Learning Disabilities & Intellectual Disability
ID with IQ > 50 - specific cause of mild disability is not identifiable in?
30-50% of cases
learning disabilities are characterized by?
academic underachievement in reading, written expression, OR math in comparison with the overall intellectual ability of child HAS POTENTIAL TO DO WELL
level of severity in ID defined on basis of?
adaptive functioning and not IQ
most common causes of specific categories - most common preventable cause
alcohol fetal syndrome
ID - potential for neck instability
atlanto-axial instability
gender predilection for any type of learning disability
boys 2-3x more likely (most commonly referred to provider because of behavior - act out, frustrated)
types of learning disabilities: dyscalculia
difficulty performing mathematical calculations
types of learning disabilities: dyslexia
difficulty reading
types of learning disabilities: auditory memory and processing disabilities
difficulty understanding and remembering words or sounds
types of learning disabilities: dysgraphia
difficulty writing
learning disability prognosis
doesn't outgrow - if recognize early and appropriate interventions, cope with it better
most common causes of specific categories - most common genetic cause
down syndrome
what is the most common type of learning disability?
dyslexia -one of the most common childhood neurodevelopmental disorders
diagnostic clues for ID
dysmorphisms - genetic syndrome such as down syndrome or isolated finding (microencephaly) -common facial features associated dysfunctions: seizures, cerebral palsy, or autism failure to meet age appropriate developmental milestones
learning disabilities detection
early detection is critical - early initiation of appropriate interventions improves prognosis
clinical implications - mild ID
educable
what is an educational diagnostician
evaluates and analyzes academic skills and sub-skills to identify areas that need addressed in educational plan must be tested on academic skills *
most common causes of specific categories - most common inherited cause
fragile x syndrome
risk factors of learning disabilities (6)
genetic factors male gender developmental delays in receptive and expressive language as well as speech articulation -must include learning disability in DDx medical factors (premature infants, cyanotic congenital heart dz, other perinatal or postnatal complications - prolonged ventilation, intracranial hemorrhage, hypoglycemia, fetal alcohol syndrome) environmental factors (lead toxicity, infections - meningitis, AIDs -, history of brain injury (shaken baby syndrome) sociocultural factors (lead to or make neurodevelopmental dysfunction worse - won't develop preacademic skills, risk of academic underachievement)
learning disabilities and genetics
genetic factors play a major role *positive family history* identification of specific chromosomal genetic abnormalities -chromosome 15 (identification of single words) -chromosome 6 (trouble decoding words or sounding out) specific genetic disorders: Klinefelter or Turner syndrome, spina bifida with shunted hydrocephalus
ID with IQ > 50 - most common organic causes
genetic syndromes with multiple minor congenital abnormalities fetal deprivation prematurity perinatal insults intrauterine exposure to drugs of abuse sex chromosomal abnormalities (Turners and Klinefelter syndrome)
educational definition of learning disability
handicap that interferes with someone's ability to store, process, or produce information
interventions for ID - multidisciplinary approach
health care providers dentist social workers educators parents
ID - chromosomal analysis
high resolution karyotype DNA probe studies
down syndrome clinical features
hypotonia upward-slanted palpebral fissues mid-face depression flat wide nasal bridge simian crease short stature increased incidence of thyroid abnormalities and congenital heart disease
fragile X syndrome patho
inactivation of FMR-1 gene
what is a preventable cause of ID?
inborn errors of metabolism
principle treatment of recognized disabilty is?
individualized instruction (IEP) that address accomodations, interventions (techniques used at home or school to utilize student's strengths to overcome difficulties), any necessary curricular modifications also psycho-social-behavioral therapies (only if struggling) -cognitive behavioral therapy -behavior modification -social skills training -psychotherapy -support groups -family counseling
fragile X syndrome clinical features
long face large ears midface hypoplasia high arched palate short stature macroorchidism mitral valve prolapse joint laxity strabismus
fetal alcohol syndrome patho
maternal alcohol consumption
learning disabilities evaluation - rule out?
medical causes - hx and pe vision and hearing screening lead screening for lead exposure get dietary hx - IDA
ID - common comorbidities
mental and neurodevelopment disorders -AD/HD -depressive and bipolar disorders -anxiety disorders -autism spectrum disorder -stereotypic movement disorder -impulse control disorders -major neurocognitive disorder Cerebral palsy seizure disorder, specifically epilepsy
ID - metabolic screening and/or neuroimaging studies
metabolic - done if not done as newborn or unclear results neuroimaging -MRI (structural or myelination abnormalities) -CT (intracranial calcifications)
fetal alcohol syndrome clinical features
microencephaly short stature midface hypoplasia short palpebral fissure thin upper lip retrognathia in infancy micrognthia in adolescence hypoplasic long or smooth philtrum
clinical implications - severe ID
minimal self-care skills and simple conversational skills; need much supervision; often institutionalized
ID with IQ < 50 "moderate or severe" - usually linked to?
organic causes -chromosomal abnormalities (Down syndrome) -other genetic syndrome (fragile X syndrome) -abnormalities of brain development -inborn errors of metabolism/neurodegenerative disorders
2 main classifications of causes in intellectual disability
organic causes (genetic disorder or brain damage) social-cultural causes (normal variation along range of intelligence combined with below-average environmental influences) -not getting stimulation needed
ID - multidisciplinary evaluation - comprehensive history and PE
pre-natal and perinatal medical hx (RF's) 3-generational family pedigree evaluate any suspected developmental delays hearing/vision eval age-appropriate standardized cognitive testing psych eval if psychiatric or emotional problems suspected
primary goal intervention - ID
reach optimal developmental potential and be able to cope as effectively as possible with handicap
ID with IQ > 50 "mild" etiology - primarily associated with?
sociocultural causes -lack of exposure to stimulating environment -4x more likely if mother hasn't completed HS -socioeconomic factors (poverty, malnutrition)
learning disabilities are defects in?
specific ability areas rather than deficiencies in global intelligence
intellectual disability - 2 components must be present to make dx
this is a syndrome! significant impairment in intelligence as measured by IQ testing: arbitrary cut-off between normal and intellectual disability has been set as 2 standard deviations from mean (70 or below = may have ID) inability to adapt to expectations of environment *this is a must* awkward in socialization, issues with communication, ADLs (eating, toilet training, dressing themselves)
clinical implications - profound ID
total supervision; often institutionalized; very minimal self-care skills
clinical implications - moderate ID
trainable - self-care/some academic skills; may be able to function independently in supervised living and sheltered workshop settings
down syndrome pathophysiology
trisomy 21 chromosomal abnormality
dyslexia etiology
unknown but most likely due to problems with integrating information from multiple brain regions or subtle differences in brain structures and functions