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Questions and Answers
What term is used throughout Ontario to describe certain conditions related to limitations in functioning?
What term is used throughout Ontario to describe certain conditions related to limitations in functioning?
Developmental Disabilities
Which of the following conditions are considered developmental disabilities? (Select all that apply)
Which of the following conditions are considered developmental disabilities? (Select all that apply)
Developmental disabilities only include genetic abnormalities.
Developmental disabilities only include genetic abnormalities.
False
What must be considered in assessing limitations in functioning?
What must be considered in assessing limitations in functioning?
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Which of the following is a criterion for diagnosing intellectual disabilities according to DSM-5?
Which of the following is a criterion for diagnosing intellectual disabilities according to DSM-5?
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Match the severity levels with their descriptions:
Match the severity levels with their descriptions:
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About 25-50% of developmental disabilities are caused by biomedical nature.
About 25-50% of developmental disabilities are caused by biomedical nature.
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The _____ is used to describe the interaction between health conditions and contextual factors.
The _____ is used to describe the interaction between health conditions and contextual factors.
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What is the purpose of the ICF-CY?
What is the purpose of the ICF-CY?
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The ICF-CY makes explicit distinctions between mental and physical disabilities.
The ICF-CY makes explicit distinctions between mental and physical disabilities.
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What does neutrality in ICF refer to?
What does neutrality in ICF refer to?
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Name one environmental factor included in the ICF.
Name one environmental factor included in the ICF.
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What are disorders of intellectual development characterized by?
What are disorders of intellectual development characterized by?
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Which of the following is NOT an inclusion under body functions related to intellectual development?
Which of the following is NOT an inclusion under body functions related to intellectual development?
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What does the term 'dual diagnosis' refer to?
What does the term 'dual diagnosis' refer to?
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The ICF-CY can be applied consistently across national boundaries.
The ICF-CY can be applied consistently across national boundaries.
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In the ICF-CY, _____ factors include social attitudes, institutions, and laws.
In the ICF-CY, _____ factors include social attitudes, institutions, and laws.
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Which Act was replaced by the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008?
Which Act was replaced by the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008?
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What perspective has led to a broader understanding of developmental disabilities?
What perspective has led to a broader understanding of developmental disabilities?
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Which of the following are grounds of discrimination under the Canadian Human Rights Act?
Which of the following are grounds of discrimination under the Canadian Human Rights Act?
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The Canadian Human Rights Act protects individuals from discrimination based on physical and mental disabilities.
The Canadian Human Rights Act protects individuals from discrimination based on physical and mental disabilities.
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What does Dual Diagnosis Consultation, Outreach Stabilization Service aim to provide?
What does Dual Diagnosis Consultation, Outreach Stabilization Service aim to provide?
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What percentage of adults with developmental disabilities might experience a comorbid mental health condition?
What percentage of adults with developmental disabilities might experience a comorbid mental health condition?
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Match the following factors contributing to mental health disorders:
Match the following factors contributing to mental health disorders:
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The process of investigating and documenting knowledge, skills, and attitudes is known as ______.
The process of investigating and documenting knowledge, skills, and attitudes is known as ______.
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What is diagnostic overshadowing?
What is diagnostic overshadowing?
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What are the basic assessment actions involved in the assessment process?
What are the basic assessment actions involved in the assessment process?
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Individuals with intellectual disabilities are often under treated in mental health settings.
Individuals with intellectual disabilities are often under treated in mental health settings.
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What does a statement of scope of practice describe?
What does a statement of scope of practice describe?
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A diagnosis is often a permanent designation.
A diagnosis is often a permanent designation.
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What is the purpose of assessing adaptive skills?
What is the purpose of assessing adaptive skills?
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Which assessment tool provides a semi-structured interview to assess adaptive functioning?
Which assessment tool provides a semi-structured interview to assess adaptive functioning?
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A diagnosis helps others to understand and identify _____, supports, and services.
A diagnosis helps others to understand and identify _____, supports, and services.
