1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.