Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 45 Developmental Disabilities

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2  A disability occurring before 22 years of age is a developmental disability (DD).  Causes of DD occur before, during, or after birth.  Childhood illness and injuries can result in disabilities.  Some infants have birth defects. Causes include: Genetic problems Genetic problems Problems with the number of chromosomes Problems with the number of chromosomes Problems with the structure of chromosomes Problems with the structure of chromosomes Problems during pregnancy Problems during pregnancy

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3  A DD can be a physical or mental impairment or both. It is severe and permanent. It is severe and permanent. Function is limited in three or more life skills: Function is limited in three or more life skills:  Self-care  Understanding and expressing language  Learning  Mobility  Self-direction  Capacity for independent living  Economic self-sufficiency

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4  Developmentally disabled children need life-long assistance, support, and special services in these areas: Housing Housing Employment Employment Education Education Civil and human rights protection Civil and human rights protection Health care Health care  Independence to the extent possible is the goal for these persons.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5  The disability affects the child and family throughout life.  Persons with developmental disabilities: Have the same rights as every citizen in the United States Have the same rights as every citizen in the United States Have rights protected by the Americans With Disabilities Act of 1990 (ADA) Have rights protected by the Americans With Disabilities Act of 1990 (ADA) Have rights protected by the Developmental Disabilities Assistance and Bill of Rights Act of 2000 Have rights protected by the Developmental Disabilities Assistance and Bill of Rights Act of 2000

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6  Some children need long-term care in centers for those who are developmentally disabled.  Some adults with DD need nursing center care. They are further protected by the Omnibus Budget Reconciliation Act of 1987 (OBRA). They are further protected by the Omnibus Budget Reconciliation Act of 1987 (OBRA). OBRA requires that centers provide age-appropriate activities. OBRA requires that centers provide age-appropriate activities. Staff must have special training to meet their care needs. Staff must have special training to meet their care needs.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7  INTELLECTUAL DISABILITIES (MENTAL RETARDATION)  Intellectual function relates to learning, thinking, and reasoning.  The American Association on Mental Retardation (AAMR) describes mental retardation (intellectual disabilities) as: An IQ (intelligence quotient) score of about 70 or below. An IQ (intelligence quotient) score of about 70 or below. A significant limit in at least one adaptive behavior A significant limit in at least one adaptive behavior The condition being present before 18 years of age The condition being present before 18 years of age

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8  Brain development is impaired. It can occur before birth, during birth, or before the age of 18 years. It can occur before birth, during birth, or before the age of 18 years.  Intellectual disabilities range from mild to severe.  The Arc believes that: Persons with intellectual disabilities must be able to enjoy and maintain a good quality of life. Persons with intellectual disabilities must be able to enjoy and maintain a good quality of life. Children should live in a family. Children should live in a family. Children should learn and play with children without disabilities. Children should learn and play with children without disabilities. Adults should control their lives to the greatest extent possible. Adults should control their lives to the greatest extent possible.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9  The Arc recognizes the sexuality of persons with intellectual disabilities and related developmental disabilities. They have physical, emotional, and social needs and desires. They have physical, emotional, and social needs and desires. Reproductive organs develop. Reproductive organs develop. Some persons can control their sexual urges. Some persons cannot. Some persons can control their sexual urges. Some persons cannot. Sometimes persons with intellectual disabilities are sexually abused. Sometimes persons with intellectual disabilities are sexually abused.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10  The Arc believes the person has these rights: The right to dignity and respect The right to dignity and respect The right to privacy and confidentiality The right to privacy and confidentiality The right to chose friendships and emotional relationships The right to chose friendships and emotional relationships The right to sexual expression The right to sexual expression The right to learn about sex, sexual abuse, safe sex, and sexually transmitted diseases The right to learn about sex, sexual abuse, safe sex, and sexually transmitted diseases The right to protection from sexual harassment, sexual and other abuses, and sexual relationships with staff members The right to protection from sexual harassment, sexual and other abuses, and sexual relationships with staff members The right to sexual relationships, including marriage The right to sexual relationships, including marriage The right to choose birth control or to have and raise children The right to choose birth control or to have and raise children

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11  DOWN SYNDROME (DS)  DS is the most common genetic cause of mild to moderate intellectual disabilities. It is caused by an error in cell division. It is caused by an error in cell division.  In DS, an extra 21st chromosome is present.  The DS child has certain features caused by the extra chromosome.  Many children with DS have other health problems.  Dementia may appear in adults with DS.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12  Persons with DS need: Speech, language, physical, and occupational therapies Speech, language, physical, and occupational therapies Health and sex education Health and sex education A healthy diet and regular exercise A healthy diet and regular exercise

