Chapter 5 Intellectual and Developmental Disabilities

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<ul><li><p>Chapter 5: Intellectual and Developmental DisabilitiesThis PowerPoint includes additional information not found in your text </p></li><li><p>Topics DefinitionPrevalenceCausesIdentificationPsychological and behavioral characteristicsEducational considerationsAssessment of progressEarly interventionTransition to adulthood</p></li><li><p>Whats in a name?Idiot, moron, imbecileFeeble-mindedMental retardationStill the classification used in Pennsylvania todayIntellectual and developmental disabilities</p></li><li><p>DefinitionReasons for cautionConcern about misdiagnosis of ethnic minoritiesPossible stigma associated with the diagnosisBelief that intellectual disability is a socially constructed condition</p></li><li><p>2002 AAIDD definitionMental retardation is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before age 18.IQ less than ____/75Need to have both low IQ and limited adaptive behavior</p></li><li><p>5 Assumptions of the AAIDD DefinitionMust consider context, age, and communityAssessment must be valid and consider culture; language; sensory, motor, and behavioral issues; and differences in communicationIndividuals have both limitations and strengthsShould develop profile of needed supportsLife functioning can improve over time with use of appropriate supports</p></li><li><p>SupportsSupportsResources and strategies that promote development, education, interests, and well beingLevels of support (1992 AAMR)Intermittentas _________Limiteddaily or weekly for _____ period of timeExtensivedaily or weekly for _____ period of timePervasivehourly or __________Types of supportNaturalService-basedTechnological</p></li><li><p>Classification of Mental Retardation(American Psychological Association)IQ ScoreMild 50-70Moderate 35-50Severe 20-35Profound 00-20</p></li><li><p>2002 Pennsylvania DefinitionMental retardation--"significantly subaverage intellectual functioning that is accompanied by significant limitations in adaptive functioning in at least two of the following areas: Communcation, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety. The onset must occur before the individuals 22nd birthday. (4210.101a)</p><p>IQ below 70</p></li><li><p>Types of Support in PALearningServices for students with a disability who require services primarily in the areas of ___________, ___________, __________, or speaking or listening skills related to academic performance Life skills"Services for students with a disability who require service primarily in the areas of academic, functional or vocational skills necessary for __________ living.</p></li><li><p>Prevalence of Intellectual ImpairmentsTheoretical prevalence of intellectual impairmentbased on normal curve = 2.27%</p></li><li><p>Prevalence of Intellectual ImpairmentsActual prevalence =</p><p>Discrepancy between theoretical and actual prevalence may be due to: consideration of adaptive behavior classification as learning disabled for those with higher IQsclassification as autistic1%</p></li><li><p>CausesPrenatal causes (before ______)Chromosomal disordersDown syndromeWilliams syndromeFragile X syndromePrader-Willi syndromeInborn errors of metabolismPKUDevelopmental disorders of brain formationMicrocephalusHydrocephalusEnvironmental influencesFetal alcohol spectrum disordersRubella</p></li><li><p>Down SyndromeThree typesTrisomy 21MosaicismTranslocation</p></li><li><p>Trisomy 21Down SyndromeTrisomy 2147 chromosomes in all cells due to trisomy of 21st chromosome92% of all cases of Down SyndromeRelated to increased parental age </p></li><li><p>Maternal age and Trisomy 21 Down Syndrome</p></li><li><p>Characteristics ofDown Syndrome Physical CharacteristicsShort statureObesity Hyperflexibility of jointsHypotonicity (low _____ _______)</p></li><li><p>Characteristics ofDown SyndromeDistinctive facial featuresFolds of skin around eyesSmall ears with very small lobesFlat appearance to face; small nose