1. Slide 1 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Textbook For Nursing Assistants Chapter 34 – Caring for People with Developmental Disabilities

2. Slide 2 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. What is a Developmental Disability?

3. Slide 3 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A developmental disability is a permanent disability that affects a person before he reaches adulthood (that is, before 19–22 years of age) and interferes with the person’s ability to achieve developmental milestones A developmental disability may be: Congenital (something a child is born with) OR Acquired (occurring after birth, as a result of trauma or illness) What is a Developmental Disability?

4. Slide 4 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Congenital (present at birth) Genetic (inherited) disorders Consumption of alcohol, drugs, or other toxic substances during pregnancy Infections during pregnancy, such as German measles (rubella) or HIV Poor nutrition during pregnancy Conditions that deprive the baby of oxygen Acquired (occurring after birth) Birth trauma Head injury Near-drowning Poisoning Examples of Developmental Disabilities

5. Slide 5 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Special Needs of People with Developmental Disabilities

6. Slide 6 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. People with developmental disabilities have the same physical and emotional needs as everyone else For example: They need good nutrition Plenty of exercise The sense of well-being that comes from feeling loved and cared for However, many people with disabilities have additional, special, needs as well Special Needs of People with Developmental Disabilities

7. Slide 7 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Mainstreaming Children with developmental disabilities go to public school alongside friends and classmates who have no disabilities Mainstreaming benefits children with developmental disabilities by making them feel less isolated and giving them higher self-esteem and better social skills Mainstreaming also benefits children who are not disabled by making them aware that people with disabilities are just like they are, except that they need extra help to do certain things Special Needs of People with Developmental Disabilities: Education

8. Slide 8 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Special educational programs are focused on the individual’s needs and cover a wide range of topics, such as Self-care skills (for example, eating or dressing) Life skills (for example, counting money) Social skills (for example, understanding appropriate behavior and “limits”) Vocational skills: focuses on teaching work skills that help people with disabilities become less dependent on others for their care Special Needs of People with Developmental Disabilities: Education

9. Slide 9 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The Americans with Disabilities Act Ensures that people who have disabilities are treated the same as those without disabilities, by guaranteeing people with disabilities access to public education, employment, and public places such as parks, restaurants, and transportation The Arc of the United States An organization that promotes the rights of people with mental disabilities Special Needs of People with Developmental Disabilities: Protection of Rights

10. Slide 10 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Reassurance, love, and acceptance are vital for everyone’s well-being, and especially for those with disabilities that can make them appear or feel “different” One notable way in which people with developmental disabilities gain self-esteem is through the Special Olympics A sporting event established to promote the physical and emotional health of people with developmental disabilities The participants are matched for their competitions according to their level of physical and mental ability Their motto is: “Let me win, but if I cannot win, let me be brave in my attempt.” Special Needs of People with Developmental Disabilities: Emotional Needs

11. Slide 11 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Types of Developmental Disabilities

12. Slide 12 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A person with mental retardation has below- average intellectual functioning and problems with adaptive skills Intellectual functioning is the ability to reason, think, and understand Adaptive skills are skills needed to live and work, such as communication skills, social skills, and self- care skills A mentally retarded person has an intelligence quotient (IQ) score of less than 70 points and limited adaptive skills in two or more areas Types of Developmental Disabilities: Mental Retardation

13. Slide 13 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Mild mental retardation Most people with mental retardation fall into this category Mild mental retardation may go unnoticed until a child begins school, and starts having trouble with reading or solving math problems With special education, a person with mild mental retardation is usually able to achieve a third- to sixth- grade learning level and master the skills needed for socially appropriate behavior Vocational (job) training is useful Types of Developmental Disabilities: Mental Retardation

14. Slide 14 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Moderate mental retardation People with moderate mental retardation have delays in both motor (manual) skills and speech development With special education, a person with moderate mental retardation is usually able to learn self-care skills, communication skills, and safety habits However, academically, she will probably not progress beyond a second-grade learning level The person may also have trouble learning socially appropriate behavior Types of Developmental Disabilities: Mental Retardation

15. Slide 15 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Severe mental retardation With special education, people with severe mental retardation are able to learn some communication and basic self-care skills, such as how to feed themselves A person with severe mental retardation can usually learn to walk, if he does not have other physical disabilities Types of Developmental Disabilities: Mental Retardation

