Intellectual Disabilities 2018

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University of Melbourne - Department of Nursing PREV NEXT 1
WELCOME Definitions 1 Intelligence 2 Problem Based Learning 3
NURS90066
Intellectual Disability
OBJECTIVES
(i) Define the terms: Pervasive Developmental Disorder (PDD), Developmental Disability (DD), Intellectual
Disability (ID) and Autism Spectrum Disorders (ASD)
(ii) Understand two different models of intelligence
(iii) explore implications for providing nursing assessment and care to individuals with an intellectual disability
or developmental disorder
START
PBL #1 PBL # 2 PBL #3 Feedback
Definition
➡ An umbrella term for severe conditions that

impact the attainment of normal developmental
Developmental
milestones
Disability
DD
➡ What’s my milestone?
Room - A3A3D2C1

Definition

Developmental
milestones
Disability
➡ Impacts are in the areas of language, mobility and
DD independence
➡ Fragile X
➡Fragile X - Behavioral Presentation

Anxiety
Social Shyness
Hyperarousal
ADHD
Sensory Defensiveness
Aggression
Self-Abuse
Autistic-like Characteristics
■
➡Fragile X - Behavioral Presentation ■
Dan has an IQ of 50 – a mental age of 4-5…. he is 20
Dan has finished school but will never work. He attends a
community participation programme Monday to Friday, where his
favourite activity is dancing
■ Dan can recite lots of lines from movies and TV programs:
■ “Sticky tape, we have sticky tape, lots of sticky tape at our
house” (Bananas in Pyjamas);
■ “I’m so in love” (Sleeping Beauty – but recited when giving mum a
hug….Thank you Mr Disney!)
■ But Dan communicates in just single words – “juice” “toast” “Ipad”
or gesturing
■ Dan can’t write his own name but is a whiz on the iPad
■ At 20 Dan will never drive a car. He can ride a bike with training
wheels, but can’t use the brakes so I have to run next to him. He
takes great delight in telling me “run” and peddling as fast as he can
(City to Surf training, thanks to Dan!)
■ Dan has trouble concentrating, exhibits features of ADHD and
suffers from epilepsy. He takes 5 different medications every day…
15 tablets a day. Last year he learned to swallow tablets with water!
■ Dan can be overwhelmed with input. If he can’t express this, it can
come out physically…hitting and biting. He sometimes has drawn
blood.
■ At 20 he still has occasional toileting accidents
■ Dan will live a full lifespan but will need constant care because
he cannot live independently
■ His sisters have had to grow up sooner than their years would
normally demand, taking on a shared parenting role.
■ But without a doubt, Dan has made us all better people. We are
more tolerant and patient.
■ Dan loves Disney princesses – last year I took him to Disneyland. It
was the best holiday of MY life
■ When I tell Dan I am the luckiest mum in the world, there is no
greater truth

Definition
➡ An umbrella term for severe conditions that impact
the attainment of normal developmental milestones
Developmental
Disability
independence
DD ➡ Fragile X
➡ Feotal Alcohol Syndrome Spectrum Disorders
(FASD)
➡FAS,
➡partial fetal alcohol syndrome (PFAS),
➡alcohol-related neurodevelopmental disorder (ARND), and
➡alcohol-related birth defects


➡ Although national guidelines advise against drinking during pregnancy,
half of Australian women reported drinking during pregnancy in the recent
(2010) national household survey.
➡Indigenous women are less likely than non-Indigenous women to drink

during pregnancy, but many who do so drink frequently and at high-risk
levels.
➡Alcohol exposure in pregnancy is a leading preventable cause of intellectual

disability, developmental delay and birth defects and can cause fetal alcohol
syndrome (FAS) and partial FAS (pFAS).
The Lililwan* Project