with small bridgeProtruding tongue due to:small mouth short roof of mouth low muscle tone in tongue Sparse, fine hair</p></li><li><p>Characteristics ofDown SyndromePhysical CharacteristicsDistinct hands and feetsimian crease across palmssmall hands with short stubby fingers little finger curves in instead of being straightshort stubby toes with wide space between big and 2nd toe</p></li><li><p>Characteristics ofDown SyndromeHealth CharacteristicsMyopia ( ____ sightedness) and/or strabismus ( _____ eyes) in 60%Heart defects in 50%Respiratory problemsHigher rate of leukemiaHigher rate of Alzheimer'sConductive hearing loss in 66-89%Hypothyroidism in 50-90%Eczema and/or dry skin in 50%Generally sterile Shorter life span 50 years average life expectancy</p></li><li><p>Characteristics ofDown SyndromeCognitive characteristicsBetter on visual-spatial tasks than verbal-auditory tasksGirls are about 5-10 IQ points higher than boysDeclining IQ as person ageshighest IQs in infancy and early childhooddevelopment plateaus in middle childhoodmost adults have moderate MRdeterioration of adaptive skills beginning at 40Language characteristicsGrammar is akin to that of 3 year oldReceptive language is better than expressive language90% have articulation problems May see more gesturing than actual language use</p></li><li><p>Characteristics ofDown SyndromeSociobehavioral characteristicsGenerally are very sociable and friendly outgoing likely to use sociability to get out of difficult tasksmay do better in inclusive settingsmay prefer playing with younger children75% described as stubbornincreased depression with age</p></li><li><p>Williams SyndromeCaused by microdeletion of the 7th chromosome (7q11.2)Characteristics:mild mental retardation in 75%attention deficit disorder and hyperactivityoverly friendly with adults incessant chatterinappropriate and repetitive speechexcessive anxiety &amp; worry 7q11.2</p></li><li><p>Williams SyndromeCharacteristics:strengths in auditory rote memory and languageextreme weakness in perceptual and motor auditory and textile hypersensitivityhigh incidence of absolute pitchcardiovascular diseasenarrowing of the main arteries leading from the heart </p><p>Middle two rows are copied spatial designs (top row) by two 11-year-old children with Williams Syndrome. Their copies distort spatial properties while preserving other design aspects, such as color. Bottom row drawings are by a six-year-old child without Williams syndrome. </p></li><li><p>Williams SyndromeCharacteristics:connective tissue abnormalitiesjoint limitation or laxity, and soft, lax skin hoarse voicebowel/bladder diverticulae and rectal prolapsedelayed rate of growth, including low stature and a slight build distinctive facial characteristics </p></li><li><p>Characteristics of Williams Syndrome________- like facial features</p><p>broad browshort nose, full nasal tip,long philtrumfull lips wide mouthsmall jawprominent earlobes </p></li><li><p>Fragile XTrinucleotides on the X chromosome expand from the usual 6-50 repetitions to morethan 200 repetitions</p><p>Fragile X symptoms become apparent @ 200 repeats;The more repetitions, the more symptoms we see </p><p>aka Martin-Bell Syndrome or Marker X syndromecaused by a trinucleotide repeat expansion of the FMR1 gene on the _____ chromosome</p></li><li><p>Characteristics ofFragile Xdistinct facelong narrow faceprominent jaw large protruding earshigh arched palate</p></li><li><p>Characteristics ofFragile Xlong hands and palmslarge testes after puberty seizures in 20% autism-like features in 7-25% (Hatton, et al., 2003)normal life expectancyADHDmildmoderate intellectual impairment in boys; borderline IQ in girlsdecline in IQs over timeperseverative speechgenerally better verbal skills than onewould expect given IQgood adaptive behavior</p></li><li><p>Prader Willi Syndrome</p><p>Caused by deletion of part of 15th chromosome (15q11-13) that derives from fathermost common cause</p></li><li><p>Characteristics ofPrader Willi SyndromeDistinct facesdown turned mouthalmond shaped eyesHypopigmentation in 50%Hypotonia (_____ muscle tone)delayed motor developmentfailure to thrive and feeding problems in infancymorbid obesity after infancyobesity related health problems</p></li><li><p>More Characteristics of Prader Willi Syndromeshort stature relative to familyadult malesavg. 