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Neuro Behavioral Med 3 > 31 - Intellectual Disability > Flashcards

31 - Intellectual Disability Flashcards

1
Q

Describe the diagnosis of intellectual disability

A

Onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, practical domains

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2
Q

What are the three criteria for diagnosing an intellectual disability?

A
  • Deficits in intellectual functions
  • Deficits in adaptive functioning
  • Onset of intellectual and adaptive deficits during the developmental period ***
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3
Q

Describe deficits in intellectual functions

A

Deficits in…

  • Reasoning
  • Problem solving
  • Planning
  • Abstract thinking
  • Judgment
  • Academic learning
  • Learning from experience

These can be tested by…

  • Clinical assessment
  • Individualized standardized intelligence testing (WAIS***)
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4
Q

Describe deficits in adaptive functioning

A

Failure to meet developmental and sociocultural standards for personal independence and social responsibility

  • **Without ongoing support, there are LIMITS on the functioning of one or more of the following activities
  • Communication
  • Social participation
  • Independent living

These effect home, school, work and community

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5
Q

When do we see the onset of intellectual and adaptive deficits?

A

** During the developmental period **

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6
Q

What are the possible etiologies of intellectual disability?

A

Multiple etiologies that can be seen as final common pathway of pathological processes that affect functioning of the CNS

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7
Q

What are the levels of intellectual functioning?

A

Categorized based on WAIS testing scores:

  • Mild mental retardation (50/55-70)
  • Moderate retardation (35/40-50-55)
  • Severe retardation (20/25-35/40)
  • Profound retardation (below 20-25)
  • Unspecified (too impaired or uncooperative to test)
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8
Q

What is adaptive functioning?

A

Adaptive functioning: personal independence and social responsibility

Remember, this is the second criteria in diagnosing an intellectual disability

** This criteria is met when one domain is sufficiently impaired that ongoing support is needed **

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9
Q

What are the domains of adaptive functioning?

A
  • Conceptual/academic (memory, language, reading)
  • Social (empathy, communication, friendship)
  • Practical (money management, organization, personal care)

Remember the criteria for deficits in adaptive functioning are met when one of these is sufficiently impaired so that ongoing support is needed

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10
Q

What are some scales you can use in order to evaluate adaptive functioning?

A
  • Vineland Adaptive Behavior Scales
  • American Association on Intellectual Disabilities Adaptive Behavior Scale

These scales provide a clinical score that is a composite score of a number of adaptive domains that vary considerably in reliability

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11
Q

What do you need to consider when evaluating adaptive functioning?

A

Instrument chosen to be used should fit the individuals…

     * Socioeconomic background
     * Education
     * Assorted handicaps
     * Motivation 
     * Cooperation

Example: if they have a physical disability, may need to adjust accordingly

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12
Q

Now we are going to go through each level of severity of intellectual disabilities and discuss the “specifiers” for each

What are the levels of severity of IDs again?

A
  • Mild
  • Moderate
  • Severe
  • Profound
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13
Q

First, what are specifiers strongly influenced by?

A

Now specifiers are strongly influenced by adaptive functioning not IQ scores as adaptive functioning determines the level of supports required

KNOW THIS ***

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14
Q

Specifiers of mild ID

A

50/55-70 WAIS

Conceptual domain

  • Preschoolers same
  • Adults show impairment in academic skills, memory

Social domain

  • Problems with emotions, limited understanding of risk/judgment
  • At risk for being manipulated (gullible) ***

Practical

  • Personal care normal
  • Need assistance with groceries, transportation, money
  • Recreation normal
  • Normal employment in jobs not needing conceptual skills
  • Health care and legal decisions need support ***
  • Raising a family need support ***
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15
Q

Specifiers of moderate ID

A

35/40-50/55 on WAIS

Conceptual

  • All throughout development they lag behind peers
  • Language slow
  • As adults, academics are at elementary level and support is needed ***

Social

  • Lower capacity for relationships
  • Less complex communication
  • Work setting needs significant social and communication support ***

Practical

  • With extended period of teaching, time and reminders, an individual may become independent ***
  • Maladaptive behavior present in a significant minority ***
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16
Q

Specifiers of severe ID

A

20/25-35/40 on WIAS

Conceptual

  • Care takers provide extensive support throughout life
  • Limited conceptual skills

Social
- Family and other offer support and help ***

Practical

  • Support for all activities of daily living ***
  • Maladaptive behavior including self injury is present in a significant minority ***
17
Q

Specifiers of profound ID

A

Below 20-25 WIAS

Conceptual
- Physical world rather than symbolic process

Social

  • Non verbal, non symbolic communication ***
  • Enjoys relationships with family but little understanding

Practical

  • Dependent on all aspects of daily physical care, health and safety ***
  • Maladaptive behaviors present in a significant minority ***
18
Q

What are associated features and disorders of ID?