16. Slide 16 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Profound mental retardation People with profound mental retardation have minimal function in all developmental areas, physical and mental These people need complete assistance with their activities of daily living (ADLs), and constant supervision to provide for their safety Types of Developmental Disabilities: Mental Retardation

17. Slide 17 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Many people with mental retardation need guidance with “appropriate” methods of displaying their love and affection to other people Adults with mental retardation may function mentally at the level of a seven- or eight-year-old but will experience the same hormonal changes and sexual drives as everyone else and may not understand what is happening; these physical drives may be very confusing Because people with mental retardation tend to be very trusting, and because they are not able to understand what is happening to them, they are often targets of sexual abuse Types of Developmental Disabilities: Mental Retardation

18. Slide 18 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Education and guidance from caregivers is very important to help a person with mental retardation learn about appropriate touch and sexual behavior In addition, caregivers must protect the person from sexual abuse As a nursing assistant, you must be especially observant for signs of sexual abuse when caring for a person with mental retardation Any observations you make or suspicions that you have should be reported to the nurse immediately One of the great rewards that you will experience as a nursing assistant is the satisfaction of helping a person with mental retardation to feel loved, and allowing her to express love back to you Types of Developmental Disabilities: Mental Retardation

19. Slide 19 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Down syndrome is a developmental disability that is the result of a genetic disorder Normally, each of our body’s cells contains 23 pairs of chromosomes, for a total of 46 A person with Down syndrome has one extra chromosome Types of Developmental Disabilities: Down Syndrome

20. Slide 20 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. People with Down syndrome have some degree of mental retardation and muscle weakness In addition, they have certain characteristic physical features Eyelid folds that give the eyes an almond-shaped appearance A large tongue in a small mouth Square hands with short, stubby fingers A small, wide nose and small ears Short stature and a wide, short neck Many people with Down syndrome are also born with heart defects that require corrective surgery or medication Frequent respiratory tract infections are also common among people with Down syndrome, due to muscle weakness (which affects the muscles used for breathing) and a compromised immune system Types of Developmental Disabilities: Down Syndrome

21. Slide 21 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Many people with Down syndrome live independently and hold down jobs Children with Down syndrome are usually raised in their own homes with their families Once a person with Down syndrome reaches adulthood, the person may continue to live with family members, or he may choose to move to a group home Group homes allow a person with Down syndrome to live independently within a supervised and supportive environment Types of Developmental Disabilities: Down Syndrome

22. Slide 22 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A person with autism has extreme difficulty communicating and relating to other people and surroundings Boys are affected more often than girls A person with autism may seem very withdrawn, like he is in his “own world” (auto- means “self”) The person may have lengthy or extreme tantrums, or show aggressive or violent behavior that can result in self-injury Other disorders, such as mental retardation and seizure disorders, may accompany autism…however, many people with autism have average or above-average intelligence Types of Developmental Disabilities: Autism

23. Slide 23 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Cerebral palsy is caused by damage to the cerebrum, the part of the brain involved with motor control Cerebral palsy has many possible causes Physical brain deformity Conditions that interfere with the flow of oxygen to the baby’s brain before, during, or shortly after birth Types of Developmental Disabilities: Cerebral Palsy

24. Slide 24 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. One type of cerebral palsy causes spasms and shortening of the muscles The affected joints may develop contractures If the hands and arms are affected, the person may be unable to perform self-care skills like feeding, bathing, or dressing If the feet and legs are affected, the person may be unable to walk The second type of cerebral palsy causes involuntary movements of the arms, legs, and upper body Facial and tongue muscles may also be involved, making the person appear to be chewing constantly Varying degrees of mental retardation may also accompany the physical disabilities associated with cerebral palsy Types of Developmental Disabilities: Cerebral Palsy

25. Slide 25 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Fragile X syndrome is an inherited type of mental retardation caused by a defect in the X chromosome Fragile X syndrome is more common and usually more severe in boys, as compared with girls People who have fragile X syndrome are usually moderately to severely mentally retarded and may have physical characteristics such as: large, cupped ears a slim build wide-set, somewhat squinting eyes velvet-like skin Types of Developmental Disabilities: Fragile X Syndrome