5 ft. 1 inchadult femalesavg. 4 ft. 10 ins.small hands and feetdelayed secondary sex characteristics; infertilityday time sleepiness and high threshold of painabnormal temperature regulation</p></li><li><p>Cognitive Functioning in Prader Willi Syndrome</p><p>Average IQ is 70Strengths in visual processingSocial behavioral issues (_______ _________)Hoarding or stealing foodPicking at skin, especially front of hands and legsTemper tantrumsStubbornnessCompulsiveUpset by changes in orderAnxiety</p></li><li><p>Prader Willi Syndrome TreatmentGrowth hormone to increase heightWeight managementlow calorie dietless than 600 kcals per day in childrenless than 1000 kcals per day in adultslimited food intakeregular exercise</p></li><li><p>QuestionJose has intellectual disabilities. As an infant, he was lethargic and had difficulty eating; however, at about one year of age he became obsessed with food. This is characteristic of Down syndromeWilliams syndromeFragile X syndromePrader-Willi syndrome</p></li><li><p>Phenylketonuria (PKU)recessive gene on 12th chromosome______ error of ________Causes body to not be able to metabolize phenylalanine (found in ________ and nutrasweet)Builds up in brain and causes brain damageTreatment involves diet with no protein or nutrasweetDiet must be followed until ______</p></li><li><p>Phenylketonuria (PKU)the longer we wait to begin diet, the lower the IQ will be</p></li><li><p>Screening Tests</p><p>Maternal serum screeningNuchal translucency sonogramAmniocentesisChorionic villus samplingNewborn screening</p></li><li><p>AmniocentesisTake sample of amniotic fluid and analyze itDone at 13-16 weeks1/250 risk of miscarriage</p></li><li><p>Chorionic Villus Sampling (CVS)Take sample of chorion, placental tissueDone at 7-11 weeks 1% chance of miscarriage</p></li><li><p>HydrocephalusCan result in intellectual impairment Untreated hydrocephalusTreated hydrocephalus</p></li><li><p>HydocephalustreatmentTreat with shuntAmount of intellectual impairment depends on shunts ability to drain fluidCan do fetal surgery and implant shunt in fetusMonitor child for signs that shunt is malfunctioning, blocked or infected increased lethargy, fever, enlarged head size</p></li><li><p>MicrocephalusMicro= ___________Cephalus or cephalo = _____________Newborn with microcephaly</p></li><li><p>MicrocephalyCauses of microcephalyMaternal protein deficiencyVarious genetic disorders</p><p>School age children with microcephalyAlthough text says life expectancy is short, life expectancy is usually related to size of head</p></li><li><p>Fetal Alcohol Spectrum DisorderFetal alcohol syndromeHave all 4 characteristicsFetal alcohol effects syndromeHave 3 of 4 characteristicsUsually lack the distinctive facial appearanceFetal Alcohol Spectrum Disorder</p></li><li><p>Characteristics of Fetal Alcohol Spectrum Disorder</p><p>History of prenatal alcohol exposure Growth deficiency for height and/or weight Distinctive facial appearance including:short eye slitsflat mid facethin upper lipshort, upturned nosesmooth or long philtrummisaligned or misshapen secondary teeth</p></li><li><p>Characteristics of Fetal Alcohol Spectrum Disorder</p><p>Flat midfaceSmooth philtrumEpicanthal folds</p></li><li><p>Characteristics of Fetal Alcohol Spectrum Disorder</p><p>History of prenatal alcohol exposure Growth deficiency for height and/or weight Distinctive facial appearanceBrain or CNS damage as evidenced by: MicrocephalyReduced size of caudate nucleus in basal ganglia(responsible for memory, attention, and cognition)Intellectual impairment tremors and or seizureshyperactivity ocular problems attention deficits poor coordinationpoor impulse and anger controldifficulties