focus of assessment and intervention with persons with ID

define adaptive behavior

the collection of conceptual, social, and practical skills that people have learned so they can function in their everyday lives

the collection of conceptual, social, and practical skills that people have learned so they can function in their everyday lives

adaptive behaviors

what happens when a person has limitations when it comes to adaptive behaviors?

Significant limitations in adaptive behavior impact a person's daily life and affect the ability to respond to a particular situation or to the environment

Limitations in what can impact a person's daily life and affect the ability to respond to a particular situation or to the environment

adaptive behaviors

three areas of adaptive behaviors

1) conceptual skills

2) social skills

3) practical skills

examples of conceptual skills

-Receptive and expressive language

-Reading and writing

-Money concepts

-Time concepts

-Number concepts

examples of social skills

- Interpersonal Social responsibility

-Self-esteem

-Gullibility (likelihood of being tricked or manipulated)

-Naivete (wariness)

-Following rules/obeying laws

-Social problem solving

-Avoiding victimization

examples of practical skills

-Personal activities of daily living such as eating, dressing, mobility, and toileting

-Instrumental activities of daily living such as preparing meals, taking medication, using the telephone, managing money, using transportation, and doing housekeeping activities

-Occupational skills

-Maintaining a safe environment

how are limitations in adaptive behaviors determined?

they can be determined by using standardized tests referenced to the general population, including people with disabilities and people without disabilities

In contrast to IQ scores for determining intellectual abilities, adaptive behavior is measured with the focus on ...

typical performance and not maximum performance

how a person typically performs, not performance potential.

(also 2 sd from mean = challenge)

a diagnosis of ID is made in what period of our lives?

childhood

T/F A diagnosis of ID is considered in adult-onset degenerative diseases such as dementia or those associated with traumatic brain injury

False

T/F we only diagnose ID in childhood

True

What diagnosis are children under the age of 5 years who have delays in developmental milestones and intellectual functioning sometimes given?

they are sometimes given a temporary diagnosis of global developmental delay (GDD) that requires reassessment after age 5

Why are children under 5 diagnosed with GGD first?

This diagnosis recognizes that accurate assessment of intellectual functioning is often not possible during this early childhood period, and therefore, the lifelong intellectual functioning prognosis is difficult to determine.

what are the two diagnostic and classification systems for the term ID?

DSM 5 and AAIDD

Although both systems agree that ID is a developmental condition characterized by significant impairment in intellectual functioning and adaptive behavior, they vary by ...

how they classify severity levels.

What system uses a classification system to further refine and categorize the diagnosis of ID through severity levels based on an individual's severity of function

DSM 5

What are the severity levels used by the DSM 5?

mild

moderate

severe

profound

when determining the severity level, what is used to classify each person to their level?

Standardized testing along with clinical judgment regarding a person's adaptive functioning across the domains of conceptual, social, and practical domains is used

T/F Both the DSM5 and the AAIDD use a classification system for severity levels

true

The AAIDD evaluates severity based on

based on the intensity of supports needed to improve function.

This system considers a person's strengths and abilities, not simply limitations, and is determined through a standardized support need tool.

This system considers a person's strengths and abilities, not simply limitations, and is determined through a standardized support need tool.

AAID

.Intensities of support levels according to the AAID

intermittent- "as-needed" basis

limited - occurs over a limited time span

extensive - assistance on a daily basis in a life area

pervasive - need for support in all life areas across all environments

AAID - 5 main assumptions that need to be considered in the diagnostic process

1. Limitations in present functioning must be considered within the context of community environments typical of the individual's age, peers, and culture.

2. Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor, and behavioral factors.

3. Within an individual, limitations often coexist with strengths.

4. An important purpose of describing limitations is to develop a profile of needed supports.

5. With appropriate personalized supports over a sustained period, the life functioning of the person with ID generally will improve.

T/F The cause of ID remains unknown

True

causes of ID may be classified according to:

1) their origin (biomedical vs environmental)

2) when they occurred in the developmental cycle (prenatally, perinatally, or postnatally)

T/F the ability to determine the cause of ID is highly correlated with the level of the ID

True

T/F The etiology of ID is more likely to be known with individuals who are mildly intellectually disabled (IQs of 50-70) than with those who are severely affected (IQs of <50)

False

Biomedical factors during the prenatal period that can contribute to ID include

genetic aberrations

birth defects that are not genetic in origin

a combination of factors

T/F Up to 50% of the individuals diagnosed with ID may have more than one causal factor

true

genetic causes of ID can be divided into 2 types:

1) single gene disorders - specific gene is defective

2) chromosomal abnormalities

all individuals with ID have deficits in

intellectual functioning and adaptive behavior occurring before the age of 18

general symptoms of ID might include

1) difficulty with gross or fine motor development

2) learning to speak

3) remembering things

4) poor awareness or use of social rules

5) trouble understanding of consequences,

6) solving problems

T/F Individuals with mild ID may not have any symptoms present until they begin elementary school.

