1. © Cengage Learning 2016 Eric J. Mash David A. Wolfe Intellectual Disability (Intellectual Developmental Disorder) 5

2. © Cengage Learning 2016 Prior to mid-19th century: children and adults with intellectual disabilities were ignored or feared even by the medical profession Intellectual disability: a significant limitation in intellectual functioning and adaptive behavior which begins before age 18 Intelligence and Intellectual Disability (ID)

3. © Cengage Learning 2016 In the mid-19th century: Samuel G. Howe opened the first humanitarian institution in North America By the 1940s: parents increased humane care for their children Intelligence and Intellectual Disability (cont’d.)

4. © Cengage Learning 2016 1950: National Association for Retarded Children was formed 1962: President John F. Kennedy formed the President’s Panel on Mental Retardation Intelligence and Intellectual Disability (cont’d.)

5. © Cengage Learning 2016 Evolutionary degeneracy theory –Pervasive in 19th century –Intellectual and social problems of children with mental retardation were viewed as regression to an earlier period in human evolution –J. Langdon H. Down interpreted “strange anomalies” as throwbacks to the Mongol race The Eugenics Scare

6. © Cengage Learning 2016 Eugenics: “the science dealing with all influences that improve the inborn qualities of a race” ~ Sir Francis Galton –Led to the view that individuals with ID (moral imbeciles, or morons) were threats to society The Eugenics Scare (cont’d.)

7. © Cengage Learning 2016 Alfred Binet and Theophile Simon (1900s) –Commissioned by the French government to identify schoolchildren who might need special help in school –Developed the first intelligence tests Measure judgment and reasoning of school children (Stanford-Binet scale) Defining and Measuring Children’s Intelligence and Adaptive Behavior

8. © Cengage Learning 2016 General intellectual functioning is now defined by an intelligence quotient (IQ or equivalent) ID is no longer defined on the basis of IQ –Level of adaptive functioning is also important Adaptive functioning: how effectively individuals cope with ordinary life demands and how capable they are of living independently Defining and Measuring Children’s Intelligence and Adaptive Behavior (cont’d.)

9. © Cengage Learning 2016 Specific Examples of Adaptive Behavior Skills

10. © Cengage Learning 2016 IQ is relatively stable over time –Except when measured in young, normally- developing infants Mental ability is always modified by experience The Flynn Effect: the phenomenon that IQ scores have risen about three points per decade Are IQ tests biased or unfair? The Controversial IQ

11. © Cengage Learning 2016 Clinical description - considerable range of abilities and interpersonal qualities –DSM-5 diagnostic criteria Deficits in intellectual functioning Concurrent deficits or impairments in adaptive functioning Below-average intellectual and adaptive abilities must be evident prior to age 18 Features of Intellectual Disabilities

12. © Cengage Learning 2016 Diagnostic Criteria for Intellectual Disability

13. © Cengage Learning 2016 About 85% of persons with ID Typically not identified until early elementary years Overrepresentation of minority group members Develop social and communication skills Live successfully in the community as adults with appropriate supports Severity Level: Mild

14. © Cengage Learning 2016 About 10% of persons with ID Usually identified during preschool years Applies to many people with Down syndrome Benefit from vocational training Can perform supervised unskilled or semiskilled work in adulthood Severity Level: Moderate

15. © Cengage Learning 2016 About 3%-4% of persons with ID Often associated with organic causes Usually identified at a very young age –Delays in developmental milestones and visible physical features are seen May have mobility or other health problems –Need special assistance throughout their lives –Live in group homes or with their families Severity Level: Severe

16. © Cengage Learning 2016 About 1%-2% of persons with ID Identified in infancy due to marked delays in development and biological anomalies Learn only the rudimentary communication skills Require intensive training for: –Eating, grooming, toileting, and dressing behaviors Require lifelong care and assistance Severity Level: Profound

