2. DD & ID.pdf

Developmental delay and intellectual disability RS 3320 Clinical Sciences in Developmental Dysfunction Johnny Lam Assistant Professor of Practice (OT) https://www.youtube.com/watch?v=2vfmL4q2koo ...

Developmental delay and intellectual disability RS 3320 Clinical Sciences in Developmental Dysfunction Johnny Lam Assistant Professor of Practice (OT) https://www.youtube.com/watch?v=2vfmL4q2koo  DD poor memory - affect social - rel https://www.youtube.com/watch?v=eMGtNbJP3Dg Intended Learning Outcome After this lecture, you will be able to identify the sign and symptoms of people with Developmental Delay/ Intellectual Disability Content Diagnostic Criteria and classification Causes, Prevalence and Comorbidity Assessment for the diagnosis of DD/ID Intellectual Functioning and Adaptive Functioning Support for people with DD/ID Role of OT in DD/ID Diagnostic Criteria and classification ICD-11 6A00 Disorder of intellectual development 6A01 Developmental speech or language disorders 6A03 Developmental learning disorder 6A04 Developmental motor coordination disorder DSM-V (APA, 2013) Neurodevelopmental disorders Intellectual Disabilities 319 Intellectual Disability (Intellectual Developmental Disorder)** 315.8 Global Developmental Delay wi #D in DSM-5 Developmental Delay Global Developmental Delay prescreening & MHCH (maternal) using and Child Health Centres questionnaire for suspected delay Global Developmental Delay diagnosis is set aside for children under the age of 5 when clinical severity point cannot be consistently evaluated during early childhood (American Psychiatric Association, 2013) The term 'developmental delay' or 'global development delay' is used when a child takes longer to reach certain development milestones than other children their age : 1 F GDD https://www.mencap.org.uk/learning-disability-explained/conditions/global-development-delay Global developmental delay can be defined as significant delay in two or more developmental domains: gross and fine motor; speech and language; cognition; personal and social development; or activities of daily living (Majnemer & Shevell, 1995) Diagnostic Criteria of GDD Significant delay (at least 2 SDs below the mean with standardized tests) in at least two developmental domains from the following: Gross or fine motor Speech/language Cognition Social/personal Activities of daily living Reserved for children - easier to understand + accept https://www.youtube.com/watch?v=HmEg1B1Ohs8 Intellectual Disability Mental Retardation and Intellectual Disability v Intellectual disability (intellectual developmental disorder) as a DSM-5 diagnostic term replaces “mental retardation” used in previous editions of the manuals. DSM 5, 2013 What is Intellectual Disability Intellectual disability is a disability characterized by A significant limitations in both intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills. This disability originates before the age of 18. (aaidd, 2019) American Association on Intellectual and Developmental Disabilities Intellectual Disability- Intellectual Functioning Intelligence General mental capacity: learning, reasoning, problem solving IQ test IQ test score of around 70 or as high as 75 indicates a limitation in intellectual functioning (aaidd, 2019)  IQ Classifications in Educational Use Wechsler, David. Wechsler Adult Intelligence Scale-Third edition Psychological Corporation, 1997 Classification IQ Score Very Superior 130 and above Superior 120-129 High Average* 110-119 Average 90-109 Low Average* 80-89 ID Borderline = suspected 70-79 Extremely Low* ** 69 and below http://www.assessmentpsychology.com/iqclassifications.htm Intellectual Disability- Adaptive Behaviour Conceptual skills—language and literacy; money, time, and number concepts; and self-direction. Social skills—interpersonal skills, social responsibility, self-esteem, 容易上當 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 e. bus g app. skills, healthcare, travel/transportation, schedules/routines, safety, & home floorwet use of money, use of the telephone. : lack insight e.. g EPF - test in reality (aaidd, 2019)  sustain ? ↑ new interaction g ↑ stimulation of social emotional attention DSM V also abt other aspects development inc , , J e memory whether : intectral/mote delay egrmbED'E.... , The DSM-5 diagnosis of ID requires the satisfaction of three criteria: 1. Deficits in intellectual functioning—“reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience”— confirmed by clinical evaluation and individualized standard IQ testing (APA, 2013, p. 33); 2. Deficits in adaptive functioning that significantly hamper conforming to developmental and sociocultural standards for the individual's independence and ability to meet their social responsibility; and 3. The onset of these deficits during childhood. ICD -11- Disorder of intellectual development 6A00.0 Disorder of intellectual development, mild Significantly below average intellectual functioning and adaptive behaviour that are approximately two to three standard deviations below the mean Exhibit difficulties in the acquisition and comprehension of complex language concepts and academic skills. Most master basic self-care, domestic, and practical activities. Generally achieve relatively independent living and employment as adults but may require appropriate support. ICD -11- Disorder of intellectual development 6A00.1 Disorder of intellectual development, moderate Significantly below average intellectual functioning and adaptive behaviour that are approximately three to