Chapter 7 - Intellectual Disability

Question 0

An individual has intellectual disability (ID) if:

Answer 0

• originated before age 18 - has significant limitations in intellectual functioning and limitations in adaptive behavior (social,conceptual & life skills).

Question 1

What is Intellectual Disability?

Answer 1

Individuals with intellectual and social deficits.

Question 2

Historically, people with ID was placed into 4 IQ levels used to place them in institutions. These levels are:

Answer 2

Mild Moderate Severe Profound

Question 3

The current classification system uses the ecological model. What is it?

Answer 3

This model considers the individual’s functioning within the microsystem (family & caretakers); mesosystem (school, neighborhood, community); and macrosystem (society’s cultural views and practices regarding individuals with intellectual disability).

Question 4

Five dimensions of the ecological system which influence individual functioning and life quality:

Answer 4

Dimension 1 - intellectual ability (2 SD below the mean/70) Dimension 2 - adaptive behavior Dimension 3 - participation, interactions & social roles Dimension 4 - health Dimension 5 - context

Question 5

How is dimension 1/intellectual ability applied?

Answer 5

An IQ of 70 or below is used to qualify an individual for services, benefits or legal services.

Question 6

Dimension 2-Adaptive Behavior - includes the individual’s cognitive, communication, academic, social and independent living skills. How do professionals enhance this dimension?

Answer 6

Professionals focus on developing social language skills, communication during daily activities (phone calls, grocery shopping etc.), reading and writing to facilitate independence, work and community integration.

Question 7

Dimension 3 - Participation, interaction & roles (communication) - how is this applied?

Answer 7

Professionals directly observe the individual’s interactions and social roles in everyday activities and focus on enhancing communication to improve social interaction.

Question 8

Dimension 4 - Health. How is this applied?

Answer 8

Health - mental & physical - influences all the other dimensions. Wide variation among individuals. Social support system influences health concerns.

Question 9

Dimension 5 - Context - What is it?

Answer 9

the individual’s family, neighborhood, and community at the micro, meso & macro levels.

Question 10

Supports - what is this in the ecological model?

Answer 10

Support system affects the individual’s level of functioning. Support needs vary throughout the life span.

Question 11

Give an example of the ecological approach.

Answer 11

8 yr old child w/ID in a general education class. Communicate w/ family and teacher who said she does not ask or answer questions in class. Work closely w/ teacher, get lesson plans in advance, and develop target questions and answers. Practice them w/ student. Teacher provides opportunities for student to ask/answer those questions in class.

Question 12

Prevalence of intellectual disability

Answer 12

• 1-3% of the population - more males than females - 15% of the SLP caseload - 9% of students aged 16 - 21 receiving services in public schools - 1.5 million aged 6 - 64 have an intellectual disability.

Question 13

The causes of intellectual disability vary in relation to 2 variables:

Answer 13

1. The timing of the risk factor (prenatal, perinatal, postnatal) 2. The type of the risk factor (biomedical/physiological, social, behavioral or educational).

Question 14

Examples of social, behavioral & educational risk factors are:

Answer 14

social - lack of access to birth care behavioral - poor parenting, poverty, shaken baby syndrome. educational - inadequate early intervention services.

Question 15

Genetics causes 50% of intellectual disabilities. Syndromes can be inherited, but may be also caused by mutations, for example…

Answer 15

TRANSLOCUTIONS. Happens when a broken piece of one chromosome attaches to another.

Question 16

Downs Syndrome is not caused by genetic mutation, it is caused by…

Answer 16

gene duplication. Chromosome 21 duplicates, creating 3 copies of the chromosome instead of 2.

Question 17

List some biomedical risk factors for intellectual disability (by timing)

Answer 17

1. Prenatal - chromosomal disorders, parental age, maternal illness. 2. Perinatal - prematurity, birth injury, neonatal disorders. 3. Postnatal - Traumatic Brain Injury, malnutrition, meningoencephalitis, seizure disorders, degenerative disorders.

Question 18

List some social risk factors of ID?

Answer 18

1. Prenatal - poverty, maternal malnutrition, domestic violence, lack of access to prenatal care. 2. Perinatal - lack of access to birth care. 3. Postnatal - impaired caregiver, lack of adequate stimulation, poverty, family illness, institutionalization.

Question 19

List some Behavioral risk factors for ID?

Answer 19

1. Prenatal - parental drug/alcohol abuse, parental smoking, parental immaturity. 2. Perinatal - parental rejection of caregiving role, parental abandonment of child 3. Postnatal - child abuse/neglect, domestic violence, inadequate safety measures, social deprivation, difficult child behaviors.

Question 20

List some educational risk factors for ID.

Answer 20

1. Perinatal - parental cognitive disability without support, lack of preparation for parenting. 2. Perinatal - lack of medical referral for intervention services at discharge. 3. Postnatal - impaired parenting, delayed diagnosis, inadequate early intervention services, inadequate special educational services, inadequate family support.

Question 21

What are genotypes and behavioral phenotypes?

Answer 21

genotype - chromosomal maps. behavioral phenotypes - connection between a person’s genetics and the observable outcome. This is a rapidly growing area of scientific research.

