SW 644: Issues in Developmental DisabilitiesDevelopmental Disabilities Part I

Part I, Foundation & Introduction Lecture Presenter:

Mary Pearlman, M.D.

Developmental Disability – Definition

Mental or Physical Disability Starting before age 22 Continues indefinitely Limits one or more major life activity

Major Life Activities

Self care Language Learning Mobility Self-direction Independent living Economic Self Sufficiency

Major Conditions

Mental Retardation Central Palsy Autism Epilepsy Conditions caused by medical disease

(e.g. Polio)

Other conditions can also severely limit major life activities

Mental Illness Severe 2° Brain Injury 2° = secondary Physical Illness

Each organization uses a slightly different definition depending on their point-of-view

State/Federal Government School System Parent/Advocacy programs Professionals of different varieties Differences due to:

Point-of-view Funding Educational Purposes

DSM IV In the DSM IV a condition must cause:

Dysfunction DisorderTo be a disorder

Dysfunction is trouble Working Playing Loving

That’s what Freud said We now use an official scale GAF (Global

Assessment of Function) to measure it

Note how similar the definition of dysfunction is to the definition of major life activity limits

The Nosological systems (i.e. system of categorization) are artificial

We use categories to describe conditions that occur in nature on continuum

Example I: Flapping

Family next door: S has flapped her hands and jumped

when excited since infancy All functions WNL (Within Normal Limits) Family notices Flapping Child gradually doing less Flapping Family ignore behavior as a childhood

characteristic No one is uncomfortable (No disease)

Dr. Pearlman demonstrates flapping

Example II: Flapping Early Childhood Screening: A has flapped her

hands and jumped when excited since infancy. Functions:

Speaks 30 single words Not potty trained Gross motor and fine motor skills excellent

in environment with more than 5 people screams and rides

Can’t play with others or take turns Family distressed by how much the child is

unhappy and the screaming There is dysfunction; there is disease

Example III: Flapping Pediatricians Office: V has flapped her hands

and jumped when excited since infancy All Functions WNL (Within Normal Limits)—No

Dysfunction Family Notices: dad insists that children

should behave properly socially and M is embarrassed by the behavior in front of friends

The family has used a light slap on the hands or clear “no” since infancy in response to the flapping. The behavior has not stopped. The family reports the child stealthily flaps and then lies about it.

Example III: Flapping (cont.)

There is an enormous amount of disease

Family function disrupted Family history: there is a cousin in

the family with sever autism, who flaps

The Five Axes

Axis I: No Axis I disorder Axis II: Cognitive Condition Axis III: Medical Disorder – None Axis IV: Family dysfunction Axis V: Overall function OK –

impairment in child’s self conceptHave to look at all 5 axes.

Do not jump to conclusions.

We don’t diagnose on the basis on behavior.

Life Long Dysfunction? Could this impairment in self concept

evolve into a life long dysfunction? It could It also could just turn into a functional but

somewhat negative adult

Poor Parenting?

Are severe disabilities like DD ever caused by poor parenting?

No It takes a blending of factors:

Genetic Environmental Caretaking goodness of fit – to produce A

DD outcome

Parenting and Environmental Factors

Parenting and environmental factors don’t cause the disease, or cure it

They can promote access to: Improved emotional stability Improved optimization of skill potential Make community life easier for all

concerned

If mental illness such as ADHD and schizophrenia can cause both disease and dysfunction from an early age on why aren’t they considered developmental disabilities?

Mental Illness Mental problems are expressed in the areas

of conditions, emotions and thought. These conditions occur because of faulty physiology and/or anatomy by the brain and body. The dysfunction are expressed through: Cognitions Emotions Thought Often a motor component

Developmental Issues

Developmental problems are expressed in the areas of cognitions, emotions, thought and motor problems

These conditions occur because of faulty physiology and/or anatomy of the brain and body

Disabilities v. Mental Disabilities

So what are the differences between disabilities and mental disabilities?

How we categorize them That’s it

Developmental Disability – True Definition A disability is something wrong with the

body/brain life to be hard and can include problems expressed in all areas of human function

Life is hard for the individual with the disorder and everyone who comes in conduct with the person

Mostly no one wants to help with the extra effort and monetary cost

People are constantly making up labels to include or exclude people from service

Dialogue The dialogue about diagnosis is

Scientific Political And should also be informed by practical social

function: Will the society function better if we people

support? Ethical considerations

How much responsibility do we have for our brother?

Suffering is transformative: Without proper support it moves the spirit tends toward bitter selfishness and narrowness of view.