Module 5 Intellectual Disability

Intellectual Disability : 

Intellectual Disability Mental Retardation is OUT Ben Atchison, PhD, OTR, FAOTA

OLD Term and Definition : 

OLD Term and Definition Mental retardation is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. American Association on Mental Retardation (2002)

New Term and Definition : 

New Term and Definition Intellectual Disability (ID)… is a disability characterized by significant limitations both in intellectual functioning (reasoning, learning, problem solving) and in adaptive behavior, which covers a range of everyday social and practical skills. This disability originates before the age of 18. American Association on Intellectual and Developmental Disabilities (AAIDD) (2007) Formerly AAMR before 2007. Look for Manual of Definitions and Classifications (in press) Publication 2010

DSM-IV Criteria for MR : 

DSM-IV Criteria for MR IQ of 70 or less Onset before 18 Limitations in 2 areas of adaptive functioning Will the DSM-V include the new term?

Slide 5: 

“DSM-IV uses the term, “Mental retardation” (MR) to describe cognitive deficits.  This term is outdated and considered pejorative by many, so the work group is considering a change to the term “Intellectual Disabilities”  The usefulness of the four current categories (Mild MR, Moderate MR, Severe MR and Profound MR) is being examined, in comparison with a single category of Intellectual Disabilities, with diagnostic specifiers for 1) IQ and 2) Adaptive functioning.    The Workgroup will seek feedback (through RFIs and meetings with stakeholder groups) on these changes in definition, as well as on the specific criteria to be proposed for the intellectual disabilities in DSM-V.” Report of the DSM-V Neurodevelopmental Disorders Work Group April 2009 Susan Swedo, M.D.

Why Change Terms? : 

Why Change Terms? No change in definitions New vision Less offensive Consistent with international terminology Enables pursuit of “disability identity”

Are ID and DD the same? : 

Are ID and DD the same? Difference is that DD includes those who have ID AND physical disabilities but some can be strictly physical.

Intellectual Disability : 

Intellectual Disability Determined by IQ And …AND!... Adaptive Behavior

IQ: Intelligence Quotient : 

IQ: Intelligence Quotient An IQ of 70—and as high as 75 will result in a diagnosis of Intellectual Disability REMEMBER: All IQ Scores have a mean of 100 and a S.D. of 15

Adaptive Behavior : 

Adaptive Behavior 3 types of skills in this category Conceptual Skills Social Skills Practical Skills

In addition to IQ and AB: : 

In addition to IQ and AB: Community environment typical of the individual’s peers and culture Linguistic diversity Cultural differences in the way people communicate, move, and behave

Slide 12: 

Lil’ Wayne could be considered to have deficits in adaptive behavior or even do poorly on a cultural biased IQ test as well as bias about the culture of rap artists..when in fact, the man is brilliant by standards applied to his culture

Etiologic Factors : 

Etiologic Factors Biologic Non-Biologic 40 % of Intellectual Disabilities have an unknown etiology

Biologic Causes : 

Biologic Causes More than 250 biologic causes are known Most grouped under the general categories of chromosomal abnormalities, other genetic factors, prenatal and perinatal factors (e.g., anoxia), acquired childhood disorders, environmental factors (e.g., lead exposure).

Examples of Adaptive Skills : 

Examples of Adaptive Skills Conceptual Skills Receptive and expressive language Reading and writing Money concepts Self-directions

Adaptive Skills : 

Adaptive Skills Social Skills Interpersonal Responsibility Self-esteem Gullibility (likelihood of being tricked or manipulated) Naiveté Follows rules Obeys laws Avoids victimization

Adaptive Skills : 

Adaptive Skills Practical Skills Personal activities of daily living such as eating, dressing, mobility and toileting. Instrumental activities of daily living such as preparing meals, taking medication, using the telephone, managing money, using transportation and doing housekeeping activities. Occupational skills Maintaining a safe environment

Adaptive Skills : 

Adaptive Skills Occupational Performance Areas, Right?

Question: : 

Question: Can a person have impaired intellectual function and not be considered mentally retarded?

Answer: : 

Answer: Yes, if there is not accompanying significant limitation in two or more adaptive skill areas

Incidence and Prevalence : 

Incidence and Prevalence 2.5-3% of population Boys 1.5 times more than girl Of those identified, typically have 2 or more older sibs Children whose mothers did not complete HS Children with older mothers

Signs and Symptoms : 

Signs and Symptoms Often associated with another diagnosis 2/3 with SMR have neuro dx Less than 20% with Mild MR have neuro dx

Slide 23: 

Classification IQ Range Profound < 20/25 Severe 2/26-35/40 Moderate 35/40-50/55 Mild 50/55-70/75

Slide 24: 

Mild : 85% Moderate 10% Severe 3.5% Profound 1.5%

Course and Prognosis : 

Course and Prognosis Differs according to cause Adaptive limitations can be improved Persons with Down Syndrome at higher risk for Alzheimers Disease after age 40

Diagnostic Adaptive Behavior Scale : 

Diagnostic Adaptive Behavior Scale DABS Protocol Interviews DABS Recruitment Response Form

Summary : 

Summary AAMR now AAIDD Term now Intellectual Disability vs MR Definitions and characteristics remain same DSM V likely to change Role of OT is historically strong and will continue DABS will be a new assessment in 2010

Resource for Powerpoint Info : 

Resource for Powerpoint Info American Association on Intellectual and Developmental Disabilities (2009). www. aaidd.org. Retrieved November 12 2009