Intellectual Disability (Intell. Devel. Disorder)

Question 1

What characterizes intellectual disability

Answer 1

deficits in general mental abilities, such as:

• reasoning
• problem solving
• planning
• abstract thinking
• judgment
• academic learning
• learning from experience

deficits result in impairments of ADAPTIVE FUNCTIONING

Question 2

what are the consequences of the deficits in adaptive functioning seen in intellectual disability

Answer 2

individual fails to meet standards of personal independence and social responsibility in ONE OR MORE aspects of daily life, including:

• communication
• social participation
• academic or occupational functioning
• personal independence at home or in community settings

Question 3

Define Intellectual Disability according to DSM 5

How many criteria are there in the DSM 5

Answer 3

intellectual disability is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in CONCEPTUAL, SOCIAL, and PRACTICAL domains

there are 3 criteria and all of them must be met

Question 4

What is criterion A for intellectual disability in DSM 5

Answer 4

Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience

these are confirmed by BOTH clinical assessment, and individualized standardized intelligence testing

Question 5

What is criterion B for intellectual disability in DSM 5

Answer 5

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
-academic or occupational functioning
-personal independence at home or in community settings
across multiple environments, such as home, school, work and community

Question 6

What is criterion C for intellectual disability in DSM 5

Answer 6

Onset of intellectual and adaptive deficits occurs during the developmental period

Question 7

List the specifiers used for intellectual disability in DSM 5

Answer 7

Mild
Moderate
Severe
Profound

Question 8

How are the various levels of severity defined? Why?

Answer 8

Defined based on adaptive functioning (not IQ scores)

this is because it is adaptive functioning that determines the level of support required
(IQ scores are also less valid in the lower end of the IQ range)

Question 9

List the characteristics of MILD intellectual disability in the conceptual domain

Answer 9

preschool children–> may be no obvious deficits

school age children and adults–> difficulties in learning academic skills involving reading, writing, arithmetic, time or money
-support needed in one or more areas to meet age-related expectations

adults–> abstract thinking, executive functioning, short term memory as well as functional use of academic skills are impaired

somewhat concrete approach to problems and solutions compared to age-mates

Question 10

What is executive functioning

Answer 10

planning
strategizing
priority setting
cognitive flexibility

Question 11

List the characteristics of MILD intellectual disability in the social domain

Answer 11

immature in social interactions compared with age mates (i.e difficulty perceiving social cues)

communication, conversation, language more concrete or immature than age-mates

may be difficulties regulating emotion and behaviour in age appropriate fashion–> noticed by peers in social settings

limited understanding of risk in social situations

at risk of being manipulated by others (gullibility)

Question 12

List the characteristics of MILD intellectual disability in the practical domain

Answer 12

may function age appropriately for personal care

need some support with complex daily living tasks in comparison to peers i.e grocery shopping, transport, home/childcare organizing, nutritious food prep, banking, money management

recreational skills similar to age-mates, though judgement related to wellbeing and organization around recreation requires support

in adults–competitive employment often seen in jobs that do not emphasize conceptual skills

Question 13

List the characteristics of MODERATE intellectual disability in the conceptual domain

Answer 13

individuals conceptual skills lag markedly behind peers throughout development

language and academic skills develop slowly, and are markedly limited compared to peers

in adults, academic skills typically at elementary level –support required for all use of academic skills in work and personal life

ongoing assistance needed on daily basis for adults in tasks of day to day life

Question 14

List the characteristics of MODERATE intellectual disability in the social domain

Answer 14

marked differences from peers in social and communicative behaviour across development

spoken language is primary tool for social communication but much less complex than peers

capacity for relationships shown in ties to family and friends; may have successful friendships and sometimes romantic relationships in adulthood

may not perceive or interpret social cues accurately; social judgment and decision making are limited

significant social and communicative support needed in work setting for success

Question 15

List the characteristics of MODERATE intellectual disability in the practical domain

Answer 15

can care for personal needs including eating, dressing, elimination, hygiene as an adult, though extended period of teaching and time needed for individual to become independent in these areas

can have independent employment but considerable support needed

recreational skills can be developed but typically require additional supports

Question 16

List the characteristics of SEVERE intellectual disability in the conceptual domain

