Chapter 8: ID

Question 1

What is intellectual disability?

Answer 1

ID is characterized by deficits in intellectual functions that can vary in severity. These include reasoning, problem-solving, planning, abstract thinking, judgement, academic learning, and learning from experience.
These deficits lead to impairments in adaptive functioning that can impact personal, social, academic, and/or occupational functioning.

Question 2

What is global developmental delay?

Answer 2

when an individual fails to meet expected developmental milestones in several areas of intellectual functioning

Question 3

How do you meet the diagnostic criteria for intellectual disability?

Answer 3

An individual must have onset of the condition during the developmental period and have both intellectual and adaptive functioning deficits in conceptual, social, and practical domains to the extent that ongoing support is needed to adequately perform activities in one or more life settings at home, work, school, or community.

Question 4

How is intellectual function typically measured?

Answer 4

Function is typically measured with individually administered and psychometrically valid, comprehensive, culturally appropriate, psychometrically sound tests of intelligence.
- Example: Wechsler Intelligence Scale for Children
Intelligence quotient (IQ) test assessing the capacity for learning, reasoning, and problem-solving.
- The average IQ score is 100. Limited intellectual functioning is determined with an IQ score of 70 or below.

Question 5

Adaptive functioning is divided into what three skill domains?

Answer 5

Conceptual skills include academic skills of memory, reading, writing, math, reasoning, language, problem-solving, judgment in novel situations, and acquisition of practical knowledge.
Social skills include interpersonal skills, social responsibility, self-esteem, gullibility, social problem-solving, and the ability to follow rules, obey laws, and avoid being victimized.
Practical skills include ADLs, work and leisure skills, healthcare, travel/transportation, schedules/routines, safety, use of money and telephone.

Question 6

Adaptive functioning is influenced by…

Answer 6

Intellectual capacity
Education
Motivation
Socialization
Personality features
Vocational opportunities
Cultural experience
Coexisting general medical conditions and mental disorders

Question 7

What are the severity levels for intellectual disability?

Answer 7

Mild
Moderate
Severe
Profound

Question 8

Describe mild intellectual disability.

Answer 8

Slowed development, modest difficulty in school
Higher level executive functioning
May sustain jobs

Individuals can often live independently with minimal support.

Question 9

Describe moderate intellectual disability.

Answer 9

Can be independent in self-care
Difficulty interpreting social cues
Academic skills are significantly lower than peers
Communication is less complex

Extensive teaching and cuing supports are needed.
Environmental and visual cuing systems can help with communication, memory, and sequencing.

Question 10

Describe severe intellectual disability.

Answer 10

Limited attainment of conceptual skills and cannot read or manipulate numbers
Communication is focused on the present
Understands simple speech and gestures
Speaks with limited vocab and grammar

Requires full time supervision
Significant support for all ADLs

Question 11

Describe profound intellectual disability.

Answer 11

Dependent in ADLs
Nonverbal and non-symbolic communication and social interaction
May follow 1-2 step actions
Often co-ocuring with physical and sensory conditions

Caregiving support for all ADLs

Question 12

What is the etiology for ID?

Answer 12

Known causes include genetic and chromosomal aberrations, congenital malformations, prenatal exposure to infections or certain substances, and trauma.
- The most common form of ID because of a genetic etiology is Down syndrome, which results from the presence of the trisomy 21 chromosome.

Question 13

What are prenatal factors for ID?

Answer 13

Prenatal factors can include infections and exposure to substances. Exposure to infections, alcohol, or drugs during the prenatal period can impact neural development.
Genetic syndromes (gene mutations and chromosomal disorders), metabolism, brain malformations, maternal disease, environmental influences

Question 14

What are perinatal factors for ID?

Answer 14

During the perinatal delivery phase, a newborn is vulnerable to a variety of risks, including exposure to bacterial infections, viruses, anoxia, cerebral hemorrhage, or delivery trauma, that can lead to an ID.
Other risk factors that can impact brain development during the prenatal or perinatal phases include premature birth and low birth weight of the child.