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The ABAS-3 assesses adaptive skills in areas important for day-to-day functioning.
The ABAS-3 assesses adaptive skills in areas important for day-to-day functioning.
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What are two long-term goals that may be developed through treatment?
What are two long-term goals that may be developed through treatment?
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Match the following scales with their primary focus areas:
Match the following scales with their primary focus areas:
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What is NOT a component of a good assessment?
What is NOT a component of a good assessment?
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What does the Self-Direction scale provide information about?
What does the Self-Direction scale provide information about?
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What is the main purpose of intervention?
What is the main purpose of intervention?
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What condition was Michelle diagnosed with?
What condition was Michelle diagnosed with?
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The assessment of SIB may require trials of interventions, some of which may cause __________ escalations.
The assessment of SIB may require trials of interventions, some of which may cause __________ escalations.
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What is the number of chromosomes after a female gamete is fertilized?
What is the number of chromosomes after a female gamete is fertilized?
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Cells that can differentiate into many cell types are known as pluripotent cells.
Cells that can differentiate into many cell types are known as pluripotent cells.
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The prescription of antipsychotic medication for challenging behaviors is considered acceptable practice.
The prescription of antipsychotic medication for challenging behaviors is considered acceptable practice.
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What period does the embryonic stage of pregnancy cover?
What period does the embryonic stage of pregnancy cover?
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What stage follows the zygotic period in human development?
What stage follows the zygotic period in human development?
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Which of the following are considered causes of intellectual disability? (Select all that apply)
Which of the following are considered causes of intellectual disability? (Select all that apply)
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What is a percentile score?
What is a percentile score?
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What is the role of genes in chromosomes?
What is the role of genes in chromosomes?
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Which of the following is not considered an effective guideline for intervention?
Which of the following is not considered an effective guideline for intervention?
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What can excessive medication lead to, as evidenced in Michelle's case?
What can excessive medication lead to, as evidenced in Michelle's case?
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The process of cell division where each cell divides into 2 daughter cells is called ______.
The process of cell division where each cell divides into 2 daughter cells is called ______.
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Meiosis results in cells with only ______ chromosomes.
Meiosis results in cells with only ______ chromosomes.
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What is the significance of the Human Genome Project?
What is the significance of the Human Genome Project?
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Match the major components with their descriptions:
Match the major components with their descriptions:
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Study Notes
Developmental disability Definitions
- Developmental Disabilities are conditions that cause limitations in present functioning.
- These limitations are considered within the context of the individual's age, peers, and culture.
- The term is used in Ontario to describe specific conditions.
- There are many other terms previously used, some appropriately and some not, such as mental handicap, mental retardation.
- Developmental Disabilities can be caused by a single or multiple factors, such as a syndrome or a combination of contributing factors.
Severity Levels
- Mild: About 85% of persons have mild intellectual disabilities.
- Moderate: About 10% of persons have moderate intellectual disabilities.
- Severe: About 3-4% of persons have severe disabilities.
- Profound: About 1-2% of persons have profound disabilities.
Diagnostic Tools
- DSM-5: (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) provides criteria for intellectual disability and other developmental conditions.
- ICD-11: (International Classification of Diseases, Eleventh Revision)
- The Education Act (Ontario) designates students as "exceptional" in five (5) categories including intellectual.
- ICF-CY: (International Classification of Functioning, Disability and Health for Children and Youth)
- ABAS-3: (Adaptive Behaviour Assessment System Third Edition)
- Vineland-3: (Adaptive behaviour assessment)
ICF Framework
- ICF (International Classification of Functioning, Disability and Health) is a framework used to describe an individual's functioning and disability.
- It includes two main components: Body functions and structures and Activities and Participation.
- Body functions include the physiological functions of body systems, including psychological functions
- Body structures are anatomical parts of the body such as organs, limbs and their components.
