Intellectual & Developmental Disabilities

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The term "developmental disability" was first instituted

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with the Developmental Disabilities Act of 1975

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Developmental disability is defined by the Developmental Disabilities Assistance and Bill of Rights Act of 2000 as:

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-a severe chronic disability of an individual that is
a)attributable to mental or physical impairment or combination of both
b)that is manifested before the individual is 22 years old
c) is likely to continue indefinitely
d) results in substantial functional limitations in 3+ areas of major life activity including self-care, receptive & expressive language, learning, mobility, self-direction, capacity for independent living, and economic self-sufficiency
e) reflects the individuals need for a combination and sequence of special interdisciplinary or genetic services, ind support, or other forms of assistance that are lifelong or of extended duration and that are ind planned/coordinated

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A major focus of working with individuals with developmental disabilities is:

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-identifying specific needs
-developing strategies that minimize the degree of limitations experienced
-providing necessary supports to enhanced functional capacities

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Common feature of developmental disabilities is functional limitations in the following areas of function:

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-speech/language
-attention and/or affect
-cognitive or learning ability
-self-direction and/or social behavior
-motor skills and mobility
-self-care and independence

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Intellectual disability

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-called mental retardation in DSM-IV-TR but updated to intellectual disability in new DSM
-is characterized by significant limitations in both intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills
-originates before age 18

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Diagnosis is made by measuring

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-intellectual functioning (using standardized IQ tests such as the Weschsler Intelligence Scales for Children or the Standford-Binet Intelligence Scale)
-adaptive functioning

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A person is classified as having an intellectual disability in relation to intellectual functioning

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-if the score falls at least two standard deviations below the mean for the testing instrument

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Classification of Mental Retardation according to the DSM-IV-TR includes:

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-mild=IQ of 50-55 to 70
-moderate=35-40 to 50-55
-severe=20-25 to 35-40
-profound=Below 20-25

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Examples of adaptive skills:

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-Conceptual skills=receptive/expressive language, reading & writing, money concepts, and self-direction
-Social Skills=interpersonal skills, gullibility and naïveté, ability to follow rules/laws, and responsibility
-Practical Skills=activities of daily living (eating, toileting, dressing), instrumental activities of daily living (preparing meals, housekeeping, telephone use, money management), job skills, ability to maintain personal safety

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AAIDD classification of mental retardation includes classification by level of support needed by the individual and includes the following:

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-intermittent=supports required periodically or on a short term basis
-limited=low-intensity, time-limited supports needed for specific needs (e.g. job training, school transition)
-extensive=ongoing, regular supports needed on a low-intensity basis to maintain adequate function in home or at work
-pervasive=extensive, ongoing, high-intensity support is required for safety and well-being

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What percentage of individuals with an intellectual disability are classified in the mild mental retardation range?

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90%

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Causes of intellectual disability can include:

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-genetic or environmental factors
-genetic abnormalities such as fragile X syndrome or trisomy 21 (Down's syndrome)
-congenital causes=brain malformations (neural tube defects), chromosomal abnormalities (Down syndrome, fragile X syndrome, Rett syndrome)
-prenatal causes=maternal exposure to rubella or herpes, maternal abuse of drugs or alcohol, maternal exposure to toxic chemicals or to teratogenic prescription drugs
-brain injury to infant during the birth process
-injury or trauma experienced during childhood
-childhood infections such as meningitis

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The most common identified genetic cause of intellectual disability in the US is

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Down syndrome

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An individual with mild intellectual disability:

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-are capable of attaining a higher level of intellectual functioning
-will likely be able to function independently or with minimal support and supervision
-will be able to be employed

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An individual with moderate intellectual disability:

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can manage self-care but will need more supervision in activities of daily living
-can learn vocational skills but processing abstract info is difficult
-function best in a semi-independent or partially supervised work environment (supported employment)

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An individual with a severe intellectual disability:

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-have limited communication skills and poorly developed motor skills
-require close supervision on most tasks
-will most likely be unable to live independently of family or group home

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The overall goal for activities and participation of individuals with intellectual disability

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to help individuals attain and maintain an optimal level of health and function throughout the life span within the range of their capacity

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Inclusion

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-refers to the integration and full participation of everyone, regardless of special needs and disabilities or the environment with typical peers in the least restrictive setting
-is essential in understanding the expectations of individuals with intellectual disability

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Vocational implications in Intellectual Disability:

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-depends on severity of the disability
-individuals typically perform better in structured environments
-may need assistance in learning how to function independently and need social skills training
-major barriers to reaching full work potential may be societal stereotypes and prejudice

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Pervasive developmental disorders

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-are the official diagnostic term in the DSM-IV-TR used to describe a broad range of developmental conditions that are characterized by impairments in multiple areas of development
-2 common conditions included in this are autism and Asperger's syndrome; also called autistic spectrum disorders (ASD)

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autistic disorder/autism

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-is a disorder of brain function that includes impairments in reciprocal social interaction and impairment in verbal and nonverbal communication, play skills, and cognitive and adaptive functioning
-is the third most common developmental disability
-is more prevalent in males than females