four standard deviations Language and capacity for acquisition of academic skills of persons affected by a moderate disorder of intellectual development vary but are generally limited to basic skills. Some may master basic self-care, domestic, and practical activities. Most affected persons require considerable and consistent support in order to achieve independent living and employment as adults. ICD -11- Disorder of intellectual development 6A00.2 Disorder of intellectual development, severe Significantly below average intellectual functioning and adaptive behaviour that are approximately four of more standard deviations below the mean Very limited language and capacity for acquisition of academic skills. Motor impairments and typically require daily support in a supervised environment for adequate care, but may acquire basic self-care skills with intensive training. ICD -11- Disorder of intellectual development 6A00.3 Disorder of intellectual development, profound Significantly below average intellectual functioning and adaptive behaviour that are approximately four of more standard deviations below the mean Very limited communication abilities and capacity for acquisition of academic skills is restricted to basic concrete skills. Co-occurring motor and sensory impairments and typically require daily support in a supervised environment for adequate care.  Intellectual Approximate Percent DSM-IV Criteria (severity DSM-5 Criteria (severity AAIDD Criteria (severity SSI Listings Criteria (The Disability Distribution of Cases by levels were based only on classified on the basis of classified on the basis of SSI listings do not specify Severity Severity IQ categories) daily skills) intensity of support severity levels, but Category needed) indicate different standards for meeting or equaling listing level severity.) Mild 85% Approximate IQ range Can live independently Intermittent support IQ of 60 through 70 and a 50–69 with minimum levels of needed during transitions physical or other mental support. or periods of uncertainty. impairment imposing an additional and significant limitation of function Moderate 10% Approximate IQ range Independent living may Limited support needed A valid verbal, 36–49 be achieved with in daily situations. performance, or full-scale moderate levels of IQ of 59 or less support, such as those available in group homes. Severe 3.5% Approximate IQ range Requires daily assistance Extensive support A valid verbal, 20–35 with self-care activities needed for daily performance, or full-scale and safety supervision. activities. IQ of 59 or less Profound 1.5% IQ - Prenatal Extrinsic Teratogens/ Toxins (Drugs of abuse, medications etc.) Infections Causes immediately b4/after ↓ / Perinatal Asphyxia Prematurity born by expected month ~ I Neonatal complications & Postnatal Neglect/ psychosocial environment Infections Trauma Toxins Prevalence Rate of GDD According to global statistics, about 5 to 16% of children have developmental disorders Census and Statistical Department, 2015 Prevalence Rate of ID A crude statistical assessment indicated that the total number of persons with intellectual disability in Hong Kong was likely to be in the region of 71 000 to 101 000, representing a prevalence rate of 1.0% to 1.4% for persons with intellectual disability in Hong Kong. Enrollment statistics for students with ID in 2015/16 from the Education Bureau indicated that ID occurred in 0.8% of the school age population. Census and Statistical Department, 2015 Comorbidity of DD/ID Prenatal encephalopathies of disruptive origin Congenital infections Teratogen – related encephalopathies Genetic encephalopathies Down syndrome Fragile-X syndrome Subtelomeric deletions Patau syndrome Chromosomal defects diagnosed by CGH array Tuberous sclerosis Congenital myotonic dystrophy Comorbidity of DD/ID Rett syndrome Dravet spectrum disorder Prader-Willi syndrome Angelman syndrome Neurofibrimatosis type 1 Inborn errors of metabolism Mitochondrial disease Lysosomal disease Perinatal and postnatal encephalopathies Brain tumor Assessment for DD/ID Diagnostic Assessment e by doc Sensory evaluation Genetic testing Chromosome microarray- measure the expression of multiple genes simultaneously Karyotype -a person's chromosomes isolated from an individual cell and arranged in numerical order Fragile X DNA testing Rett syndrome testing Whole-exome or -genome sequencing / Neuroimaging obvious braindamage/malfi Metabolic investigations Biochemical investigations Neurophysiology Assessment for intellectual functioning Wechsler Intelligence Scale for Children (WISC) Psychological assessment that measures different aspects of intelligence Designed for children between the ages of 6 to 16 Assessment for intellectual functioning WISC- Wechsler Intelligence Scale for Children The Visual Spatial Index reflects the ability to understand visual details and relationships in order to solve puzzles and construct geometric designs. F The Fluid Reasoning Index reflects the ability to detect relationships among visual objects The Working Memory Index reflects the ability to register, maintain, and manipulate visual and auditory information. The Processing Speed Index reflects the speed at which a child can accurately make decisions. Verbal Comprehension Index measures a child’s ability to verbally reason, which can be heavily influenced by their semantic knowledge. https://youtu.be/Glx3-vkI880 Assessment for intellectual functioning Wechsler Adult Intelligence Scale (WAIS) most commonly used adult IQ test for