Residential Services for Persons with Intellectual and Developmental Disabilities
Chapter 5 Intellectual and Developmental Disabilities
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Transcript of Chapter 5 Intellectual and Developmental Disabilities
Chapter 5: Intellectual and Developmental Disabilities
This PowerPoint includes additional information not found in your text
Topics • Definition• Prevalence• Causes• Identification• Psychological and behavioral characteristics• Educational considerations• Assessment of progress• Early intervention• Transition to adulthood
What’s in a name?
• Idiot, moron, imbecile
• Feeble-minded
• Mental retardation– Still the classification used in Pennsylvania
today
• Intellectual and developmental disabilities
Definition
Reasons for caution Concern about misdiagnosis of ethnic
minorities Possible stigma associated with the
diagnosis Belief that intellectual disability is a socially
constructed condition
2002 AAIDD definition
• Mental retardation is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before age 18.– IQ less than ____/75– Need to have both low IQ and limited
adaptive behavior
5 Assumptions of the AAIDD Definition
• Must consider context, age, and community• Assessment must be valid and consider
culture; language; sensory, motor, and behavioral issues; and differences in communication
• Individuals have both limitations and strengths
• Should develop profile of needed supports• Life functioning can improve over time with
use of appropriate supports
Supports• Supports
– Resources and strategies that promote development, education, interests, and well being
• Levels of support (1992 AAMR)
– Intermittent—as _________– Limited—daily or weekly for _____ period of time– Extensive—daily or weekly for _____ period of time– Pervasive—hourly or __________
• Types of support– Natural– Service-based– Technological
Classification of Mental Retardation(American Psychological Association)
IQ Score
Mild 50-70
Moderate 35-50
Severe 20-35
Profound 00-20
2002 Pennsylvania Definition
• Mental retardation--"significantly subaverage intellectual functioning that is accompanied by significant limitations in adaptive functioning in at least two of the following areas: Communcation, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety. The onset must occur before the individual’s 22nd birthday.”
(§4210.101a)
IQ below 70
Types of Support in PA• Learning
– “Services for students with a disability who require services primarily in the areas of ___________, ___________, __________, or speaking or listening skills related to academic performance”
• Life skills– "Services for students with a disability who
require service primarily in the areas of academic, functional or vocational skills necessary for __________ living.”
Prevalence of Intellectual Impairments
Theoretical prevalence of intellectual impairmentbased on normal curve = 2.27%
Prevalence of Intellectual Impairments
• Actual prevalence =
• Discrepancy between theoretical and actual prevalence may be due to:– consideration of adaptive behavior– classification as learning disabled for
those with higher IQs– classification as autistic
1%1%
Prevalence of People with Mental Retardation by Classification
Profound 2%
Moderate10%
Severe3%
Mild85%
Causes• Prenatal causes (before ______)
Chromosomal disorders• Down syndrome• Williams syndrome• Fragile X syndrome• Prader-Willi syndrome• Inborn errors of metabolism
• PKU
• Developmental disorders of brain formation• Microcephalus• Hydrocephalus
• Environmental influences• Fetal alcohol spectrum disorders• Rubella
Down Syndrome
Three typesTrisomy 21MosaicismTranslocation
Trisomy 21Down Syndrome
Trisomy 21 47 chromosomes in all
cells due to trisomy of 21st chromosome
92% of all cases of Down Syndrome
Related to increased parental age
Maternal age and Trisomy 21 Down Syndrome
Characteristics ofDown Syndrome
Physical Characteristics Short stature Obesity Hyperflexibility of joints Hypotonicity (low _____ _______)
Characteristics ofDown Syndrome
Distinctive facial features Folds of skin around eyes Small ears with very small lobes Flat appearance to face; small nose
with small bridge Protruding tongue due to:
small mouth short roof of mouth low muscle tone in tongue
Sparse, fine hair
Characteristics ofDown Syndrome
Physical Characteristics• Distinct hands and feet
– simian crease across palms– small hands with short stubby
fingers – little finger curves in instead of
being straight– short stubby toes with wide
space between big and 2nd toe
Characteristics ofDown Syndrome
Health Characteristics Myopia ( ____ sightedness) and/or strabismus ( _____ eyes) in 60% Heart defects in 50% Respiratory problems Higher rate of leukemia Higher rate of Alzheimer's Conductive hearing loss in 66-89% Hypothyroidism in 50-90% Eczema and/or dry skin in 50% Generally sterile Shorter life span
50 years average life expectancy
