3. What’s in this Video?
In this video we will explore the questions:
What is Intellectual Disability (ID)?
What are the symptoms of ID?
4. Intellectual Disability (ID)
Describes diverse group with diverse outcomes
◦ Ex. Severe developmental disabilities to mild delays
DSM diagnostic criteria requires
◦ Deficits in intellectual functioning
◦ Deficits in adaptive functioning
◦ Onset of deficits during developmental period
5. Intellectual Disability (ID)
Intellectual functioning
◦ Problems with:
◦ Perceiving and processing new information, learning quickly & efficiently, applying knowledge & skills to
solve novel problems, thinking creatively & flexibly, responding rapidly & accurately
◦ Children 5+: IQ ≤ 70
6. Intellectual Disability (ID)
Adaptive functioning
◦ Problems with:
◦ Conceptual skills
◦ Social skills
◦ Practical skills
◦ Measured using DABS (Diagnostic Adaptive Behaviour Scale):
◦ Ex. Scores below 70 on at least 1 domain indicate impairment in AD
7. Intellectual Disability (ID)
Mild (AD scores 55-70)
Conceptual
◦ Preschoolers: No obvious differences
◦ School-aged: difficulties acquiring academic skills; abstract thinking & planning impaired; thinking tends to be
concrete
Social
◦ More immature than peers: communication, conversation & language; difficulty understanding social cues of
others
◦ Difficulties w/ emotion and behaviour regulation
Practical
◦ Personal care: functioning similar to peers
◦ Teens: assistance may be needed to perform more complex tasks like shopping, cooking, managing money
8. Intellectual Disability (ID)
Moderate (AD scores 40-55)
Conceptual
◦ Preschoolers: language & preacademic skills develop slowly
◦ School-aged: slow progress in academic skills
◦ Adolescents: academic skills usually at elementary school level
Social
◦ Marked differences in social & communicative skills compared to peers
◦ Spoken language simplistic & concrete
◦ Social judgment & decision-making limited. Friendships affected by social deficits
Practical
◦ Needs more time & practice to learn self-care skills
◦ Teens: household skills can be acquired with ample practice
9. Intellectual Disability (ID)
Severe (AD scores 35-40)
Conceptual
◦ Little understanding of written language or numbers
◦ Caretakers must provide extensive support for problem-solving throughout life
Social
◦ Spoken language is very limited with simplistic vocabulary & grammar
◦ Speech may be single words/phrases
◦ Child understands simple speech and gestures
◦ Relationships with family members and other familiar people
Practical
◦ Needs ongoing support for all activities of daily living
◦ Caregivers must supervise children at all times
◦ Some youths show challenging behaviours such as self-injury
10. Intellectual Disability (ID)
Profound (AD scores <25)
Conceptual
◦ Skills generally involve the physical world rather than abstract symbols
◦ Some visual-spatial skills may be acquired with practice
◦ Co-occurring physical problems may greatly limit functioning
Social
◦ Limited understanding of symbolic communication
◦ May understand some simple instructions & gestures
◦ Communication usually through nonverbal, nonsymbolic means
◦ Relationships with family members and other familiar people
◦ Co-occurring physical problems may greatly limit functioning
Practical
◦ Dependent on others for all aspects of physical case, health & safety (may participate in some aspects)
◦ Some youths show challenging behaviours such as self-injury
◦ Co-occurring health/physical problems may greatly limit functioning
11. Intellectual Disability (ID)
American Association on Intellectual and Developmental Disabilities (AAIDD)
◦ Describes individuals with ID in terms of need for support
◦ Broad array of assistance that helps the individual function effectively in society
◦ 4 levels of support:
◦ Intermittent (i.e., occasional, in time of crisis)