17. © Cengage Learning 2016 Examples of Support Areas

18. © Cengage Learning 2016 Approximately 1-3% of population (depending on cutoff) Twice as many males as females among those with mild cases More prevalent among children of lower SES and children from minority groups, especially for mild cases –More severe levels - identified almost equally in different racial and economic groups Prevalence

19. © Cengage Learning 2016 Factors Accounting For Racial Differences

20. © Cengage Learning 2016 Developmental-versus-difference controversy –Do all children—regardless of intellectual impairments—progress through the same developmental milestones in a similar sequence, but at different rates? Developmental position –Similar sequence hypothesis –Similar structure hypothesis Developmental Course and Adult Outcomes

21. © Cengage Learning 2016 Difference viewpoint: cognitive development of children with ID is qualitatively different in reasoning/problem-solving –Familial versus organically based ID Developmental-Versus-Difference Controversy (cont’d.)

22. © Cengage Learning 2016 Many children with mild ID are able to learn and attend regular schools Often susceptible to feelings of helplessness and frustration in their learning environments Children who have mild ID are able to stay on task and develop goal-directed behavior –With stimulating environments and caregiver support Motivation

23. © Cengage Learning 2016 IQ scores can fluctuate in relation to the level of impairment Major cause of ID affects the degree to which IQ and adaptive abilities may change Slowing and stability hypothesis –IQ of children with Down syndrome may plateau during middle childhood, then decrease over time Changes in Abilities

24. © Cengage Learning 2016 Development follows a predictable and organized course Characteristics displayed with Down syndrome –The underlying symbolic abilities of children are believed to be largely intact –There is considerable delay in expressive language development; expressive language is weaker than receptive language Language and Social Behavior

25. © Cengage Learning 2016 Fewer signals of distress or desire for proximity with primary caregiver Delayed, but positive, development of self- recognition Delayed and aberrant functioning in internal state language –Reflects emergent sense of self and others Deficits in social skills and social-cognitive ability; can lead to rejection by peers Characteristics Displayed With Down Syndrome (cont'd.)

26. © Cengage Learning 2016 Rate is three to seven times greater than in typically developing children –Largely due to limited communication skills, additional stressors, and neurological deficits Most common psychiatric diagnoses: –Impulse control ddisorders, anxiety disorders, and mood disorers Internalizing problems and mood disorders in adolescence are common Emotional and Behavioral Problems

27. © Cengage Learning 2016 ADHD-related symptoms are common Pica is seen in serious form among children and adults with ID Self-injurious behavior (SIB) –Can be life-threatening –Affects about 8% of persons across all ages and levels of ID Emotional and Behavioral Problems (cont'd.)

28. © Cengage Learning 2016 Health and development are affected Degree of intellectual impairment is a factor Prevalence of chronic health conditions in ID population is much higher than in the general population Life expectancy for individuals with Down syndrome is now approaching 60 years Other Physical and Health Disabilities

29. © Cengage Learning 2016 Chronic Health Conditions Among Children With Intellectual Disabilities

30. © Cengage Learning 2016 Scientists cannot account for the majority of cases, especially the milder forms Genetic or environmental causes are known for almost two-thirds of individuals with moderate to profound ID Causes

31. © Cengage Learning 2016 Prenatal: genetic disorders and accidents in the womb Perinatal: prematurity and anoxia Postnatal: meningitis and head trauma Prenatal, Perinatal, and Postnatal Causes

32. © Cengage Learning 2016 Organic group – there is a clear biological basis –Associated with severe and profound MR Cultural-familial group – there is no clear organic basis –Associated with mild MR The Two-Group Approach

33. © Cengage Learning 2016 Four major categories of risk factors –Biomedical –Social –Behavioral –Educational Risk Factors

34. © Cengage Learning 2016 Causes Risk Factors (cont'd.)

