Assignment: Study Guide Forum To Prepare Your Instructor will assign you to a specific neurodevelopmental disorder from the DSM-5-TR.Research your assigned disorder using the Walden Library. Then, d
1 Week 8Assignment: Study Guide Forum: Intellectual Disability Heather Leach College of Nursing-PMHNP, Walden University NRNP 6665: PMHNP Care Across the Lifespan I Dr. Shelton July 24, 2022 2 Intellectual Disability Educationcorner.com. (2022) Intellectual disability, also known as Intellectual Developmental Disorder (IDD), is a neurodevelopmental disorder characterized by impairments in mental abilities such as intellectual functioning and adaptive behaviors (American Psychiatric Association (APA), 2013). IDD impacts one or more aspects of independence, socialization, communication, academics, and occupational functioning (APA, 2013). Prevalence of IDD Adaptive Behaviors:  activities of daily functioning  communication  independence  socialization  motor skillsIntellectual Functioning:  learning/comprehension  problem solving  judgment  reasoning  planning,  abstract thinking 3  IDD affects approximately 1% of the population (APA, 2022).  Nearly 85% have mild intellectual disability (APA, 2022).  Males are more likely to be impacted than the female gender (APA, 2013).  IDD occurs in all races and cultures (APA, 2013).  The prevalence of IDD is lower for Asian non-Hispanics among all other races (Centers for Disease Control and Prevention (CDC), 2017).  Between 2016-2019 2.1% of children with IDD were from families with incomes below the poverty level (CDC, 2017).  1.7% of children between 5-17 years were reported to have IDD in 2019 (CDC, 2017). This chart identifies the prevalence of children between the ages of 3-17 diagnosed with IDD (by age, sex, race, and ethnicity) in the United States from 2014-2016 (CDC, 2017). 4 Development and Course  Can develop during prenatal development or any time before the age of 18 (Centers for Disease Control and Prevention (CDC), 2021)  IDD is generally lifelong; however, severity levels can change over time (APA, 2013).  Children may learn and develop more slowly than children of the same age (CDC, 2021).  IDD may result abruptly after sustaining head trauma (APA, 2013). Levels of Intellectual Disability  Severity determines the age and characteristics of features: delayed motor skills, language, and developmental milestones (APA, 2013).  May be identified before 2 years of age with severe IDD (APA, 2013).  Mild IDD may not appear until school age, during academic learning (APA, 2013).  The degree of IDD is a combination of IQ and level of adaptive functioning (Thapar et al., 2015). MILD IQ of 50-69 MODERATE IQ of 35-49 SEVERE IQ of 20-35 PROFOUND IQ below 20 Causes of IDD  IDD is heterogeneous with multiple causes (APA, 2013). 5  IDD associated with genetic mutations may have physical characteristics or behavioral issues (APA, 2013). Genetics Environmental Factors Prenatal Issues Intelligence is moderately heritable (Thapar et al., 2015) Socioeconomic adversity- higher rates of IDD in low and middle-income countries (Thapar et al., 2015). Fetal exposure to substances such as alcohol (Fetal Alcohol Syndrome) (NIH, 2021). Genetic mutations such as in Rhett Syndrome (National Institute of Child Health and Human Development (NIH), 2021) Obstetric adversity (Thapar et al., 2015). Pregnancy hypertension, asthma, urinary tract infection, pre-pregnancy obesity, and pre-gestational diabetes were shown to increase the risk of IDD significantly (Lee et al., 2022). Chromosome anomalies such as Down Syndrome (the most common chromosomal abnormality) (NIH, 2021). Environmental toxins (Thapar et al., 2015). Uncontrolled maternal diabetes, malnutrition, and obstetrical complications causing anoxia (placenta previa, placenta abruption, and umbilical cord prolapse) (Lee et al., 2022). Fragile X Syndrome- X- linked inheritance, occurs in 1 in 5000 males (Thapar et al., 2015). Poor Schooling (Thapar et al., 2015). Infections during pregnancy: cytomegalovirus (CMV), genital herpes, toxoplasmosis (NIH, 2021). Sex chromosome anomalies- most frequent are Klinefelter Syndrome (XXY) and Turner Syndrome (XO) (Thapar et al., 2015). Poverty (Thapar et al., 2015). Problems during childbirth resulting in a decrease in blood and oxygen supply to the brain (cord wrapped around baby’s neck) (NIH, 2021). Autosomal Dominant Disorders- passed from one generation to the next: NF1, Noonan Syndrome, Abuse and neglect during early development (NIH, 2021). Pre-term birth (NIH, 2021). 