◦ Limited (i.e., short-term)
◦ Extensive (i.e., long-term)
◦ Pervasive (i.e., constant)
◦ Own semistructured interview that measures support needs in areas of home living, community living,
lifelong learning, employment, health & safety, social activities, & protection and advocacy
◦ Frequency, amount, type of support required
Compared to DSM-5: conveys more information about those with ID, focuses on abilities rather
than limitations, cumbersome
12. Global Developmental Delay (GDD)
Neurodevelopmental disability only diagnosed in children younger than 5 years of age
Infant fails to meet developmental milestones in several areas
◦ Need significant delays in at least 2 areas
◦ Fine/gross motor skills, speech/language, social/personal skills, daily living
Temporary diagnosis though not all will later develop ID
13. Intellectual Disability (ID): Prevalence
Approximately 1-3% of population (depending on cutoff)
Twice as many males as females among those with mild cases
More prevalent among children of lower SES and children from minority groups, especially for
mild cases
More severe levels - identified almost equally in different racial and economic groups
ID is more prevalent among child of lower SES families & children from minority groups
◦ For mild ID
14. To Sum Up
ID is characterized by deficits in intellectual & adaptive functioning that begin during the developmental
period
The DSM-5 allows rating of severity according to 4 levels, mild, moderate, severe & profound
In very young infants, GDD may be used as a temporary diagnosis
In the next video we will explore the challenging behaviours associated with intellectual
disability
16. What’s in this Video?
In this video we will explore the questions:
What is the course of ID?
What are the causes of ID?
17. Developmental-versus-difference
Controversy
Do all children - regardless of intellectual impairments -progress through the same
developmental milestones in a similar sequence, but at different rates?
Developmental position:
◦ Similar sequence hypothesis
◦ Similar structure hypothesis
Difference viewpoint: cognitive development of children with ID is qualitatively different in
reasoning/problem-solving
◦ Familial versus organically based ID
18. Motivation & Changes in Abilities
Many children with mild ID are able to learn and attend regular schools
Often susceptible to feelings of helplessness and frustration in their learning environments
Children who have mild ID are able to stay on task and develop goal-directed behavior
With stimulating environments and caregiver support
Remember that environment can influence intellectual development
Ex. Slowing and stability hypothesis
◦ Children with Down syndrome may alternate between periods of gain in functioning & little to no
advancement
19. Language & Social Behaviour
Development follows a predictable and organized course
The underlying symbolic abilities of children are believed to be largely intact
There is considerable delay in expressive language development; expressive language is weaker
than receptive language
Fewer signals of distress or desire for proximity with primary caregiver
Delayed, but positive, development of self-recognition
Delayed and aberrant functioning in internal state language
Reflects emergent sense of self and others
Deficits in social skills and social-cognitive ability; can lead to rejection by peers
20. Challenging Behaviours
~ 1 in 4 children with ID engage in challenging behaviour
Challenging behaviour adversely affects children’s health and development in several ways:
◦ Can be physically harmful
◦ Can strain relationship with parents & cause peer rejection
◦ Limit access to social experiences
◦ Interfere with cognitive development & academic achievement
◦ Treatment can be time consuming & costly
21. Challenging Behaviours: Stereotypies