➡ In 127 pregnancies, alcohol was used in 55%.
➡FAS or pFAS was diagnosed in 13/108 children,
➡a prevalence of 120 per 1000 (95% confidence interval 70–196).
➡Prenatal alcohol exposure was confirmed for all children with FAS/pFAS,
➡80% in the first trimester
➡50% throughout pregnancy.
➡Ten of 13 mothers had Alcohol Use Disorders Identification Test scores and
all drank at a high-risk level.
➡Of children with FAS/pFAS,
➡69% had microcephaly,
➡85% had weight deficiency and
➡all had facial dysmorphology and
➡central nervous system abnormality/impairment in 3 to 8 domains.
Fitzpatrick, etal (2015) Journal of Paediatrics and Child Health, 51, 450–457
The Lililwan* Project
➡ CNS structure including microcephaly or other structural CNS abnormality

➡Hard and/or soft neurological signs; seizure disorder; gross and/or fine
motor functioning (± articulation, phonology and motor speech)
➡ Cognition – cognitive delay and/or uneven cognitive profile
➡ Memory – auditory and/or visual
➡ Executive functioning and abstract reasoning
➡ Communication – expressive and/or receptive language
➡ Attention deficit/hyperactivity (± other behavioural problems ± sensory
function)
➡ Visual motor integration
➡ Adaptive behaviour/social skills/social communication
➡ Academic achievement
Fitzpatrick, etal (2015) Journal of Paediatrics and Child Health, 51, 450–457

Definition

Developmental
milestones
Disability
DD independence
➡ Fragile X
➡ Feotal Alcohol Syndrome
➡ Down’s Syndrome
Trisomy 21
Down’s Syndrome
➡ first described, in 1866, by John Langdon Down, a physician at the

Earlswood Asylum for Idiots.
➡ 1:1,000 births / 2 births per day
➡ no correlation between obviousness of DS physical attributes and
cognitive or developmental delay
➡ Sensory problems: glue ear, grommets, 50% sensory deafness, 70%
corrective lenses by age 7, respiratory infections, mouth
breathing ...
Dierssen M, de la Torre Fornell R. (2102) Down Syndrome. [Electronic Resource] : From Understanding The Neurobiology To Therapy [e-book]. Burlington : Elsevier Science

WELCOMEFragile Intelligence 2 Fragile

X1 (male) X (female)
Down’s Syndrome Definitions Problem Based Learning 3
Reilly C. Behavioural Phenotypes and Special Educational Needs: Is Aetiology Important in the Classroom?. Journal Of Intellectual Disability Research [serial online]. October 1, 2012;56(10):929-946.
WELCOMEFragile Intelligence 2 Fragile

X1 (male) X (female)
Down’s Syndrome Definitions Problem Based Learning 3
Reilly C. Behavioural Phenotypes and Special Educational Needs: Is Aetiology Important in the Classroom?. Journal Of Intellectual Disability Research [serial online]. October 1, 2012;56(10):929-946.

Definition

Developmental
milestones
Disability
DD independence
➡ Fragile X
➡ Feotal Alcohol Syndrome
➡ Down’s Syndrome
➡ Intellectual disability
➡ Pervasive Developmental Disorders
Definition
➡is an umbrella term for five psychiatric disorders
Pervasive manifesting as delays in attainment of
Developmental developmental milestones
Disorder
PDD
Definition
➡is an umbrella term for five psychiatric disorders
Pervasive manifesting as delays in attainment of
Developmental developmental milestones
Disorder ➡these include:
➡Childhood disintergrative disorder
PDD ➡Rett’s Syndrome
➡Autism spectrum disorders
➡ Asperger’s Syndrome
➡A regression or loss of milestones

Example of regression or loss
Bobby
A regression ➡2 years old would call out “3” when parents or others
or loss of said, “one ... two ....”
milestones
➡2 years runs and loves hide and seek games
PDD ➡2 years six months toilet trained for bladder not bowels
➡2 years six months no longer calls out “3”
➡3 years shows no interest in seek but likes to hide
➡3 years unable to control bladder and bowels
➡3 years no longer uses transitional object
Example of developmental disruption
Janney
A regression ➡8 years old
or loss of ➡Can’t throw overhand
milestones ➡Can’t ride a bike
PDD ➡Can ride tricycle
➡Uses mnemonics to learn
➡Sexual feelings are apparent

