Intellectual Disability (Intell. Devel. Disorder) Flashcards
What characterizes intellectual disability
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
what are the consequences of the deficits in adaptive functioning seen in intellectual disability
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
Define Intellectual Disability according to DSM 5
How many criteria are there in the DSM 5
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
What is criterion A for intellectual disability in DSM 5
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
What is criterion B for intellectual disability in DSM 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
What is criterion C for intellectual disability in DSM 5
Onset of intellectual and adaptive deficits occurs during the developmental period
List the specifiers used for intellectual disability in DSM 5
Mild
Moderate
Severe
Profound
How are the various levels of severity defined? Why?
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)
List the characteristics of MILD intellectual disability in the conceptual domain
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
What is executive functioning
planning
strategizing
priority setting
cognitive flexibility
List the characteristics of MILD intellectual disability in the social domain
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)
List the characteristics of MILD intellectual disability in the practical domain
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
List the characteristics of MODERATE intellectual disability in the conceptual domain
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
List the characteristics of MODERATE intellectual disability in the social domain
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
List the characteristics of MODERATE intellectual disability in the practical domain
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
List the characteristics of SEVERE intellectual disability in the conceptual domain
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
List the characteristics of SEVERE intellectual disability in the social domain
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
List the characteristics of SEVERE intellectual disability in the practical domain
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
List the characteristics of PROFOUND intellectual disability in the conceptual domain
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
List the characteristics of SEVERE intellectual disability in the social domain
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
List the characteristics of SEVERE intellectual disability in the practical domain
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
how do those with intellectual disability typically score on validated tests of intelligence
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
what is the Flynn effect
overly high test scores due to out of date test norms
what factors may affect intelligence test scores
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
what factors must be considered when an intelligence test is “normed”
instruments must be normed for the individuals sociocultural background and native language
what is better than an IQ score for understanding intellectual abilities
in what areas are IQ tests insufficient
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
what are the three domains of adaptive functioning
adaptive reasoning in:
conceptual
social
practical domains
what is the conceptual domain
aka academic domain
competence in memory, language, reading, writing, math reasoning, acquisition of practical knowledge, problem solving, judgment in novel situations
what is the social domain
awareness of others thoughts, feeling, experiences, empathy, interpersonal communication skills, friendship abilities, social judgment
what is the practical domain
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
outside of intellectual disability/testing, what factors can influence an individuals adaptive functioning
intellectual capacity education motivation socialization personality features vocational opportunity cultural experience coexisting general med condition or other mental disorder
what do you do if standardized testing is not possible (i.e due to sensory impairment or other factor)
may diagnose person with unspecified intellectual disability
what are frequent co-occurring/associated difficulties in those with intellectual disability
difficulties with:
social judgment
assessment of risk
self management of behaviour, emotions or interpersonal relationships
motivation in school or work environments
what factor in intellectual disability may predispose to disruptive or aggressive behaviours
lack of communication skills
what features, that can be present in intellectual disability, can result in exploitation by others
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
what is the prevalence if intellectual disability
1%
(overall general population prevalence)
prevalence rates vary by age
prevalence of severe intellectual disability = 6/1000
what is the age and characteristic features at onset of intellectual disability
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
what is a behavioural phenotype
specific behaviours that are characteristic of a particular genetic disorder i.e Lesch-Nyhan syndrome
when might both an intellectual disability and a neurocognitive disorder be diagnosed at the same time
when intellectual disability results from loss of previously acquired skills i.e in severe traumatic brain injury
is intellectual disability generally progressive or nonprogressive
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
list some prenatal etiologies of intellectual disability
genetic syndromes
inborn error of metabolism
brain malformations
maternal disease (including placental disease)
environmental influences (alcohol, drugs, toxins teratogens)
list some perinatal etiologies of intellectual disability
variety of labour and delivery related events leading to neonatal encephalopathy
list some postnatal causes of intellectual disability
hypoxic ischemic injury
TBI
infections
demyelinating disorders
seizures disorders
severe and chronic social deprivation
toxic metabolic syndromes and intoxications (i.e lead, mercury)
what is the sex distribution of intellectual disability
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
other than tests of intellectual and adaptive functioning, what might constitute part of the assessment of a patient for intellectual disability
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
how should an intellectual disability occurring in the context of a genetic syndrome be documented
noted as concurrent diagnoses
what is the major differential diagnosis for intellectual disability
major and mild neurocognitive disorders
communication disorders
specific learning disorders
autism spectrum disorder
how do neurodevelopmental and neurocognitive disorders differ
neurocognitive disorders are characterized by LOSS of cognitive functioning
they may co occur
how to distinguish between intellectual disability and communication/learning disorders
those with communication/learnign disorders have deficits specific to these domains, and do NOT show deficits in intellectual and adaptive behaviour
may co occur
what are the most common co occurring mental and neurodevelopmental disorders
ADHD
depressive and bipolar disorders
anxiety disorders
ASD
stereotypic movement disorder
impulse control disorders
major neurocog disorder
what is global developmental delay
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
what is unspecified intellectual disability
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
