Intellectual Disability - SHOW

8/9/2019 Intellectual Disability - SHOW

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Intellectual disability AMANY SALAMA NAHLA MAHMOUD Definition• Intellectual disability is 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 the age of 18.

(AAMR – 2002) Classification Alternate Classification System Onset of Mental Retardation Time of onset depends on the suspected cause of the disability. Some cases of mild mental retardation are not diagnosed until the

child enters preschool. specific physical attributes associated with a syndrome that causes

mental retardation are present by birth. Delayed developmental milestones

Characteristics• Difficulty in memorizing• Difficulty in retaining information.• Problem solving skills• Tend to think in a more concrete manner• Inability to generalize from one situation to another• Deficits in social skills• Struggle with understanding social rules like taking turns

(Tammi Reynolds – 2007) Co-morbid Disorders Attention Deficit Hyperactivity Disorder Mood disorders, including major depression Stereotypic Movement Disorders Schizophrenia (about 3% )

(Mark Dombeck, 2006) Convulsions: About 25% of people with mental retardation get

convulsions. Sensory impairments: Difficulties in seeing and hearing are present in

about 5-10% of persons with mental retardation.

(WHO, 2006) Prenatal causes

Chromosomal & Genetic Factors

• Downs Syndrome• PWS• PKU• ALD Prenatal causes

Brain malformations



• Micro-cephalic• Hydrocephalic Prenatal Causes

Adverse material / environmental influences• Severe malnutrition in pregnancy• Use of alcohol during pregnancy• Exposure to radiation• Maternal infections e.g. Rubella Perinatal Causes

Last Trimester• Maternal Diseases e.g. Heart problem, Diabetes• Placental Dysfunction

During Delivery• Severe Prematurity• Very low birth weight• Birth Anoxia

Neo natal (first four weeks of life)• Severe jaundice• Hypoglycemia Post natal

(In infancy & Childhood) Brain infections e.g. encephalitis, meningitis Head Injury Lead poisoning Chronic malnutrition Basis of Inheritance PKU is caused by a recessive gene, meaning both parents must

be carriers to have a child with PKU It is autosomal, not sex-linked The mutation occurs on chromosome 12 At least 500 different mutations can cause this defective

enzyme This is why there are many different degrees of enzyme

deficiency Untreated, PKU causes mental retardation Age of Onset & Symptoms PKU babies appear normal at birth Many may have blue eyes and fairer complexions than their

family members Untreated infants have early symptoms such as:

◦ Vomiting

◦ Irritability

◦ Rash

◦ Mousy odor to the urine

◦ Increased muscle tone

◦ Active muscle tendon reflexes Later, without treatment, mental retardation and seizures

would occur as well Statistics The chance that two carriers will meet is 1 out of 2,500



In the United States, about 1 out of every 10,000 babies hasPKU

About 1 in 4,500 births in Ireland About 1 in 100,000 births in Finland Down Syndrome Followed in an early intervention program

No feeding problems, but at risk for overweight Hypothyroidism diagnosed at 35 months, medication started

Common health concerns related to Down syndrome Weight management Celiac Disease Diabetes Constipation Hyper and hypothyroidism GERD Dentition Prader-Willi Syndrome (PWS)

is an uncommon genetic disorder. It causes poor muscle tone, low levels of sex hormones and a

constant feeling of hunger. The part of the brain that controls feelings of fullness or

hunger does not work properly in people with PWS. They overeat, leading to obesity. Babies with PWS are usually floppy, with poor muscle tone,

and have trouble sucking. Boys may have undescendedtesticles. Later, other signs appear. These include

Short stature Poor motor skills Weight gain Underdeveloped sex organs Mild mental retardation and learning disabilities Position Paper of the ADA

It is the position of the American Dietetic Association that nutritionservices are essential components of comprehensive

care for infants, children and adults with developmentaldisabilities and special

health care needs. JADA, 2004.