26. Slide 26 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. They usually have delayed speech and communication skills They may be hyperactive, and prone to “mood swings” They may be autistic Special education helps people with fragile X syndrome learn self-care and behavior skills A calm, structured environment that keeps distractions and disturbances to a minimum is useful when caring for a person with fragile X syndrome Unfortunately, because the syndrome has only recently been identified as a developmental disorder, more research is still needed to determine the most effective methods of caring for people with this disability Types of Developmental Disabilities: Fragile X Syndrome

27. Slide 27 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Fetal alcohol syndrome is a combination of physical and mental problems that affect a child whose mother consumed alcohol during pregnancy The degree of disability seems to depend on the amount of alcohol the mother drank during her pregnancy, as well as on how frequently she drank Babies born with fetal alcohol syndrome are usually smaller than normal and have mental retardation, behavioral problems, learning difficulties, and facial deformities Although the disabilities caused by fetal alcohol syndrome are permanent, special education and therapy can help to maximize the person’s abilities Types of Developmental Disabilities: Fetal Alcohol Syndrome

28. Slide 28 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Spina bifida is a congenital defect of the spinal column Normally, the vertebrae enclose the spinal cord, protecting it from harm In a person with spina bifida, the vertebrae do not close properly during development, leaving the spinal cord exposed Types of Developmental Disabilities: Spina Bifida

29. Slide 29 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. As with other developmental disabilities, spina bifida varies in severity Some people with spina bifida have only a slight bone deformity that is not even visible on the outside of the body, except for possibly a dimple or tuft of hair on the back Other people have more severe deformities that result in the meninges, the spinal cord, or both bulging through a large opening on the back Types of Developmental Disabilities: Spina Bifida

30. Slide 30 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Sometimes called “water on the brain,” results from a build-up of cerebrospinal fluid (CSF) Many cases of hydrocephalus are congenital When hydrocephalus occurs in a child younger than 2 years, the child’s head often enlarges, because the bones of the skull have not yet fused together Types of Developmental Disabilities: Hydrocephalus

31. Slide 31 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Whether the hydrocephalus is congenital or acquired, it is often treated by surgically inserting a tube (called a shunt) that allows the fluid to drain from the brain to another part of the person’s body Types of Developmental Disabilities: Hydrocephalus

32. Slide 32 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Caring for a Person with a Developmental Disability

33. Slide 33 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. During your career as a nursing assistant, you may have many opportunities to care for people with developmental disabilities, in many different types of health care settings: If you work in a hospital, you may care for a person with a developmental disability while he is receiving treatment for an acute health problem, such as a heart problem, a respiratory tract infection, a nutritional deficiency, or seizures If you work for a home health care agency or in a long-term care facility, you may have the opportunity to form a longer-lasting relationship with a person with a developmental disability Caring for a Person with a Developmental Disability

34. Slide 34 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. When working with a person who has a developmental disability, the care that you provide must be specific to the person’s abilities and disabilities Learn as much as you can about each person in your care Focusing on each person’s abilities, whether developmentally disabled or not, will help you to provide the standard of care that each of your patients or residents needs from you Caring for a Person with a Developmental Disability: What should you do?

35. Slide 35 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Many people with developmental disabilities have difficulty communicating with other people When caring for a person with a developmental disability: Ask family members what communication techniques work best with the person Use simple words and short phrases Perhaps the most useful communication method is that of a touch, a smile, or a kind word, all of which transmit the message of your care and compassion for the person Communicating with a Person with a Developmental Disability

36. Slide 36 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Because many people with severe developmental disabilities have difficulty communicating, they may be unable to tell you if they are experiencing pain or discomfort Learn to watch for small, subtle changes in your patients or residents, such as changes in behavior, eating habits, or sleeping habits: changes like these may be a sign that the person is ill Because you will most likely be the member of the health care team who spends the most time with the person, you will likely be the first to notice that "something is not quite right" Always be sure to report your observations to the nurse Communicating with a Person with a Developmental Disability

37. Slide 37 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A person with a developmental disability has the same physical needs as everyone else Assisting the person with activities of daily living (ADLs)  Depending on the severity and type of disability, the person may need assistance with ADLs  As with any patient or resident, helping a person achieve the greatest possible level of independence is the best type of assistance that you can give Assisting with rehabilitation  Physical therapy or respiratory therapy may be needed to help the person maintain levels of function or to treat accompanying illnesses  As a nursing assistant, you may play a very important role in helping the person with physical rehabilitation Meeting the Physical Needs of a Person with a Developmental Disability

38. Slide 38 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. End of Presentation