- Activity is the execution of a task or action by an individual
- Participation is involvement in a life situation
- Environmental Factors make up the physical, social and attitudinal environment in which people live and conduct their lives.
ICF-CY Framework
- The International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) is a WHO- approved classification based on the ICF.
- It is a detailed classification used to document the relevant aspects of functioning and health in children and youth.
- The ICF-CY is intended for use by clinicians, educators, policy-makers, family members, consumers and researchers.
Key facts
- Approx. 25-50% of all developmental disabilities are caused by a biomedical nature, most commonly genetic abnormalities.
- 2/3rds of people with disabilities have mild to moderate intellectual disabilities, while ⅓ have severe to profound disabilities.
- Most common disabilities in Canada include: autism, fetal alcohol syndrome, downs syndrome, fragile X syndrome and 22q11 deletion syndrome.
- In Ontario, the IPRC (Identification, Placement and Review Committee) makes decisions on whether students are exceptional based on observations, test results and assessments.
International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY)
- ICF-CY provides a framework for understanding health, functioning, and development for children and youth
- It encompasses bodily functions and structures, activity limitations, participation restrictions, and environmental factors
- Utilizes a common language to describe the health of children and youth
- Can be applied across disciplines, government sectors, and nations
Intellectual Functions
- Refers to mental abilities, including all cognitive functions and their development
- Includes functions related to intellectual growth and intellectual disability/mental retardation
- Excludes memory functions, thought functions, basic and higher-level cognitive functions
Disorders of Intellectual Development
- Characterized by significantly below average intellectual functioning and adaptive behavior
- The individual typically scores at least 2 standard deviations below the mean in standardized intellectual tests
- If standardized testing is unavailable, diagnosis relies on clinical judgment and assessment of comparable behavioral indicators
Pros and Cons of Disability Terms
- Cons:
- May lead to isolation and segregation of individuals
- Denies personal freedoms and human rights, including procreation
- Contributes to stereotyping
- Pros:
- Helps identify and assist people with special needs
- Protections for rights and needs of these groups
- Common basis for understanding and advocacy
- Broadens understanding and facilitates self-advocacy
- Focuses attention on specific issues
International Classification of Diseases, 11th Revision (ICD-11)
- Used globally for resource allocation to people with developmental disabilities
- Focuses on mental, behavioral, and neurodevelopmental disorders
- Defines neurodevelopmental disorders as conditions with significant difficulties in acquiring and executing specific intellectual, motor, or social functions
Neurodevelopmental Disorders
- Characteristics:
- Arise during the developmental period
- Involve significant difficulties in acquiring and executing specific intellectual, motor, or social functions
- Are distinct from other mental and behavioral disorders that may emerge during development (e.g., Schizophrenia, Bipolar Disorder)
- Includes only disorders whose core features are neurodevelopmental
- Etiology is often complex, and in many cases unknown
Trends and Perspectives on Developmental Disabilities
- Understanding of developmental disabilities is evolving over time
- Traditionally viewed through categories of intellectual capacities, communication skills, behavior, or developmental rate
- Modern perspectives consider broader aspects like how individuals handle life demands and level of independence compared to their peers
- Emphasize inclusion and human rights, moving away from deficit-focused approaches
Types of Models for Understanding Developmental Disabilities
- Legal: Focuses on legal status and eligibility for services, with potential implications for rights and privileges
- Biomedical: Emphasizes diagnoses and medical intervention with specific rules and regulations determining care
- Social/Human Rights: Examines the disability within the context of societal barriers and limitations, aiming for inclusion and empowerment
Developmental Disabilities in Ontario
- Ontario's Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008:
- Broadened the definition of developmental disabilities to include conditions like Autism Spectrum Disorder and Fetal Alcohol Spectrum Disorder
- Emphasizes a person-centered approach and increased community-based supports
- Supports direct funding and person-directed planning, empowering individuals to make choices and manage their own services