Nutrition Risk Factors for Child with Developmental Disabilities andSpecial Health Care Need

Failure to Thrive Altered Growth Potential Obesity Altered Energy Needs Conditions Which Alter Growth Potential

Chromosomal Aberrations Down syndrome Prader-Willi syndrome How Growth is Altered



Limited growth potential for height and head circumference Low muscle tone Delayed gross motor development Greater potential for being overweight Delayed growth velocity after the first year Factors That Influence Growth In Children With Special Health Care

Needs Medication Disease Congenital deviation in growth Impaired motor skills Feeding problems General Goals of Medical

Nutrition Therapy Maintain biochemical balance for the affected metabolic

pathway Provide adequate nutrition for growth and development Support social and emotional development

Proposed Causes of Autism Disorders Toxic environment Toxic food Nutritionally Deficient Foods Immune system problems Oxidative stress Emotional stress Medical Nutrition Therapy Mineral and vitamin therapy Exclusion diets

◦ Gluten-Casein Free

◦ Specific Carbohydrate diets

◦ Body Ecology dietProblems: very little published to show valueCost of the special foodsSome website information for parents is notscientifically correct.

ADHD is Neurologically Based There is a 6 % prevalence rate in school children More common in males than females Linked to mood and anxiety disorders

◦ Learning disorders

◦

Oppositional Defiant Disorders◦ 20-30% of children with ADHD have one parent with

ADHD Some authors report that 60% of children with (PDD) meet

criteria for ADHD. In contrast, autistic traits have also been identifiedin children with ADHD. Recent studies confirm that the most common diagnosis prior

to autism is ADHD.



Diagnostic Criteria Inattention Hyperactivity Impulsivity FAMOUS ADHD Napoleon

Thomas Jefferson Bill Clinton Benjamin Franklin Thomas Edison Winston Churchill Bono (lead singer for US) John F. Kennedy Abraham Lincoln Physician’s Statement

for Children With a Disability The child’s disability Explanation of why the disability restricts the child’s diet

Major life activity affected by the disability Food or foods to be omitted from the diet and food choices

that may be substituted Most Frequent Nutrition Problems Menu Modification for

◦ Calorie Restriction

◦ Increased Calories

◦ Diabetic

◦ Food Intolerances- Feeding Problems requiring:

Texture modification

Tube feeding The Team Approach Successful food service for children with special needs and

disabilities takes a team approach that involves:

◦ Parents

◦ Teachers

◦ Therapists

◦ Food service team Expected Outcomes Better health for the child Better school attendance Improved learning

A Healthy Diet Whole foods Unprocessed Organic Fermented foods: rich in probiotics Grass-fed/pastured meat and eggs Good fats Free of food intolerances What is Diet?



1) Remove: Avoid offending foods➢ Gluten, casein, soy, corn, phenols, oxalates, starches➢ Replenish: Increase healthy foods➢ Consume more nutrients and Probiotics in foods➢ Make foods more digestible for absorption

Food Additives

Unhealthy Ingredients to Avoid Ingredients to Avoid:

◦ Artificial colors/flavors and preservatives - candy, cereal, “kids’foods”

◦ MSG (hydrolyzed protein, yeast extracts) - broth, bullion, soup,meat-flavored foods

◦ Pesticides - non-organic produce and meat

◦ Aspartame and other artificial sweeteners - sodas and otherfoods

◦ Trans fats - partially hydrogenated oil, commercial margarine,mayonnaise, peanut butter

◦

Nitrates/nitrites - bacon, hotdogs, lunch meat These ingredients can cause:

◦ Hyperactivity *

◦ Inattentiveness

◦ Aggression

◦ Irritability

◦ Headaches/pain

◦ Trigger asthma

◦ Overload detoxification Natural Food Compounds Diet Benefits AVOID

Beyond GFCF Soy-free Corn-free Specific Carbohydrate Diet Food additives Feingold Diet Dysbiosis - Adding Probiotics/fermented foods, Body Ecology

Diet Low Oxalate Diet Specific Carbohydrate Diet TM

Removes disaccharides and polysaccharides(most sugars & starches)

Allows only monosaccharides(honey, fruit, non-starchy vegetables)

SCD Specifics(Begin SCD casein-free)

Possible Causes of Picky Eating



Addictions to opiates (gluten/casein) cause consumption of primarily wheat and dairy containing foods

Addictions to chemicals (MSG, artificial additives) causerestriction to one brand or large preference for processedfoods

Nutrient deficiencies (zinc) makes everything taste bad or

bland Yeast, viral, and microbial overgrowth may cause focus on

eating mainly high carb and sugar foods Sensory sensitivities can restrict the

consumption of certain textures. For Picky Eaters Always provide food child likes in addition to one "new" food. Involve your children in food preparation of "new" food. Small taste ~ 1/2 teaspoon. Let child determine amount. Inform them. Let child know whether it is sweet, salty or sour. Let them spit it out. Try and Try Again! At least 15 times!

