31 - Intellectual Disability Flashcards
(33 cards)
Describe the diagnosis of intellectual disability
Onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, practical domains
What are the three criteria for diagnosing an intellectual disability?
- Deficits in intellectual functions
- Deficits in adaptive functioning
- Onset of intellectual and adaptive deficits during the developmental period ***
Describe deficits in intellectual functions
Deficits in…
- Reasoning
- Problem solving
- Planning
- Abstract thinking
- Judgment
- Academic learning
- Learning from experience
These can be tested by…
- Clinical assessment
- Individualized standardized intelligence testing (WAIS***)
Describe deficits in adaptive functioning
Failure to meet developmental and sociocultural standards for personal independence and social responsibility
- **Without ongoing support, there are LIMITS on the functioning of one or more of the following activities
- Communication
- Social participation
- Independent living
These effect home, school, work and community
When do we see the onset of intellectual and adaptive deficits?
** During the developmental period **
What are the possible etiologies of intellectual disability?
Multiple etiologies that can be seen as final common pathway of pathological processes that affect functioning of the CNS
What are the levels of intellectual functioning?
Categorized based on WAIS testing scores:
- Mild mental retardation (50/55-70)
- Moderate retardation (35/40-50-55)
- Severe retardation (20/25-35/40)
- Profound retardation (below 20-25)
- Unspecified (too impaired or uncooperative to test)
What is adaptive functioning?
Adaptive functioning: personal independence and social responsibility
Remember, this is the second criteria in diagnosing an intellectual disability
** This criteria is met when one domain is sufficiently impaired that ongoing support is needed **
What are the domains of adaptive functioning?
- Conceptual/academic (memory, language, reading)
- Social (empathy, communication, friendship)
- Practical (money management, organization, personal care)
Remember the criteria for deficits in adaptive functioning are met when one of these is sufficiently impaired so that ongoing support is needed
What are some scales you can use in order to evaluate adaptive functioning?
- Vineland Adaptive Behavior Scales
- American Association on Intellectual Disabilities Adaptive Behavior Scale
These scales provide a clinical score that is a composite score of a number of adaptive domains that vary considerably in reliability
What do you need to consider when evaluating adaptive functioning?
Instrument chosen to be used should fit the individuals…
* Socioeconomic background
* Education
* Assorted handicaps
* Motivation
* Cooperation
Example: if they have a physical disability, may need to adjust accordingly
Now we are going to go through each level of severity of intellectual disabilities and discuss the “specifiers” for each
What are the levels of severity of IDs again?
- Mild
- Moderate
- Severe
- Profound
First, what are specifiers strongly influenced by?
Now specifiers are strongly influenced by adaptive functioning not IQ scores as adaptive functioning determines the level of supports required
KNOW THIS ***
Specifiers of mild ID
50/55-70 WAIS
Conceptual domain
- Preschoolers same
- Adults show impairment in academic skills, memory
Social domain
- Problems with emotions, limited understanding of risk/judgment
- At risk for being manipulated (gullible) ***
Practical
- Personal care normal
- Need assistance with groceries, transportation, money
- Recreation normal
- Normal employment in jobs not needing conceptual skills
- Health care and legal decisions need support ***
- Raising a family need support ***
Specifiers of moderate ID
35/40-50/55 on WAIS
Conceptual
- All throughout development they lag behind peers
- Language slow
- As adults, academics are at elementary level and support is needed ***
Social
- Lower capacity for relationships
- Less complex communication
- Work setting needs significant social and communication support ***
Practical
- With extended period of teaching, time and reminders, an individual may become independent ***
- Maladaptive behavior present in a significant minority ***
Specifiers of severe ID
20/25-35/40 on WIAS
Conceptual
- Care takers provide extensive support throughout life
- Limited conceptual skills
Social
- Family and other offer support and help ***
Practical
- Support for all activities of daily living ***
- Maladaptive behavior including self injury is present in a significant minority ***
Specifiers of profound ID
Below 20-25 WIAS
Conceptual
- Physical world rather than symbolic process
Social
- Non verbal, non symbolic communication ***
- Enjoys relationships with family but little understanding
Practical
- Dependent on all aspects of daily physical care, health and safety ***
- Maladaptive behaviors present in a significant minority ***
What are associated features and disorders of ID?
- ID is a heterogeneous condition with multiple causes
- No specific personality or behavioral disorders
- Can be passive or aggressive
- Lack of communication skills can lead to disruptive aggression
- Gullibility, vulnerable to exploitation, victimization or being denied rights and opportunities
How are IDs related to mental health disorders?
- Suicide risks exist as in all mental health disorders ***
- Screen for suicide
- May be hard to screen based on level of retardation and communication
- Rely on observation for screening
What patients are at a higher risk of Alzheimer’s disease?
** DOWN SYNDROME **
Down’s patients are at a higher risk for Alzheimer’s type dementia with pathological changes in the early 40s and clinical symptoms appearing later
What is the overall prevalence of IDs?
1% of population
What is the disease course of ID?
- Onset before 18 ***
- Depends on etiology and severity
- If more severe, then it is recognized early ***
- If it is acquired, it comes on abruptly ***
What do you NEED to know about the nature of IDs?
Intellectual disabilities are NOT static
- Even those with failure in academics can be altered by training which improves adaptive skills in other domains
- An individual can move from moderate to mild with adequate training
What are the risk and prognostic factors for intellectual disabilities?
KNOW THIS ***
- Primarily biological or psychosocial or a combination of both ***
- 30-40% have NO clear etiology for cause of intellectual disability ***
- Specific etiologies are more common in severe or profound intellectual disability
