Download - Intellectual Disaabilities
Intellectual Disabilities
Dr. Shewikar El BakryAss. Prof. Psychiatry
Banha University
The Nature of Intellectual Disability
“An intellectual disability, formerly referred to as “mental retardation” is characterized by a combination of deficits in both cognitive functioning and adaptive behavior.The severity of the intellectual disability is determined by the discrepancy between the individual's capabilities in learning and in and the expectations of the social environment. (Project IDEAL, 2008)
Definition• Deficits in IQ and adaptive functioning• IQ of 70 or below– Measured by standard scales• Wechsler, Stanford-Binet, Kaufman
• Impairments in Adaptive Functioning– Effective coping with common life demands– Ability to meet standards of independence– Measured by standard scales• Vineland, AAMR Adaptive Behavior Scale
The Nature of Intellectual Disability
“ Intellectual disability is a term used when a person has certain limitations in mental functioning and skills such as communicating, taking care of himself/herself and social skills.These limitations cause a child to learn and develop more slowly than a typical child.
Definitions for Intellectual Disability
“Significantly sub-average general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child’s educational performance.”
IDEA (Individuals with Disabilities Education Act)
Conceptual skills—language and literacy; money, time, and number concepts; and self-direction.
Social skills—interpersonal skills, social responsibility, self-esteem, gullibility, naïveté (i.e., wariness), social problem solving, and the ability to follow rules/obey laws and to avoid being victimized.
Practical skills—activities of daily living (personal care), occupational skills, healthcare, travel/transportation, schedules/routines, safety, use of money, use of the telephone.
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AAMR Adaptive Skill
Areas
Prevalence
• 1% (1 – 3% in developed countries)• The prevalence of ID due to biological factors is
similar among children of all SES; however, certain etiological factors are linked to lower SES (e.g., lead poisoning & premature birth)
• More common among males (1.5:1)• In cases without a specifically identified biological
cause, the MR is usually milder; and individuals from lower SES are over-represented
Distribution
CAUSES
Etiology and Classifications of Intellectual Disability
PRENATAL CAUSES
PERINATAL CAUSES
POSTNATAL CAUSES
1. Chromosomal Disorders
2. Inborn Errors of Metabolism
3. Developmental Disorders of Brain Formation
4. Environmental Influences
1. Anoxia (complete deprivation of oxygen)
2. Low birth weight (LBW)
3. Syphilis and herpes simplex
1. Biological
2. Psychosocial
3. Child Abuse and Neglect
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Possible Causes of Mental Retardation
PRENATAL CAUSESChromosomal
Disorders
Congenital intellectual disability and microcephally
Involves heart defects, hearing loss, and abnormalities of fingers and hands. Short stature
Manifest self-injurious behavior and limited speech and stereotypy
PRENATAL CAUSESChromosomal Disorders
Cornelia de Lange Syndrome
(Pierangelo & Giuliani,2007)
Difficulty swallowing and sucking
Low birth weight and poor growth
Unusual facial features and epicanthal fold broad flat nose
Hyperactive, aggressive, and repetitive movements
PRENATAL CAUSESChromosomal Disorders
Cri-du-ChatSyndrome
Also referred to as trisomy 21Usually not an inherited
conditionThe most common type of
chromosomal disorderIt involves the anomaly at the
21st set of chromosomes.People with DS exhibits
unusual facial features and with broad hands with short fingers
PRENATAL CAUSESChromosomal Disorders
Down’s Syndrome
(Pierangelo & Giuliani, 2007)
Sterility in menDecreased IQ Poor coordinationSkeletal abnormalitiesPoor coordination
PRENATAL CAUSESChromosomal Disorders
Klinefelter’s Syndrome
Prader-Willi Syndrome
Inherited from fatherInfants are lethargic and have
difficulty eating but eventually becomes obsessed with food as they grow hoarding and obsessive
The leading genetic cause of obesity.
People with Prader-Willi syndrome are at risk for a variety of other health problems such heart defects, kidney problems, scoliosis, etc.
PRENATAL CAUSESChromosomal Disorders
Turner’s Syndrome
Normally found in femalesPersons with Turner’s
syndrome has webbing of the neck, puffiness or swelling of the hands and feet
Associated with heart defects and kidney problems
PRENATAL CAUSESChromosomal Disorders
(Pierangelo & Giuliani,2007)
William’s Syndrome
Caused by the absence of material on the seventh pair of chromosome.
People with William’s syndrome exhibit heart defects and “elfin” facial features.
Their unusual sensitivity to sound makes them competent in music and language despite of their low IQ level.
PRENATAL CAUSESChromosomal Disorders
Fragile X Syndrome
Most common known hereditary cause of intellectual disability
Associated with X chromosome in the 23rd pair of chromosomes
Occurs less often in femalesPersons with Fragile X Syndrome have
behavior and emotional problems and poor socialization skills
They become anxious when routines are change
They have unusual facial features
PRENATAL CAUSESChromosomal Disorders
(Hallahan & Kauffman,2003) (Piearangelo & Giuliani, 2007)
PRENATAL CAUSESInborn Errors of
Metabolism
Galactosemia - inability of the body to use simple sugar galactose
Hunter Syndrome – defective breakdown of chemical mucopolysaccharide.
Phenylketonuria (PKU) – inability of the body to convert phenylalanine to tyrosine)
Tay-Sachs Disease – absence of Hex-A enzyme.
