Intellectual Disabilities

1. Intellectual Disabilities zentall

2. Prevalence • a high-incidence disability -- the third largest disability category but varies depending on the state (Heward, 2003) zentall

3. Characteristics: Cognitive • Failure to meet intellectual development markers • Inability to meet educational demands of school • Decreased learning ability; Learning is slower and less efficient--While most students only need 2 or 3 trials with feedback to learn a task, “a child with mental retardation may need 20 to 30 or more trials to learn the same information” (Heward, 2003, p. 207). • Deficits in attention, short-term memory,working memory, and memory strategy zentall

4. Characteristics: Academic Lower skills in: Reading, Writing, Basic Math, & Skills needed in a workplace Children often receive direct instruction because they have: • poor incidental learning (Mercer & Snell, 1977). • poor abstract reasoning skills • poor ability to transfer information to a new context (generalize) and to categorize information zentall

5. Characteristics Social-Personal -Communicating with others -Taking care of personal needs -Health and safety -Home living skills zentall

6. rejected or neglected at school expect failure and therefore more likely to come to rely on external control less likely to develop self-determination and transition to adult status. high levels of social stress from interpersonal experiences (Hartley & Maclean, 2005). Characteristics Social zentall

7. Characteristics: Communication • Usually do not learn to speak with words until around 3 years and do not speak in sentences until around 5 years. zentall

8. Accommodations • More likely to learn self determination and self-esteem when allowed to make choices (e.g., what to wear, which shoes to buy) and when allowed to set goals (Copeland & Hughes, 2002). • More likely to learn when presented with direct instruction; usually do not benefit from unstructured lessons zentall

9. Interventions In actual settings, teaching life skills (e.g., dressing, tasks for a job, cooking) produces • more success than in a restrictive classroom (Katsiyannis & Zhang, 2002). • better independent living after completion of school (Wehmeyer & Agran, 2005). zentall

10. Interventions--social • Interventions used for social skills training not successful. In contrast, when students with MiMH were taught problem solving skills based on their own interests there is higher retention over time (Edeh, 2006). • Inclusion or heterogeneous grouping: provides “social advantages from positive peer modeling and greater achievement” (Freeman, 2000, p. 2). • Students need to learn to evaluate the controllability of situations. 3 types of coping: active, distraction, and avoidant. Only active coping (gaining control over a stressful situation or over one’s emotions) decreases social stress in MiMH (Hartley & Maclean, 2005). Distraction and avoidant coping are associated with aggression, depression, anxiety, and delinquency. zentall

11. DOWN SYNDROME zentall

12. Look at this link zentall http://youtube.com/watch?v=-_-P4t2jR1g

13. Physical zentall • Facial features • Epicanthic fold • Brushfield spots- white dots located on the iris which don’t affect vision • Small and low set ears-- smaller canals causing them to retain water which causes frequent ear infections • Under developed nasal bridge often have problems breathing and sleep apnea • Small jaw bone and mouth • Small teeth and smaller space for tongue

14. MEDICAL COMPLICATIONS zentall • Seizures= 5-10% in the first 3 years • Congenital heart defects-- 50-75% of newborns less blood is getting to the body parts fatigue and problems breathing, eating, and moving • Sensory impairments • Visual problems • Hearing impairments - 75% recurrent ear infections • Digestive problems-- 5-10% • Immune system weaknesses-- 50% decrease in the amount of the proteins that act as antibodies

15. Characteristics: Behavior • Higher distractibility and less persistence • Sometimes stubborn or strong willed • Increased tendency to escape/avoid undesirable tasks zentall

16. SOCIAL zentall Negative • Depression • Low social status compared to others • Set apart as their own group from other students • Frustrated when not understood because of communication problems Positive • Affectionate • Very sensitive of own needs & needs of others • Loveable • Nice • Friendly (want to be friends with everyone) • Cheerful • Generous • Fun

17. Traumatic Brain Injury Not degenerative

18. Case Study From a survivors perspective: “ after a car accident, I awoke in the hospital to a world I didn’t understand. I had to learn to ask people to talk slower. Some stranger had taken over my body. She reacted in ways that were foreign to me, like making obscene gestures and saying things that I would never be caught dead saying.” -Before her injury she had no emotional or psychiatric problems. (Bryant, 2002)

19. Prevalence • Main cause of death and disability in youth in U.S. a. fastest growing disability group in U.S. due to increased survival rates b. 25% of all pediatric injuries are brain injuries c. called “the silent epidemic” 2. 65-75 % mild in nature MTBI (missing a lot of these kids)

20. Look at this link Leading causes of TBI: http://www.cdc.gov/InjuryViolenceSafety/

21. CONCEPT MAP Child Biogenetic Factors (Cognitive & Behavioral) Family Factors Environmental Etiologies No Oxygen External Force Types of Damage Contusion Shearing Concussion