- Enhances accountability to ensure efficient use of public funds and safeguard individual well-being
Human Rights Legislation for People with Disabilities
- Canada has robust legal framework for protecting the rights of people with disabilities:
- Canadian Charter of Rights and Freedoms guarantees equal rights regardless of disability
- Canadian Human Rights Act prohibits discrimination in employment, services, and other areas based on disability
- Grounds of discrimination under the Canadian Human Rights Act:
- Race, national or ethnic origin, color, religion, age, sex, sexual orientation, marital status, family status, disability, conviction for which a pardon has been granted or a record suspended
- Individuals experiencing discrimination can file complaints with the Canadian Human Rights Commission
Comorbidity and Dual Diagnosis in Developmental Disabilities
- Individuals with Intellectual Disability can also experience mental illness
- Dual diagnosis refers to the presence of intellectual disability and mental illness
- Understanding of dual diagnosis within the developmental disability population has evolved
- People with intellectual disability experience a similar range of mental illness as the general population
- Mental health concerns include mood and anxiety disorders, adjustment problems, personality disorders, and ADHD
- Behavioral challenges associated with dual diagnosis:
- Verbal and physical aggression, self-injurious behavior, attentional difficulties, oppositional behaviors
- Some disorders, like Autism Spectrum Disorder, are more prevalent among people with intellectual disability compared to the general population
Dual Diagnosis Consultation, Outreach Stabilization Service
- Offered in Windsor-Essex through Hotel Dieu Grace Healthcare (HDGH)
- Serves individuals 16 years and older with pre-existing intellectual/developmental disability and mental health disorder
- Targets individuals exhibiting self-harming or threatening behaviors
- Provides short-term stabilization program (6-12 months) with a focus on bio-mental healthcare intervention
Factors Contributing to Mental Health Concerns in Individuals with Intellectual/Developmental Disabilities
- Biological, psychosocial, and environmental factors play a role
- Biological factors include genetic predisposition and physiological changes associated with disability
- Psychosocial factors include family history of mental illness, social isolation, and lack of support
- Environmental factors include access to healthcare, educational opportunities, and societal attitudes
Prevalence Rate of Mental Illness in DD Population
- Current research suggests an increased likelihood of mental health conditions within the DD population.
- Estimates range from 10% to 40% of adults with DD experiencing comorbid mental health issues.
- It's estimated that out of 227,000 individuals diagnosed with DD, 85,000 are expected to have a mental health issue.
- Specific DD groups are more vulnerable to certain mental health disorders, with individuals diagnosed with Autism Spectrum Disorder showing a propensity for mood and adjustment disorders.
Clinical Challenges in Assessing DD Population
- Diagnostic Overshadowing: There is a tendency to underestimate signs of psychiatric or emotional disturbances in the DD population.
- Problematic behaviors are often misconstrued as part of the developmental disability rather than potential symptoms of a comorbid disorder.
- Behavioral Highlighting: The presence of severe or intense behavioral problems can hinder the detection of underlying mental health concerns.
- Communication and cognitive impairments make it difficult for individuals with DD to convey distress.
- Recognizing clinical challenges and utilizing assessment tools tailored to this population is crucial for providing appropriate care, supports, and interventions.
Assessment
- Objective - Assessment provides valuable insights into an individual's strengths and needs.
- Holistic - Considers all aspects of an individual's life and their interactions within their environment.
- Adaptability - Evaluates how an individual's needs and capabilities change over time.
Five Basic Assessment Actions
- Identify the problem - Determine the specific issue or situation requiring attention.
- Gather information - Collect as much relevant data as possible about the problem or situation.
- Analyze strengths and needs - Identify aspects of the situation working well (strengths) and those that require improvement (needs).
- Understand influencing factors - Determine factors contributing to improvements and those hindering progress.
- Develop intervention plans - Establish strategies to enhance positive factors and minimize hindering factors.
The Regulated Health Professions Act (RHPA) framework is designed to:
- Protect and serve the public interest.
- Ensure a transparent and accountable system of self-governance within health professions.
- Modernize the regulation of health professions.