35. © Cengage Learning 2016 Genetic influences are potentially modifiable by environment Genotype: a collection of genes that pertain to intelligence Phenotype: the expression of the genotype in the environment (gene- environment interaction) Inheritance and the Role of the Environment

36. © Cengage Learning 2016 Heritability describes the proportion of the variation of a trait attributable to genetic influences in the population –Ranges from 0% to 100% –The heritability of intelligence is about 50% Major environmental variations affect cognitive performance and social adjustment in children from disadvantaged backgrounds Inheritance and the Role of the Environment (cont'd.)

37. © Cengage Learning 2016 Chromosome abnormalities –Down syndrome is usually the result of failure of the 21st pair of the mother’s chromosomes to separate during meiosis ► causes an additional chromosome Fragile-X syndrome is the most common cause of inherited ID Prader-Willi and Angelman syndromes –Both are associated with abnormality of chromosome 15 Genetic and Constitutional Factors

38. © Cengage Learning 2016 Images Down Syndrome-Moderate level of ID

39. © Cengage Learning 2016 Fragile X: Mild to Moderate; Males are more affected

40. © Cengage Learning 2016 Prader –Willi Urge to eat constantly Abnormality on Chr. 15

41. © Cengage Learning 2016 Ataxia (strange walking) Hand flapping, jerky movements Absence of speech Large jaw Angelman Syndrome Moderate to severe Abnormality on Chr. 15

42. © Cengage Learning 2016 PKU (Phenylketonuria) Single-gene recessive condition can be controlled with appropriate diet

43. © Cengage Learning 2016 Single-gene conditions: inborn errors of metabolism –Excesses or shortages of certain chemicals which are necessary during developmental stages –Cause of 3-7% of cases of severe ID –Phenylketonuria results in lack of liver enzymes necessary to metabolize phenylalanine Can be treated successfully Genetic and Constitutional Factors (cont’d.)

44. © Cengage Learning 2016 Adverse biological conditions –Examples: infections, traumas, and accidental poisonings during infancy and childhood Fetal Alcohol Spectrum Disorder (FASD) –Estimated to occur in one-half to two per 1000 live births Teratogens increase risk of ID Neurobiological Influences

45. © Cengage Learning 2016 Central Nervous System Dysfunction Growth retardation Abnormities of facial features Fetal Alcohol Syndrome The most preventable form of ID

46. © Cengage Learning 2016 Least understood and most diverse factors causing ID Environmental influences and other mental disorders account for 15-20% of ID –Deprived physical and emotional care and stimulation of the infant –Other mental disorders accompanied by ID, such as autism Parents are critically important Social and Psychological Dimensions

47. © Cengage Learning 2016 Child’s overall adjustment is a function of: –Parental participation, family resources, social supports, level of intellectual functioning, basic temperament, and other specific deficits Treatment involves a multi-component, integrated strategy –Considers children’s needs within the context of their individual development, their family and institutional setting, and their community Prevention, Education, and Treatment

48. © Cengage Learning 2016 ID related to fetal alcohol syndrome, lead poisoning, rubella) can be prevented if precautions are taken Prenatal programs for parents caution about use of alcohol, tobacco, drugs, and caffeine during pregnancy Prenatal Education and Screening

49. © Cengage Learning 2016 Early intervention –One of the most promising methods for enhancing the intellectual and social skills of young children with developmental disabilities –Carolina Abecedarian Project provides enriched environments from early infancy through preschool years –Optimal timing for intervention is during preschool years Psychosocial Treatments

50. © Cengage Learning 2016 Initially seen as a means to control or redirect negative behaviors Association for Behavior Analysis (ABA) Task Force advocates that: –Each individual has the right to the least restrictive effective treatment and the right to treatment that results in safe and meaningful behavior change Behavioral Approaches

51. © Cengage Learning 2016 Self-instructional training and metacognitive training Verbal instructional techniques Teaching the child to be strategical and metastrategical Cognitive-Behavioral Therapy

52. © Cengage Learning 2016 Help families cope with the demands of raising a child with ID Some ID children and adolescents benefit from residential care or out-of-home placement The inclusion movement integrates individuals with disabilities into regular classroom settings –Curriculum is adapted to individual needs Family-Oriented Strategies