PRENATAL CAUSESInborn Errors of Metabolism
(Piearangelo & Giuliani, 2007)
Can be prevented through an early detection (e.g. newborn screening) and can be treated by providing a special diet program.
PRENATAL CAUSESDevelopmental
Disorders of Brain Formation
Microcephalus
The intellectual disability usually ranges from severe to profound.
There is no specific treatment and life expectancy is low.
PRENATAL CAUSESDevelopmental Disorders
of Brain Formation
(Hallahan & Kauffman,2003)
Hydrocephalus
Results from an accumulation of cerebrospinal fluid inside or outside the brain.
The degree of intellectual disability depends on how early the condition is diagnosed and treated.
PRENATAL CAUSESDevelopmental Disorders
of Brain Formation
(Hallahan & Kauffman,2003)
PRENATAL CAUSESEnvironmental
Influences
Maternal Malnutrition and Infection
Fetal Alcohol Syndrome (FAS)
Lead exposureIllicit drug exposureExposure to RadiationRubella (German measles)
PRENATAL CAUSESEnvironmental Influences
PERINATAL CAUSES
Anoxia (deprivation of oxygen)
Low birth weight (LBW)
Syphilis and herpes simplex
PERINATAL CAUSES
(Hallahan & Kauffman,2003)
POSTNATAL CAUSESEnvironmental and
Psychosocial Problems
Nutritional ProblemsAdverse living
conditionsInadequate health careLack of early cognitive
stimulation
POSTNATAL CAUSESEnvironmental and
Psychosocial Problems
Child abuse and neglectTraumatic Brain InjuryMeningitis or EncephalitisLead Poisoning
POSTNATAL CAUSESEnvironmental and
Psychosocial Problems
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Assessing Intellectual Ability and Adaptive Behavior
• Assessing Intellectual Ability (IQ testing)– Problems:• Potential for cultural bias• Flexibility of IQ scores• Overemphasis on IQ scores
• Assessing Adaptive Behavior – Considers the context of the individual’s
environment and cultural influences– Often measured by direct observation, interviews,
behavior rating scales
How Are ID Classified?
• Severity (Used in schools since the 1980s and based on IQ)– Mild = 50 to 70-75, Moderate = 35 to 50– Severe = 20 to 35, Profound = Below 20
• AAMR Levels of Support Needed– Intermittent – Limited– Extensive– Pervasive
Diagnosis
• History: pregnancy, labour, medications.• family, consanguinity• Psychiatric interview: Speech, thinking, mood• Physical examination: face , eyes, ears, tongue, teeth, • skin, thyroid, measurements• Neurological examination: gait, coordination, • sensations, reflexes, tone, motility
Investigations
• Chromosomal studies• Lab• EEG• Neuro imaging• Hearing, Eye and speech evaluation• Psychological assessment
Comorbid Conditionsfor Persons with
Intellectual Disabilities
Most Commonly Associated Axis I Disorders
• ADHD• Mood Disorders• Pervasive Developmental Disorders• Stereotypic Movement Disorders• Schizophrenia• Mental Disorders due to a GMC• Epilepsy
PLACEMENT PROGRAMS
for Persons with Intellectual Disabilities
For children with mild intellectual disability, readiness and functional academic skills are present and thus can be placed into Inclusion Programs.
Educational placement programs for children with moderate to severe intellectual disability can be more tedious. Curriculum and materials for these children should be age-appropriate, which should help develop independent behavior within the child.
Individualized Education Program (IEP) is designed to cater the special educational needs of special children. This is a useful and common vehicle to develop skills and educate children with intelletual disabilities who are in more severe cases.
Behavior Therapy Programs may also be employed, as they are very useful in altering behavior by lessening distruptive or inappropriate actions of a particular child.
Alternative Programs can also be incorporated in a child’s special education process. Such programs would include vocational training, physical education, theatre, music, etc.
Unlike preschool programs for children at risk, in which the goal is to prevent intellectual disability from occurring, programs for infants and preschoolers who are already identified with intellectual disability are designed to help them achieve as high a cognitive level as possible (Hallahan & Kauffman, 2003).
PLACEMENT PROGRAMSEarly Childhood
These programs gives more emphasis on conceptual and language development and usually involves speech and physical therapists most specially when children have multiple disabilities.
PLACEMENT PROGRAMSEarly Childhood
How Do I Teach Students with Intellectual Disabilities?
• Direct instruction with clear objectives, advance organizers, “think-aloud” model, guided practice, independent practice, post-organizers– Focus on task analysis– Focus on sequencing tasks for recognition, recall,
reconstruction– Focus on presentation and practice, including use
of prompts• Generalization
Most authorities agree that although the degree of emphasis on transition programming should be greater for older than for younger students, such programming should begin in the elementary years (Hallahan & Kauffman, 2003).
PLACEMENT PROGRAMSTransition to Adulthood
Transition programming for individuals involves two related areas; first, community adjustment to acquire a number of self-help skills and second, employment to lead to a meaningful job.
PLACEMENT PROGRAMSTransition to Adulthood
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Family Issues
• Families with a child with mental retardation may experience a wide range of concerns and often rely on a support network made up of friends and family members in addition to parent organizations and professional groups.
Medical Therapy
• SSRI (fluoxetine, sertraline, proxetine)• Antipsychotics (Risprdone, olanzapine,
aripiprazole)• Alpha 2 agonists (clonididne)• Lithium• Anticonvulsants