Abnormal Child Psychology Sixth Edition 5 Intellectual Disability

Abnormal Child Psychology Sixth Edition 5 Intellectual Disability (Intellectual Developmental Disorder) Eric J. Mash A. 2016 Wolfe ©David Cengage Learning © Cengage Learning 2016

Intelligence and Intellectual Disability (ID) • Prior to mid-19 th century: children and adults with intellectual disabilities were ignored or feared even by the medical profession • Intellectual disability: a significant limitation in intellectual functioning and adaptive behavior which begins before age 18 © Cengage Learning 2016

Intelligence and Intellectual Disability (cont’d. ) • In the mid-19 th century: Samuel G. Howe opened the first humanitarian institution in North America • By the 1940 s: parents increased humane care for their children © Cengage Learning 2016

Intelligence and Intellectual Disability (cont’d. ) • 1950: National Association for Retarded Children was formed • 1962: President John F. Kennedy formed the President’s Panel on Mental Retardation © Cengage Learning 2016

The Eugenics Scare • Evolutionary degeneracy theory – Pervasive in 19 th century – Intellectual and social problems of children with mental retardation were viewed as regression to an earlier period in human evolution – J. Langdon H. Down interpreted “strange anomalies” as throwbacks to the Mongol race © Cengage Learning 2016

The Eugenics Scare (cont’d. ) • Eugenics: “the science dealing with all influences that improve the inborn qualities of a race” ~ Sir Francis Galton – Led to the view that individuals with ID (moral imbeciles, or morons) were threats to society © Cengage Learning 2016

Defining and Measuring Children’s Intelligence and Adaptive Behavior • Alfred Binet and Theophile Simon (1900 s) – Commissioned by the French government to identify schoolchildren who might need special help in school – Developed the first intelligence tests • Measure judgment and reasoning of school children (Stanford-Binet scale) © Cengage Learning 2016

Defining and Measuring Children’s Intelligence and Adaptive Behavior (cont’d. ) • General intellectual functioning is now defined by an intelligence quotient (IQ or equivalent) • ID is no longer defined on the basis of IQ – Level of adaptive functioning is also important • Adaptive functioning: how effectively individuals cope with ordinary life demands and how capable they are of living independently © Cengage Learning 2016

Specific Examples of Adaptive Behavior Skills © Cengage Learning 2016

The Controversial IQ • IQ is relatively stable over time – Except when measured in young, normallydeveloping infants • Mental ability is always modified by experience • The Flynn Effect: the phenomenon that IQ scores have risen about three points per decade • Are IQ tests biased or unfair? © Cengage Learning 2016

Features of Intellectual Disabilities • Clinical description - considerable range of abilities and interpersonal qualities – DSM-5 diagnostic criteria • Deficits in intellectual functioning • Concurrent deficits or impairments in adaptive functioning • Below-average intellectual and adaptive abilities must be evident prior to age 18 © Cengage Learning 2016

Diagnostic Criteria for Intellectual Disability © Cengage Learning 2016

Severity Level: Mild • About 85% of persons with ID • Typically not identified until early elementary years • Overrepresentation of minority group members • Develop social and communication skills • Live successfully in the community as adults with appropriate supports © Cengage Learning 2016

Severity Level: Moderate • About 10% of persons with ID • Usually identified during preschool years • Applies to many people with Down syndrome • Benefit from vocational training • Can perform supervised unskilled or semiskilled work in adulthood © Cengage Learning 2016

Severity Level: Severe • About 3%-4% of persons with ID • Often associated with organic causes • Usually identified at a very young age – Delays in developmental milestones and visible physical features are seen • May have mobility or other health problems – Need special assistance throughout their lives – Live in group homes or with their families © Cengage Learning 2016

Severity Level: Profound • About 1%-2% of persons with ID • Identified in infancy due to marked delays in development and biological anomalies • Learn only the rudimentary communication skills • Require intensive training for: – Eating, grooming, toileting, and dressing behaviors • Require lifelong care and assistance © Cengage Learning 2016

Examples of Support Areas © Cengage Learning 2016

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 © Cengage Learning 2016

Factors Accounting For Racial Differences © Cengage Learning 2016

Developmental Course and Adult Outcomes • 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 © Cengage Learning 2016

Developmental-Versus-Difference Controversy (cont’d. ) • Difference viewpoint: cognitive development of children with ID is qualitatively different in reasoning/problem -solving – Familial versus organically based ID © Cengage Learning 2016