Characteristics ofDown Syndrome
Cognitive characteristics Better on visual-spatial tasks than verbal-auditory tasks Girls are about 5-10 IQ points higher than boys Declining IQ as person ages
highest IQs in infancy and early childhood development plateaus in middle childhood most adults have moderate MR deterioration of adaptive skills beginning at 40
Language characteristics Grammar is akin to that of 3 year old Receptive language is better than expressive language 90% have articulation problems May see more gesturing than actual language use
Characteristics ofDown Syndrome
Sociobehavioral characteristics Generally are very sociable and friendly
outgoing likely to use sociability to get out
of difficult tasks may do better in inclusive settings may prefer playing with younger
children 75% described as stubborn
increased depression with age
Williams Syndrome• Caused by microdeletion
of the 7th chromosome (7q11.2)
• Characteristics:– mild mental retardation in
75%– attention deficit disorder
and hyperactivity– overly friendly with adults
• incessant chatter• inappropriate and
repetitive speech– excessive anxiety & worry
7q11.2
Williams Syndrome
• Characteristics:– strengths in auditory rote
memory and language– extreme weakness in
perceptual and motor – auditory and textile
hypersensitivity– high incidence of absolute
pitch– cardiovascular disease
• narrowing of the main arteries leading from the heart
Middle two rows are copied spatial designs (top row) by two 11-year-old children with Williams Syndrome. Their copies distort spatial properties while preserving other design aspects, such as color. Bottom row drawings are by a six-year-old child without Williams syndrome.
Williams Syndrome
• Characteristics:– connective tissue abnormalities
• joint limitation or laxity, and soft, lax skin
• hoarse voice
• bowel/bladder diverticulae and rectal prolapse
– delayed rate of growth, including low stature and a slight build
– distinctive facial characteristics
Characteristics of Williams Syndrome
• “________- like facial features
– broad brow– short nose, full nasal
tip,– long philtrum– full lips – wide mouth– small jaw– prominent earlobes
Fragile X
Trinucleotides on the X chromosome expand from the usual 6-50 repetitions to morethan 200 repetitions
Fragile X symptoms become apparent @ 200 repeats;
The more repetitions, the more symptoms we see
•aka Martin-Bell Syndrome or Marker X syndrome•caused by a trinucleotide repeat expansion of the FMR1 gene on the _____ chromosome
Characteristics ofFragile X
• distinct face long narrow face prominent jaw large protruding ears high arched palate
Characteristics ofFragile X
long hands and palms large testes after puberty seizures in 20% autism-like features in 7-25% (Hatton, et al., 2003)
normal life expectancy ADHD mild—moderate intellectual impairment
in boys; borderline IQ in girls decline in IQs over time
perseverative speech generally better verbal skills than one
would expect given IQ good adaptive behavior
Prader Willi Syndrome
• Caused by deletion of part of 15th chromosome (15q11-13) that derives from father
• most common cause
Characteristics ofPrader Willi Syndrome
Distinct faces down turned mouth almond shaped eyes
Hypopigmentation in 50% Hypotonia (_____ muscle tone)
delayed motor development failure to thrive and feeding problems in infancy morbid obesity after infancy obesity related health problems
More Characteristics of Prader Willi Syndrome
short stature relative to family adult males—avg. 5 ft. 1 inch adult females—avg. 4 ft. 10 ins. small hands and feet
delayed secondary sex characteristics; infertility
day time sleepiness and high threshold of pain
abnormal temperature regulation
Cognitive Functioning in Prader Willi Syndrome
Average IQ is 70 Strengths in visual processing Social behavioral issues (_______ _________)
Hoarding or stealing food
Picking at skin, especially front of hands and legs
Temper tantrums
Stubbornness
Compulsive Upset by changes in order Anxiety
Prader Willi Syndrome Treatment
• Growth hormone to increase height• Weight management
low calorie diet less than 600 kcals per day in children less than 1000 kcals per day in adults
limited food intake regular exercise
Question
• Jose has intellectual disabilities. As an infant, he was lethargic and had difficulty eating; however, at about one year of age he became obsessed with food. This is characteristic of
a)Down syndrome
b)Williams syndrome
c)Fragile X syndrome
d)Prader-Willi syndrome
Phenylketonuria (PKU)
recessive gene on 12th chromosome
______ error of ________ Causes body to not be able to
metabolize phenylalanine (found in ________ and nutrasweet)
Builds up in brain and causes brain damage
Treatment involves diet with no protein or nutrasweet Diet must be followed until ______
Phenylketonuria (PKU)
the longer we wait to begin diet, the lower the IQ will be
Age of treament and IQ in PKU (Hanley et al.)
