Intellectual Disability
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Intellectual Disability
Outline
z
Definition z
Definition z
Medical investigationC
d
z
C
ommon syndromes
z
Associated comorbidity andmanagement z
Educational issues z
Medication z
Transition to adulthood z
Transition to adulthood
Cognitive FunctioningWHO 1968WHO 1968
z
mild ID
IQ
50-55 to 70
z
mild ID
IQ
50 55 to 70
z
moderate ID
IQ
35-40 to 50-
ID
IQ
20 25 t
z
severe ID
IQ
20-25 to 35-
z
profound ID
IQ
below 20-
Old terminology
gy
z
idiot- profound z
idiot
profound
z
imbecile -moderate/severe
f
bl
i d d
ild
z
moron or feeble minded- mild
DSM-IV and ICD-
z
DSM IV
z
DSM
IV
z
“dysfunction or impairment in >2areas:communication, self-care, homeliving, social/interpersonal skills, use ofcommunity resources, self direction,functional academic skills, work, leisure ,health and safety” z
onset before age 18
g
DSM-1V and ICD-
z
ICD
z
ICD
z
“mental retardation is a condition of
t d
i^
l t
d
l^
t
f
arrested or incomplete development ofthe mind, which is especiallycharacterised by impairment of skillscharacterised by impairment of skillsmanifested during the developmentalperiod contributing to the overall level ofperiod, contributing to the overall level ofintelligence- cognitive, language, motorand social abilities”
DSM IV
z
Mental Retardation z
Mental
Retardation
z
A. Significantly subaverage intellectualfunctioning: an IQ of approximately 70 orfunctioning: an IQ of approximately 70 orbelow on an individually administered IQtest (for infants a clinical judgment oftest (for infants, a clinical judgment ofsignificantly subaverage intellectualfunctioning)functioning).
DSM IV
z
B. Concurrent deficits or impairments in z
B. Concurrent deficits or impairments inpresent adaptive functioning (i.e., the person'seffectiveness in meeting the standardsexpected for his or her age by his or hercultural group) in at least two of the following
i^
ti
lf
h
li i
areas: communication, selfcare, home living,social/interpersonal skills, use of communityresources self-direction functional academicresources, self-direction, functional academicskills, work, leisure, health, and safety.
DSM V
z
Intellectual Disability z
Intellectual
Disability
z
A. Current intellectual deficits of two or morestandard deviations below the population
p p
mean, which generally translates intoperformance in the lowest 3% of a person’sage and cultural group, or an IQ of 70 orbelow. This should be measured with anindividualized standardized culturallyindividualized, standardized, culturallyappropriate, psychometrically sound measure.
DSM V
z
B. And concurrent deficits in at least two z
B. And concurrent deficits in at least twodomains of adaptive functioning of at least twoor more standard deviations, which generallytranslates into performance in the lowest 3 %of a person’s age and cultural group, or
t^
d
d
f 70
b l
Thi
h
ld b
standard scores of 70 or below. This should bemeasured with individualized, standardized,culturally appropriate psychometrically soundculturally appropriate, psychometrically soundmeasures. Adaptive behavior domainstypically include:yp
y
DSM V
z
C
With onset during the developmental
z
C. With onset during the developmentalperiod. zz z
Code no longer based on IQ level
A
daptive Functioning
p
g
z
Refers to how effectively individuals z
Refers to how effectively individualscope with everyday life demands, andhow well they meet standards ofhow well they meet standards ofpersonal independence expected ofsomeone of that age and socioeconomicsomeone of that age and socioeconomicand cultural background.
Measures of adaptive functioning
p
g
z
Is the instrument suitable to the ethnic z
Is the instrument suitable to the ethnicand cultural background? z
Vineland
uses a number of different
z
Vineland -uses a number of differentsources to gauge adaptive functioning
Frequency
q
y
z
occurs in 1-10 % of the population and is z
occurs in 1 10 % of the population and ismost accurately diagnosed in the schoolyearsyears. z
Developmental delay often used inpreschool yearspreschool years z
sex ratio 1.5 :1 M:F z
biological inequity related to the sexchromosomes with the well establishedX- linked single gene mutations