Cognitive Disabilities

An IQ and adaptive behavior score < 70

Most children with moderate, severe and profound mental retardation have a known cause such as Downs (moderate) or intractable seizures and microcephaly (severe)

In most cases, there is no known cause

Mild mental retardation

• IQ and adaptive behavior score < 70
• Mild MR - 50-70
• Moderate MR - 50-35
• Severe 35-20
• Profound <20

2 %

Mild MR

Moderate MR

• Medical evaluations and medical treatment. -May need genetic services, hearing and ophthalmology services.
• Early intervention services
• Special education
• Appropriate therapies –speech therapy, occupational therapy, and physical therapy Vocational rehabilitation services
• CAPS and other home-based services

• Usually conducted in evaluation centers or school
• psychologists usually do the testing but educational specialists or therapists may do it

A specialized plan

Individualized Family service plan

IEP

They get a similar plan as children or school aged kids

They are designed by the responsible social agency together with the family and they must be updated regularly

• Information about preschool or classroom placement
• Goals for each subject area especially language arts and math.
• Therapies including the amount of time per week.
• Adaptations such as special computers.

• In North Carolina the medical community is often separate from the schools, etc. and this can cause some problems because these same children often need medical work-ups for genetic diseases, metabolic diseases, or behavioral problems.
• Typically, the physicians have to connect with the schools to make sure that appropriate services are in place - they may recommend more thorough evaluations

• they help children get services that they need
• Duke has a special ed clinic that does this

• They test everyday behavior such as dressing
• to qualify as MR, <70

• Difficulty with one or more areas of processing
• IQ is average but academic range is below average

• Reading
• writing
• Math
• Written language most common problem; reading is the second most common problem; math problems are not as common.
• This is different from children with mental retardation or autism.

• Intellectual
• Ex: deaf or blind

6-8%

• Intellectual - processing problems
• Learning-normal IQ and adaptive bahavior, no physical disabilities

• Visual processing
• auditory processing
• language
• fine motor
• memory
• sequencing
• metacognition
• attention
• organization
• social skills
• reading
• math
• written language

• ? IQ testing –verbal versus performance IQ is often assessed.
• ? Achievement testing –reading, math, written language in particular.
• ? Comparison of discrepancies.
• ? Additional testing may include speech and language testing, or occupational therapy testing.

• Discrepancies in scores result in services in North Carolina public schools
• ? Need 20 point discrepancy between verbal and performance IQ
• ? Need 15 point discrepancy between IQ and subject area.

• special education services in a resource class.
• the majority of classes are in the regular classroom.
• specific therapies like speech therapy.
• Individualized Education Plan.
• Children with just ADHD can get a 504 plan.
• Some children can be labeled OHI.
• May get up to three hours per day in special education classes.
• Some children are in self-contained special education but can go to some regular classes.
• Some schools have special classrooms that are essentially regular classrooms but have a second special education
• teacher in the classroom to help the students with special needs.

• Speech and language delays or deficiencies. Some affected individuals are nonverbal.
• Social skills are abnormal. Relate poorly to people. May make poor eye contact. May talk about bizarre topics.
• Repetitive or ritualistic behaviors. May be obsessed with weather, may have odd gestures.

Part of the increase in frequency may be due to the increase in services available to autistic children (parents want the dx) but this doesnt totally explain the huge increase

1 in 150

boys

• 70%
• This is lower that what it used be

20% of adolescents with autism have seizures

• Infantile
• Hugh functioning
• Aspergers Syndrome
• Pervasive development disorder

Classical autism may be mild, moderate or severe

May not be intellecutually disabled or mentally retarded

Good cognitive ability and good language but still have preoccupations and social problems

On the spectrum but fails to meet all criteria for autism

High functioning autism

• Usually DSM IV is used
• congnitive testing is done but not tested by area rather than just IQ - testing in fine motor domain, language domain, ect
• often children with autism have average gross and fine motor but poor verbal and social skills

• Genetic and metabolic work up - chromosome and fragile X are usually done because many of these disorders have high number of autism
• MRI is normal so usually not done unless very low functioning
• EEG - may be necessary to rule out seizures
• Medications - often used for hyperactivity, OCD, anxiety, depression **children aren't great medication responders**
• Often have problems sleeping

• Special education - Classrooms appeal to visual strengths and motor strengths.
• Children may have pictures that outline their day. Structure is very emphasized.
• Speech and language therapy
• Occupational therapy
• Social skills groups

chromosomal abnormalities

1 in 700 births

Turners syndrome

Fragile X syndrome

Fragile X

• the most common cause of inherited mental retardation, learning disabilities, and autism.
• X-linked disorder
• Males more severely affected than females
• This is the single one thing to look for in autism

Insertions or deletions

Chromosomal work up should be considered

In the newborn nursery which qualifies them for a full range of early intervention services

• 7q11.23 deletion
• 16 deleted genes identified to date
• causes mental retardation, small stature, and heart disease