93.5
71.654.5 55.5
40.8
0
20
40
60
80
100
0-2
months
2-6
months
6-12
months
12-24
months
over 24
months
age
IQ
Screening Tests
• Maternal serum screening
• Nuchal translucency sonogram
• Amniocentesis
• Chorionic villus sampling
• Newborn screening
Amniocentesis
• Take sample of amniotic fluid and analyze it
• Done at 13-16 weeks• 1/250 risk of
miscarriage
Chorionic Villus Sampling (CVS)
• Take sample of chorion, placental tissue
• Done at 7-11 weeks • 1% chance of
miscarriage
Hydrocephalus
Can result in intellectual impairment
Untreated hydrocephalus Treated hydrocephalus
Hydocephalustreatment
Treat with shunt Amount of intellectual
impairment depends on shunt’s ability to drain fluid
Can do fetal surgery and implant shunt in fetus
Monitor child for signs that shunt is malfunctioning, blocked or infected
– increased lethargy, fever, enlarged head size
MicrocephalusMicro= ___________
Cephalus or cephalo = _____________
Newborn with microcephaly
Microcephaly
Causes of microcephaly
• Maternal protein deficiency
• Various genetic disorders
School age children with microcephaly
Although text says “life expectancy is short,” life expectancy is usually
related to size of head
Fetal Alcohol Spectrum Disorder
Fetal alcohol syndrome•Have all 4 characteristics
Fetal alcohol effects syndrome•Have 3 of 4 characteristics
•Usually lack the distinctive facial appearance
Fetal Alcohol Spectrum Disorder
Characteristics of Fetal Alcohol Spectrum Disorder
• History of prenatal alcohol exposure
• Growth deficiency for height and/or weight
• Distinctive facial appearance including: short eye slits flat mid face thin upper lip short, upturned nose smooth or long
philtrum misaligned or
misshapen secondary
teeth
Characteristics of Fetal Alcohol Spectrum Disorder
Flat midface
Smooth philtrum
Epicanthal folds
Characteristics of Fetal Alcohol Spectrum Disorder
• History of prenatal alcohol exposure • Growth deficiency for height and/or weight • Distinctive facial appearance• Brain or CNS damage as evidenced by:
Microcephaly Reduced size of caudate nucleus in basal ganglia– (responsible for memory, attention, and cognition) Intellectual impairment tremors and or seizures hyperactivity ocular problems attention deficits poor coordination poor impulse and anger control difficulties with judgment & abstract reasoning memory impairments
Fetal Alcohol Effects Syndrome (FAES)
• Aka alcohol-related neurodevelopmental disorder (ARND)
• Fewer physical signs• Occurs 3 times more
frequently than FAS (Streissguth, 1997)
Fetal Alcohol Spectrum DisorderSecondary characteristics
90% develop mental health problems 60% quit school 60% trouble with law 50% incarcerated at some time 49% inappropriate sexual behavior 35% alcohol or drug problems
Congenital Rubella
aka German measles Problematic if mom gets rubella
during early part of pregnancy or right before pregnancy
Rubella: Pregnancy outcomes in mothers who had congenital
rubella (Sever, Hardy et al.,)
Age of infection
Percentage of Affected infants
Preconception 0-28 days before
conception
43%
First trimester 0-12 weeks after
conception
51%
Second trimester
13-26 weeks after
conception
23%
Third trimester 27-40 weeks after
conception
0%
Most severe
outcomes
Effects of Congenital Rubella
congenital cataracts blind intellectual impairment deaf deaf-blind hydrocephaly microcephaly heart defects
Congenital cataracts
Causes (cont’d)
• _______ causes (at the time of birth) Anoxia Low birth weight Infections passed from mother
Syphilis Herpes
Anoxia (lack of or too little ______)
• Don’t know exactly how much anoxia is needed to produce brain damage
• Causes of anoxia: Breech birth Prolonged labor Precipitous birth Placenta previa Cephalo-pelvic
insufficiency Umbilical cord prolapse or
cord wrapped around baby’s neck
Drugs use to speed labor or sedate mother
Low Birth Weight
• Full term babies – born after ______ weeks
• weigh less than 2500 grams (_______ lbs) Aka “small for gestational age”
Low birth weight vs. Prematurity
Time of gestation
Weight
Premature Less than 36 weeks
Less than 5.5 lbs.