- Provide consumers with choices and options.
- Implement mechanisms to improve the quality of care.
Challenges in Determining Disability
- Establishing consistent diagnostic criteria across different policies and regulations can be challenging.
- Services may have different eligibility requirements, requiring varying emphasis on specific aspects of the disability.
- Determining responsibility for diagnosis and understanding the purpose behind it are crucial.
Assessment & Treatment Formulation
- Systematically examine multiple areas potentially contributing to a disturbance.
- Identify concerns - Recognize what the problem is, who is affected, and why it's occurring.
- Analyze history of the concern - Understand what interventions have been attempted, what worked, and what didn't.
- Understand background information - Assess the individual's developmental level, social circumstances, medical history, emotional responses and coping skills, prior psychiatric history, and available supports.
- Conduct thorough examinations - Assess the individual's physical health, mental status, and existing data.
- Evaluate support systems - Determine the adequacy and effectiveness of existing support systems.
Problem Identification and Intervention
- Problem: Michelle, a 29-year-old nonverbal woman with autistic behaviors, exhibits severe self-injurious behaviors (SIB) since infancy.
- Location: The problem is located in the individual (Michelle), and within the system (group home, family doctor, emergency room, various specialists).
- Further Data Required: A multidisciplinary assessment including all relevant experts to determine environmental and individual factors contributing to SIB.
- Intervention: A comprehensive treatment plan addressing both the immediate concerns (SIB) and long-term goals of reducing the risk of recurrence.
Assessment of Adaptive Behaviors
- ABAS-3: An assessment tool that evaluates adaptive skills in various areas such as communication, self-care, safety, and independent skills. It helps identify strengths and weaknesses, develop treatment plans, monitor progress, and determine eligibility for services.
- Vineland-3: Another tool similar to the ABAS-3, but includes interview forms, parent/caregiver questionnaires, and teacher reports, providing a broader perspective on adaptive behaviors.
Treatment Principles
- Interventions should center around improving the person's quality of life.
- Interventions should be tailored to specific needs identified through assessment.
- Objectives must be clear, achievable, and designed to improve the individuals life with disabilities.
- Interventions should be based on sound theoretical or practical rationale.
- Interventions should be the choice of the individual or at least agreeable to them, never causing harm.
- Transition from intervention should be smooth.
- Follow-up interventions are crucial where needed.
Types of Intervention
- Active focused therapies: Examples include IBI (intensive behavioral intervention) and ABA (applied behavior analysis).
- Age-related therapies: These take into account the person's age and developmental stage.
- Communication: Focuses on improving communication skills.
- Education and training: Provides education and training relevant to the individual's needs.
- Health & medication: Includes monitoring and managing health conditions and adjusting medication as needed.
- Lifestyle and personal support: Encompasses assistance with activities of daily living.
- Personal and skill development: Targets developing specific skills and promoting independence.
Specific Treatment Considerations
- Decrease organic/biological contribution: Treatment may include addressing sensory impairments (vision/hearing), physical impairments, and treating medical conditions such as seizures and mental illness.
- Decrease stress: Focuses on providing appropriate environments, realistic expectations, and supports tailored to the individual's needs.
- Increase competence: Includes developing coping skills, communication skills, self-esteem, and social supports.
Case Study: Michelle's Treatment
- Challenges: Michelle's treatment was complicated by the lack of a multidisciplinary approach, lack of psychiatric follow-up, and a reliance on high doses of antipsychotic medication.
- Importance of Multidisciplinary Assessment: A multidisciplinary assessment can identify factors contributing to SIB and guide treatment effectively.
- Continuity of Care: A consistent system of care, including responses to crises, is necessary to provide ongoing assessment and treatment.
Key Takeaways
- Thorough assessment and a multidisciplinary approach are crucial for effective treatment of individuals with complex needs.
- Continuous care and a comprehensive treatment plan, encompassing both short-term and long-term goals, are essential for positive outcomes.