Behaviours that are performed in a consistent, rigid, and repetitive manner and that have no
immediate, practical significance
When they limit academic or social functioning, stereotypic movement disorder can be
diagnosed
Prevalence: 71% of youths with both ID and autism
Reasons for engagement vary:
◦ Genetics, self-reinforcing, regulation of anxiety or frustration
22. Challenging Behaviours: Self-injurious
Behaviours
Repetitive movements of the hands, limbs, or head in a manner that causes physical harm or
damage to the person
Classified in 3 ways:
◦ Severity: mild (ex. Head rubbing) to severe (ex. eye gouging)
◦ Frequency: low occurrence acts with high potential for harm (ex. Head banging once per day) to high
occurrence acts that may cause harm over time (ex. Hand rubbing)
◦ Purpose: reinforced by responses elicited from others, self-reinforcing
~10-12% of kids with ID engage in SIB (inversely related to cognitive & adaptive functioning)
Possible causes:
◦ Functional
◦ Hypersensitivity to dopamine
◦ High levels of endogenous opioids or endorphins
23. Emotional & Behavioural Problems
Rate is three to seven times greater than in typically developing children
Largely due to limited communication skills, additional stressors, and neurological deficits
Most common psychiatric diagnoses:
Impulse control disorders, anxiety disorders, and mood disorders
Internalizing problems and mood disorders in adolescence are common
24. Other Health Disabilities
Health and development are affected
Degree of intellectual impairment is a factor
Prevalence of chronic health conditions in ID population is much higher than in the general
population
Life expectancy for individuals with Down syndrome
is now approaching 60 years
25. Intellectual Disability: Causes
Scientists cannot account for the majority of cases, especially the milder forms
Genetic or environmental causes are known for almost two-thirds of individuals with moderate
to profound ID
Organic group – there is a clear biological basis
◦ Associated with severe and profound ID
Cultural-familial group – there is no clear organic basis
◦ Associated with mild ID
26. Intellectual Disability: Causes
Timing Biomedical Social Behavioral Educational
Prenatal 1. Chromosomal disorders
2. Single-gene disorders
3. Syndromes
4. Metabolic disorders
5. Cerebral dysgenesis
6. Maternal illness
7. Parental age
1. Poverty
2. Maternal malnutrition
3. Domestic violence
4. Lack of access to
prenatal care
1. Parental drug
use
2. Parental
alcohol use
3. Parental
smoking
4. Parental
immaturity
1. Parental
cognitive
disability
without
supports
2. Lack of
preparation for
parenthood
Perinatal 1. Prematurity
2. Birth Injury
3. Neonatal disorders
1. Lack of access to
prenatal care
1. Parental
rejection of
caretaking
2. Parental
abandonment
of child
1. Lack of medical
referral for
intervention
servicesat
discharge
27. Intellectual Disability: Causes
Timing Biomedical Social Behavioral Educational
Postnatal 1. Traumatic brain injury
2. Malnutrition
3. Meningoencephalitis
4. Seizure disorders
5. Degenerative disorders
1. Impaired child-
caregiver interaction
2. Lack of
adequate
stimulation
3. Family poverty
4. Chronic illness in
the family
5. Institutionalization
1. Child abuse and
neglect
2. Domestic
violence
3. Inadequate
safety
measures
4. Social
deprivation
5. Difficult child
behaviours
1. Impaired
parenting
2. Delayed
diagnosis
3. Inadequate
early
interventions
services
4. Inadequate
special
education
services
5. Inadequate
family support
28. Intellectual Disability: Chromosomal
Abnormalities
Down Syndrome
~95% of cases caused by an extra 21st chromosome (trisomy 21) due to a nondisjunction
◦ Can also occur when child inherits one chromosome 21 from each parent & one abnormally fused
chromosome from one parent (translocation)
◦ Can also occur when some cells fail to separate during mitosis (results in mix of cells with normal vs.
