ID Flashcards
Intellectual Disability
Intellectual Disability (Intellectual Developmental Disorder) is a disorder
with onset during the developmental period that includes both
intellectual and adaptive functioning deficits in conceptual, social, and
practical domains. (DSM-5 definition)
• A developmental disorder which manifests itself in significantly sub
average intellectual functioning resulting in, or associated with,
concurrent impairment in adaptive behavior and manifested during the
developmental period, before age of 18. (Sadock and Sadock)
Diagnostic Criteria
Deficits in intellectual functions, such as reasoning, problem-solving, planning, abstract thinking,
judgment, academic learning and learning from experience, and practical understanding
confirmed by both clinical assessment and individualized, standardized intelligence testing.
Intellectual functioning is typically measured with individually administered and
psychometrically valid, comprehensive, culturally appropriate, psychometrically sound tests of
intelligence.
• Deficits in adaptive functioning that result in failure to meet developmental and sociocultural
standards for personal independence and social responsibility. Without ongoing support, the
adaptive deficits limit functioning in one or more activities of daily life, such as communication,
social participation, and independent living, and across multiple environments, such as home,
school, work, and recreation
• Onset of intellectual and adaptive deficits during the developmental period.
classificstion of intellectual disability
Mild- IQ range 50 to 70
• Moderate - IQ range 35 to 49
• Severe - IQ range 20 to 34
• Profound - IQ below 19
Mild ID
• IQ 50-70
• Slower than typical in all developmental areas
• No unusual physical characteristics
• Able to learn practical skills
• Attain reading and maths skills up to grade levels 3-6
• Able to blend in socially
• Functions in daily life
Moderate ID
IQ 35-49
• Noticeable developmental delays such as speech and motor skills
• May have physical signs of impairment such as a thick tongue
• Can communicate in basic, simple ways
• Able to learn basic health and safety skills
• Can complete self care activities
• Can travel alone to nearby familiar places
Severe ID
IQ 20-34
• Considerable delays in development
• Understands speech but have little ability to communicate
• Able to learn daily routines
• May learn very simple self care
• Need direct supervision in social situations
Profound ID
IQ less than 20
• Significant developmental delays in all areas
• Obvious physical and congenital abnormalities
• Requires close supervision
• Requires attendant to assist with self care activities
• Mya respond to physical and social activities
• Not capable of independent living
Deficits in Developmental Characteristics
Communication
• Academic functioning
• Vocational capability
• Social functioning
Specific Problems
Ability to learn
• Motivation and drive
• Cognition- motor planning, planning, thought process, problem
solving
• Concentration
• Memory
• Language development (receptive, language output, expressive)
Emotions (responses, duration, appropriateness, control, judgment and
anxiety
• Self esteem
• Perceptual and motor development difficulties (coordination, hyper- or
hypoactivity, stereotyped movements, balance, body schema & orientation
in space, laterality and directionality, muscle slackness, tire easily,
estimates distance poorly and bump into things
• Sensory defects-impaired vision, hearing (sensory deprivation)
Additional medical/physical handicaps-cerebral palsy, epilepsy,
psychiatric disabilities
• Social behaviour-conversation skills, social judgment and norms,
egocentric, inappropriateness, demanding, clinginess
• Poor personal habits-drooling, appearance-poor acceptance by others
• Play –no initiative and spontaneity
Family’s Problems
Loss of self esteem
• Feelings of shame
• Ambivalence towards the child
• Depression
Self-reproach
• Self-sacrifice
• Defensiveness and overprotection
• Denial
• Impact on family life and family functioning
Caregiver Problems
Difficult coping with and accepting a child who is difficult to accept (no
response, tactile defensive, restless, unable to communicate, destructive,
incontinent
• Disappointment and frustration due to slow progress and minimal results
COMPASSION is key
Special Needs
Help in understanding the world around him
• Love and physical contact
• Security and protection against harm
• Assistance during participation in activities
• Sensory experiences
• Social contact
• Praise and reward
Unique educational needs
• Physical movement
• Respect
• Effective communication
• Sexual needs
Clinical Management
Multidisciplinary Approach
Child Psychiatrists
• Educational Psychologists
• Occupational therapists,
• Speech and language therapists
• Social workers
• Specialist teachers
• Pediatricians, family physicians and nurses
Considerations for a management plan
Medical and developmental status
• Stability of the family to provide needed cognitive stimulation and
promote the child’s self esteem
• Educational status and needs of the child
• Presence of any emotional and behavioral problems
Outcome of intervention
Depends on general care, cognitive and other stimulation
• Given good care, stable family settings to grow in, suitable treatment of any
superimposed psychiatric problems most mild ID children make satisfactory
adjustments in society. However, their intellectual and other limitations,
management and education limit expected treatment outcomes.