Michelle's Case Study
- Michelle's care involved various local services: residential and day counsellors, consulting behaviour therapist, family physician, community psychiatrist, specialist assessment services, pharmacist, emergency hospital services, inpatient psychiatric services, specialist medical services, community nursing, and the Office of the Official Guardian and Public Trustee.
- Regular meetings occurred to review Michelle's progress, ensure all partners in her care were informed, and avoid anxiety related to changing medication or Michelle becoming a long-term patient.
- Michelle's behaviour stabilized, and a cyclic pattern emerged after the crises abated.
- She was treated with mood-stabilizing medication, and her antipsychotic medication was reduced.
- These changes significantly improved her quality of life and reduced self-injurious behavior (SIB).
SIB and Assessment
-
SIB (sometimes referred to as "challenging" behavior) arises from various circumstances but can be adequately assessed in a continuous and stable setting where carers and healthcare staff have a shared understanding of the individual's developmental needs, including:
- Psychological and adaptive functioning
- Unique and atypical communication methods
- Sensory issues
- Emotional responses, particularly when communicating.
-
The prescription of antipsychotic medication for challenging behaviours is no longer an acceptable practice. Multidisciplinary assessment and treatment are required.
Psychological Assessment
- Psychological assessment is systematic, problem-oriented, dynamic, and conceptual.
- Assessment consists of problem clarification, planning, development, implementation, outcome determination, and dissemination.
Testing and Percentile Scores
- Percentile scores represent a person's position relative to others their age who took the same test.
- A score of 40 means the individual scored better than 40% of test-takers but lower than the remaining 60%.
- The average range falls between the 25th and the 74th percentiles.
Intelligence and Distribution
- The normal distribution, or the bell curve, represents the distribution of intelligence, including the intellectually disabled population.
- Standard scores for IQ tests are referenced to age expectations, with 90-110 representing the average range.
- Scaled scores for subtests also have an average range of 8-12.
Types of Validity
- Content Validity: Tests adequately sample all relevant aspects of the construct being measured.
- Criterion-Related Validity: Scores are shown to be related to specified external criteria, such as performance on another measure or group membership.
- Construct Validity: The construct purported to be measured by the test is actually measured.
Causes of Intellectual Disability
-
Obvious Physical Damage:
- Down Syndrome
- Disease
- Teratogens (agents that can cause birth defects)
- Prenatal malnourishment
- Injury
-
No Obvious Signs of Brain Damage:
- Combination of genetic and environmental conditions
- Parents have low IQ
- Home life is highly disorganized, emotionally and cognitively deprived
Stages of Developmental before Birth
-
Conception:
- Ovum: Contains oocytes (immature ova)
- Sperm: Germ cells/gametes
-
Zygote (Germinal period):
- Fertilized ovum, chromosome count increases to 46
- Pluripotent cells (can differentiate into many cell types)
-
Embryonic Period:
- Weeks 2-8 in pregnancy
- Differentiation and development of major body systems
-
Fetal Period:
- End of week 8 to birth
- Continued growth and development
Chromosomes and Genes
- 23 pairs of chromosomes, 46 individual chromatids.
- Chromosomes carry all genetic material.
- Composed of DNA and genes (sections of DNA with particular functions)
- DNA is made of ACTG (adenine, cytosine, guanine, thymine)
- Double Helix structure discovered by Watson and Crick
- Sex chromosomes (X and Y), each individual has one sex chromosome
Cell Division
- Mitosis: Each cell divides into two daughter cells with the same number of chromosomes as the parent cell.
- Meiosis: Produces germ cells (sperm and egg) with only 23 chromosomes each.
The Human Genome Project
- The Human Genome Project mapped the human genome.
- Human Chromosome #20 is one of the chromosomes that was mapped.
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Description
Test your knowledge on developmental disabilities and the ICF-CY framework. This quiz covers terms, criteria, and the distinction between mental and physical disabilities. Perfect for students and professionals in health and social services fields.