Answer 16

limited skill attainment

generally has little understanding of written language or concepts involving numbers, quantity, time and money

caretakers provide extensive support for problem solving across lifespan

Question 17

List the characteristics of SEVERE intellectual disability in the social domain

Answer 17

spoken language limited in vocabulary and grammar

speech may be single words or phrases and may be supplemented through augmented means

focused on here and now within everyday events

understand simple speech and gestural communication

relationships with family members and familiar others are source of pleasure and help

Question 18

List the characteristics of SEVERE intellectual disability in the practical domain

Answer 18

requires support for all ADLs

requires supervision at all times

cannot make responsible decisions regarding wellbeing of self or others

requires ongoing support and assistance into adulthood with participation in tasks

maladaptive behaviour, including self injury, present in significant minority

Question 19

List the characteristics of PROFOUND intellectual disability in the conceptual domain

Answer 19

conceptual skills generally involve physical world rather than symbolic processes

may use objects in goal directed fashion for self care, work, recreation

may acquire some visuospatial skills i.e matching and sorting but co-occurring motor and sensory impairments may prevent functional use of objects

Question 20

List the characteristics of SEVERE intellectual disability in the social domain

Answer 20

very limited understanding of symbolic communication in speech or gesture

may understand some simple instructions or gestures

expresses own desires or emotions largely non-verbally

enjoys relationships with wellknown family members/caretakers/familiar others

may prevent many social activities

Question 21

List the characteristics of SEVERE intellectual disability in the practical domain

Answer 21

dependent on others for all aspects of daily physical care, health and safety though may be able to participate in some of these activities

co occurring physical and sensory impairments are frequent barriers to participation (beyond watching) in home, recreational, vocational activities

maladaptive behaviour present in significant minority

Question 22

how do those with intellectual disability typically score on validated tests of intelligence

Answer 22

scores of 65-75
(on tests with SD of 15 and mean of 100)

this represents scores of approximately two standard deviations or more below the population mean

including margin for measurement error (+/- 5 points)

*clinical training and judgment are required to interpret test results and assess intellectual performance

Question 23

what is the Flynn effect

Answer 23

overly high test scores due to out of date test norms

Question 24

what factors may affect intelligence test scores

Answer 24

practice effects and the flynn effect

invalid scores may result from use of brief intelligence screening tests or group tests

co-occurring disorders that affect communication, language and/or motor or sensory function may affect scores

Question 25

what factors must be considered when an intelligence test is "normed"

Answer 25

instruments must be normed for the individuals sociocultural background and native language

Question 26

what is better than an IQ score for understanding intellectual abilities in what areas are IQ tests insufficient

Answer 26

individual cognitive profiles based on neuropsychiatric testing --> these may ID areas of relative strength and weakness and may be important for academic and vocational planning IQ test scores approximate conceptual functioning but may be insufficient to assess reasoning in real life situations and mastery of practical tasks

Question 27

what are the three domains of adaptive functioning

Answer 27

adaptive reasoning in: conceptual social practical domains

Question 28

what is the conceptual domain

Answer 28

aka academic domain competence in memory, language, reading, writing, math reasoning, acquisition of practical knowledge, problem solving, judgment in novel situations

Question 29

what is the social domain

Answer 29

awareness of others thoughts, feeling, experiences, empathy, interpersonal communication skills, friendship abilities, social judgment

Question 30

what is the practical domain

Answer 30

learning and self management across life settings i.e personal care, job responsibilities, money management, recreation, self management of behaviour, school and work task organization

Question 31

outside of intellectual disability/testing, what factors can influence an individuals adaptive functioning