with judgment &amp; abstract reasoningmemory impairments</p></li><li><p>Fetal Alcohol Effects Syndrome (FAES)Aka alcohol-related neurodevelopmental disorder (ARND)Fewer physical signsOccurs 3 times more frequently than FAS (Streissguth, 1997)</p></li><li><p>Fetal Alcohol Spectrum DisorderSecondary characteristics90% develop mental health problems60% quit school60% trouble with law50% incarcerated at some time49% inappropriate sexual behavior35% alcohol or drug problems</p></li><li><p>Congenital Rubellaaka German measlesProblematic if mom gets rubella during early part of pregnancy or right before pregnancy</p></li><li><p>Rubella: Pregnancy outcomes in mothers who had congenital rubella (Sever, Hardy et al.,)Most severe outcomes</p><p>Age of infection</p><p>Percentage of Affected infants</p><p>Preconception</p><p>0-28 days before conception</p><p>43%</p><p>First trimester</p><p>0-12 weeks after conception</p><p>51%</p><p>Second trimester</p><p>13-26 weeks after conception</p><p>23%</p><p>Third trimester</p><p>27-40 weeks after conception</p><p>0%</p></li><li><p>Effects of Congenital Rubellacongenital cataracts blindintellectual impairmentdeaf deaf-blind hydrocephaly microcephalyheart defectsCongenital cataracts</p></li><li><p>Causes (contd)_______ causes (at the time of birth)AnoxiaLow birth weightInfections passed from motherSyphilisHerpes</p></li><li><p>Anoxia (lack of or too little ______)Dont know exactly how much anoxia is needed to produce brain damageCauses of anoxia:Breech birth Prolonged labor Precipitous birthPlacenta previa Cephalo-pelvic insufficiency Umbilical cord prolapse or cord wrapped around babys neck Drugs use to speed labor or sedate mother</p></li><li><p>Low Birth WeightFull term babies born after ______ weeks weigh less than 2500 grams (_______ lbs)Aka small for gestational age</p></li><li><p>Low birth weight vs. Prematurity</p><p>Time of gestation</p><p>Weight</p><p>Premature</p><p>Less than 36 weeks</p><p>Less than 5.5 lbs.</p><p>Low birth weight</p><p>More than 36 weeks</p><p>Less than 5.5 lbs.</p></li><li><p>Low Birth WeightCauses of Low Birth Weight Maternal smokingMaternal malnutritionMaternal cocaine useMultiple and close pregnanciesTeen or young motherEffects of Low Birth WeightDeath 5 times increased riskLow IQMicrocephalyFailure to thrive syndrome</p></li><li><p>Congenital Syphilis SyndromeSexually transmitted disease in motherCaused by a spirochete bacteria Bacteria crosses the placenta and damages the fetusCrossover cannot occur until 16th-18th week of pregnancy Can prevent by:Treating infected pregnant women with penicillin prior to the 16th week of pregnancyGive untreated babies penicillin after birth</p></li><li><p>Effects of Congenital Syphilis SyndromeSyphilis in babyFetal death 30% are stillborn (Mavrov et al., 2001)Distension of brain ventricle systemIntellectual impairment in 6% (Mavrov et al., 2001)</p></li><li><p>Congenital HerpesViral infection spread through exposure to Herpes lesionsPrevent exposure to lesions through Caesarian delivery</p></li><li><p>Effects of Congenital HerpesSeizuresDeath50% die within 6 or 7 daysIntellectual Impairment and/or Cerebral PalsyHerpes lesions on baby</p></li><li><p>Causes (contd)Postnatal causes (_____ birth)Biological postnatal causesTraumatic brain injury**EncephalitisMeningitisLead poisoningPsychosocial postnatal causes</p><p>**Discussed in depth in Chapter 13</p></li><li><p>Meningitis &amp; EncephalitisEncephalitis--inflammation of head or brainMeningitis--inflammation of meningesCan occur at any time; Can result in death, intellectual impairment, hearing loss, deaf-blindness, and/or finger/toe loss</p></li><li><p>Lead PoisoningLead accumulates in brain and bodily organsCan cause:Learning disabilitiesLower IQBorderline or mild intellectual impairmentBehavior problemsNeurological problemsKidney disease</p></li><li><p>Sources of Lead </p><p>Paint chipsLead pipes &amp;solder In old plumbi...</p></li></ul>


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