Based on lecture by Nina Bass, M.D.
Developmental Challenge = anything that throws a child off his or her developmental track
History: in Victorian era, developmentally challenged children were viewed as inferior, even demons. In the 1950's, the Kennedy movement began (after Joe Kennedy had a child who was mentally retarded and received a lobotomy).
Today, involuntary sterilization and infanticide persist, particularly in developing countries.
Mental Retardation see also
The Mental Retardation cutoffs, per DSM-IV:
Mental Retardation IQ Equivalent
Mild 50-55 - 70 6th grade
Moderate 35-40 - 50-55 1st grade
Severe 20-25 - 35-40 Requires constant supervision
Profound below 20-25 Requires constant care
Mental Retardation Definition:
- Measured impairment of intelligence; IQ < 70 = cutoff, gradations by 15 points
- Adaptive deficits in personal function
- Manifestation prior to age 18 (note, can be diagnosed later, but must be able to get a history of onset before age 18)
- Developmental milestones appear in correct order, but are delayed,
- Versus autism, in which milestones may appear erratically and be lost.
Unspecified MR and Borderline MR (75-80 IQ) are two additional categories.
Standardized Measures of Intelligence
WISC (Wechsler) - reported on a normal (bell) curve; used for older children (8 or above).
WIPPSI (Wechsler Preschool) - developed as a screening tool for normal v. abnormal child; was intended to be very simple; given at 4 y/o, but many children blossom thereafter; can stigmatize a child (used heavily by educational system).
Recommendation: retest at 8 with the WISC.
Peabody Picture Vocabulary
Adaptive and Developmental Measures
Vineland Social Maturity Scale (Adaptive Behavior Scale) - would be excellent tool to determine a child's ability to enter a school environment, but not commonly used
Coordinated psychomotor skills
ADLS (self help/independence)
Accommodation to environment
Denver Developmental Screening Test - used commonly by pediatricians; excellent test; series of tasks, e.g., stacking cubes, that tests development
Bailey Infant Scale
- tends to worsen with age, so be aggressive with assessment or will get inappropriate intervention (e.g., treated in special education classes)
- oral v. manual
- lipreading v. signing
Varies from visual impairment to social blindness to virtual blindness to total blindness.
- in Georgia, you can drive with virtual blindnes
Qualitative impairment in reciprocal/social interaction; child does not communicate back with you.
Impairment in verbal/nonverbal communication.
Markedly restricted repertoire of activities. Tend to do the same thing over and over and not lose interest in. Parallel play late developmentally.
Onset during infancy or childhood, usually in first 3 years.
Asperger's is a variant of autism.
Occurs 5/10,000 births.
4 times as common in males.
Caused by brain dysfunction, NOT by poor maternal bonding as was previously believed.
Milestones emerge erratically and out of order; children may learn to walk, for example, then later lose it.
This is in contrast to mental retardation, in which milestones emerge in correct order, but delayed.
IQ: most have mental retardation; 60% have IQ's less than 50, 20% 50-70, 20% > 70.
<5% will be Autistic Savants as in the movie "Rainman" with Dustin Hoffman
Management Problems in Autism:
Coexisting psychiatric conditions; sometimes misdiagnosed
Self-mutilation is not the norm, but is more common in autism
Profound resistance to change, as seen in movie "Rainman."
Sensitivity to environment
Aggression; probably a function of autism.
Ritvo definition of autism:
- disturbance in rate of appearance of physical, social, and language skills
- abnormal response to sensation
- absent or delayed speech/language
- abnormal manners of relating to people, objects, events
Pervasive Developmental Delays
must have normal IQ
cannot be diagnosed as both LD and MR
utilize maladaptive strategies; may do very well in some categories, but poorly in others
now have specific disabilities, e.g., mathematical disability
low frustration tolerance
low self esteem
low severity, high prevalence disorders
develop during school age/latency years
global responses to perceived failures
variants of learning disabilities:
impairment of attention, selection, disinhibition
poorly modulated activity
social failure, superficiality
difficulties in temporal-sequential organization
language processing problems
receptive language dysfunction
parents who can go with the flow and adapt behavior to child, shape behavior appropriately have better outcomes
do NOT give diagnosis of Auditory Processing Disorder or Visual Spatial Processing Disorder; this is probably a bogus diagnosis, often given by neurologists
- Disorder of Movement (period)
- Spastic muscles, may lead to abnormal posture
- Maybe from static encephalopathy prenatally, perinatally, or even in early childhood
- associated with high risk pregnancy, multiple pregnancies
- variation in tone
- delayed achievement of motor landmarks
- spastic hemiparesis = cardinal neurological findings
- extreme nearsightedness
- hearing deficit
- 50% or greater association with mental retardation, but maybe test dependent problem because children don't test well.
- Aspiration/choking - a common form of death
- Weight fluctuations
Multiple Handicapping Conditions
Congenital rubella syndrome - blind, deaf, severe mental retardation, + cerebral palsy
Progressive neurological disorders
Development of Milestones
Mental retardation: orderly, but delayed; don't tend to lose milestones once achieved.
Autism: erratic, may regress and lose prior milestones, maybe out of order.
Cerebral Palsy or Sensory Deficits: Isolated delays or omission - early and "soft" neurological signs important in diagnosis eg poor bonding, feeding, irritability
Coexisting Psychiatric Disorders occur in 30% of patients with developmental delays.
Mainstreaming: putting developmentally impaired children into classrooms with those who aren't; controversial.
Early Intervention: good if before kindergarten.
Head Start: government program aimed at poor children
1935 - Title V of the Social Security Act
1975 - PL 94-142: controversial law that mandates children must be educated in the least restrictive environment, and school must pick up the tab for any attendant medical expenses, e.g., respirators in the classroom.
- draining resources out of the school system; is being aggressively fought.
- Most mental retardation treatment facilities have been effectively shut down.
1991 - Americans With Disabilities Act