Intellectual Disability and Fetal Alcohol Syndrome

Question 1

Eugenics movement

Answer 1

1900-1930 heyday - segregation, sterilization, restrictive immigration policies

Question 2

DSM-5 intellectual disability

Answer 2

1. Diagnosed prior to 18 yrs old
2. These two criteria are NEEDED
   • IQ is less than or equal to 65-75
   • Impairment in adaptive functioning
     in 2 or more areas
     - Communication, self-care,
     home living, social skills, use
     of community resources, self-
     direction, academics, leisure,
     health, safety

Question 3

Intellectual disability prevalence

Answer 3

1-3% overall
Mild is 85% of that

Question 4

Common sources of information in assessing intellectual disability

Answer 4

1. IQ testing
2. Interview parents/caregivers
   ↪ Adaptive functioning scales
   ↪ Scales of Independent Behavior
3. Direct observation

Question 5

Etiological factors in intellectual disability

Answer 5

Complicated & varied
Two group approach: distinction between organic and cultural/familial

Organic: early environmental issues can impact IQs
Cultural/familial: genetics

Question 6

Chromosomal abnormalities and intellectual disability: List

Answer 6

1. Down syndrome
2. Fragile X syndrome
3. Prader-Willi syndrome
4. Angelman syndrome

Question 7

What is Down Syndrome?

Answer 7

Extra 21st chromosome (“trisomy 21”).
~ 1 in 1000 population but rises with maternal age

Question 8

What is Fragile X Syndrome?

Answer 8

Significant intellectual disability
Protruding ears
Male-dominated
Difference in X chromosome
1/10,000

Question 9

Prader-Willi Syndrome

Answer 9

Inherited from MOTHER
Constant hunger ➛ high obesity risk
Chromosome 15

Question 10

Angelmann Syndrome

Answer 10

Inherited from FATHER
Chromosome 15
Pointed ears, elfin face, intense need for socialization ➛ loneliness, anxiety

Question 11

What is Fetal Alcohol Syndrome characterized by?

Answer 11

Characterized by:
1. Facial characteristics
↪ epicanthal folds, thin palpebral fissure, wide nose bridge, flat philtrum

2. Lower head circumference and physical growth retardation
3. Intellectual disability and/or neuropsychological impairment

Question 12

Fetal Alcohol Spectrum Disorder

Answer 12

Some, but not all, of the requirements for FAS

Question 13

FAS prevalence

Answer 13

< 1%

Question 14

FASD prevalence

Answer 14

~1%

Question 15

FAS - limitation of alcohol

Answer 15

Greatest concern over binge drinking – 5+ drinks in one sitting, especially in early pregnancy.

There was an animal study showing 2 drinks leading to impairment, but the clinical implications are unclear.

Question 16

FAS associations

Answer 16

Poverty and smoking

Question 17

Washington Diagnostic System for FASD

Answer 17

Four aspects
1. Growth deficiency
2. Brain dysfunction
3. FAS facial features
4. Alcohol exposure

Ranked 1-4,
↪1: none
2: unknown
3: some risk
4: high risk

Pediatrician and psychologist score, then use scores to assign to patterns

Question 18

Washington Diagnostic System Patterns

Answer 18

Growth 3, Face 4, Brain 3, Alcohol 4 = FAS

Growth 2, Face 4, Brain 4, Alcohol 3 = Atypical FAS (some difference in presentation)

Growth 2, Face 3, Brain 3, Alcohol 2 = Static Encephalopathy (stable damage to brain, can’t be certain that alcohol was the cause)

Question 19

Lack of FAS facial features

Answer 19

Alcohol Related Neurodevelopmental Disability (ARND)

Question 20

FAS interventions

Answer 20

Individually tailored

Depends on nature of impairment. Can include life skills training, executive function tasks, traditional behavior therapy for problem behaviors.

Medicine is also an option for attention and/or mood problems.