Motivation • 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 © Cengage Learning 2016

Changes in Abilities • IQ scores can fluctuate in relation to the level of impairment • Major cause of ID affects the degree to which IQ and adaptive abilities may change • Slowing and stability hypothesis – IQ of children with Down syndrome may plateau during middle childhood, then decrease over time © Cengage Learning 2016

Language and Social Behavior • Development follows a predictable and organized course • Characteristics displayed with Down syndrome – 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 © Cengage Learning 2016

Characteristics Displayed With Down Syndrome (cont'd. ) • Fewer signals of distress or desire for proximity with primary caregiver • Delayed, but positive, development of selfrecognition • 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 © Cengage Learning 2016

Emotional and Behavioral 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 © Cengage Learning 2016

Emotional and Behavioral Problems (cont'd. ) • ADHD-related symptoms are common • Pica is seen in serious form among children and adults with ID • Self-injurious behavior (SIB) – Can be life-threatening – Affects about 8% of persons across all ages and levels of ID © Cengage Learning 2016

Other Physical and 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 © Cengage Learning 2016

Chronic Health Conditions Among Children With Intellectual Disabilities © Cengage Learning 2016

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 © Cengage Learning 2016

Prenatal, Perinatal, and Postnatal Causes • Prenatal: genetic disorders and accidents in the womb • Perinatal: prematurity and anoxia • Postnatal: meningitis and head trauma © Cengage Learning 2016

The Two-Group Approach • Organic group – there is a clear biological basis – Associated with severe and profound MR • Cultural-familial group – there is no clear organic basis – Associated with mild MR © Cengage Learning 2016

Risk Factors • Four major categories of risk factors – Biomedical – Social – Behavioral – Educational © Cengage Learning 2016

Causes Risk Factors (cont'd. ) © Cengage Learning 2016

Inheritance and the Role of the Environment • Genetic influences are potentially modifiable by environment • Genotype: a collection of genes that pertain to intelligence • Phenotype: the expression of the genotype in the environment (gene-environment interaction) © Cengage Learning 2016

Inheritance and the Role of the Environment (cont'd. ) • Heritability describes the proportion of the variation of a trait attributable to genetic influences in the population – Ranges from 0% to 100% – The heritability of intelligence is about 50% • Major environmental variations affect cognitive performance and social adjustment in children from disadvantaged backgrounds © Cengage Learning 2016

Genetic and Constitutional Factors • Chromosome abnormalities – Down syndrome is usually the result of failure of the 21 st pair of the mother’s chromosomes to separate during meiosis ► causes an additional chromosome • Fragile-X syndrome is the most common cause of inherited ID • Prader-Willi and Angelman syndromes – Both are associated with abnormality of chromosome 15 © Cengage Learning 2016

Genetic and Constitutional Factors (cont’d. ) • Single-gene conditions: inborn errors of metabolism – Excesses or shortages of certain chemicals which are necessary during developmental stages – Cause of 3 -7% of cases of severe ID – Phenylketonuria results in lack of liver enzymes necessary to metabolize phenylalanine • Can be treated successfully © Cengage Learning 2016

Neurobiological Influences • Adverse biological conditions – Examples: infections, traumas, and accidental poisonings during infancy and childhood • Fetal Alcohol Spectrum Disorder (FASD) – Estimated to occur in one-half to two per 1000 live births • Teratogens increase risk of ID © Cengage Learning 2016

Social and Psychological Dimensions • 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 © Cengage Learning 2016

Prevention, Education, and Treatment • 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 © Cengage Learning 2016

Prenatal Education and Screening • 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 © Cengage Learning 2016

Psychosocial Treatments • 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 © Cengage Learning 2016

Behavioral Approaches • Initially seen as a means to control or redirect negative behaviors • Association for Behavior Analysis (ABA) Task Force advocates that: – Each individual has the right to the least restrictive effective treatment and the right to treatment that results in safe and meaningful behavior change © Cengage Learning 2016

Cognitive-Behavioral Therapy • Self-instructional training and metacognitive training • Verbal instructional techniques • Teaching the child to be strategical and metastrategical © Cengage Learning 2016

Family-Oriented Strategies • Help families cope with the demands of raising a child with ID • Some ID children and adolescents benefit from residential care or out-of-home placement • The inclusion movement integrates individuals with disabilities into regular classroom settings – Curriculum is adapted to individual needs © Cengage Learning 2016