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1. Child and Adolescent Psychiatry > Intellectual Disability (Intell. Devel. Disorder) > Flashcards

Intellectual Disability (Intell. Devel. Disorder) Flashcards

1
Q

What characterizes intellectual disability

A

deficits in general mental abilities, such as:

  • reasoning
  • problem solving
  • planning
  • abstract thinking
  • judgment
  • academic learning
  • learning from experience

deficits result in impairments of ADAPTIVE FUNCTIONING

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2
Q

what are the consequences of the deficits in adaptive functioning seen in intellectual disability

A

individual fails to meet standards of personal independence and social responsibility in ONE OR MORE aspects of daily life, including:

  • communication
  • social participation
  • academic or occupational functioning
  • personal independence at home or in community settings
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3
Q

Define Intellectual Disability according to DSM 5

How many criteria are there in the DSM 5

A

intellectual disability is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in CONCEPTUAL, SOCIAL, and PRACTICAL domains

there are 3 criteria and all of them must be met

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4
Q

What is criterion A for intellectual disability in DSM 5

A

Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience

these are confirmed by BOTH clinical assessment, and individualized standardized intelligence testing

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5
Q

What is criterion B for intellectual disability in DSM 5

A

Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility

without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life such as:
-communication
-social participation
-academic or occupational functioning
-personal independence at home or in community settings
across multiple environments, such as home, school, work and community

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6
Q

What is criterion C for intellectual disability in DSM 5

A

Onset of intellectual and adaptive deficits occurs during the developmental period

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7
Q

List the specifiers used for intellectual disability in DSM 5

A

Mild
Moderate
Severe
Profound

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8
Q

How are the various levels of severity defined? Why?

A

Defined based on adaptive functioning (not IQ scores)

this is because it is adaptive functioning that determines the level of support required
(IQ scores are also less valid in the lower end of the IQ range)

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9
Q

List the characteristics of MILD intellectual disability in the conceptual domain

A

preschool children–> may be no obvious deficits

school age children and adults–> difficulties in learning academic skills involving reading, writing, arithmetic, time or money
-support needed in one or more areas to meet age-related expectations

adults–> abstract thinking, executive functioning, short term memory as well as functional use of academic skills are impaired

somewhat concrete approach to problems and solutions compared to age-mates

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10
Q

What is executive functioning

A

planning
strategizing
priority setting
cognitive flexibility

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11
Q

List the characteristics of MILD intellectual disability in the social domain

A

immature in social interactions compared with age mates (i.e difficulty perceiving social cues)

communication, conversation, language more concrete or immature than age-mates

may be difficulties regulating emotion and behaviour in age appropriate fashion–> noticed by peers in social settings

limited understanding of risk in social situations

at risk of being manipulated by others (gullibility)

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12
Q

List the characteristics of MILD intellectual disability in the practical domain

A

may function age appropriately for personal care

need some support with complex daily living tasks in comparison to peers i.e grocery shopping, transport, home/childcare organizing, nutritious food prep, banking, money management

recreational skills similar to age-mates, though judgement related to wellbeing and organization around recreation requires support

in adults–competitive employment often seen in jobs that do not emphasize conceptual skills

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13
Q

List the characteristics of MODERATE intellectual disability in the conceptual domain

A

individuals conceptual skills lag markedly behind peers throughout development

language and academic skills develop slowly, and are markedly limited compared to peers

in adults, academic skills typically at elementary level –support required for all use of academic skills in work and personal life

ongoing assistance needed on daily basis for adults in tasks of day to day life

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14
Q

List the characteristics of MODERATE intellectual disability in the social domain

A

marked differences from peers in social and communicative behaviour across development

spoken language is primary tool for social communication but much less complex than peers

capacity for relationships shown in ties to family and friends; may have successful friendships and sometimes romantic relationships in adulthood

may not perceive or interpret social cues accurately; social judgment and decision making are limited

significant social and communicative support needed in work setting for success

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15
Q

List the characteristics of MODERATE intellectual disability in the practical domain

A

can care for personal needs including eating, dressing, elimination, hygiene as an adult, though extended period of teaching and time needed for individual to become independent in these areas

can have independent employment but considerable support needed

recreational skills can be developed but typically require additional supports

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16
Q

List the characteristics of SEVERE intellectual disability in the conceptual domain

A

limited skill attainment

generally has little understanding of written language or concepts involving numbers, quantity, time and money

caretakers provide extensive support for problem solving across lifespan

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17
Q

List the characteristics of SEVERE intellectual disability in the social domain

A

spoken language limited in vocabulary and grammar

speech may be single words or phrases and may be supplemented through augmented means

focused on here and now within everyday events

understand simple speech and gestural communication

relationships with family members and familiar others are source of pleasure and help

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18
Q

List the characteristics of SEVERE intellectual disability in the practical domain

A

requires support for all ADLs

requires supervision at all times

cannot make responsible decisions regarding wellbeing of self or others

requires ongoing support and assistance into adulthood with participation in tasks

maladaptive behaviour, including self injury, present in significant minority

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19
Q

List the characteristics of PROFOUND intellectual disability in the conceptual domain

A

conceptual skills generally involve physical world rather than symbolic processes

may use objects in goal directed fashion for self care, work, recreation

may acquire some visuospatial skills i.e matching and sorting but co-occurring motor and sensory impairments may prevent functional use of objects

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20
Q

List the characteristics of SEVERE intellectual disability in the social domain

A

very limited understanding of symbolic communication in speech or gesture

may understand some simple instructions or gestures

expresses own desires or emotions largely non-verbally

enjoys relationships with wellknown family members/caretakers/familiar others

may prevent many social activities

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21
Q

List the characteristics of SEVERE intellectual disability in the practical domain

A

dependent on others for all aspects of daily physical care, health and safety though may be able to participate in some of these activities

co occurring physical and sensory impairments are frequent barriers to participation (beyond watching) in home, recreational, vocational activities

maladaptive behaviour present in significant minority

22
Q

how do those with intellectual disability typically score on validated tests of intelligence

A

scores of 65-75
(on tests with SD of 15 and mean of 100)

this represents scores of approximately two standard deviations or more below the population mean

including margin for measurement error (+/- 5 points)

*clinical training and judgment are required to interpret test results and assess intellectual performance

23
Q

what is the Flynn effect

A

overly high test scores due to out of date test norms

24
Q

what factors may affect intelligence test scores

A

practice effects and the flynn effect

invalid scores may result from use of brief intelligence screening tests or group tests

co-occurring disorders that affect communication, language and/or motor or sensory function may affect scores

25
Q

what factors must be considered when an intelligence test is “normed”

A

instruments must be normed for the individuals sociocultural background and native language

26
Q

what is better than an IQ score for understanding intellectual abilities

in what areas are IQ tests insufficient

A

individual cognitive profiles based on neuropsychiatric testing –> these may ID areas of relative strength and weakness and may be important for academic and vocational planning

IQ test scores approximate conceptual functioning but may be insufficient to assess reasoning in real life situations and mastery of practical tasks

27
Q

what are the three domains of adaptive functioning

A

adaptive reasoning in:
conceptual
social
practical domains

28
Q

what is the conceptual domain

A

aka academic domain

competence in memory, language, reading, writing, math reasoning, acquisition of practical knowledge, problem solving, judgment in novel situations

29
Q

what is the social domain

A

awareness of others thoughts, feeling, experiences, empathy, interpersonal communication skills, friendship abilities, social judgment

30
Q

what is the practical domain

A

learning and self management across life settings i.e personal care, job responsibilities, money management, recreation, self management of behaviour, school and work task organization

31
Q

outside of intellectual disability/testing, what factors can influence an individuals adaptive functioning

A 
intellectual capacity
education
motivation
socialization
personality features
vocational opportunity
cultural experience
coexisting general med condition or other mental disorder
32
Q

what do you do if standardized testing is not possible (i.e due to sensory impairment or other factor)

A

may diagnose person with unspecified intellectual disability

33
Q

what are frequent co-occurring/associated difficulties in those with intellectual disability

A

difficulties with:
social judgment

assessment of risk

self management of behaviour, emotions or interpersonal relationships

motivation in school or work environments

34
Q

what factor in intellectual disability may predispose to disruptive or aggressive behaviours

A

lack of communication skills

35
Q

what features, that can be present in intellectual disability, can result in exploitation by others