Question 22

Traumatic Brain Injury (TBI) is a common postnatal cause. What is TBI?

Answer 22

Acquired injury to the brain by external physical force. It results in total or partial functional disability or psychological impairment.

Question 23

TBI is increasing in infants and preschoolers. What are some common causes of childhood TBI?

Answer 23

falling, car accidents, and physical abuse.

Question 24

Syndromes associated with genetic causation of intellectual disability:

Answer 24

1. Downs Syndrome - 1/750 births; 5-6% of individuals w/ ID. 2. Klinefelter Syndrome - 1/1000 births 3. Fragile X Syndrome - 1/4000 males 4. Prader-Willi Syndrome - 1/10,000-15,000 births 5. Angelman Syndrome - 1/20,000 births 6. Williams Syndrome - 1/25,000 births

Question 25

What is Top Down processing?

Answer 25

learning that is conceptually driven or guided by higher level processes, eg, familiarity with the context and information gained from environmental cues.

Question 26

What is Bottom-up Learning?

Answer 26

Perceptual learning. The professional considers an individual’s bottom up abilities, (eg. how fast/slow is his visual processing, what is his short and long term memory capacity), while enhancing top down learning.

Question 27

Bottom Up skills include:

Answer 27

attention discrimmination organization transfer memory/working memory

Question 28

How to work with bottom up learning skills….

Answer 28

attention - increase wait time for child to respond. discrimination - manipulate the task and teach self monitoring organization - teach chunking and word association (metaorganization) transfer - teach simple metacognitive strategies, eg. selfquestioning. memory - teach verbal & image rehearsal, repetition or chunking motivation & task mastery - match task with ability level

Question 29

Stimulus overselectivity is…

Answer 29

a disturbance of discrimination. Child has a selective response to a limited number of stimuli cues. Eg. John recognizes his name by only the letter J. He selects any name beginning with J as his own name. Also occurs during assessment when the child continually responds to an item because of its position.

Question 30

Chunking is a strategy in organization. What is it?

Answer 30

organizing items into familiar units. Sad, morose, pensive have the same meaning, but children w/ ID may learn each new word as a new concept without making the connections to similar words.

Question 31

Transfer of information

Answer 31

Ability to apply learning to new situations. Near transfer - applying info to closely related contexts; Far transfer - applying learning to different contexts. Simple metastrategy for transfer is the use of self-questioning: What should I do first? second? last? and, Did I finish each step?

Question 32

Children with ID have better communication skills in naturalistic and familiar settings, and use environmental cues which reflects better Top Down learning. What are some strategies to improve Top Down learning for functional communication?

Answer 32

1. Improve writing skills - write a shopping list, fill out forms, take phone messages. 2. Select tasks that occur in daily life. 3. Provide familiar cues. 4. Use social reinforcement not tangible rewards. 5. Build on strengths and interests.

Question 33

Motivation/mastery motivation: Children with ID have similar goal-directed behaviors as typical children, however…

Answer 33

they have reduced mastery of difficult tasks. SLP should increase motivation by matching the task with the skill level.

Question 34

Children with ID are language delayed, not language disordered. Their developmental sequence is typical, just slower with less language produced. However after age 10,…

Answer 34

they are language disordered.

Question 35

Language delay vs. disorder? What are some points to consider when making a determination?

Answer 35

• Children with ID is a heterogenous population. Hard to generalize. - language delay vs. disorder may not be mutually exclusive. A general development framework can be used for young children, while an ecological approach may be used for continually examining the functional use of communication skills and consider how it affects his everyday life.

Question 36

When it comes to Form, Content, & Use, children with ID…

Answer 36

vary within ID subtypes by cognitive ability. Some have language competencies surpassing expectations, given their nonverbal IQ; other show less than expected language skills.

Question 37

Nonverbal IQ or nonverbal intelligence is the child’s ability to do motor tasks or analyze & solve problems using visual reasoning. It is used to measure general ability for children with language deficits. Tasks used in nonverbal IQ tests include:

Answer 37

• recognizing and remembering visual sequences. - understanding meanings of pictures and recognizing relationships - completing visual analogies - recognizing causal relationships in pictures

Question 38

Downs Syndrome: Form, Content & Use. Describe them.. Form: phonological deficits; reduced intelligibility & shorter sentences due to reduced respiratory control; significant morphosyntax deficits Content - vocabulary equal to nonverbal IQ, although overall lang. development is below expected levels; reading overachievers.

Answer 38

Use - delayed turntaking, babbling & gesturing; reduced imitation. Pragmatics vary: appropriate at 1 word level, and turntaking is fine in adolescence, but morphosyntax difficulties impair pragmatic functions.

Question 39

Fragile X Sydrome - Describe Form, Content & Use. Language ability is consistent w/ nonverbal cognitive ability (nonverbal IQ). Form - phonological impairment, difficulty w/ prosody (rate, inflection). May have high pitch voice or poor voice quality. Morphosytax problems at sentence level & short sentences.