Question 15

What are postnatal factors for ID?

Answer 15

Behavioral and social factors, such as malnutrition, abuse, and neglect, and neurological trauma can also lead to an intellectual disability.
Hypoxic ischemic injury, traumatic brain injury, infections, demyelinating disorders, seizure disorders, severe and chronic social deprivation, and toxic metabolic syndromes and intoxications (mercury, lead, etc.)

Question 16

What is the course of ID?

Answer 16

ID typically occurs during the developmental years.
The life expectancy for people with intellectual disabilities is increasing, although individuals with intellectual disabilities generally have a shorter life span than the general population, with an average age at death of 66 years.

Question 17

What disorders often coexist with ID?

Answer 17

Mental health disorders often coexist with an ID. The factors associated with intellectual disability (e.g., poor cognitive functioning, inflexible patterns of behavior, mood dysregulation, and low frustration tolerance) are also factors associated with mental illness.

Question 18

What are the gender differences with ID?

Answer 18

The prevalence rate of intellectual disability among males is greater than that among females.
Two conditions associated with an intellectual disability have differing gender rates: The prevalence in Fragile X syndrome is higher in males than females, and Rett syndrome is almost exclusive to females.
Males more likely than females to be diagnosed with mild and severe forms of ID.
Sex linked genetic factor and male vulnerability to brain insult may account for gender difference.

Question 19

What impact does ID have on mental functions?

Answer 19

The presence of significant limitations in executive functioning affecting the performance of daily activities is the core nature of intellectual disabilities.
Correlations between specific cognitive and executive functions and IQ or severity levels, particularly in the mild to moderate range, are situationally influenced by task and context for performance

Question 20

What impact does ID have on mental health?

Answer 20

Psychiatric disorders are 4-5x higher in individuals with ID than in the general population.
Children and adolescents with an ID are 2x as likely to have a mental health or psychiatric diagnosis.

Question 21

What impact does ID have on sensory and motor functions?

Answer 21

Sensory functions, such as vision and hearing, are often compromised for people with intellectual disabilities.
Locomotor skills, postural balance, and object manipulation are often slower for individuals with an intellectual disability.

Question 22

What impact does ID have on health and wellness?

Answer 22

Individuals with an ID have higher rates of obesity than the general population and can lead to other health conditions, such as cardiovascular disease, diabetes, GI problems, joint issues, asthma, depression, and other potential chronic conditions that can limit engagement in occupational performance with higher physical demands.
Factors contributing to obesity and overweight for individuals with an intellectual disability include sedentary behavior, poor nutrition, and a lack of support to participate in a variety of physical activities.

Question 23

What impact does ID have on intimacy and sexuality?

Answer 23

Negative and prejudicial attitudes regarding interpersonal relationships, intimacy, and sexuality can present barriers to social inclusion.
There are legitimate concerns for the person with an intellectual disability engaging in intimate relationships, such as the capacity to give consent, sexual knowledge, experience, relational needs, sexual expression, and safety.

Question 24

What impact does ID have on work?

Answer 24

The desire and expectation to participate in productive employment activities exists for the same reasons as for people without an intellectual disability: to earn money, be productive, engage socially, and feel a sense of pride and accomplishment for self and from others.
The Americans with Disabilities Act established the right for individuals with disabilities to participate in community life.
The Individuals with Disabilities Education Act (IDEA) includes vocational planning within transition services. Young adults with an ID who participated in high school transition planning were five times more likely to secure post-high school employment.

Question 25

What impact does ID have on community participation?

Answer 25

Social inclusion and participation in the everyday flow of life includes physical presence in the community, as well as engaging in meaningful choices and opportunities in community life such as IADLs, leisure and recreation, and vocational activities.
Other mediating factors impacting a person’s participation in community life include whether the person lives in a segregated or community setting, the length of time the person has lived in a community setting, and the severity of the person’s intellectual disability.