abnormal amounts of genetic material – chromosomal mosaicism)
Characteristics:
◦ Facial features
◦ Physical features
◦ ID
◦ Language deficits
29. Intellectual Disability: Chromosomal
Abnormalities
Prader-Willi Syndrome
Noninherited genetic disorder occurring in ~ 1 in 20,000 children
◦ Caused by deletion of portions of chromosome 15
Characteristics:
◦ Mild ID
◦ Overeating & obesity
◦ Oppositional and defiant actions toward adults
◦ Obsessive-compulsive behaviours
30. Intellectual Disability: Chromosomal
Abnormalities
Angelman Syndrome
Noninherited genetic disorder occurring in ~ 1 in 15,000 to 20,000 children
◦ Caused by deletion of portions of chromosome 15
Characteristics:
◦ ID
◦ Speech impairment
◦ Happy demeanor
◦ Unusual motor behaviour
31. Intellectual Disability: Chromosomal
Abnormalities
Fragile X Syndrome
Inherited genetic disorder occurring in ~ 1 in 20,000 children
◦ Caused by mutation in a FMR-1 gene on the X chromosome
Characteristics:
◦ Moderate to severe ID
◦ Physical abnormalities
◦ Social/behavioural problems
32. Intellectual Disability: Metabolic
Abnormalities
Phenylketonuria (PKU)
Inherited genetic disorder occurring in ~ 1 in 11,500 children
◦ Caused by recessive gene that results in inability to convert phenylalanine to tyrosine
Characteristics:
◦ Severe ID if untreated
◦ Language deficits
◦ Hyperactivity, erratic movements
◦ Gastrointestinal problems
◦ Seizures
33. Intellectual Disability: Neurobiological
Influences
Maternal illness
◦ Ex. TORCH
◦ Toxoplasmosis
◦ Other infections
◦ Rubella
◦ Cytomegalovirus
◦ Herpes simplex virus type 2
Fetal alcohol spectrum disorder (FASD)
◦ Covers a range of outcomes associated with all levels of prenatal alcohol exposure
Fetal alcohol syndrome
◦ A leading cause of ID (6-9 per 1000 school-aged children)
◦ Prevalence higher among certain minority compared to majority groups
◦ Characterized by:
◦ CNS dysfunction
◦ Facial feature abnormalities
◦ Growth retardation
34. Intellectual Disability: Social &
Psychological Influences
Least understood and most diverse factors causing ID
Environmental influences and other mental disorders account for 15-20% of ID
Deprived physical and emotional care and stimulation of the infant
Other mental disorders accompanied by ID, such as autism
Parents are critically important
35. To Sum Up
There is debate regarding the differences in course of intellectual development between kids
with ID and those without
Some children with ID show challenging behaviours such as stereotypy and self-injurious
behaviour
There are numerous causes of ID, the majority of which are unknown
In the next video we will look at interventions for ID
37. What’s in this Video?
In this video we will explore the questions:
What are interventions for ID?
38. Interventions
Child’s overall adjustment is a function of:
Parental participation, family resources, social supports, level of intellectual functioning, basic
temperament, and other specific deficits
Treatment involves a multi-component, integrated strategy
◦ Considers children’s needs within the context of their individual development, their family and
institutional setting, and their community
39. Interventions
ID related to fetal alcohol syndrome, lead poisoning, rubella can be prevented if precautions are
taken
Prenatal programs for parents caution about use of alcohol, tobacco, drugs, and caffeine during
pregnancy
Screening during gestation can be used
◦ Ex. Genetic screening, serum screening, amniocentesis, chorionic villus sampling (CVS)
40. Interventions: Psychosocial
Early intervention
One of the most promising methods for enhancing the intellectual and social skills of young
children with developmental disabilities
Carolina Abecedarian Project provides enriched environments from early infancy through
preschool years
Optimal timing for intervention is during preschool years
Mixed effects from systematic studies
41. Interventions: Psychosocial
Early educational intervention
One of the most promising methods for enhancing the intellectual and social skills of young
children with developmental disabilities
Carolina Abecedarian Project provides enriched environments from early infancy through
preschool years
Optimal timing for intervention is during preschool years
Mixed effects from systematic studies
Mainstreaming vs. Inclusion vs. Universal Design
42. Interventions: Psychosocial
Behavioural Treatments
Initially seen as a means to control or redirect negative behaviors
ABA techniques
◦ Event recording
◦ Interval recording
◦ Duration recording
Iwata et al (1994)’s functional analysis method
◦ Attention condition – positive reinforcement
◦ Demand condition – negative reinforcement
◦ Alone condition – automatically reinforced
43. Interventions: Psychosocial
Behavioural Treatments
Whenever possible, positive reinforcement is used to strengthen desirable behaviour and
reduce undesirable behaviour
Positive punishment is only used when problem behaviours are dangerous or life threatening
and other methods have been ineffective
◦ Ex. Contingent stimulation, overcorrection, positive practice
Negative punishment is usually less aversive than positive punishment
◦ Ex. Planned ignoring, time-outs, response cost
Social skills training (see textbook)
Cognitive-behavioural & family therapies can also be used (see textbook)
44. To Sum Up
Interventions treatment involves multicomponent, integrated strategies that take into consideration the
child’s needs within the context of their individual development, family, institution and community
settings.
