Neurodevelopmental conditions - Intellectual Disability

What is intellectual disability? (2)

Neurodevelopmental disorder w/ onset during childhood.

Characterised by both

• Intellectual impairment

• Adaptive functioning difficulties

What 3 criteria must be met for intellectual disability?

1. Deficits in intellectual functioning

2. Deficits in adaptive functioning that limit independence and social responsibility

3. Onset has to be during developmental period

What are 3 types of deficits in adaptive functioning?

• Conceptual - language, literacy, numeracy

• Social - communication, relationships, social judgment

• Practical - self-care, daily living skills

What is global developmental delay?

Evidence there is deficits in intellectual and adaptive functioning under 5, but cannot be measured yet.

If present beyond age 5, might be upgraded to ID

What is adaptive functioning influenced by? (3)

• Learning opportunities

• Cultural and environmental expectations

• Available supports

What are severity levels for ID?

• Mild - intermittent support and relative independence

• Moderate - ongoing support, focus on practical and vocational skills

• Severe - Extensive support, limited independence

• Profound - pervasive, lifelong support across all settings

It is important to note severity levels reflect what?

Adaptive functioning not fixed IQ cut-offs

What is the developmental course of ID? (4)

• Identified in childhood due to delayed cognitive and adaptive development

• Generally lifelong, but functional skills can improve with intervention

• Development often involves periods of progress and plateaus

• Early identification and consistent supports are associated w/ better outcomes

What are causes of ID?

Multifactorial/Risk susceptibility model, outcomes depend on timing, severity, support access

• Genetic/biological

• Prenatal/perinatal

• Postnatal

• Psychosocial

What are genetic/biological contributory causes of ID?

Down syndrome, Turners, Fragile X

Rule out medical causes for appeared delays

What are prenatal causes of ID? (5, name like 2)

maternal illness

Toxin exposure

Prematurity

birth complications

Increasing parental age

What are post natal contributory causes of ID?

Brain injury

Neurological illness

Severe deprivation

What are psychosocial contributors to ID?

Poverty, access to education and healthcare

What is a developmental delay?

Development following the typical sequence, more slowly

Common in mild ID

Cognitive skills resemble developmental immaturity

What is a developmental difference?

Qualitatively different patterns of thinking or learning

More common in profound to moderate ID

Development organised differently(?)

What are rates of co-morbidity for ID?

3-4x more common, with some research suggesting up to 50% of people with ID have a comorbidity

Co-occurring conditions share what with IDs?

Neurodevelopmental and experiential risk

What are common co-occurring conditions for ID?

• Neurodevelopmental - ADHD, autism, communication disorders

• Mental health - anxiety, depression

• Medical - Epilepsy, chronic health conditions

What are clinical issues with co-occurring conditions?

Distress often presents as behavioural change leading to risk of diagnostic overshadowing

What are differential diagnoses for ID?

Specifical learning difficulties

ASD

ADHD

Neurocognitive disorders (acquired decline)

ID involves global WHAT?

Global intelllectual and adaptive impairment from development

What are principles of ID assessment? (5, with 1 main point)

• Assessment of intellectual abilities/cognitive functioning

• Comprehensive evaluation of adaptive functioning across settings

• Review of developmental history, early milestones

• Identification of strengths, protective factors, and support needs

• Aim: Understanding functioning to guide intervention, not dx alone

When assessing interventions for ID, we consider what?

Where we can make the most meaningful impact

Mild severity - communication, learning, independence, support needs

Communication - Functional, difficulty with complex language and social cues

Learning - Academic difficulties, can develop academic and vocational skills with support

Independence - Independent self-care, difficulties w/ judgement and relationships

Support needs - intermittent

Moderate severity - communication, learning, independence, support needs

Communication - Less complex language, variable social communication

Academic - marked difficulty, focus on practical and vocational learning

Independence - partial, limited complex decision-making

Support needs - ongoing but limited

Severe severity - communication, learning, independence, support needs

Communication - limited functional communication

Learning - Focus on self-care, adaptive behaviour, basic communication

Independence - Dependent for most activities of daily living

Support needs - extensive

Profound severity - communication, learning, independence, support needs

Communication - very limited or absent

Learning - minimal, responds to sensory input and routines

Independence - fully dependent, high medical needs common

Support needs - Pervasive, lifelong supports

Intervention and support is?

Individualised and formulation-driven

What is the focus of intervention and support? (3)

• Developing adaptive and functional skills

• Maximising participation and inclusion

• Supporting well-being and self-determination

What is a key idea in intervention and support?

Support needs vary over time and across contexts