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13  CEREBRAL PALSY (CP)  CP is a term applied to a group of disorders involving muscle weakness or poor muscle control. The defect is in the motor region of the brain. The defect is in the motor region of the brain.  Abnormal movements, posture, and coordination result.  It occurs before, during, or within a few years after birth.  Causes include: Lack of oxygen to the brain Lack of oxygen to the brain Brain defects from faulty brain development Brain defects from faulty brain development  There is no cure.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14  Infants at risk include those who: Are premature Are premature Have low birth weight Have low birth weight Do not cry within the first 5 minutes after birth Do not cry within the first 5 minutes after birth Need mechanical ventilation Need mechanical ventilation Have bleeding in the brain Have bleeding in the brain Have heart, kidney, or spinal cord defects Have heart, kidney, or spinal cord defects Have blood problems Have blood problems Have seizures Have seizures Have fetal alcohol syndrome Have fetal alcohol syndrome  Brain damage in infancy and early childhood also can result in CP.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15  These types are the most common: Spastic cerebral palsy Spastic cerebral palsy Athetoid cerebral palsy Athetoid cerebral palsy  Certain terms describe the body parts involved: Hemiplegia Hemiplegia  The arm and leg on one side are paralyzed. Diplegia means that similar body parts are affected on both sides of the body. Diplegia means that similar body parts are affected on both sides of the body.  Both arms or both legs are paralyzed. Quadriplegia Quadriplegia  Both arms, both legs and the trunk and neck muscles are paralyzed.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 16  The person with CP can have many other impairments.  Care needs depend on the degree of brain damage.  Disabilities and impairments range from mild to severe.  The goal is for the person to be as independent as possible. Physical, occupational, and speech therapies can help. Physical, occupational, and speech therapies can help. Some persons need braces and use crutches. Some persons need braces and use crutches. Some need wheelchairs. Some need wheelchairs. Some need eyeglasses and hearing aids. Some need eyeglasses and hearing aids. Drugs can control seizures. Drugs can control seizures. Surgery and drugs can help some muscle problems. Surgery and drugs can help some muscle problems.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17  AUTISM  Autism begins in early childhood. It can be diagnosed by 3 years of age. It can be diagnosed by 3 years of age.  Autism is a brain disorder with no cure. The child has: The child has:  Problems with social skills  Verbal and nonverbal communication problems  Repetitive behaviors and routines  Narrow interests

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 18  Autism is more common in boys than in girls.  The cause is unknown. Genetics and environmental factors may be involved. Genetics and environmental factors may be involved.  With therapy, the person can learn to change or control behaviors. Many therapies are used. Many therapies are used.  The person needs to develop social and work skills.  Persons with autism may have other disorders. Intellectual disabilities and seizures are common. Intellectual disabilities and seizures are common.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 19  SPINA BIFIDA  Spina bifida is a defect of the spinal column. The defect occurs during the first month of pregnancy. The defect occurs during the first month of pregnancy.  Hydrocephalus often occurs with spina bifida.  In spina bifida, vertebrae do not form properly. This leaves a split in the vertebrae. This leaves a split in the vertebrae.  The split leaves the spinal cord unprotected.  Spina bifida can occur anywhere in the spine. The lower back is the most common site. The lower back is the most common site.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 20  Types of spinal bifida Spina bifida occulta Spina bifida occulta  The vertebrae are closed.  The spinal cord and nerves are normal.  The person has a dimple or tuft of hair on the back.  Often there are no symptoms.  Foot weakness and bowel and bladder problems can occur. Spina bifida cystica Spina bifida cystica  Part of the spinal column is in a pouch or sac.  A membrane or a thin layer of skin covers the sac.  The pouch is easily injured.  Infection is a threat. There are two types of spina bifida cystica. There are two types of spina bifida cystica.  Meningocele  Myelomeningocele (or meningomyelocele)

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 21 Meningocele Meningocele  The sac does not contain nerve tissue.  The spinal cord and nerves are usually normal.  Nerve damage usually does not occur.  Surgery corrects the defect. Myelomeningocele Myelomeningocele  The pouch contains nerves, spinal cord, meninges, and cerebrospinal fluid.  Nerve damage occurs.  Loss of function occurs below the level of damage.  The defect is closed with surgery.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 22  HYDROCEPHALUS  With hydrocephalus, cerebrospinal fluid collects in and around the brain. The head enlarges. The head enlarges. Pressure inside the head increases. Pressure inside the head increases. Intellectual disabilities (mental retardation) and neurological damage occur without treatment. Intellectual disabilities (mental retardation) and neurological damage occur without treatment.  A shunt is placed in the brain to allow cerebrospinal fluid to drain from the brain. The shunt must remain open (patent). The shunt must remain open (patent).  The person can have many problems. Vision problems, seizures, and learning disabilities can occur. Vision problems, seizures, and learning disabilities can occur.