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