Answer 39

Content - Area of strength. Receptive language relatively intact. Expressive shows word finding problems. Use- Pragmatic skills vary. May be deficits in conversational turntaking & topic maintenance, off topic & stereotypical language production.

Question 40

Williams Syndrome - Form, Content & Use. - better than expected verbal abilities given their nonverbal IQ. This is very unique. Form - initially delayed, but by adolescence, morphosyntax and lexical skills surpasses mental age. Hoarse voice but good intelligibility. Good articulation & prosody.

Answer 40

Content - delayed verbal skills in early childhood, but by adolescence abilities equal to mental age. Use - overly friendly, too trusting. Inappropriate eye contact, difficulty with topic introduction, topic maintenance, conversational turn-taking.

Question 41

Language ability varies with cognitive abilities/nonverbal IQ. For example, in the ID subtypes of:

Answer 41

Williams Syndrome - language is a strength compared to nonverbal. Fragile X Syndrome - language is equivalent to nonverbal IQ. Down’s Syndrome - morphosyntax is less than nonverbal IQ, but a strength for lexical learning.

Question 42

Practitioners assess communication skills of children with ID using norm referenced and criterion referenced test. However, criterion is better with this population. Why?

Answer 42

Because too few students with ID are included in norm referenced tests, and pragmatics is not usually assessed. Dr. Reed thinks that the test groups are diverse, but agrees that pragmatics is not assessed.

Question 43

Criterion referenced tests should always include:

Answer 43

• a language sample analysis to determine language skills. - analysis of discourse to identify social communication abilities. - classroom based assessment to determine vocabulary/comm needs. - interviews with child, family, caregivers, teachers to identify targets. - evaluation of reading and writing abilities.

Question 44

During Functional assessment/functional analysis the professional gathers information about a child’s behavior to identify the function of an aversive behavior. This assessment is typically ..

Answer 44

• used with children with behavioral problems. - used to develop behavioral change interventions.

Question 45

In conducting a FUNCTIONAL ASSESSMENT, challenging behaviors are classified in 3 ways:

Answer 45

1. To get something (tantrums to get attention, candy) 2. To avoid something (hair pulling when asked to come to the table) 3. As sensory stimulation (rocking, self-biting)

Question 46

The ACI is A Comprehensive Guide to Assessment & Intervention. It has several components, including…

Answer 46

• the Communications Opportunities Inventory (provides 68 opportunities during daily activities, eg. talking on phone, restaurant) - the Communication Skill Inventory (rates individual in 11 communicative skill categorized in 4 domains)

Question 47

The goal of the Communication Skills Inventory is to collect info about the individual’s current communication skills and help identify realistic outcomes for intervention. The 4 domains measures independence in these areas:

Answer 47

• interacting - communicating - expressing information - receiving information

Question 48

Principles for Intervention with individuals with Intellectual Disability:

Answer 48

1. Provide intervention from the prelinguistic stage through adulthood. 2. Follow a 3-pronged approach to programming. Consider: a. typical language development b. lifespan needs - skills & concepts required at various ages. c. modifications in response to strengths and weaknesses 3. Use an ecological viewpoint.

Question 49

Functional Communication Approach (FCT) is a behavioral intervention used to replace maladaptive or problem behaviors (eg, tantrums, hitting, selfinjury) with more socially acceptable behaviors. It is based on the concept of functional assessment. There are 4 steps:

Answer 49

1. Identify the antecedent stimuli (time of day, settings, people) triggering the behavior. 2. Determine the purpose of the behavior & the reinforcement (via functional analysis). 3. Identify equivalent behavior that accomplishes the same purpose. 4. Monitor generalization & use of new communicative skill.

Question 50

ABC Chart: analysis of antecedent - behavior - consequence. It is used to capture environmental triggers for inappropriate behaviors - the who/what/where/when/why of the behavior associated with when the behavior occurred and did not occur. An example is …

Answer 50

1. Who: occurred when working w/ 1 teach & multi students/did not occur when working w/1 teacher. 2. What: occurred when asked to do something he did not like. Draws instead of completing assignment/ 3. Where: occurred in math class/did not occur in art class. 4. When: occured when asked to read silently in class/did not during group reading. 5. Why: uses maladaptive behavior to avoid completing frustrating or less preferred work. Behaviors less likely to occur during kinesthetic learning, when he gets adults attention, when unfamiliar w/ content.

Question 51

Functional Communication Training (FCT) To teach the new communication behavior, the practitioner:

Answer 51

1. Provides frequent opportunities for the child to practice the targeted behavior/replacement form. 2. Uses behavior modification techniques (reinforcement, prompting, fading) 3. Teaches tolerance to reinforcement delays. 4. Monitors use of the new behavior in everyday situations.

Question 52

Intervention Approach: IT’s Fun Program is a performance based intervention for school aged kids with Downs Syndrome. It is a 3-week “speech camp” with theme-based activities that…

Answer 52

• emphasize communicative strengths (social skills, receptive language) - focus on improving intelligibility, respiratory control, prosody, increased verbal output. - activities include shared book reading, story reenactments, mime & improvisation, singing & dancing, play rehearsals.