6 Tuberous Sclerosis (Thapar et al., 2015). Autosomal Recessive Disorders-associated with severe forms of IDD caused by inborn metabolism disorders such as phenylketonuria or homocystinuria (Thapar et al., 2015). Duplications and deletions of chromosomal regions- Williams and Smith- Magenis syndromes, Prader-Willi and Angelman syndromes (Thapar et al., 2015). Recognizing IDD: Signs and Symptoms  Sit up, crawl, or walk later than other children (NIH, 2021).  Lack of communication skills, delayed speech, or trouble speaking (NIH, 2021).  Deficits in social interaction or developing relationships (APA, 2013).  Difficulty remembering things (NIH, 2021).  Trouble learning or with comprehension (APA, 2013). by Unknown Author is licensed under 7  Trouble understanding social rules (NIH, 2021).  Difficulty managing self-regulation: behavior, emotions, motivation (APA, 2013).  Aggression or disruptive behaviors (APA, 2013).  Trouble seeing the results of their actions (NIH, 2021).  Difficulty solving problems (NIH, 2021). Differential Diagnoses  A diagnosis of IDD is made when the DSM-5 criteria A, B, and C are met (APA, 2013).  In the presence of a genetic or medical condition, IDD should not be assumed (APA, 2013).  Differential diagnoses include: Major and Mild Neurocognitive Disorders (APA, 2013). Communication Disorders (APA, 2013). Specific Learning Disorder (APA, 2013). Autism Spectrum Disorder (APA, 2013). 8 Comorbidities  IDD can co-occur with other mental, neurodevelopmental, medical, and physical disorders (APA, 2013).  The most common include (APA, 2013):  Other comorbid disorders include: cerebral palsy, epilepsy, communication disorders, major neurocognitive disorder (APA, 2013).  Those with severe IDD may exhibit disruptive and/or aggressive behaviors toward self or others (APA, 2013). Autism Spectrum Disorder ADHD Anxiety Disorders Bipolar Disorder Stereotypic Movement Disorder Impulse Control Disorders Depression 9 Prognosis  IDD is a life-long disorder, but severity can change (APA, 2013).  IDD is typically non-progressive except for periods of worsening followed by stabilization, such as in Rhett Syndrome (APA, 2013).  Early intervention may improve adaptive functioning (APA, 2013).  Early diagnosis is essential to improve adaptive functioning (APA, 2013).  Medications may not be the primary treatment for IDD but play a vital role in treating comorbidities (ADHD, depression, anxiety, bipolar) (Lee et al., 2022).  Medication is often used to treat behavior issues associated with IDD (Lee et al., 2022).  Risperidone has been shown to be helpful in managing disruptive, aggressive, and self- harm behaviors in individuals with IDD (Lee et al., 2022). Pharmacological Treatments by Unknown Author is licensed under 10  Aripiprazole is another antipsychotic used to manage aggressive behaviors (Lee et al., 2022).  Tardive dyskinesia may result from the use of antipsychotics though the risk is reduced with Risperidone (Lee et al., 2022).  Antidepressants: SSRIs (fluoxetine, paroxetine, and sertraline) are useful in treating obsessive-compulsive symptoms and stereotyped motor movements (Lee et al., 2022).  Methylphenidate or atomoxetine are commonly used to manage ADHD symptoms (Lee et al., 2022).  Stimulants such as methylphenidate may cause irritability, decreased appetite, drowsiness, and social withdrawal (Sadock et al., 2015).  Individuals with IDD are at higher risk for polypharmacy (Lee et al., 2022). Nonpharmacological Treatment  Early interventions are essential in treating individuals with IDD (APA, 2022).  Treatment is focused on an individual’s strengths and needs (APA, 2022). by Unknown Author is licensed under 11  Nonpharmacological treatments may include: special education, transition services (childhood to adulthood), vocational programs, adult day programs, and case management (APA, 2022).  Family education-assists family members in understanding and managing IDD (Lee et al., 2022).  Behavioral therapy- encourages positive behaviors and aims to assist in reducing negative behaviors (Lee et al., 2022).  Cognitive therapy- changes negative behaviors by identifying and changing one’s thoughts/emotions (Lee et al., 2022).  