Early interventions such as prenatal screening and parental education can be helpful in preventing ID.
Early educational interventions have been shown to be effective.
Psychological interventions based on behavioural principles are effective at reducing problem behaviours
and helping the child acquire more adapt forms of behaviour.
In the next video we will explore autism spectrum disorder
46. What’s in this Video?
In this video we will explore the questions:
What are the features of autism spectrum disorder (ASD)?
What is the etiology of ASD?
What are the interventions for ASD?
47. Autism Spectrum Disorder
First described by Kanner more than 70 years ago
Involves significant impairment in social communication skills and the display of stereotyped
interests and behaviours
◦ Symptoms vary on a continuum from mild to severe and affect each person differently
◦ Deficits in social communication & interaction
◦ Atypical social-emotional reciprocity, Atypical nonverbal communication, Difficulties developing and maintaining relationships
◦ Repetitive behaviour or restricted interests or activities
◦ Repetitive speech, movement or use of objects, Intense focus on rituals or routines and strong resistance to change, Intense
fixations or restricted interests, Atypical sensory reactivity
48. Autism Spectrum Disorder
DSM-5 allows the use of specifiers to describe the child’s functioning:
Specify if:
With or without accompanying intellectual impairment
With or without Accompanying language impairment
Associated with a known medical or genetic condition or environment factor.
Associated with another neurodevelopment, mental, or behavioral disorder
With catatonia
49. Autism Spectrum Disorder
Three factors contribute to the spectrum nature of autism
◦ Children with autism may differ in the level of intellectual ability, from profound disability to above-
average intelligence
◦ Children with autism vary in the severity of their language problems.
◦ The behavior of children with autism changes with age.
50. Autism Spectrum Disorder: Associated
Features
About 70% of autistic children with autism have co-occurring intellectual impairment
A common pattern is low verbal scores and high nonverbal scores
About 25% have splinter skills or islets of ability
5% (autistic savants) display isolated and remarkable talents
51. Autism Spectrum Disorder: Associated
Features
Deficits in processing social-emotional information
Difficulty in situations that require social understanding
Do not understand pretense or engage in pretend play
Deficit in mentalization or theory of mind (ToM)--- difficulty understanding others’ and their own
mental states
◦ Do not understand false-belief tests
52. Autism Spectrum Disorder: Associated
Features
Executive functions (higher-order planning and regulatory behaviors)
Weak drive for central coherence (strong human tendency to interpret stimuli in a relatively
global way to account for broader context)
◦ Do well on tasks requiring focus on parts of stimulus
53. Autism Spectrum Disorder: Associated
Features
Lack of ToM is one of the most specific characteristics of ASD
◦ Deficits in processing socio-emotional information and executive functioning deficits are less specific to
ASD
A single cognitive abnormality cannot explain all the deficits present in children with ASD
There is a view that children with ASD have an underlying impairment in social motivation
54. Autism Spectrum Disorder: Associated
Features
About 10% of children with ASD have a coexisting medical condition
◦ Motor and sensory impairments, seizures, immunological and metabolic abnormalities
Sleep disturbances occur in 65%
Gastrointestinal symptoms occur in 50%
About 20% have a significantly larger-than-normal head size - more common in those who are
higher functioning
55. To Sum Up
Neurodevelopmental disorders have strong biological causes, which most often involve
structural and functional abnormalities in the brain
Early intervention is key when treating neurodevelopment disorders