Definition
➡A total of six (or more) from (1), (2) and (3), with at least
two from (1) and one each from (2) and (3).
Autism 1) qualitative impairment in social interaction as manifested

Spectrum by at least two of the following:
Disorders (a) marked impairment in the use of multiple nonverbal
ASD behaviours, such as eye-to-eye gaze, facial expression,

body postures, and gestures to regulate social interaction
(b) failure to develop peer relationships appropriate to
developmental level
(c) a lack of spontaneous seeking to share enjoyments,
interests or achievements w other people.
(d) lack of social or emotional reciprocity
Definition
Autism 2) qualitative impairments in communication as manifested by

Spectrum at least one of the following
Disorders (a) delay or total lack of, the development of spoken
ASD language
(b) in individuals with adequate speech, marked impairment
in the ability to initiate or sustain conversation
(c) stereotyped and repetitive use of language or
idiosyncratic language
(d) lack of spontaneous make-believe play or social
imitative play at appropriate developmental level
Definition
3) restricted repetitive & stereotyped patterns of behaviour,

Autism
interests, and activities, as manifested by at least one of the
Spectrum
following:
Disorders
(a) encompassing preoccupation w one or more stereotyped
ASD & restricted patterns of interest that is abnormal in
intensity or focus
(b) apparent inflexible adherence to specific nonfunctional
routines or rituals
(c) stereotyped and repetitive motor mannersisms
Asperger’s? (flapping / twisting)
(d) persistent occupation of parts of objects

Definition
➡mental retardation
➡significant subaverage intellectual functioning (onset b’f 18)
➡IQ 70 or below
➡concurrent impairments (incl failure to meet milestones)
Intellectual
➡ communication
Disability
➡self-care
ID ➡home living
➡social / interpersonal skills
➡use of community resources
➡self-direction
➡functional academic skills
➡work, leisure
➡safety
Definition
50-55 Mild MR
Intellectual
Disability 35/40 -50/55 Moderate
ID
20/25 - 35/40 Severe
20/25 or below Profound
Intelligence distribution
What is
Intelligence
?

Intelligence Classification
130+ Very superior

120-129 Superior,
What is
Intelligence 110-119 High average

? 90-109 Average
80-89 Low average
70-79 Borderline
69- Extremely low
What is
Ravens
Progressive
Matrices?
What is the
Flynn
Effect ?

Learn, remember, perform - in different ways
visual spatial
Body kinesthetic
Multiple
Intelligence Musical
? Interpersonal
Intrapersonal
Sal Khan Linguistic
Howard Garner
Logical mathematical
Definition
➡ Umbrella term for difficulty learning in a typical manner

➡ Processing of information:
Learning ➡input,
Disorders ➡integration,
➡storage,
LD ➡output
➡ Reading Disorder
➡Mathematics Disorder
➡Disorder of written expression
➡Learning Disorder Not Otherwise Specified
Clinical implications from definitions

PBL Mary, a 10-year-old grade-two student, has been
brought to the GP practice by her mother who is
concerned about her breathing. Mary has shown flu
#1 symptoms for two days (snotty, grotty, cranky).
You notice that Mary’s vital signs are within normal

Down’s limits although there is evidence of tachycardia.
Syndrome
Assessment Implications?
Nursing Care Implications?

PBL James, an 11-year-old grade-five student, has
presented to ED via ambulance with a compound
#2 fracture to his left arm sustained in the playground.

