Intellectual disability

Intellectual disability

Previously known as mental retardation

Why it is now called intellectual disability

A holistic perspective that includes the capabilities of the person with in the context of the environment

Definition of intellectual disability

Significant limitations both intellectually functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before 18

Intellectual functioning means

Intelligence) is the general mental capability of an individual

What does intellectual functioning entail

Ability to reason, plan, problem solve, think abstractly, comprehend complex ideas, and learn from experience

How is intelligence measured

The IQ score is given after an administration of standardized test is given by a trained professional

What does AAIDD determine as a significant limitation in intellectual functioning

Two standard deviation's below the mean

Does the IQ test alone determine if someone has an intellectual disability

No must be considered in the context of adaptive behavior, health, participation, and context

What is a common concern among occupational therapist

Adaptive behavior

Definition of adaptive behavior

Collection of conceptual, social, and practical skills that people have learned so that they can function in their every day lives independently in a safe responsible manner

Examples of adaptive conceptual skills

Receptive and expressive language, reading and writing, money concepts, time concepts, and number concepts

Examples of adaptive social skills

Interpersonal, social responsibility, self-esteem, gullibility, following rules, obeying laws, social problem-solving, and avoiding victimization

Examples of adaptive practical skills

• ADLS(dressing)

• IADLs(cooking)

• occupational skills and maintaining a safe environment

How is limitations in adaptive behavior determined

Using standardized test reference to the general population including people with disabilities and people without disabilities

How are significant limitations in adaptive behavior operationally defined

Performance that is at least two standard deviation's below the mean

Criteria critical to measuring limitations in adaptive behavior is

How a person typically performs not performance potential

Intellectual disability occurs when

Before the age of 18

Why are children under the age of five given a temporary diagnosis of global development delay

When children have delays and developmental milestones and intellectual functioning. This will require additional reassessment after the age of five

One assumption that needs to be considered in the diagnostic process

Limitations in present functioning must be considered within the context of the community environments typical of the individuals age peers and culture

A second assumption that needs to be considered in the diagnosis process

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

A third assumption that needs to be considered in the diagnostic process

With in an individual, limitations often coexist with strengths

A fourth assumption that needs to be considered in the diagnostic process

And important purpose of describing limitations is to develop a profile of needed supports

A fifth assumption that needs to be considered in the diagnostic process

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

How are intellectual disabilities classified

When they occurred in the developmental cycle (prenatally, perinatally,, or postnatally) or by the origin( biomedical versus environmental)

The ability to determine cause is highly correlated with what

The level of the intellectual disability

The etiology of ID is less likely to be known with individuals who are mildly intellectually disabled IQs of 50-70 Compared to

Those that are severely affected IQs of less than 50

What causes intellectual disability

78% no defined cause 12.4% prenatal conditions 7.1% genetic 2.9% teratogenic

What kinds of prenatal factors can cause intellectual disability

Genetic aberrations, birth defects that are not genetic in origin, environmental influences, or a combination of factors

What is the problem with genetic aberrations

It's either in the genes or in the chromosomes which carry the genes

What are the two most common genetic causes of intellectual disability

Down syndrome and fragile X syndrome

What causes down syndrome

An extra 21st chromosome

What causes fragile X syndrome

A mutation at what is known as the fragile site on the X chromosome

Can birth defects contribute to our cause ID

Yes the type of birth defects that are not considered genetic in origin

Examples of some birth defects that cause ID

Such things as malformation of parts in the central nervous system (cortical atrophy, Hydrocephaly, spina bifida, craniostenosis), Congenital cardiac anomalies, or metabolic disorders not associated with genetic deficit

Example of environmental factors that may be involved in prenatal development

Chemical agents such as alcohol or nonprescription drugs, maternal conditions such as hyperphenylalaninemia, toxemia, hypertension, diabetes, or congenital infections such as cytomegalovirus

What are the two types of genetic causes

Single gene disorders in chromosome all abnormalities

What happens in single gene disorders

There is a problem with the quality of genetic material a specific gene is defective

What happens in chromosome all abnormalities

The problem is with the quantity of material too much or too little genetic material in a specific chromosome

Single gene disorders follow specific patterns of transmission

Autosomal dominant, autosomal recessive, or sex linked

What is autosomal dominant gene disorder

• A single altered gene

• Either parent may be a carrier or there may have been a spontaneous mutation of the gene