True

T/F Once a diagnosis is confirmed, the functional presentation will not vary between individuals depending on severity level and possible co-occurring diagnoses.

False

In the DSM-5, one of the core components for the diagnosis of ID is ... which may initially present itself as ...

impairment in intellectual functioning

This may initially present as difficulty with reading, writing, mathematics, understanding of time or money, abstract thinking, and memory.

To be considered intellectually disabled, a person's performance on a standardized intelligence test must be

two standard deviation units or more below the mean

T/F all individuals in a particular classification will function at exactly that level.

FALSE

Core symptoms of ID

1) Impairment of intellectual functioning

2) Severe limitations in adaptive behavior

If an individual with ID has severe limitation ins adaptive behavior, how does this impact their daily lives?

they would have difficulties with skills required to live independently in a safe and responsible manner

According to the DSM 5: Mild ID

According to the DSM 5: Moderate ID

According to the DSM 5: Severe ID

According to the DSM 5: Profound ID

Common co-occuring conditions of ID

• Attention-deficit/ hyperactivity disorder

• Depressive and bipolar disorders

• Anxiety disorders

• Autism spectrum disorders

• Stereotypic movement disorder (with or without self-injurious behavior)

• Impulse control disorders

• Major neurocognitive disorders

T/F a high proportion of individuals with ID also have some form of mental illness.

true

Some of the common types of mental illness seen in people with ID include:

personality disorders, affective disorders, psychotic disorders, avoidant disorder, paranoid personality disorder, and severe behavior problems that may include self-injurious behavior

T/F Because of limited communication skills and limitations in abstract thinking caused by the ID, the diagnosis of mental illness and mental health problems can be a very difficult process and is frequently inexact.

TRUE

What must be performed to determine whether a person meets the criteria for being intellectually disabled.

An evaluation

Parts of an evaluation for ID

1) administration of an appropriate standardized intelligence test by a qualified individual.

2) evaluation of adaptive behavior as It relates to the targeted adaptive life skill areas

- adaptive behavior scale

- evidence should be gained from one or more, independent, reliable sources who are familiar with the abilities of the child in different contexts

define adaptive functioning:

an individual's ability to cope with life demands and meet societal expectations for independence depending on age group

Vineland Adaptive Behavior Scale (VAB)

assesses personal, social, and adaptive functioning of handicapped and non handicapped

one of the most common adaptive functioning scales

3 domains of the VAB

Once a diagnosis and classification of ID have been made through testing of intellectual functioning and adaptive behavior, it is important to

complete the assessment framework by determining the level and system of supports needed for an individual in order to meet the demands of their environment

Supports Intensity Scale (SIS)

standardized tool designed to measure the type and intensity of supports that a person with ID requires to be successful in their environment

standardized tool designed to measure the type and intensity of supports that a person with ID requires to be successful in their environment

SIS

Is ID a life long condition?

ID is generally considered a lifelong condition, but the course and prognosis will vary depending upon the cause(s) of the disability and access to resources

Life expectancy for people with ID

live as long as the general population

but people with profound ID are less likely to reach old age - neurological deficits

ID is:

a) progressive

b) nonprogressive

non progressive

emphasis of treating ID

managing the medical aspects of the condition and helping individuals to achieve their highest potential.

treatment goal for individuals with progressive diseases such as muscular dystrophy and down syndrome

help them achieve the highest level of independence and maintain it as long as possible.

One significant issue that can impact prognosis in people with ID is

the presence of stigma in our society.

ID is strongly associated with symptoms of

anxiety and depression

what can mediate the impact of stigma and support psychological wellbeing in people with ID?

social inclusion

For example, membership in organizations like the Special Olympics can increase self-esteem, increase quality oflife, and reduce stress

An important factor in the improvement of the prognosis for people with ID is:

access to services that focus on strengths and increase adaptive functioning.

With these services, it is possible for individuals with mild ID to gain adaptive behavior skills through remedial programs to the extent that they no longer meet the diagnostic criteria for being intellectually disabled, although their intellectual function has probably not changed significantly

T/F ID can be directly treated with medications

false

however, surgery or medications may be needed for some of the conditions that could occur in tandem.

Examples of systems of supports that might be beneficial for people with ID include

individual therapies, education and vocational training programs, organization-level consultation through community initiatives

ID impact on occupations

• May be at risk for decreased activity engagement or may be offered limited opportunities to participate

• Societal stigma that may lead to low self -esteem & exclusion

• ADLs & iADLs• Social participation

• Education / Work

OT role in ID

OT provides services in different settings along the life span, both individual andgroup interventions.

When providing services for people with ID what is something OTs should always consider?

Important to provide services in a natural environment that facilitates the implementation ofthe skills learned.

We can facilitate people with ID to achieve the highest level of function via:

1) Adaptation & remediation approaches

2) Skills training

3) Role playing

4) Family /Caregiver training - consistent use of prompts (cues)

5) Developing healthy routines

emphasis of treating ID

Some of the common types of mental illness seen in people with ID include: