Intellectual Disaabilities

Intellectual Disabilities

Dr. Shewikar El BakryAss. Prof. Psychiatry

Banha University

The Nature of Intellectual Disability

“An intellectual disability, formerly referred to as “mental retardation” is characterized by a combination of deficits in both cognitive functioning and adaptive behavior.The severity of the intellectual disability is determined by the discrepancy between the individual's capabilities in learning and in and the expectations of the social environment. (Project IDEAL, 2008)

Definition• Deficits in IQ and adaptive functioning• IQ of 70 or below– Measured by standard scales• Wechsler, Stanford-Binet, Kaufman

• Impairments in Adaptive Functioning– Effective coping with common life demands– Ability to meet standards of independence– Measured by standard scales• Vineland, AAMR Adaptive Behavior Scale

The Nature of Intellectual Disability

“ Intellectual disability is a term used when a person has certain limitations in mental functioning and skills such as communicating, taking care of himself/herself and social skills.These limitations cause a child to learn and develop more slowly than a typical child.

Definitions for Intellectual Disability

“Significantly sub-average general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child’s educational performance.”

IDEA (Individuals with Disabilities Education Act)

Conceptual skills—language and literacy; money, time, and number concepts; and self-direction.

Social skills—interpersonal skills, social responsibility, self-esteem, 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 skills, healthcare, travel/transportation, schedules/routines, safety, use of money, use of the telephone.

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AAMR Adaptive Skill

Areas

Prevalence

• 1% (1 – 3% in developed countries)• The prevalence of ID due to biological factors is

similar among children of all SES; however, certain etiological factors are linked to lower SES (e.g., lead poisoning & premature birth)

• More common among males (1.5:1)• In cases without a specifically identified biological

cause, the MR is usually milder; and individuals from lower SES are over-represented

Distribution

CAUSES

Etiology and Classifications of Intellectual Disability

PRENATAL CAUSES

PERINATAL CAUSES

POSTNATAL CAUSES

1. Chromosomal Disorders

2. Inborn Errors of Metabolism

3. Developmental Disorders of Brain Formation

4. Environmental Influences

1. Anoxia (complete deprivation of oxygen)

2. Low birth weight (LBW)

3. Syphilis and herpes simplex

1. Biological

2. Psychosocial

3. Child Abuse and Neglect

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Possible Causes of Mental Retardation

PRENATAL CAUSESChromosomal

Disorders

Congenital intellectual disability and microcephally

Involves heart defects, hearing loss, and abnormalities of fingers and hands. Short stature

Manifest self-injurious behavior and limited speech and stereotypy

PRENATAL CAUSESChromosomal Disorders

Cornelia de Lange Syndrome

(Pierangelo & Giuliani,2007)

Difficulty swallowing and sucking

Low birth weight and poor growth

Unusual facial features and epicanthal fold broad flat nose

Hyperactive, aggressive, and repetitive movements

PRENATAL CAUSESChromosomal Disorders

Cri-du-ChatSyndrome

Also referred to as trisomy 21Usually not an inherited

conditionThe most common type of

chromosomal disorderIt involves the anomaly at the

21st set of chromosomes.People with DS exhibits

unusual facial features and with broad hands with short fingers

PRENATAL CAUSESChromosomal Disorders

Down’s Syndrome

(Pierangelo & Giuliani, 2007)

Sterility in menDecreased IQ Poor coordinationSkeletal abnormalitiesPoor coordination

PRENATAL CAUSESChromosomal Disorders

Klinefelter’s Syndrome

Prader-Willi Syndrome

Inherited from fatherInfants are lethargic and have

difficulty eating but eventually becomes obsessed with food as they grow hoarding and obsessive

The leading genetic cause of obesity.

People with Prader-Willi syndrome are at risk for a variety of other health problems such heart defects, kidney problems, scoliosis, etc.

PRENATAL CAUSESChromosomal Disorders

Turner’s Syndrome

Normally found in femalesPersons with Turner’s

syndrome has webbing of the neck, puffiness or swelling of the hands and feet

Associated with heart defects and kidney problems

PRENATAL CAUSESChromosomal Disorders

(Pierangelo & Giuliani,2007)

William’s Syndrome

Caused by the absence of material on the seventh pair of chromosome.

People with William’s syndrome exhibit heart defects and “elfin” facial features.

Their unusual sensitivity to sound makes them competent in music and language despite of their low IQ level.

PRENATAL CAUSESChromosomal Disorders

Fragile X Syndrome

Most common known hereditary cause of intellectual disability

Associated with X chromosome in the 23rd pair of chromosomes

Occurs less often in femalesPersons with Fragile X Syndrome have

behavior and emotional problems and poor socialization skills

They become anxious when routines are change

They have unusual facial features

PRENATAL CAUSESChromosomal Disorders

(Hallahan & Kauffman,2003) (Piearangelo & Giuliani, 2007)

PRENATAL CAUSESInborn Errors of

Metabolism

Galactosemia - inability of the body to use simple sugar galactose

Hunter Syndrome – defective breakdown of chemical mucopolysaccharide.

Phenylketonuria (PKU) – inability of the body to convert phenylalanine to tyrosine)

Tay-Sachs Disease – absence of Hex-A enzyme.

PRENATAL CAUSESInborn Errors of Metabolism

(Piearangelo & Giuliani, 2007)

Can be prevented through an early detection (e.g. newborn screening) and can be treated by providing a special diet program.

PRENATAL CAUSESDevelopmental

Disorders of Brain Formation

Microcephalus

The intellectual disability usually ranges from severe to profound.

There is no specific treatment and life expectancy is low.

PRENATAL CAUSESDevelopmental Disorders

of Brain Formation

(Hallahan & Kauffman,2003)

Hydrocephalus

Results from an accumulation of cerebrospinal fluid inside or outside the brain.

The degree of intellectual disability depends on how early the condition is diagnosed and treated.

PRENATAL CAUSESDevelopmental Disorders

of Brain Formation

(Hallahan & Kauffman,2003)

PRENATAL CAUSESEnvironmental

Influences

Maternal Malnutrition and Infection

Fetal Alcohol Syndrome (FAS)

Lead exposureIllicit drug exposureExposure to RadiationRubella (German measles)

PRENATAL CAUSESEnvironmental Influences

PERINATAL CAUSES

Anoxia (deprivation of oxygen)

Low birth weight (LBW)

Syphilis and herpes simplex

PERINATAL CAUSES

(Hallahan & Kauffman,2003)

POSTNATAL CAUSESEnvironmental and

Psychosocial Problems

Nutritional ProblemsAdverse living

conditionsInadequate health careLack of early cognitive

stimulation

POSTNATAL CAUSESEnvironmental and

Psychosocial Problems

Child abuse and neglectTraumatic Brain InjuryMeningitis or EncephalitisLead Poisoning

POSTNATAL CAUSESEnvironmental and

Psychosocial Problems

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Assessing Intellectual Ability and Adaptive Behavior

• Assessing Intellectual Ability (IQ testing)– Problems:• Potential for cultural bias• Flexibility of IQ scores• Overemphasis on IQ scores

• Assessing Adaptive Behavior – Considers the context of the individual’s

environment and cultural influences– Often measured by direct observation, interviews,

behavior rating scales

How Are ID Classified?

• Severity (Used in schools since the 1980s and based on IQ)– Mild = 50 to 70-75, Moderate = 35 to 50– Severe = 20 to 35, Profound = Below 20

• AAMR Levels of Support Needed– Intermittent – Limited– Extensive– Pervasive

Diagnosis

• History: pregnancy, labour, medications.• family, consanguinity• Psychiatric interview: Speech, thinking, mood• Physical examination: face , eyes, ears, tongue, teeth, • skin, thyroid, measurements• Neurological examination: gait, coordination, • sensations, reflexes, tone, motility

Investigations

• Chromosomal studies• Lab• EEG• Neuro imaging• Hearing, Eye and speech evaluation• Psychological assessment

Comorbid Conditionsfor Persons with

Intellectual Disabilities

Most Commonly Associated Axis I Disorders

• ADHD• Mood Disorders• Pervasive Developmental Disorders• Stereotypic Movement Disorders• Schizophrenia• Mental Disorders due to a GMC• Epilepsy

PLACEMENT PROGRAMS

for Persons with Intellectual Disabilities

For children with mild intellectual disability, readiness and functional academic skills are present and thus can be placed into Inclusion Programs.

Educational placement programs for children with moderate to severe intellectual disability can be more tedious. Curriculum and materials for these children should be age-appropriate, which should help develop independent behavior within the child.

Individualized Education Program (IEP) is designed to cater the special educational needs of special children. This is a useful and common vehicle to develop skills and educate children with intelletual disabilities who are in more severe cases.

Behavior Therapy Programs may also be employed, as they are very useful in altering behavior by lessening distruptive or inappropriate actions of a particular child.

Alternative Programs can also be incorporated in a child’s special education process. Such programs would include vocational training, physical education, theatre, music, etc.

Unlike preschool programs for children at risk, in which the goal is to prevent intellectual disability from occurring, programs for infants and preschoolers who are already identified with intellectual disability are designed to help them achieve as high a cognitive level as possible (Hallahan & Kauffman, 2003).

PLACEMENT PROGRAMSEarly Childhood

These programs gives more emphasis on conceptual and language development and usually involves speech and physical therapists most specially when children have multiple disabilities.

PLACEMENT PROGRAMSEarly Childhood

How Do I Teach Students with Intellectual Disabilities?

• Direct instruction with clear objectives, advance organizers, “think-aloud” model, guided practice, independent practice, post-organizers– Focus on task analysis– Focus on sequencing tasks for recognition, recall,

reconstruction– Focus on presentation and practice, including use

of prompts• Generalization

Most authorities agree that although the degree of emphasis on transition programming should be greater for older than for younger students, such programming should begin in the elementary years (Hallahan & Kauffman, 2003).

PLACEMENT PROGRAMSTransition to Adulthood

Transition programming for individuals involves two related areas; first, community adjustment to acquire a number of self-help skills and second, employment to lead to a meaningful job.

PLACEMENT PROGRAMSTransition to Adulthood

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Family Issues

• Families with a child with mental retardation may experience a wide range of concerns and often rely on a support network made up of friends and family members in addition to parent organizations and professional groups.

Medical Therapy

• SSRI (fluoxetine, sertraline, proxetine)• Antipsychotics (Risprdone, olanzapine,

aripiprazole)• Alpha 2 agonists (clonididne)• Lithium• Anticonvulsants