A

gullibility (often a feature of intellectual disability )–> naivete in social situations and tendency for being easily led by others

and

lack of awareness of risk

  • -can result in victimization, fraud, unintentional criminal involvement, false confessions, risk of physical/sexual abuse
  • -important factors in criminal cases
36
Q

what is the prevalence if intellectual disability

A

1%
(overall general population prevalence)

prevalence rates vary by age

prevalence of severe intellectual disability = 6/1000

37
Q

what is the age and characteristic features at onset of intellectual disability

A

dependent on etiology and severity of brain dysfunction

delayed milestones may be seen within first 2 years of life in those with more severe intellectual disability; mild levels may not be noted until school age when difficulty with academic learning is more obvious

38
Q

what is a behavioural phenotype

A

specific behaviours that are characteristic of a particular genetic disorder i.e Lesch-Nyhan syndrome

39
Q

when might both an intellectual disability and a neurocognitive disorder be diagnosed at the same time

A

when intellectual disability results from loss of previously acquired skills i.e in severe traumatic brain injury

40
Q

is intellectual disability generally progressive or nonprogressive

A

nonprogressive

BUT–in certain genetic disorders (i.e Rett syndrome) there are periods of worsening followed by stabilization

in others (i.e Sanfilippo syndrome) there may be progressive worsening of intellectual function

41
Q

list some prenatal etiologies of intellectual disability

A

genetic syndromes

inborn error of metabolism

brain malformations

maternal disease (including placental disease)

environmental influences (alcohol, drugs, toxins teratogens)

42
Q

list some perinatal etiologies of intellectual disability

A

variety of labour and delivery related events leading to neonatal encephalopathy

43
Q

list some postnatal causes of intellectual disability

A

hypoxic ischemic injury

TBI

infections

demyelinating disorders

seizures disorders

severe and chronic social deprivation

toxic metabolic syndromes and intoxications (i.e lead, mercury)

44
Q

what is the sex distribution of intellectual disability

A

males more likely than females to be diagnosed with intellectual disability

mild–ratio is 1.6:1 M:F

severe–ratio is 1.2:1 M:F

sex linked genetic factors and male vulnerability to brain insult may account for some of the gender differences

45
Q

other than tests of intellectual and adaptive functioning, what might constitute part of the assessment of a patient for intellectual disability

A

ID of genetic vs nongenetic etiologies

evaluate for associated medical conditions i.e cerebral palsy

evaluate for cooccurring mental, emotional, behavioural disorders

pre-and perinatal medical history

3 generation family pedigree

physical exam

genetic evaluation (karyotype etc)

metabolic screening

neuroimaging assessment

46
Q

how should an intellectual disability occurring in the context of a genetic syndrome be documented

A

noted as concurrent diagnoses

47
Q

what is the major differential diagnosis for intellectual disability

A

major and mild neurocognitive disorders

communication disorders

specific learning disorders

autism spectrum disorder

48
Q

how do neurodevelopmental and neurocognitive disorders differ

A

neurocognitive disorders are characterized by LOSS of cognitive functioning

they may co occur

49
Q

how to distinguish between intellectual disability and communication/learning disorders

A

those with communication/learnign disorders have deficits specific to these domains, and do NOT show deficits in intellectual and adaptive behaviour

may co occur

50
Q

what are the most common co occurring mental and neurodevelopmental disorders

A

ADHD

depressive and bipolar disorders

anxiety disorders

ASD

stereotypic movement disorder

impulse control disorders

major neurocog disorder

51
Q

what is global developmental delay

A

a diagnosis reserved for those UNDER AGE 5 when clinical severity level cannot be reliably assessed during early childhood

this is used when an individual fails to meet expected developmental milestones in several areas of intellectual functioning

applies to those who are unable to undergo systematic assessments of intellectual functioning, including children too young to undergo testing

requires reassessment after a period of time

52
Q

what is unspecified intellectual disability

A

reserved for individuals OVER AGE 5 when assessment of the degree if intellectual disability by means of locally available procedures is rendered difficult or impossible due to associated sensory or physical impairments (i.e blindness, prelingual deafness, severe behaviour problems or co occurring mental disorder)

should only be used in exceptional circumstances and requires reassessment after a period of time

1. Child and Adolescent Psychiatry (15 decks)

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