A
  • ID is a heterogeneous condition with multiple causes
  • No specific personality or behavioral disorders
  • Can be passive or aggressive
  • Lack of communication skills can lead to disruptive aggression
  • Gullibility, vulnerable to exploitation, victimization or being denied rights and opportunities
19
Q

How are IDs related to mental health disorders?

A
  • Suicide risks exist as in all mental health disorders ***
  • Screen for suicide
  • May be hard to screen based on level of retardation and communication
  • Rely on observation for screening
20
Q

What patients are at a higher risk of Alzheimer’s disease?

A

** DOWN SYNDROME **

Down’s patients are at a higher risk for Alzheimer’s type dementia with pathological changes in the early 40s and clinical symptoms appearing later

21
Q

What is the overall prevalence of IDs?

A

1% of population

22
Q

What is the disease course of ID?

A
  • Onset before 18 ***
  • Depends on etiology and severity
  • If more severe, then it is recognized early ***
  • If it is acquired, it comes on abruptly ***
23
Q

What do you NEED to know about the nature of IDs?

A

Intellectual disabilities are NOT static

  • Even those with failure in academics can be altered by training which improves adaptive skills in other domains
  • An individual can move from moderate to mild with adequate training
24
Q

What are the risk and prognostic factors for intellectual disabilities?

KNOW THIS ***

A
  • Primarily biological or psychosocial or a combination of both ***
  • 30-40% have NO clear etiology for cause of intellectual disability ***
  • Specific etiologies are more common in severe or profound intellectual disability
25
Q

What are prenatal risk factors for ID?

KNOW THIS ***

A
  • Genetic syndromes
  • Inborn errors of metabolism
  • Brain malformations
  • Maternal disease
  • Environmental influences
26
Q

What are the perinatal risk factors for ID?

KNOW THIS ***

A
  • Labor and delivery events
27
Q

What are the postnatal risk factors for ID?

A
  • Hypoxic ischemic injury
  • Traumatic brain injury
  • Infections
  • Demyelinating disorders
  • Seizures
  • Severe and chronic social deprivation
  • Toxic metabolic syndromes
  • Intoxications( lead, mercury)
28
Q

What are specific social and cultural features of ID?

**

A
  • You need to understand their culture/language before assessing ID in a new community
  • Biologic factors are seen across socioeconomic classes unless specific linkages (lead poisoning or prematurity)

**In milder intellectual disabilities, lower socioeconomic classes are overrepresented **

29
Q

What are specific age and gender features of ID?

A

Development needs to be taken into consideration when looking at different age groups

Gender

  • Mild M:F = 1.6:1 (male prominence)
  • Severe M:F = 1.2:1 (male prominence, lesser degree)
30
Q

When do you diagnose ID? What if there is another diagnosis as well?

A
  • Diagnosis is made whenever criteria are met *****
  • Fairly concrete and structured
  • When a genetic syndrome is linked to the disability, it should be noted as a concurrent diagnosis
31
Q

What is on your differential diagnosis when diagnosing an ID patient?

A

Learning disorder or communication disorder

  • Specific area of impairment
  • Do NOT show deficits in intellectual or adaptive behavior

Autism spectrum disorder

  • Needs reassessment across developmental period
  • IQ is unstable

Major and mild neurocognitive disorders
- Decline from previous level of functioning

32
Q

Describe the comorbidities seen in ID patients ***

KNOW THIS ***

A
  • Prevalence of co-morbid conditions like mental health disorders, cerebral palsy and epilepsy may be 3-4 times greater than the general public
  • They may have shared etiology (head trauma, ID, etc.)
  • Mental health disorders with ID may be no different than the presentation in the general population
33
Q

What are the most common comorbidities in ID patients?

A
  • Attention-Deficit/Hyperactivity Disorder
  • Mood Disorders (BAD and MMD)
  • Anxiety Disorders
  • Autism Spectrum Disorder
  • Stereotypic Movement Disorders ( with or without self injurious behavior)
  • Impulse control disorder
  • Major Neurocognitive Disorder

Neuro Behavioral Med 3 (16 decks)

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