Chapter 17 Developmental Delay and Intellectual Disability Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Early Identification of Developmental Delay Global developmental delay Temporary diagnosis in young children at risk for develop- mental disabilities, especially intellectual disabilities Failure to achieve age-appropriate neurodevelopmental milestones in language, motor, social-adaptive development Early identification crucial: developmental surveillance should be part of routine pediatric care and include Concerns from parents Record of developmental milestones Screening test Best approach to early identification is multifaceted (monitoring, early intervention programs, parent education, evaluations by appropriate specialists) Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Defining Intellectual Disability Intellectual disability replaces term mental retardation and includes Current intellectual impairment Deficit in adaptive functioning Onset during developmental period Intellectual functioning: disagreements and concerns include Assessment of intellectual functioning Underlying value of IQ score Predictive validity and cultural bias Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Defining Intellectual Disability (continued) Adaptive impairments: impaired ability to adapt or function in daily life Three domains: conceptual, practical, and socialization skills Measured using individualized, standardized, culturally appropriate, psychometrically sound tests Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Classification of Intellectual Disability Degree of intellectual impairment (APA, 2000) Based on IQ levels: mild, moderate, severe, profound Accepted widely in medical community, but controversial Classification solely on basis of IQ not sufficient Required supports (AAIDD) Based on patterns and intensity of needed support Focuses on abilities of individuals to function in inclusive environment Controversial See the textbook Children with Disabilities, Seventh Edition, for full citation and reference information. Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Classification of Intellectual Disability (continued) Domains of disability (NCMRR; Msall, 2005) Based on abilities within five domains: pathophysiology, impairment, functional limitation, disability, and societal limitation Advantage of approach: leads right to treatment, focuses on overcoming limitations See the textbook Children with Disabilities, Seventh Edition, for full citation and reference information. Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Prevalence of Intellectual Disability Based on definition, method of ascertainment, and population studied 6.7%–10.37% of 1,000 Peaks at 10–14 years old Mild impairments identified later than severe Recurrence risks for families with one child with severe intellectual disability Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Etiology Mild intellectual disability Often associated with racial, social, familial factors Identifiable in less than half affected individuals Common biological causes are genetic/chromosomal syndromes, perinatal complications, prenatal alcohol/drug exposure Familial clustering common Severe intellectual disability Linked to biological/genetic origin Identifiable in 75% of cases Common causes: Down syndrome, fragile X syndrome, fetal alcohol spectrum disorders Biological origins: the earlier the problem, the more severe its consequences Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Associated Impairments (Comorbid Conditions) Common associated impairments: Cerebral palsy, seizure disorders, communication disorders, sensory impairments, psychological/behavioral disorders Essential to identify comorbid conditions for intervention and treatment Associated impairments make it difficult to distinguish intellectual disability from other developmental disabilities Repeated assessments may be necessary Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Medical Diagnostic Testing Testing should be based on medical history and physical examination Some children with subtle physical or neurological findings also may have determinable biological origins of intellectual disability Factors to consider: What is the degree of intellectual disability? Is there a specific diagnostic path to follow? Are parents planning to have more children? What are the parents’ wishes? Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Psychological Testing and Interpretation A variety of tests are used to evaluate individual intelligence and adaptive skills Poor predictive validity until about 10 years old Tests can help differentiate in young children with severe intellectual disability, but not with mild Wechsler Scales (Wechsler, 2002, 2003) are accurate in predicting adult IQ in school-age children Often there is a correlation between scores on intelligence and adaptive scales See the textbook Children with Disabilities, Seventh Edition, for full citation and reference information. Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Treatment Approaches Most useful treatments are multimodal: Educational services—most important discipline involved in intervention Dependent on interaction between student and teacher Must be relevant to child’s needs, addressing strengths and challenges (IFSP, IEP) Leisure and recreational needs—peer socialization influences social-emotional development Socialization competencies and experiences affect school readiness, participation, and future success in adult life Sports or exercise regimens offer short- and long-term benefits Activities can increase independence Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Treatment Approaches (continued) Behavior therapy—problems may result from organic problems, unrealistic parental expectations, family difficulties, school-related adjustment difficulties Consider “cognitive” vs. “chronological” age Environmental changes may improve behavior Behavior management techniques Most useful treatments are multimodal: Use of medication—not useful in treating core symptoms, but can help with comorbid behavioral or emotional disorders (ADHD, self-injurious behavior or aggression, mood disorders and/or OCD) Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Treatment Approaches (continued) Treating comorbid conditions—ongoing physical, occupational, speech-language, or behavioral therapy; adaptive equipment; medication Family counseling—anticipatory and ongoing guidance helps families to adjust to having child with intellectual disability Periodic reevaluation—review should include child’s health status, functioning at home, school, and other social contexts; further testing can be recommended; transition plans for adolescents moving into adulthood Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Outcome Mild intellectual disability: Many gain functional literacy, some economic and social independence, intermittent supports Life expectancy not usually adversely affected Moderate intellectual disability: Supported employment (trained by a coach to do specific job rather than gain “prerequisite skills”) Often live at home or in supervised setting in the community Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Outcome (continued) Severe–profound intellectual disability: Comorbid conditions often limit adaptive functioning Often live in community with supportive adaptations in environment and supervisory oversight Increased need for medical and behavioral health care Shortened life span Chapter 17 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.