Get creative. Try new food in preferred texture - crunchy, smooth. Avoid being emotionally “attached” - children sense anxiety. Keep mealtime calm. Visualize child eating/enjoying new food. Avoid forcing or pushing - maintain trust. Choose rewards or other encouragement. Make sure whole family participates - serve everyone at the table Make it fun! Seek support when needed. ALD Adrenoleukodystrophy is passed down from parents to their children as

an X-linked genetic trait. It therefore affects mostly males, although some women who are

carriers can have milder forms of the disease. It affects approximately 1 in 20,000 people from all races. The condition results in the buildup of very-long-chain fatty acids in the

nervous system, adrenal gland, and testes, which disrupts normalactivity.

There are three major categories of disease: Childhood cerebral form: appears in mid-childhood (at ages 4-8) Adrenomyelopathy --occurs in men in their 20s or later in life Impaired adrenal gland function (called Addison disease or Addison-like

phenotype) -- adrenal gland does not produce enough steroidhormones

SymptomsChildhood cerebral type:

Adrenal problems Changes in muscle tone, especially muscle spasms and

spasticity Crossed eyes (strabismus) Decreased understanding of verbal communication (aphasia) Deterioration of handwriting Difficulty at school



Difficulty understanding spoken material Hearing loss Hyperactivity Progressive nervous system deterioration

◦ Coma

◦ Decreased fine motor control

◦ Paralysis Seizures Swallowing difficulties Visual impairment or blindness

Signs and tests Blood levels show elevated very-long-chain fatty acids Chromosome study shows ABCD1 gene mutations MRI of the head shows damage to the white matter of the

brain Treatment Adrenal dysfunction is treated with steroids

(such as cortisol). A specific treatment for X-linked Adrenoleukodystrophy is not

available, but eating a diet low in very-long-chain fatty acidsand taking special oils can lower the blood levels of very-long-chain fatty acids.

These oils are called Lorenzo's oil, after the son of the familywho discovered the treatment. This treatment is being testedfor X-linked Adrenoleukodystrophy,

but it does not cure the disease and may not help all patients.Sadly, Lorenzo lost his battle with ALD anddied on May 30, 2008, one day after his 30th birthday.

It's due to the oil that I'm here now.Glenn Stafford

Perhaps the oil could prevent the disease ever appearing. Boys like Barry's younger brother Glenn were put on the oil. After 10 years the results are finally through. And they are

dramatic. Of 120 boys in the trial 83 are still free of the disease.

Lorenzo's Oil is showing a significant preventative effect. According to Dr Moser taking the oil reduced the chance of

getting the disease by half. And Glenn Stafford, the first non-symptomatic patient to be

out on the oil is now 21 years old and fully fit. So now there is real hope. Tests can identify boys with thegene, and the oil gives them a hugely improved chance of escaping the horrific disease.

DietGoals



to decrease the exogenous source of VLCFA - food sources of fats, cholesterol, grains, nuts, fruits and vegetable skins, milk -> very restrictive diet

to decrease the endogenous production of VLCFA with theingestion of monounsaturated VLCFA's

Glyceryl Trierucate Oil (GTO)

90% oleic acid (C18:1) found naturally in olive oil, corn oil,sunflower seed oil

ingestion results in a decrease in VLCFA's by 50% in 4 monthsGlyceryl Trioleate Oil (GTE) erucic acid (C22:1) - found naturally in rapseed oil

Lorenzo's Oil 4 parts GTO: 1 part GTE VLCFA-restricted diet with Lorenzo's Oil may normalize C26:0

levels within 4 weeks normalizes RBC membrane microviscosity

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Intellectual Disability - SHOW