What is dominant inheritance gene disorder

Occurs when one parent passes on the defective gene which allows a 50% risk of the child being affected in each pregnancy

Example of dominant inherited disorder

Tuberous sclerosis

What is the AutoSomal recessive

Both parents are carriers but show no outward signs or symptoms of having the disorder and inheritance occurs when both parents pass the defective gene to their offspring each pregnancy has a 25% risk

Type of autosomal recessive example

Phenylketonuria and Tay-Sachs disease

What is X linked disorder

The affected Gene is on the sex chromosome specifically the X chromosome and can occur in either parent I carry your mother has a 25% risk of having and affected son if the father has the effect of Jean all daughters will be carriers sons will not be affected

Example of X linked disorders

• Duchenne muscular dystrophy

• Fragile X syndrome

• Lesch-Nyhan syndrome

• Hunter syndrome

Chromosome aberrations

Missing or extra chromosomes either in a part such as a short arm or the total chromosomes as in found in trisomal types

Most common trisomies

21, 18, and 13

Examples of environmental causes of ID in the prenatal period

Maternal infections such as rubella, Cytomegalovirus, toxoplasmosis, and syphilis

Maternal factors associated with low birth weight that would be environmental influence include

Smoking, lack of prenatal care, infections, poor nutrition, toxemia, and placental insufficiency

Other environmental influences include

Industrial chemicals or drugs, including certain over-the-counter prescriptions and illegal substances, can also affect birth weight, particular during the first trimester of pregnancy

What are the two major causative factors of ID in the perinatal period

• Mechanical injuries at birth

• Perinatal hypoxia (Reduced oxygen supply)

Mechanical injuries are caused by what

Difficulties of labor because of Malposition, Malpresentation, disproportion, or other labor complications that result in tears of the meninges, blood vessels or other substances of the brain

Factors that cause perinatal hypoxia or anoxia are

• Premature placental separation

• Massive hemorrhage from placenta previa

• Umbilical cord wrapped around the baby's neck

• Meconium aspiration

Post natal factors in acquiring intellectual disability

Traumas or infections that results in injury or lack of oxygen to the brain

Examples of trauma that can cause intellectual disability

• Near drowning or strangulation

• Child abuse

• Closed head injuries

Another example of a post natal factor

Early severe psychosocial deprivation example removal from the family home, or attachment disorder

Is ID one of the most frequent occurring developmental disabilities

Yes one to 3%

Are boys are at greater risk of getting ID

Yes 1.5 times more likely to be diagnosed with ID which may be related to the sex linked genetic disorder

Does ID occur in tandem with or as a secondary manifestation of another diagnosis

Yes

Other conditions that occur with ID

Cerebral palsy, epilepsy, and hearing in visual impairments

What system is frequently used for ID diagnostic purposes

The American psychiatric Association publishes the diagnostic and statistical manual of mental disorders most recently published in 2013

What are the two major criteria that classifies ID according to the DSM

• Intellectual functioning

• Deficits in adaptive functioning

What are the four different degrees of mental retardation according to the DSM - five

Mild, moderate, severe, and profound

How many steps does the classification system developed by the AAIDD involve

Three

What is the first step in diagnosing ID

Standardized intelligence and adaptive skills assessments that are appropriate for the individuals age, communication abilities, and cultural experience

The second step of the classification system

Describe the individual strengths and weaknesses across the dimensions of 1. intellectual and adaptive behavior skills, 2. psychological/emotional considerations, 3. Physical/health/etilogical considerations, and 4. Environmental considerations

Third step of diagnosing ID

Interdisciplinary team determined needed supports across these for dimensions

Supports need to be classified based on

Level of intensity and include intermittent, Limited, extensive, and pervasive

A high proportion of individuals with intellectual disability also have some form of mental illnesses such as:

• Personality disorders

• Affective disorders

• Psychotic disorders

• Avoidance disorder

• Paranoid personality disorder

• Severe behavior problems that may include self injurious behavior

Examples of misconceptions about people with intellectual disability

The belief that people who are intellectually disabled cannot also be mentally ill, do not experience normal feelings and emotions, and are not affected by changes in their environment

What is the course and prognosis of ID

Lifelong condition but will vary depending upon the causes of the disability

How are people with ID viewed in our society?

Negative stereotypes and prejudice that can lead to isolation and discrimination lower self-esteem and social exclusion

What positive things can impact people with ID in a positive manner

Membership in organizations like Special Olympics can increase self-esteem, increase quality of life, and reduce stress