SW 644: Issues in Developmental Disabilities Developmental Disabilities Part I Part I, Foundation & Introduction Lecture Presenter: Mary Pearlman, M.D.

Developmental Disability – Definition  Mental or Physical Disability  Starting before age 22  Continues indefinitely  Limits one or more major life activity

Major Life Activities  Self care  Language  Learning  Mobility  Self-direction  Independent living  Economic Self Sufficiency

Major Conditions  Mental Retardation  Central Palsy  Autism  Epilepsy  Conditions caused by medical disease (e.g. Polio)

Other conditions can also severely limit major life activities  Mental Illness  Severe 2° Brain Injury  2° = secondary  Physical Illness

Each organization uses a slightly different definition depending on their point-of-view  State/Federal Government  School System  Parent/Advocacy programs  Professionals of different varieties  Differences due to: Point-of-view Funding Educational Purposes

DSM IV  In the DSM IV a condition must cause: Dysfunction Disorder To be a disorder  Dysfunction is trouble Working Playing Loving  That’s what Freud said  We now use an official scale GAF (Global Assessment of Function) to measure it

Note how similar the definition of dysfunction is to the definition of major life activity limits

The Nosological systems (i.e. system of categorization) are artificial

We use categories to describe conditions that occur in nature on continuum

Example I: Flapping  Family next door: S has flapped her hands and jumped when excited since infancy All functions WNL (Within Normal Limits) Family notices Flapping Child gradually doing less Flapping Family ignore behavior as a childhood characteristic No one is uncomfortable (No disease) Dr. Pearlman demonstrates flapping

Example II: Flapping  Early Childhood Screening: A has flapped her hands and jumped when excited since infancy.  Functions: Speaks 30 single words Not potty trained Gross motor and fine motor skills excellent in environment with more than 5 people screams and rides Can’t play with others or take turns Family distressed by how much the child is unhappy and the screaming There is dysfunction; there is disease

Example III: Flapping  Pediatricians Office: V has flapped her hands and jumped when excited since infancy  All Functions WNL (Within Normal Limits)—No Dysfunction  Family Notices: dad insists that children should behave properly socially and M is embarrassed by the behavior in front of friends  The family has used a light slap on the hands or clear “no” since infancy in response to the flapping. The behavior has not stopped. The family reports the child stealthily flaps and then lies about it.

Example III: Flapping (cont.)  There is an enormous amount of disease  Family function disrupted  Family history: there is a cousin in the family with sever autism, who flaps

The Five Axes  Axis I:No Axis I disorder  Axis II:Cognitive Condition  Axis III:Medical Disorder – None  Axis IV:Family dysfunction  Axis V:Overall function OK – impairment in child’s self concept Have to look at all 5 axes. Do not jump to conclusions. We don’t diagnose on the basis on behavior.

Life Long Dysfunction?  Could this impairment in self concept evolve into a life long dysfunction?  It could  It also could just turn into a functional but somewhat negative adult

Poor Parenting?  Are severe disabilities like DD ever caused by poor parenting?  No  It takes a blending of factors: Genetic Environmental Caretaking goodness of fit – to produce A DD outcome

Parenting and Environmental Factors  Parenting and environmental factors don’t cause the disease, or cure it  They can promote access to: Improved emotional stability Improved optimization of skill potential Make community life easier for all concerned

If mental illness such as ADHD and schizophrenia can cause both disease and dysfunction from an early age on why aren’t they considered developmental disabilities?

Mental Illness  Mental problems are expressed in the areas of conditions, emotions and thought. These conditions occur because of faulty physiology and/or anatomy by the brain and body. The dysfunction are expressed through: Cognitions Emotions Thought Often a motor component

Developmental Issues  Developmental problems are expressed in the areas of cognitions, emotions, thought and motor problems  These conditions occur because of faulty physiology and/or anatomy of the brain and body

Disabilities v. Mental Disabilities  So what are the differences between disabilities and mental disabilities?  How we categorize them  That’s it

Developmental Disability – True Definition  A disability is something wrong with the body/brain life to be hard and can include problems expressed in all areas of human function  Life is hard for the individual with the disorder and everyone who comes in conduct with the person  Mostly no one wants to help with the extra effort and monetary cost  People are constantly making up labels to include or exclude people from service

Dialogue  The dialogue about diagnosis is Scientific Political And should also be informed by practical social function:  Will the society function better if we people support? Ethical considerations  How much responsibility do we have for our brother? Suffering is transformative: Without proper support it moves the spirit tends toward bitter selfishness and narrowness of view.