• Sometimes parents and other carers are the biggest limiting factor due to a
gloomy view of what these children can achieve
Occupational Therapy Assessment
Variety of settings
• Unstructured settings-variety of stimuli
• Settings where specific stimulus is given
• Interpersonal settings
• Task oriented settings familiar and unfamiliar tasks. Build rapport;
Adaptation of instructions; vary verbal and visual stimuli
• Checklists for development and behaviour, Records and Reports,
Observations, p278-279, C & A, 2005
• Theory of Creative Ability vs Normal Child Development. Refer to
p275, C & A, 2005
• Specific structured evaluations
Approaches to planning treatment
self study, p 208-209, C & A, 1997
Determining skills to be learned and selecting appropriate methods to
achieve these goals
Model of creative ability
• Developmental and functional approaches
• Behaviour modification approach
• Sensory integration approach
• The individual needs approach
• Hands on approach
• Model of human occupation
Strategies
Habilitation
• Maintenance
• Preventative
• health promotion-Create, promote
• Modify (compensation, adaptation)
• Establish
Aims of treatment
Encourage independence in self management tasks
• Encourage emotional development and growth
• Encourage development of social skills (communication and IPRs)improve self
esteem
• Stimulate cognitive development
• Provide sensory integrative training
Encourage play development and creative participation
• Stimulate academic skills (higher functioning children-necessary skills)
• Promote domestic usefulness and occupational skills
• Teach constructive use of leisure time
• Life skills and coping skills to expand their life experiences
Handling Principles
Respond to comfort needs
• Empathy
• Flexibility
• Sensitivity to the child’s needs
• Patience
• Praise
• Communicate clearly
• Use nonverbal communication
Provide security in your relationship with the child
• Enthusiasm
• Respect for the child
• Firm handling
• Emotional maturity
• Compassionate
Activity selection
Allow for limited attention span
• Allow for just participating-norms and quality
• Selection of toys/objects (sensory input, easy to pick up, durable, safe,
social play)
• Avoid High risk of failure activities (artistic skill, fine coordination, physical
agility, initiative
• Concrete with tangible end product
• Immediate gratification
• Adaptable and simplification
Activity presentation
Present activities clearly and concretely-communicate clearly (sensory
deficits)
• Breakdown instructions
• Demonstration is essential-repeat
• Repeat instructions and allow for practice runs
• Verbalize and reinforce response
• Present activities in an interesting way
• Use gentle persuasion
• Present one task at a time
• Compensate for any deficits and limitation as needed
Treatment programme
Provide for level of functioning of individual clients or groups
• Different areas (self mx, social, play, academic, vocational and leisure)
• Preparation for adult life and community living
Programmes for various degrees of
disability and level of ability
Profound ID benefit from a sensory motor stimulation programme
• Tactile
• Visual
• Auditory
• Gustatory
• olfactory
Severe, moderate and mild ID
Benefits from
• Motor development
• Self management skills such as toileting, feeding, dressing
• Social skills development
• Cognitive skills (pre-grade-basic arithmetic, matching, sorting, perceptual
training)
Prevocational, vocational and leisure programmes
• Domestic tasks
• Gardening
• Simple crafts
• Sporting activities- (special olympics)
• Outdoor games
Suggested activities
Appropriate for needs and skills to be learned and culturally appropriate
• Institutional programme (school, day care, residential care)
Treatment options to deal with ID
Requires assessment of social, educational, psychiatric and environmental
needs
• Treatment optimal in the presence of preventative measures on primary,
secondary and tertiary prevention levels
Prevention
Education to increase public awareness and knowledge
• Upgrading public health policies, Legislation to provide maternal and child
health
• Family education-genetic predisposition
• Social support services for mothers from low socioeconomic areas to
minimize medical and psychosocial complications
Management
Education for the child
• Behavioral and pharmacological interventions
• Family education
• Social interventions (Special Olympics)
• Support groups
