Intellectual disabilities

Mental Retardation Was Changed Why? The term mental retardation does not communicate dignity or respect and, in fact, frequently results in the reduction of such persons. Intellectual disability has been increasingly used by professional, organizations, journals, agencies and published research as the preferred term for the disability historically referred to as mental retardation.

American Association on Mental Retardation define it “significantly sub-average general intellectual functioning accompanied by significant limitations in adaptive functioning in a least two of the following skills areas: communication, self-care, social skills, self-direction, academic skills, work, leisure, health and/or safety. These limitations manifest themselves before 18 years of age.” Adaptive functioning means how well a person handles common demands in life and how independent they are compared to others of a similar age and background.

Causes of ID Genetic factors Pregnancy and birth factors Infancy and childhood medical problems Unknown factors

The American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th edition (cutoff IQ score for MR remains 70( AAMR, the upper limit of sub-average general intellectual functioning as Intelligence Quotient (IQ) “70 to 75”.

AAMR Individuals whose IQs are greater than 50 are more likely to benefit from a formal academic educational program; those whose IQs are less than 50 benefit more from an emphasis on life skills training. Mild 51-75 Sever less than 50

Grades Of Intellectual Disabilities DSM-IV-TR Mild 55-69 Moderate 40-54 Severe 25-39 Profound

Mild Reach a level of education at least equal to the upper primary level. Develop mentally 1/2 to 3/4 the level of their “normal” peers. Acquire vocational skills at some level

Moderate Develop mentally 1/4 to 1/2 the level of “normal” children. Education at approximately a 2nd grade level is possible

Severe to Profound Grossly intellectually deficient. Develop mentally at no more than 1/4 the level of “normal” children. Learn some fundamental skills, but many never develop competence even in self-help skills. Needs to be taught how to imitate and lacks the ability to attend to obvious stimuli independently.

How does Intellectual disabilities affect the child Developmental aspects affected by: Attention Memory Language ability Gross and fine motor coordination Learning and problem-solving abilities Social and self-care skills Ability to control emotion and behavior

Adaptability in daily life would be affected: Ability to communicate Self-care Housework Social skills Working and learning Community life

Clinical presentation Most affected children present with “speech” delay, the most common type of developmental delay (language development is the best indicator of future cognitive abilities(.

The following delays are definitely abnormal Failure to turn to a voice by 6 months Failure to babble by 9 months Failure to orient to name at 13 months Failure to point to request or comment by 18 months Failure to follow a simple command without a gesture by 18 months

Failure to use 10 to 25 single words by 24 months Failure to speak in two-word phrases by 26 months Failure to speak in three-word sentences by 36 months Unintelligible speech in a child older than 36months Regression in language skills at any age

Characteristics of ID students Obesity and overweight problems • Congenital diseases • Postural abnormalities: misalignments of the trunk or legs, protruding abdomen, flexed head, externally rotate the legs and use a wide base of support when walking and running • Developmental patterns occur at a slower pace than other pupils • Physical fitness and motor proficiency may be below normal

May be more successful in skills involving physical ability Function best in concrete, non-complicated activities Generalization of skills may not occur without intervention Maintenance of skills may not occur without intervention

Incidental learning may not occur Memory and attention span may be deficient Vocabulary may be limited These students may be underestimated May be easily frustrated May have an inadequate self image May lack motivation and aggressiveness

Tend to be followers, not leaders May have difficulty exhibiting appropriate behavior May be easily upset with changes in routine May not be self-motivated May show little interest in play due to a lack of healthy play experiences

TEACHING TIPS AND SUGGESTED ACTIVITIES Short instruction periods. Teach in small groups. Use few and simple words and maximize demonstrations. Over teach the cognitive information. Provide opportunities for choice of activities

Use peer partner. Emphasize range of motion exercises. Concentrate on postural righting activities. Concentrate on vestibular activities. Provide a well-rounded program of fitness and motor activities based on each student’s present level of performance and developmental psychomotor needs.

Allow for periods of rest during instruction. Simplify, demonstrate, positively reinforce, and use multi-sensory approaches. Plan activities with few rules to memorize. Program for generalization with the use of different people, equipment, environments, and times.

Teach safety often by stressing cause-effect relationships. Provide prompt and consistent feedback. Check for skill retention often. Present information and instructions in small, sequential steps and review each step frequently.

Generalize to community-based settings by teaching skills that the students can use frequently and apply to settings other than school. Offer activities that provide initial success. When appropriate, put in leadership roles. Systematically ignore inappropriate behaviors, model appropriate behaviors, and praise appropriate behaviors and responses.

Program systematic, age-appropriate activities that include all domains of development including psychomotor, social, vocational, and academic objectives. Early intervention may lesson or prevent secondary problems such as posture and fitness deficiencies.

Instruments to Measure Cognition Bayley Scales of Infant Development III Wechsler Preschool and Primary Scale of Intelligence III Stanford-Binet Intelligence Scale (5th Ed) Kaufman Assessment Battery for Children II Wechsler Intelligence Scale for Children (WISC-IV)

Instruments to Measure Adaptive Skills Vineland Adaptive Behavior Scales II (VBAS II) Assesses five major domains: communication, daily living skills, socialization, motor skills, maladaptive behavior For children birth to 19 years of age

Scales of Independent Behavior-Revised (SIB-R) Comprehensive assessment of 14 areas of adaptive behavior and 8 areas of problem behavior For persons from birth to 80 years of age A version is available for use with persons who are visually impaired