Answer 31

``` intellectual capacity education motivation socialization personality features vocational opportunity cultural experience coexisting general med condition or other mental disorder ```

Question 32

what do you do if standardized testing is not possible (i.e due to sensory impairment or other factor)

Answer 32

may diagnose person with unspecified intellectual disability

Question 33

what are frequent co-occurring/associated difficulties in those with intellectual disability

Answer 33

difficulties with: social judgment assessment of risk self management of behaviour, emotions or interpersonal relationships motivation in school or work environments

Question 34

what factor in intellectual disability may predispose to disruptive or aggressive behaviours

Answer 34

lack of communication skills

Question 35

what features, that can be present in intellectual disability, can result in exploitation by others

Answer 35

gullibility (often a feature of intellectual disability )--> naivete in social situations and tendency for being easily led by others and lack of awareness of risk - -can result in victimization, fraud, unintentional criminal involvement, false confessions, risk of physical/sexual abuse - -important factors in criminal cases

Question 36

what is the prevalence if intellectual disability

Answer 36

1% (overall general population prevalence) prevalence rates vary by age prevalence of severe intellectual disability = 6/1000

Question 37

what is the age and characteristic features at onset of intellectual disability

Answer 37

dependent on etiology and severity of brain dysfunction delayed milestones may be seen within first 2 years of life in those with more severe intellectual disability; mild levels may not be noted until school age when difficulty with academic learning is more obvious

Question 38

what is a behavioural phenotype

Answer 38

specific behaviours that are characteristic of a particular genetic disorder i.e Lesch-Nyhan syndrome

Question 39

when might both an intellectual disability and a neurocognitive disorder be diagnosed at the same time

Answer 39

when intellectual disability results from loss of previously acquired skills i.e in severe traumatic brain injury

Question 40

is intellectual disability generally progressive or nonprogressive

Answer 40

nonprogressive BUT--in certain genetic disorders (i.e Rett syndrome) there are periods of worsening followed by stabilization in others (i.e Sanfilippo syndrome) there may be progressive worsening of intellectual function

Question 41

list some prenatal etiologies of intellectual disability

Answer 41

genetic syndromes inborn error of metabolism brain malformations maternal disease (including placental disease) environmental influences (alcohol, drugs, toxins teratogens)

Question 42

list some perinatal etiologies of intellectual disability

Answer 42

variety of labour and delivery related events leading to neonatal encephalopathy

Question 43

list some postnatal causes of intellectual disability

Answer 43

hypoxic ischemic injury TBI infections demyelinating disorders seizures disorders severe and chronic social deprivation toxic metabolic syndromes and intoxications (i.e lead, mercury)

Question 44

what is the sex distribution of intellectual disability

Answer 44

males more likely than females to be diagnosed with intellectual disability mild--ratio is 1.6:1 M:F severe--ratio is 1.2:1 M:F sex linked genetic factors and male vulnerability to brain insult may account for some of the gender differences

Question 45

other than tests of intellectual and adaptive functioning, what might constitute part of the assessment of a patient for intellectual disability

Answer 45

ID of genetic vs nongenetic etiologies evaluate for associated medical conditions i.e cerebral palsy evaluate for cooccurring mental, emotional, behavioural disorders pre-and perinatal medical history 3 generation family pedigree physical exam genetic evaluation (karyotype etc) metabolic screening neuroimaging assessment

Question 46

how should an intellectual disability occurring in the context of a genetic syndrome be documented

Answer 46

noted as concurrent diagnoses

Question 47

what is the major differential diagnosis for intellectual disability

Answer 47

major and mild neurocognitive disorders communication disorders specific learning disorders autism spectrum disorder

Question 48

how do neurodevelopmental and neurocognitive disorders differ

Answer 48

neurocognitive disorders are characterized by LOSS of cognitive functioning they may co occur

Question 49

how to distinguish between intellectual disability and communication/learning disorders

Answer 49

those with communication/learnign disorders have deficits specific to these domains, and do NOT show deficits in intellectual and adaptive behaviour may co occur

Question 50

what are the most common co occurring mental and neurodevelopmental disorders

Answer 50

ADHD depressive and bipolar disorders anxiety disorders ASD stereotypic movement disorder impulse control disorders major neurocog disorder

Question 51

what is global developmental delay

Answer 51

a diagnosis reserved for those UNDER AGE 5 when clinical severity level cannot be reliably assessed during early childhood this is used when an individual fails to meet expected developmental milestones in several areas of intellectual functioning applies to those who are unable to undergo systematic assessments of intellectual functioning, including children too young to undergo testing requires reassessment after a period of time

Question 52

what is unspecified intellectual disability

Answer 52

reserved for individuals OVER AGE 5 when assessment of the degree if intellectual disability by means of locally available procedures is rendered difficult or impossible due to associated sensory or physical impairments (i.e blindness, prelingual deafness, severe behaviour problems or co occurring mental disorder) should only be used in exceptional circumstances and requires reassessment after a period of time