Cognitive impairment

Question 1

Define disability

Answer 1

It is defined by the Australian Disability Services Act as a condition
- attributable to an intellectual, psychiatric, cognitive, neurological, sensory or physical impairment or a combination of these impairments
- permanent or likely to be permanent, may or may not be of a chronic or episodic nature i.e. epilepsy
- results in substantially reduced capacity of the person for communication, social interaction, learning or mobility; and a need for continuing support services

Question 2

Describe types of disabilities

Answer 2

• sensory: hearing, vision, smell, pain desensitisation
  
  • physical: mobility and functional
  • mental: anxiety, depression, mood disorders
  • cognitive-1: intellectual and developmental disability
  • cognitive-2: age-related MCI, dementia
    Note: often people have dual diagnoses

Question 3

Describe ASD

Answer 3

• used interchangeably with autsim
• a developmental disorder
• characterised by symptoms from early childhood
• 200k in Australia, a 25% increase from 2015 - due to increasing diagnosis…and possibly over-diagnosis
• Males 3.5 times as likely

Note: Some similarity in symptoms in ASD and ADHD, and small overlap of co-occurring conditions, but are distinct conditions.
Many people with ADHD are highly functional and do not exhibit low intelligence.

Question 4

Compare and contrast intellectual and developmental disabilities

Answer 4

• Intellectual: A disability characterized by significant limitations in both intellectual functioning and in adaptive behaviour, which covers many everyday social and practical skills. This disability originates before the age of 18.
• Developmental: is an umbrella term, includes disabilities that are apparent during childhood. It may/may not include intellectual disability.
  
  • Chronic disability/ies that can be cognitive or physical or both
  • *The disability/ies appear before the age of 22 and are likely to be life-long.
  • Some may have mainly physical manifestations, such as Cerebral Palsy or Epilepsy
  • Some may have a condition that includes both physical & intellectual disability. E.g.: Down syndrome

Question 5

Discuss broad etiologies of intellectual disability

Answer 5

There is some significant overlap between etiologies of intellectual disability.
- many unknown causes
- known causes
- genetic causes: Down, Rett, Fragile X, other genetic causes
- non-genetic causes
- FASD
- other teratogenic causes
- infections e.g. meningitis
- other adverse events e.g. head injury

Question 6

Discuss the use of IQ and pitfalls

Answer 6

Usually IQs, although DSM has moved away and added focus on support required.
Limited because it does not assess emotional intelligence and other multiple intelligences.

Question 7

Describe models of disability

Answer 7

• Medical model views disability as a consequence of a health condition, disease or trauma that disrupts the functioning of a person in a physiological or cognitive way
• Functional model defines disability as caused by physical, medical or cognitive defects, which limits the functioning or ability to perform functional activities
• Social model defines disability as not as a consequence of the individual’s impairment or condition but by their environment
• thus barriers are consequences of a lack of social organisation

The human rights model of disability collates all these and affirms the right of the person with disability to dismantle inaccessible systems and services.

ICF
The International Classification of Functioning, Disability and Health (commonly known as ICF) is a framework for describing and organising information on functioning and disability.

It provides a standard language and a conceptual basis for the definition and measurement of health and disability.

It consider how health condition impacts body function and structure, activities and participation (and its impact on condition), considering how environmental and personal factors shape the individual’s experience of their disability.

Question 8

Describe NDIS

Answer 8

The National Disability Insurance Scheme (NDIS) is the new way of providing support for Australians with disability, their families and carers. NDIA is the agency responsible for NDIS.

The NDIS provides about 500,000 Australians under the age of 65* (with a permanent and significant disability) with the reasonable and necessary supports they need to live an ordinary life. As an insurance scheme, the NDIS takes a lifetime approach, investing in people with disability early to improve their outcomes later in life.

The NDIS supports people with disability to build skills and capability so they can participate in the community and employment. The NDIS helps people with disability to:

• Access mainstream services and supports [including health services]*
• Access community services and supports
• Maintain informal support arrangements
• Receive reasonable and necessary funded supports

Constitutes the third largest budget item, with spending set to increase.

Question 9

Describe training of health workforce

Answer 9

Availability & accessibility of health services, particularly by doctors, may not be always be an issue – their adequacy of training and degree of confidence in dealing with people with intellectual and developmental disability.

Average medical school training is about 2.5 hours.
This in turn impacts medical professionals’ confidence in managing e.g. morbidity of people with intellectual disabilities.