klinische ontwikkelingspsychologie
hoofdstuk 5 intellectual disability
5.1 intelligence and intellectual disability
intellectual disability = neurodevelopmental disorder, group of conditions with onset in the
developmental period that produce impairments of social, personal, academic, or
occupational functioning. characterized by significant limitations in mental abilities, that result
in impairments in adaptive functioning, such as conceptual, social and practical skills needed
to fulfill aspects of everyday life
general intellectual functioning is defined by an intelligence quotient (IQ). subaverage
intellectual functioning is an IQ of <70. adaptive functioning = how individuals cope with
ordinary life demands, and how capable they are of living independently and abiding by
community standards. IQ tests have a lot of cons though.
5.2 features of intellectual disability
there is a lot of variety in terms of cognitive and behavioral abilities.
3 criteria in DSM:
- deficits in the intellectual functions of reasoning, problem-solving, planning,
abstract thinking, judgment, academic learning and learning from experience (usually
determined by IQ tests, no cutoff IQ)
- deficits in adaptive functioning, failure to meet developmental and sociocultural
standards for personal independence and social responsibility
- deficits must have begun during the developmental period (before 18)
4 levels of severity, based in 3 primary domains of adaptive functioning (conceptual, social,
practical):
- mild: largest group (85%), small delays during preschool, identified in school
- moderate: 10%, identified during preschool, supervision
- severe: 4%, identified young, special assistance/supervision
- profound: 2%, identified in infancy, lifelong care and assistance
1-3% of the general population (based on IQ of <70), but it varies across time and countries.
males 1,6 to females 1. mild is more prevalent among lower SES and minority groups.
5.3 developmental course and adult outcomes
chromosome abnormalities are the most common cause of Down syndrome and
moderate/severe intellectual disability.
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? or do children with ID develop in a different, less sequential fashion?
- developmental: 2 hypotheses. supported with familial ID
- similar sequence: same order, just different rates
- similar structure: same behaviors and underlying processes as typical
development (mental age, same reasoning, cognitive tasks etc.)
- difference: different reasoning, cognitive tasks etc
children with ID may have less motivation because they expect to fail.
,slowing and stability hypothesis = children with Down syndrome alternate between periods
of gain in functioning and periods with no advance.
a lot of their abilities are intact, they just develop more slowly.
children with ID are at risk for emotional and behavioral disturbances → high
comorbidity. internalizing problems, ADHD related symptoms, self-injurious
behavior.
5.4 causes
1000+ genetic disorders are associated with ID. the cause of mild ID is unknown, but 2/3 of
moderate to profound ID have known causes. causes can be prenatal, perinatal and
postnatal.
ID causes are divided into 2 groups:
- organic causes: clear biological basis
- cultural-familial causes: no clear organic basis. environmental & situational factors
4 categories of risk factors: biomedical, social, behavioral and educational
some genetic factors/disorders:
- chromosomal abnormalities → Down syndrome (nondisjunction) + other
disorders
- fragile-X syndrome → inherited ID, autism
- Prader-Willi syndrome
- Angelman syndrome → moderate to severe ID
- single-gene conditions: PKU
neurobiological influences: FASD/FAS, malnutrition, exposure to toxic substances, infections
social and psychological influences: care, home environment, parental involvement
5.5 prevention, education, and treatment
treatment and education for children with ID involves a multicomponent, integrated strategy
that considers children’s needs within the context of their individual development, their family
or institutional setting, and their community.
prenatal education and screening is important. intervention starting during preschool years
has a lot of influence. interventions include both behavioral and educational components.
hoofdstuk 6 autism disorder
6.1 description & history
ASD = complex neurodevelopmental disorder characterized by abnormalities in social
communication and unusual behaviors and interests
preservation of sameness = anxious and obsessive insistence on the maintenance of
sameness in daily routines and activities.
6.2 DSM-5
DSM: (1) significant and persistent deficits in social interaction and communication skills and
(2) restricted and repetitive patterns of interests and behaviors. symptoms in both domains.
must be persistent, occur in multiple settings and be present early in development.
(1) has 3 symptoms, all 3 required
- deficits in social-emotional reciprocity
, - deficits in nonverbal communication behaviors used for social interaction
- deficits in developing, maintaining, and understanding relationships
(2) has 4 symptoms, at least 2 required
- stereotyped or repetitive motor movements, use of objects, or speech
- insistence on sameness, inflexible adherence to routines, or ritualized
patterns of verbal or nonverbal behavior
- highly restricted fixated interests that are abnormal in intensity or focus
- hyperreactivity or hyporeactivity to sensory input or unusual interest in
sensory aspects of the environment
severity range 1-3
specifiers (medical condition) and modifiers (other important psychological conditions)
3 factors:
- level of intellectual ability
- severity of language problems
- behavior changes with age
6.3 core deficits
the core deficits are interconnected
- social interaction: processing and expressing emotional information in unusual ways
- social communication: ability for protoimperative (express needs) and instrumental
gestures, inability for protodeclarative (sharing) and expressive gestures, problems
with language (pronouns, pragmatics)
- restricted and repetitive behaviors and interests: self-stimulatory behaviors
6.4 associated characteristics
- intellect: around 70% intellectual disability, 25% splinter skills, 5% savants
- motivation: less social motivation
- medical: seizures, sleep problems, bigger head etc
- psychological: 90% has co-occuring disorder, mostly ID, epilepsy, anxiety, learning
disability, conduct problems, mood disturbances
- cognition: processing social-emotional information deficits (theory of mind) &
general deficits: (executive function & central coherence (bigger picture))
6.5 prevalence and course
4/5 times more common in boys than girls. found in every social class and culture. diagnosis
mostly during preschool or later (around 2 years old).
6.6 causes
multiple causes/mechanisms
- problems in early development: pregnancy, birth
- genetic influences: fragile X anomaly, tuberous sclerosis, siblings 15-20%, identical
twins 70-90%, susceptibility genes, mutations
- brain: cerebellum, medial temporal lobe, limbic system, prefrontal cortex
6.7 treatment
treatments want to minimize the core problems, maximize independence and quality of life,
and help children and families cope more effectively.
family treatments, educational interventions, speech and language therapy, medication