Low birth weight
More than 36 weeks
Less than 5.5 lbs.
Low Birth Weight
Causes of Low Birth Weight
Maternal smoking Maternal malnutrition Maternal cocaine use Multiple and close
pregnancies Teen or young mother
Effects of Low Birth Weight
Death 5 times increased risk
Low IQ Microcephaly Failure to thrive
syndrome
Congenital Syphilis Syndrome• Sexually transmitted disease in mother• Caused by a spirochete bacteria • Bacteria crosses the placenta and damages the fetus
– Crossover cannot occur until 16th-18th week of pregnancy
• Can prevent by: Treating infected pregnant women with penicillin prior to the 16th
week of pregnancy Give untreated babies penicillin after birth
Effects of Congenital Syphilis Syndrome
• Syphilis in baby
• Fetal death 30% are stillborn (Mavrov et al., 2001)
• Distension of brain ventricle system• Intellectual impairment in 6% (Mavrov et al., 2001)
Congenital Herpes
Viral infection spread through exposure to Herpes lesions
Prevent exposure to lesions through Caesarian delivery
Effects of Congenital Herpes Seizures Death
50% die within 6 or 7 days Intellectual Impairment and/or Cerebral
Palsy Herpes lesions on baby
Causes (cont’d)
• Postnatal causes (_____ birth) Biological postnatal causes
Traumatic brain injury** Encephalitis Meningitis Lead poisoning
Psychosocial postnatal causes
**Discussed in depth in Chapter 13
Meningitis & Encephalitis
Encephalitis--inflammation of head or brain
Meningitis--inflammation of meninges
•Can occur at any time; •Can result in death, intellectual impairment, hearing loss, deaf-blindness, and/or finger/toe loss
Lead Poisoning
Lead accumulates in brain and bodily organs
Can cause: Learning disabilities Lower IQ Borderline or mild intellectual impairment Behavior problems Neurological problems Kidney disease
Sources of Lead
Paint chips
Lead pipes &solder
In old plumbingToys, jewelry, blinds,
and ceramic
items from China
Dirt from areas
near freeways
Psychosocial
Socioeconomic status (SES)
High Middle Low
0-20 IQ 1 1 1
20-50 IQ 4 4 4
50-75/80 IQ 10 25 50
75/80-90 IQ 50 170 300
Retardation prevalence per 1,000 School-age children by SES and IQ level
Psychosocial
Children who live in poverty for first 5 years of life average 9 IQ points lower than those who have never lived in poverty (Duncan et al., 1994)
Common correlates of low income
• Poor language and verbal skills of parents• Low maternal education• Few books and toys• Limited educational opportunities and expectations• Single and/or teenage mothers
– reduced supervision– reduced time spent with parent– emotional support may be lacking– lack of knowledge of child care
• Inadequate prenatal care• Multiple pregnancies in short time period• Limited routines, rituals and consistency
– sometimes, constant, unpredictable changes (Bernheimer, 2003)
PsychosocialTalk addressed to Child by Parent
0
2000
4000
6000
12 18 24 30 36
age in months
vocabula
ry
UpperSESMiddleSESLow SES
From Greenwood, Hart, Walker, Risley (1994)
Talk addressed by Child to Parent
0
500
1000
1500
2000
2500
3000
12 18 24 30 36
age in months
vocabula
ry
Upper SES
Middle SES
Lower SES
Low maternal education
Low vocabulary development in child
Low Mental Age in child
Low achievement in school
Early school drop out
Parenthood
Vocabulary size of the child is the single most important predictor of reading success (Anderson & Nagy, 2002)
IdentificationIntelligence tests
IQ tests for children (WISC-IV)
Cautions in using and interpreting IQ tests IQs can _______ from one
administration to next All tests are culturally
biased Younger the child, the less
valid the test IQ does not guarantee
outcomes
Adaptive behavior skills Parent or teacher answer
questions concerning the ability of student to perform adaptive skills
Vineland
Need both
Psychological and Behavioral Characteristics
• Genetic syndromes and behavioral phenotypes
• Specific learning problems Poor working memory Poor language comprehension and production Poor self-regulation (metacognition) Need external motivation