His mother has been contacted an is on her way, but
will be another hour due to public transport. The
Ambulance officer states that James has Asperger’s
Autism Syndrome and has just started mainstream schooling
this year.
Spectrum
Disorder

PBL
Larry, a 30-year-old nightclub worker, is in

#3 rehabilitation following a blunt trauma to the
occipital region of the skull. Larry states he was born
with pFAS and wants to know if he the injury is
going to make him worse.
Feotal
Alcohol
Syndrome

Intellectual Disabilities 2018

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Download Student Socrative

on to your mobile device

University of Melbourne - Department of Nursing PREV NEXT 1

WELCOME Deﬁnitions 1 Intelligence 2 Problem Based Learning 3

PBL #1 PBL # 2 PBL #3 Feedback

WELCOME Deﬁnitions 1 Intelligence 2 Problem Based Learning 3

➡ An umbrella term for severe conditions that

University of Melbourne - Department of Nursing PREV NEXT 3

➡ An umbrella term for severe conditions that

University of Melbourne - Department of Nursing PREV NEXT 4

➡Fragile X - Behavioral Presentation

University of Melbourne - Department of Nursing PREV NEXT 5

University of Melbourne - Department of Nursing PREV NEXT 6

University of Melbourne - Department of Nursing PREV NEXT 7

WELCOME Deﬁnitions 1 Intelligence 2 Problem Based Learning 3

University of Melbourne - Department of Nursing PREV NEXT 9

University of Melbourne - Department of Nursing PREV NEXT 11

University of Melbourne - Department of Nursing PREV NEXT 13

University of Melbourne - Department of Nursing PREV NEXT 14

➡Indigenous women are less likely than non-Indigenous women to drink

➡Alcohol exposure in pregnancy is a leading preventable cause of intellectual

University of Melbourne - Department of Nursing PREV NEXT 15

The Lililwan* Project

University of Melbourne - Department of Nursing PREV NEXT 16

The Lililwan* Project

➡ CNS structure including microcephaly or other structural CNS abnormality

University of Melbourne - Department of Nursing PREV NEXT 17

➡ An umbrella term for severe conditions that

University of Melbourne - Department of Nursing PREV NEXT 18

WELCOME Deﬁnitions 1 Intelligence 2 Problem Based Learning 3

University of Melbourne - Department of Nursing PREV NEXT 20

WELCOME Deﬁnitions 1 Intelligence 2 Problem Based Learning 3

➡ first described, in 1866, by John Langdon Down, a physician at the

University of Melbourne - Department of Nursing PREV NEXT 21

WELCOMEFragile Intelligence 2 Fragile

University of Melbourne - Department of Nursing PREV NEXT 23

WELCOMEFragile Intelligence 2 Fragile

University of Melbourne - Department of Nursing PREV NEXT 24

➡ An umbrella term for severe conditions that

University of Melbourne - Department of Nursing PREV NEXT 25

WELCOME Deﬁnitions 1 Intelligence 2 Problem Based Learning 3

University of Melbourne - Department of Nursing PREV NEXT 26

WELCOME Deﬁnitions 1 Intelligence 2 Problem Based Learning 3

➡A regression or loss of milestones

University of Melbourne - Department of Nursing PREV NEXT 27

Example of regression or loss

University of Melbourne - Department of Nursing PREV NEXT 29

WELCOME Deﬁnitions 1 Intelligence 2 Problem Based Learning 3

Example of developmental disruption

University of Melbourne - Department of Nursing PREV NEXT 30

University of Melbourne - Department of Nursing PREV NEXT 31

Autism 1) qualitative impairment in social interaction as manifested

ASD behaviours, such as eye-to-eye gaze, facial expression,

University of Melbourne - Department of Nursing PREV NEXT 32

WELCOME Deﬁnitions 1 Intelligence 2 Problem Based Learning 3

Autism 2) qualitative impairments in communication as manifested by

University of Melbourne - Department of Nursing PREV NEXT 33

WELCOME Deﬁnitions 1 Intelligence 2 Problem Based Learning 3

3) restricted repetitive & stereotyped patterns of behaviour,

University of Melbourne - Department of Nursing PREV NEXT 34

University of Melbourne - Department of Nursing PREV NEXT 35

WELCOME Deﬁnitions 1 Intelligence 2 Problem Based Learning 3

University of Melbourne - Department of Nursing PREV NEXT 36