22. BEHAVIORAL FACTORS Active & Risk –Taking (e.g., ADHD) Child Risk Factors COGNITIVE FACTORS • LD & MI/MH

23. Family Factors • Disorganized families • 1/4 of TBI occur for children less than 2 yrs. Examples are: • shaken babies • tossed babies

24. Environmental Etiologies Environmental CAUSES External Forces • Birthing process • Drowning • Strokes • External Force • 10% from firearms but 9/10 of these die • Falls: younger than 5 & older than 75 • Opposing Forces • Vehicles (car, bike, pedestrian) account for ½ adolescent TBIs • Contact sports LACK Oxygen

25. Contact sports in high school About 63,000 cases of MTBI annually in H.S. varsity athletes Football accounts for 63% of the cases. (Powell, 2000)

26. See the effect of some sports at this link http://nz.youtube.com/watch?v=M9q87i2xDzQ&NR=1 Bananas Comedy Bob Nelson

27. Concussion Contusion Shearing bruising = focal effects that are recovered --no damage of tissue bleeding and toxic effects to brain = focal damage to brain cells layers riding up on each other therefore cutting of nerve pathways = global damage Types of Damage

28. Indicators of Damage • Seizures and types • Auras (warnings that may be motor or sensory) • Coma • Secondary (co-occurring) disabilities

29. Look at this link • http://www.hbo.com/docs/programs/coma/index.html

30. Physical Outcomes Physical stamina can by less (fatigue) Gross motor coordination--73% have good recovery of these functions but (severe injury may require wheelchairs) Fine motor speech impairments Headaches (even 1 year out) Seizures (within 2 years of injury)

31. Sensory & SomaticOutcomes • Dizziness • Insomnia • Nausea • Vision problems (e.g., blurred or double, low vision/blindness, visual field cuts) • Loss of smell or taste (CDC, 2003)

32. Possible Cognitive Outcomes Declines in general intelligence—especially nonverbal abilities Slowed processing and response speed Cognitive fatigue and attention/concentration deficits Language and visual processing deficits Deficits in memory and new learning Problems with executive functions (e.g., working memory)

33. Focal mild attention/concentration visual perceptual Different short term memory judgment loss of academic new learningor language (naming and receptive) Global attention/concentration visual perceptual Different long term memory IQ--problem-solving/disorganization -- loss of old learning Cognitive Characteristics

34. School and Vocational Outcomes • Problems initiating and completing work • Slowed work pace • Increased impulsivity • Trouble navigating physical surroundings, especially in new settings (e.g., motor limitations, spatial deficits) • Decreased productivity • Loss of employment

35. Social Characteristics Communication • May say inappropriate things • Difficulty understanding another’s perspective • Poor awareness of social environment Functioning losses • Relationships: loss of friends, relationships • Loss of the ability to manage home or school environment

36. Emotional In general, the presence of an acquired brain injury places individuals at greater risk for developing a new psychiatric disorder (about 5 times expectancies) • Depression • Anxiety • Sleep disturbances • Frequent mood changes or difficulty regulating emotions

37. Which type of disability is more likely to have secondary psychiatric disorders?

38. Case Study II • A 15 year old girl with a history of anorexia nervosa. • She sustained a head injury when she fell from her bicycle. • Initially she was drowsy, slow to respond, and disoriented in time but oriented in place and person. • During the following 3 weeks, she was tired, lost interest in activities, and had poor hygiene, slept excessively, and worried about not being able to remember the accident. • Then difficulties in thinking, and hearing voices, but was unable to elaborate on her thinking and hearing. • Finally diagnosed with Bipolar disorder from sustaining the head injury. (Sayal, 2000)

39. Interventions Interventions may depend upon which area of the brain was affected: • Memory • Reviewing • Consistent Routine • Comprehension • Repetition • Emphasize Main Points • Attention • Break down large assignments into smaller tasks

40. Interventions: May require changes in instructional formatting: 1. Advance Organizers • Draw maps in planning the day • List solutions when giving them a problem • Use outlines 2. Groupings • Use groups with different disabilities

41. Prevention of Mild TBI Supervision Safety rules and education • Never drive while under the influence Protective gear • Wear a seat belt. • Wear a helmet and make sure your children wear helmets • Avoid falling at home by: using a step stool, installing handrails, installing window guards, and using safety gates. (CDC,2003)

42. put something soft under the person’s head put something in the person’s mouth hold onto the person’s tongue clear the floor around the person 5. call for assistance if the seizure is longer than 5 min 6. try to revive the student and bring him/her around 7. turn person onto their side T or F in Response to Seizure

43. T F F T T F T Answers