7. NDD Flashcards
NDD diagnosed
first in infancy, childhood or adolescence
IDD DSM 5 Criteria
deficits in intellectual function
deficits in adaptive function. without ongoing support, limit functioning in one or more activities of daily life across multiple environments
onset of intellectual and adaptive deficits during the developmental period
IDD gender differences
more in males
more also in middle income versus high income countries
common cooccurring conditions with IDD
ADHD, depressive and bipolar disorders, anxiety disorders, ASD, stereotypic movement disorder, impulse control disorders, major neurocognitive disorder
Intellectual functioning assessment
WISC-V
SB-V
D -ABC
W-J IV
Non-verbal assessments
leiter international performance scale - 3
weschler nonverbal scale of ability
test of non verbal intelligence - 4
raven’s standard or coloured progressive matrices
UNIT-2
developmental assessments (younger children)
WPPSI-IV
Bayley scales of infant and toddler development - III
Griffiths Mental Developmental Scales - III
Mullen Scales of Early learning
Adaptive skills
Vineland 0-90YO
ABAS 0-89 YO
SIB-R 0-80+ YO
Intellectual functioning IDD diagnosis
current deficits 2 or more SDs below M
IQ 70 or below
IQ measures less valid in the lower end of the IQ range
Adaptive functioning IDD diagnosis
needs to be 2 or more SDs below mean (independnet functioning expected of someone that age and socioeconomic and cultural background)
severity defined based on adaptive functioning, determines level of support needed (mild, moderate, severe, profound)
SLD DSM-V-TR criteria
Impairments in reading, written expression or mathematics
Criteria:
learning diff for >6MO despite targeted help
academic skills sig below level expected for their age
learning diff began during school age years
not better accounted for by ID, uncorrected visual or auditory acuity, other mental or neurological disorder, psychosocial adversity, lack of proficiency in language or inadequate educational instruction
SLD with impairment in reading
word reading accuracy
reading rate or fluency
reading comprehension
SLD with impaired written expression
spelling accuracy
grammar and punctuation accuracy
clarity or organisation of written expression
SLD with impaired mathematics skills
deficits in:
number sense
memorisation of arithmetic facts
accurate or fluent calculation and accurate math reasoning
SLD diagnostic criteria based on history of
developmental
medical
family
educational
school reports
psychoeducational assessment
assessment battery
IQ test
achievement test
other tests of specific cognitive processing
possible underlying cognitive deficits
language comprehension
fluid reasoning
long term retrieval
visual spatial reasoning
phonological processing
processing speed
STM
language free intelligence tests
nods and pointing only
WNV
TONI
Ravens matricesA
Academic achievement assessments
WIAT
WRAT-4
Woodcock johnson-III
possible alternative explanations for learning difficulties or contributing factors
emotional and motivation issues
attention and behaviour problems disrupting testing and engagement
poor educational opportunities
cultural considerations or ESL
differential diagnosis with ID, DLD, ADHD
SLD deficits should be evident in excess of these issues
common assessment referral reasons
secondary mental health conditions
emotion regulation
challenging behaviour
why MI more common in NDD
awareness of differences
social difficulties cause avoidance
harder to make friends
difficulties in ambiguous/unstructured times
more likely bullied
intolerance of uncertainty linked strongly to anxiety
sensory processing differences
difficulties with self regulation (poor awareness/interoception)
stressful when change/transition occurs
anxiety
high rates with ID and FASD
most common MI in ASD
anxiety may look different- behaviour may be better indicator than words
40% iwth ASD had at least 1 comorbid anxiety disorder
depression
risk of suicidal thoughts or attempts more common in NDD
may exacerbate social challenges, harder to express mood/feelings
considerations and modifications for therapy
may not be motivated by same things as others- need to find motivator, focus on strengths, talents and expanding areas of interest
less questioning and reflection, use visuals to elicit information, teach this skill
might have difficulty with organisation- may need to be structured and systematic
timer
may be used to warn of transition
turn taking
may use with schedules
time more tangible
bottom up approaches
help clients cope with raw emotions and defence mechanisms
yoga, EMDR, comprehensive resource model, sensorimotor psychotherapy
emotion triggered by sensory stimuli (e.g. threat) responds better to bottom up strategies
top down approaches
how to help clients think differently
MBCT, CBT
emotion triggered by thoughts/appraisals respond better to top down strategies
building emotion skills
identify and understand emotions
recognise level of emotions and build vocabulary
coping and self regulation skills
risk for developing challenging behaviour in NDD increases with
ID severity
decreased communication skills and other adaptive behaviours
Why are individuals with NDD more vulnerable to challenging behaviour
communciation difficulties
poor udnerstanding of social expectations/theory of mind
social motivational differences
cognitive processing issues
cognitive inflexibility
pervasive self reinforcing self stimulatory behaviours
typical behaviour management strategies may be less effective
functional assessment
improves likelihood of success of behavioural inteventions
functions of behaviour- tangible (want), escape (don’t want), sensory stimulation, attention
pyramid for changing behaviour from bottom to tip
proactive strategies
teaching new skills
reactive strategies
proactive strategies
structuring/manipulating envionrment
reinforcement and prompting
teaching new skills
what to do instead
skills people may need explicit teaching to do
communciating ‘no’
making choices
asking for help
communicating confusion
asking for something
making choices
start with definite preferred and definite non-preferred
work up to choosing between desirably options
new is sometimes avoided due to cognitive inflexibility
using reinforcement for desirable behaviour
may not find social praise/attention rewarding
aim to use highest level that is effective
intrinsic, praise and attention, contingent access and attention, tangible and attention, edible and attention
break v time out
break can be an accidental reward if funciton is to escape
teach to ask for a breka and honour this
reactive strategies
planned ignoring for minor safe behaviours
logical consequences
verbal de-escalation
isolation/remove peers and keep safe when very distressed
physical/chemical restraint