learned helplessness
Poor social development Increased gullibility
Educational Considerations
Functional academics– NCLB access to the general curriculum in:
_________, __________, and _____
Instruction in real-life settings with real materials
Grocery shopping in grocery store
Educational Considerations
Systematic instruction– Involves systematic
________, consequences for performance, transfer of stimulus control, and data based decisions
Constant time delay Progressive time delay
Prompt types• Ambiguous verbal• Specific verbal• Modeling• Gestures• Priming
– Enough physical help to start performing
• Physical assistance– Faded through
graduated guidance
Question• Karen is trying to transfer control away from
prompts to a more naturally occurring stimulus. She tells her daughter “ Pick up your toys. Put them in that box (points to box). “Over the next few days, she will tell her daughter to pick up her toys, but will wait 10 seconds before telling her to put them in the box. This is an example of
a) Progressive time delay
b) Constant time delay
c) Intermittent time delay
Functional behavioral assessment (FBA)
• Finding out the consequences, antecedents, and setting events that maintain the behavior– Used to identify the purpose or function of the behavior
• 5 most common functions of behavior1.______ attention2.escape from a ________3.access to ______ ________4.self stimulation / sensory stimulation
5.lack of knowledge or skill
Positive behavioral intervention and support (PBIS)• Support ______ behavior rather than ______ undesirable behavior
Service delivery models• Regular class with support (inclusion)
– Class wide peer tutoring– Co-teaching
• Resource room– Pennsylvania law limits 20 students to a
resource room
• Special class– in PA, usually 12-15 life skills or learning support
students– in PA, usually 8 students with multiple disabilities
• Special school– day school– residential school
• Hospital or homebound
More restrictive
Less restrictive
Assessment
Progress monitoring • Academic skills
Curriculum-based measurement (CBM)
• Adaptive behavior skills
Outcome measures Academic skills
PSSA-testing accommodations
PASA—alternative assessment
Adaptive behavior skills
Quality of lifeNeed
both types
Early InterventionPrograms designed for:
Prevention• _______ Preschool
Project• At age 27,
– Higher graduation rates
– Fewer arrests– Less teen pregnancies– Less welfare– Higher income
Further development• Language• Conceptual skills• Behavior• Motor skills
or
Transition to Adulthood• Self-determination
– Ability to make personal choices, plan and regulate one’s life, and be a self _______
– Cultural differences– Can it be carried too
far?
Transition to Adulthood• Person-centered planning
– Focus on the person– Supports a team approach– Vision, purposes, and
goals– Understand focus person’s
past, present and future life– Develop actions for
change, mutual support, personal and team development, and learning
– Usually creates the best contextual fit
Goals of Person Centered Planning (Iovannone, 2004)
1. Being present and participating in community life
2. Gaining and maintaining satisfying relationships
3. Expressing preferences and making choices in everyday life
4. Having opportunities to fulfill respected roles and live in dignity
5. Continuing to develop personal competencies
Transition to Adulthood: Community Adjustment
Community residential facilities
• aka ______ ______• 3-10 folks• Supervision
Supported living• Own home or
apartment • Support
Transition to Adulthood: Employment
Sheltered Workshop• no integration• less than minimum
wage• "non-meaningful"
work• no opportunities for
advancement• support, often
continuous
Transition to Adulthood: Employment
Supported Competitive• integrated• prevailing wage and
benefits• real, meaningful work• opportunities for
advancement• ongoing, unlimited support
– support in form of job coach, natural supports or technological supports