Cognitive behavioral therapy- a combination of the two therapies most widely used behavioral intervention in those with IDD (Lee et al., 2022). Diagnostics and Labs  I DD is confirmed by: clinical assessment, comprehensive history, and individualized and standardized intelligence testing (APA, 2013). by Unknown Author is licensed under 12  Diagnostic features include impairments in cognitive abilities and impairments in daily adaptive functioning out of proportion to that of normal development (APA, 2013).  Adaptive functioning is assessed through standardized tests, individual interviews, and gathering information from family members, teachers, and caregivers (Lee et al., 2022).  IQ tests can be administered but are less valid due to the various levels of severity in adaptive functioning (APA, 2013).  A physical exam is needed to differentiate IDD from other disorders (Lee et al., 2022).  A neurological exam can identify any deficit comorbid with IDD or that may mimic IDD (Lee et al., 2022).  Vision and hearing screenings are essential to identify communication issues leading to a delay in development (Lee et al., 2022).  Neuroimaging, urine/blood tests, and genetic and chromosomal analyses have been used to identify the etiology of IDD (Lee et al., 2022). Legal and Ethical Considerations  Treatment is based on the needs of the patient (Lee et al., 2022).  The provider must serve the patients’ best interests through an interprofessional approach (Lee et al., 2022). by Unknown Author is licensed under 13  The interprofessional team may include PCP, psychiatrist, psychologist, neurologist, social workers, special education teachers, nurse educators, speech/hearing pathologists, and pharmacists (Lee et al., 2022).  Prompt and accurate documentation of assessment, diagnosis, services provided, and follow-up plans are essential (Lee et al., 2022).  Federal law requires early intervention services to identify and assist those with IDD (APA, 2022).  Federal law also requires special education and other related services are available at no cost to anyone with IDD (APA, 2022). Patient Education and Considerations  Patient education is essential to both the patient and family/caregivers (Lee et al., 2022).  Families must understand that those with IDD are more prone to rejection and failure (Lee et al., 2022). 14  Providing a supportive environment is important to prevent discouragement (Lee et al., 2022).  Those with IDD are prone to social skill deficits and social isolation (Lee et al., 2022).  The Special Olympics International Program can help improve social interactions, self- esteem, and friendships (Lee et al., 2022).  Government resources are available for those with IDD, such as social security benefits, community services, housing, food delivery, employment opportunities, and educational support (Lee et al., 2022). Tips for Families (APA, 2022):  Learn about IDD  Connect with other parents  Be patient  Encourage independence and responsibility  Educate self on laws, educational and community services/supports  Encourage social and recreational activities  Ask for help by Unknown Author is licensed under 15 References: American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5 th ed.). American Psychiatric Association (APA). (2022). What is intellectual disability? Retrieved July 18, 2022 from https://www.psychiatry.org/patients-families/intellectual-disability/what- is-intellectual-disability Centers for Disease Control and Prevention (CDC). (2017). Estimated prevalence of children with diagnosed developmental disabilities in the United States, 2014-2016. Retrieved July 21, 2022, from https://www.cdc.gov/nchs/products/databriefs/db291.htm Centers for Disease Control and Prevention (CDC). (2021). Facts about intellectual disability . Retrieved July 18, 2022, from https://www.cdc.gov/ncbddd/developmentaldisabilities/facts-about-intellectual- disability.html Lee, K., Cascella, M., & Marwaha, R. (2022). Intellectual disability . Retrieved July 18, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK547654/ National Institute of Child Health and Human Development (NIH). (2021). What causes intellectual and developmental disabilities (IDDs)? Retrieved July 18, 2022, from https://www.nichd.nih.gov/health/topics/idds/conditioninfo/causes National Institute of Child Health and Human Development (NIH). (2021). What infections can 16 affect pregnancy? Retrieved July 18, 2022, from https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/infections Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11 th ed.). Wolters Kluwer. Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6 th ed.). Wiley Blackwell.