Developmental Disabilities and ICF-CY Quiz

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Questions and Answers

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)

Influenza

Autism (correct)

Fetal Alcohol Syndrome (correct)

Down Syndrome (correct)

Developmental disabilities only include genetic abnormalities.

False

What must be considered in assessing limitations in functioning?

Community environments typical of the individual’s age, peers, and culture Signup and view all the answers

Which of the following is a criterion for diagnosing intellectual disabilities according to DSM-5?

Deficits in intellectual functions Signup and view all the answers

Match the severity levels with their descriptions:

Mild = About 85% of persons with ID, typically not identified until early elementary years Moderate = About 10% of persons with ID, usually identified during preschool years Severe = About 3-4% of persons with ID, associated with organic causes Profound = About 1-2% of persons with ID, require intensive training for daily activities Signup and view all the answers

About 25-50% of developmental disabilities are caused by biomedical nature.

True Signup and view all the answers

The _____ is used to describe the interaction between health conditions and contextual factors.

ICF (International Classification of Functioning, Disability and Health) Signup and view all the answers

What is the purpose of the ICF-CY?

To document characteristics of health and functioning in children and youth Signup and view all the answers

The ICF-CY makes explicit distinctions between mental and physical disabilities.

False Signup and view all the answers

What does neutrality in ICF refer to?

Domain names should be worded in neutral language. Signup and view all the answers

Name one environmental factor included in the ICF.

Social attitudes Signup and view all the answers

What are disorders of intellectual development characterized by?

Significantly below average intellectual functioning and adaptive behavior. Signup and view all the answers

Which of the following is NOT an inclusion under body functions related to intellectual development?

Memory functions Signup and view all the answers

What does the term 'dual diagnosis' refer to?

Comorbid diagnoses of mental illness and developmental disabilities. Signup and view all the answers

The ICF-CY can be applied consistently across national boundaries.

True Signup and view all the answers

In the ICF-CY, _____ factors include social attitudes, institutions, and laws.

environmental Signup and view all the answers

Which Act was replaced by the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008?

Developmental Services Act Signup and view all the answers

What perspective has led to a broader understanding of developmental disabilities?

The social and human rights model. Signup and view all the answers

Which of the following are grounds of discrimination under the Canadian Human Rights Act?

Sex Signup and view all the answers

The Canadian Human Rights Act protects individuals from discrimination based on physical and mental disabilities.

True Signup and view all the answers

What does Dual Diagnosis Consultation, Outreach Stabilization Service aim to provide?

Clinical intervention that provides bio-mental healthcare to people with intellectual/developmental disabilities. Signup and view all the answers

What percentage of adults with developmental disabilities might experience a comorbid mental health condition?

10% to 40% Signup and view all the answers

Match the following factors contributing to mental health disorders:

Biological Factors = Brain injury, trauma, disease or infection Psychosocial Factors = Lack social opportunities, sense of failure Environmental Factors = Impoverished and isolated circumstances Genetic Factors = Family history of mental illness Signup and view all the answers

The process of investigating and documenting knowledge, skills, and attitudes is known as ______.

Assessment Signup and view all the answers

What is diagnostic overshadowing?

Underestimating signs of psychiatric disorders in individuals with DD Signup and view all the answers

What are the basic assessment actions involved in the assessment process?

Attend to a situation, gather information, analyze strengths and needs, understand aiding and hindering factors, and decide on intervention plans. Signup and view all the answers

Individuals with intellectual disabilities are often under treated in mental health settings.

True Signup and view all the answers

What does a statement of scope of practice describe?

What the profession does Signup and view all the answers

A diagnosis is often a permanent designation.

True Signup and view all the answers

What is the purpose of assessing adaptive skills?

To identify individual strengths and weaknesses and to develop treatment plans. Signup and view all the answers

Which assessment tool provides a semi-structured interview to assess adaptive functioning?

Vineland-3 Signup and view all the answers

A diagnosis helps others to understand and identify _____, supports, and services.

resources Signup and view all the answers

The ABAS-3 assesses adaptive skills in areas important for day-to-day functioning.

True Signup and view all the answers

What are two long-term goals that may be developed through treatment?

Reducing risk of recurrence and developing coping strategies. Signup and view all the answers

Match the following scales with their primary focus areas:

ABAS-3 = Adaptive skills assessment Vineland-3 = Adaptive behavior assessment WISC-V = Cognitive abilities DSM-5 = Diagnostic criteria for mental health disorders Signup and view all the answers

What is NOT a component of a good assessment?

Providing only medical diagnosis Signup and view all the answers

What does the Self-Direction scale provide information about?

Skills needed for independence, responsibility, and self-control. Signup and view all the answers

What is the main purpose of intervention?

To maintain and/or improve the person's life Signup and view all the answers

What condition was Michelle diagnosed with?

Autistic behaviours. Signup and view all the answers

The assessment of SIB may require trials of interventions, some of which may cause __________ escalations.

behavioral Signup and view all the answers

What is the number of chromosomes after a female gamete is fertilized?

46 Signup and view all the answers

Cells that can differentiate into many cell types are known as pluripotent cells.

True Signup and view all the answers

The prescription of antipsychotic medication for challenging behaviors is considered acceptable practice.

False Signup and view all the answers

What period does the embryonic stage of pregnancy cover?

Week 2-8 Signup and view all the answers

What stage follows the zygotic period in human development?

Embryonic stage Signup and view all the answers

Which of the following are considered causes of intellectual disability? (Select all that apply)

Down Syndrome Signup and view all the answers

What is a percentile score?

A rank-order score that describes the position of a person's score relative to others. Signup and view all the answers

What is the role of genes in chromosomes?

Genes are sections of DNA with particular functions. Signup and view all the answers

Which of the following is not considered an effective guideline for intervention?

Ignore the preferences of the person with disabilities Signup and view all the answers

What can excessive medication lead to, as evidenced in Michelle's case?

Severe medical complications. Signup and view all the answers

The process of cell division where each cell divides into 2 daughter cells is called ______.

mitosis Signup and view all the answers

Meiosis results in cells with only ______ chromosomes.

23 Signup and view all the answers

What is the significance of the Human Genome Project?

It aimed to map and understand all the genes of the human species. Signup and view all the answers

Match the major components with their descriptions:

Chromosomes = Carry all genetic material Alleles = Alternative forms of genes ACTG = The bases of DNA Double helix = Structure of DNA as discovered by Watson and Crick Signup and view all the answers

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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