Intellectual Disabilities: Symptoms, Diagnostics, and Treatment - PDF Guide

**Intellectual Disabilities** ============================= **[Intellectual Disability]** ----------------------------------------- - Refers to a heterogenous group of disorders of childhood - Impairments result in difficulties across various domains of day-to-day life - Wide range of...

**Intellectual Disabilities** ============================= **[Intellectual Disability]** ----------------------------------------- - Refers to a heterogenous group of disorders of childhood - Impairments result in difficulties across various domains of day-to-day life - Wide range of the level of cognitive impairment - Learning difficulties often present - Comorbidities are prevalent - Intellectual Disability (ID) or Intellectual Developmental Disorder has replaced term "mental retardation" - Two domains of functioning most important in assessment: ***IQ*** and ***Adaptive Behaviour*** **[Intellectual Disabilities (IDs)]** - Significantly subaverage general **intellectual functioning** as measured by a technically adequate and appropriately standardized IQ test - Score below 70-75 - IQ tests should be administered by a competent and well-trained professional - Must take into account all cultural, linguistic, and sensory-motor limitations that may affect performance ***Adaptive Functioning*** - A collection of skills across multiple domains that we learn in order to function in our daily lives (dressing, social skills, toileting) - Standardized assessment must be used (e.g., Diagnostic Adaptive Behavior Scale Must manifest during the developmental period ***before age 18*** **[Intellectual Functioning]** - A person must have significantly subaverage intellectual functioning and impairments in adaptive abilities with onset during the developmental period: - Problems surrounding operationalizing this definition have arisen for both biological and philosophical reasons: - Psychometric properties of Assessment and Measurement Variance - Instability of IQ over time - High variability in trajectories across conditions - Concerns over predictive validity and cultural bias **[Importance of Adaptive Behavior]** - ***Adaptive behaviour:*** One's participation and performance in one or more aspects of daily life activities, such as communication, social participation, function at school or work, or personal independence at home or in community settings - Ensures differential diagnosis among children who did not have educational opportunities and may underperform on measures of intellectual functioning due to linguistic, cultural, or other systemic factors **[Importance of Adaptive Behavior]** American Association on Intellectual and Developmental Disabilities (AAIDD) divides adaptive functioning into ***three domains:*** 1. ***Conceptual:*** Language, literacy, money, time, number concepts, and self-direction 2. ***Practical:*** ADL, occupational skills, health care, travel/transportation, schedules/routines, safety, use of money, use of communication devices 3. ***Socialization:*** Interpersonal skills, social responsibility, self-esteem, naivete, social problem solving, and the ability follow rules and obey laws **[Adaptive Behavior]** - DSM-5 it was emphasized that ID should be classified by adaptive behaviour - Provides a more complete view of everyday functioning across domains than classification by degree of intellectual impairment - More clinically useful for adults - Less useful for children who often display discordance in the domains of adaptive behavior - Must be measured using individualized, standardized, and culturally appropriate tests and scales **[Etiology of IDs]** - No clear etiology in approximately 30-40% of cases - Hereditary disorders (e.g., Tay-Sachs disease) affects 5% of cases - Early Alterations of Embryonic Development affects 30% of cases - Chromosomal changes or prenatal damage due to environmental toxins - Later Pregnancy and Perinatal Problems affects 10% of cases - Include fetal malnutrition, placental insufficiency, prematurity, viruses/infection - Medical Conditions acquired during childhood and accidents affect 5% of cases (e.g., meningitis or lead poisoning) - Other Mental Disorders/environmental variables (15-20%) **[Prevalence]** - Intellectual disability occurs in \~7.2 per 1000 individuals - Numbers are similar across the world - Boys are more likely to be diagnosed with an ID than girls - Mild impairments identified later than severe - Recurrence risks for families with one child with severe intellectual disability **[Assessment: Medical Diagnostic Testing]** - Testing should be based on medical history and physical examination - Some children with subtle physical or neurological findings also may have determinable biological origins of intellectual disability Factors to consider: - What is the degree of intellectual disability? - Is there a specific diagnostic path to follow? - Are parents planning to have more children? - What are the parents' wishes? **[Assessment of Intellectual Disability]** - Standardized Cognitive Assessments (IQ tests) - Assessments of Adaptive Behavior - Early Learning Abilities/Academics - Restrictive behavior (Functional Behavior Assessment) - Skills Training (Individual and Family goals) - Habituation, Goal Setting, and Choice - Focus is on identifying environmental supports to enhance a person's functioning across domains (focuses more on what people ***can do*** rather than their deficits) - STRENGTHS! **[Assessment: Psychological Testing]** - A variety of tests are used to evaluate individual intelligence and adaptive skills - Poor predictive validity until about 10 years old - Tests can help differentiate in young children with severe intellectual disability, but not with mild - Wechsler scales (Wechsler, 2012; Wechsler, 2014) are accurate in predicting adult IQ in school-age children - Often there is a correlation between scores on intelligence and adaptive scales - Consider non-verbal tests of intelligence - Consider academic assessment/skills assessment **[Comorbidity]** - High rates of comorbidity with medical and psychological disorders (i.e., Dual Diagnosis) - Common associated impairments: - Cerebral palsy, seizure disorders, communication disorders, sensory impairments, psychological/behavioral disorders - Essential to identify comorbid conditions for intervention and treatment - Associated impairments make it difficult to distinguish intellectual disability from other developmental disabilities - Repeated assessments may be necessary **[Support & Intervention]** - Environmental Interventions and Enrichment Programs - Active learning/Engagement - Specialized and effective instruction methods - Ensuring communication needs are met - Behavioral Interventions/Applied Behavior Analysis - Teach skills that will allow access to meaningful environments and less restriction - Reduce dangerous behavior/self-harm with the goal of being able to access less restrictive environments - Community Living/Transition Goals - Ensuring skills and goals selected are meaningful - Importance of teaching ***Choice*** and ***Supported Decision Making*** **[Least Restrictive Environment and Right to Education]** IDEA (Individuals with Disabilities Education Improvement Act) - Explicitly states that "to the maximum extent appropriate" that children with disabilities be educated with children who do not have disabilities - Requires special education services be provided in the Least Restrictive Environment (LRE) **[Studies of "Self-Contained" Classrooms (Wehmeyer, 2021)]** - ***Self-contained** **classroom**:* Segregated within a school from the regular classroom environment where a special education teacher is responsible for the instruction of all academic subjects - Students often work in isolation without effort to create a supportive learning community - Significant portions of their day were spent in non-academic activities - Significant number of interruptions and distractions during the day (e.g., adults in the room conversing and leaving and entering the room) - Poorer social and academic outcomes for children with ID **[Special Education Laws in Ontario]** ***Ontario:*** Special Education Act sets out rules around access and eligibility for special education - No specific language around LRE; however, "rationale/reasons" must be provided by the Identification, Placement, and Review Committee (IPRC) if the child is placed in special education classroom - No suspension limitations other than its "not mandatory" for children with disabilities - "Temporary withdrawal" must be only one school day unless consent from parent is obtained **[Beyond Sight Words: Reading Programs for People with Intellectual Disabilities]** - Sight word instruction with emphasis on safety and functional words -- has limitations in ***maintenance and generalization*** - Reviews the ***Edmark Reading Program*** -- direct instruction/programmed instruction approach to teach sight words to individuals with intellectual disabilities - Limitation of ERP is it ***does not include phonics*** instruction - Reviewed programs with effective instruction components/modifications that have shown efficacy with individuals with ID **[The Right to Eat Too Many Donuts and Take a Nap (Bannerman et al., 1990)]** - ***Habilitation:*** Teaching the skills needed to live as independently as possible - Compromises in rights and liberties to achieve habilitation goals - Client input around treatment goals - Lack of consideration around client preference and choice due to other competing interests - Choice making is often not taught **Research on Choice:** - Individuals prefer activities with choice embedded - Individuals participate more in activities when choices are embedded - Availability of choice has been shown to improve performance - Availability of choice reduces problem behavior **[Supported Decision Making]** - A tool that allows people with disabilities to retain the decision-making capacity by choosing supporters to help them make choices - Supporters agree to help the person understand, consider, and communicate decisions, giving the person with a disability the tools to make her/his own informed decisions - This can look different for everyone and must be tailored to the individual - Plain language materials or audio-visual information - Provision of extra time to discuss choices - Role playing - Bringing supporter to appointments to take notes and help remember options