measuring intelligence The Perceptual Reasoning Index (PRI) Block design Matrix reasoning Visual puzzles picture completion The Verbal Comprehension Index (VCI) describe how various concepts and words are similar evaluate semantic knowledge, verbal comprehension, abstract verbal reasoning, and verbal expression. The Working Memory Index (WMI) evaluates how well you can remember things. recall a list of numbers in the order that they were given (digit span) and a series of numbers and letters in order (letter-number sequencing). The Processing Speed Index (PSI) measure of how fast your brain works. symbol search, cancellation, and coding Assessment for adaptive behaviour Diagnostic Adaptive Behavior Scale (DABS) Assess the adaptive behavior of people between 4 and 21 years old Assess the presence of significant limitations in adaptive behavior as expressed in conceptual, social, or practical adaptive skills Vineland Adaptive Behavior Scales (VABS) Vineland-3 focuses on what he or she actually does in daily life Assess the presence of significant limitations in adaptive behavior in communication, daily living skills, socialization and motor skills Intellectual Functioning and Adaptive Functioning Intellectual and Adaptive Function Intellectual functioning (such as learning, problem solving, judgement) Adaptive functioning (activities of daily life such as communication and independent living) Intellectual and Adaptive Function functional in career https://youtu.be/j5uzLb4WNGI Intellectual and Adaptive Function https://youtu.be/1MIRCJjc_VI Intellectual and Adaptive Function https://youtu.be/gwwygs9SsPU Intellectual and Adaptive Function https://youtu.be/_6sUfkUiV34 Learning Difficulties ( ) EDB(HKSAR), 2018 Intellectual and Adaptive Function Deficits in intellectual functioning Reasoning; Problem solving; Planning; Abstract thinking; Judgment; Academic learning (ability to learn in school via traditional teaching methods); Experiential learning (the ability to learn through experience, trial and error, and observation) https://www.mentalhelp.net/intell ectual-disabilities/dsm-5-criteria/ Intellectual and Adaptive Function Deficits in adaptive functioning Communication Social skills Personal independence at home or in community settings School or work functioning https://www.mentalhelp.net/intell ectual-disabilities/dsm-5-criteria/ Support for people with DD/ID Support for people with ID (Hong Chi Association, 2010) Respect – like you and me, people with intellectual disabilities have their feelings, strengths and weaknesses. They are equal members of the society who enjoy equal opportunities and rights as we do. We should appreciate their achievement with realistic expectation. Acceptance of their limitations – people with intellectual disabilities take longer time to adapt to new environment and they face more challenges when learning new skills. Allow them to finish their task at * their own pace. i ts be adaptive on the demand of client Support for people with ID (Hong Chi Association, 2010) Encourage them to lead more independent lives – being over- protective or ignoring their abilities will hinder their development. Be attentive and compliment them on proper behaviour; assist them to integrate into society. Provide them with job opportunities – with professional training, people with intellectual disabilities can also become diligent employees who do not hop from job to job. Communication with People with Intellectual Disabilities (Hong Chi Association, 2010) 1. Attention Pay attention to all of their expressions – not only "listen" to what they say and the sounds they make, but also study their gestures and facial expressions. 2. Response Promptly respond to their expressions, whether verbal or non-verbal, to encourage them to communicate. 3. Opportunity Prompt them to voice their needs. Do not do everything for them because they cannot speak well. Instead of asking questions, try to encourage them to start a conversation; otherwise, they may only know how to respond but to initiate. Communication with People with Intellectual Disabilities (Hong Chi Association, 2010) 4. Motivation Make use of daily routines or special arrangements to inspire them to speak. Share their attention and interest, and talk about it with them. 5. Simple speech Give a single instruction or question in simple sentence every time because they may feel confused by complicated message and over questioning at the same time. 6. Use of tools Use of tools like PECS (Picture Exchange Communication System) communication books and boards, speech synthesiser, and computer-assisted technology is beneficial to effective communication. Services for people with DD in HK Services for people with ID in HK SWD (HKSAR), 2019 Services for people with DD/ID in HK EDB (HKSAR), 2012 Role of OT OT in Pre-School settings OT in Pre-School settings Sensory Motor Cognition Psychosocial Play skills Pre-writing, writing and reading skills ADL skills OT in School-age settings Caritas Jockey Club Lok Yan School http://www.lys.edu.hk/ Sam Shui Natives Association Lau Pun Cheung School http://www.lpc.edu.hk/it- school/php/webcms//public/index.php3?refid=1351&mode=publishe d&lang=zh&nocache1402373480 EDB Integrated Education https://www.edb.gov.hk/tc/edu- system/special/support/wsa/index.html OT in School-age settings Writing and reading skills ADL skills Social skills OT service for adult and adolescent with DD/ID OT training for adult and adolescent with DD/ID Vocational skills IADL skills Social skills Community living skills