Common Forms of Developmental Disabilities
Developmental disabilities refer to conditions which manifest themselves
during childhood (before the age of 22 years). They typically consist
of disorders which may alter or delay the normal development of one or
more of the following skills; language, speech, learning, self-help, mobility,
or independent living. Any disorder or condition which is chronic in nature
and significantly alters normal human development falls under the heading
of developmental disability. Although five of the most common forms of
developmental disability are discussed here, remember that this list is
in no way exhaustive.
Autism
Cerebral Palsy
Down Syndrome
Mental Retardation
Spina Bifida
Autism
Autism refers to a pervasive developmental syndrome characterized by
a distinct group of behaviors and cognitive differences. It often is associated
with genetic and acquired conditions that affect brain development. The
etiology of autism is unclear. The complexity and spectrum of autistic
function suggest diversity in causal relationships/factors. It has been
posited that the brains of individuals with autism may demonstrate abnormal
micro-architecture and/or disturbances in select neurotransmitter metabolism.
There are many factors which influence the degree of expression of autism,
such as co-morbidity of mental retardation and/or Fragile-X syndrome.
Age also appears to be a determinant of autistic expression; symptoms
often improve as a child develops language skills and thus gains some
control of his or her environment. Symptoms of autistic expression are
typically strongest between the ages of four to five years. It is estimated
that autism affects approximately 1-2 persons per thousand, with males
being affected approximately 3.5 times as frequently as females. Recent
studies have indicated perhaps even a higher prevalence rate (as high
as 1 in 250).
(See the DSM-IV-R for expanded diagnostic criteria.)
www.msnusers.com/TheAutismHomePage/communicationsymptomsdsmiv.msnw
Persons with autism often display one or more of the following: impaired
development of social skills; impaired development of verbal and nonverbal
communication skills; ritualistic and perseverative behavior; resistance
to environmental change or change in daily routines; gaps in intellectual
development; poorly developed play skills; pronomial reversal; labile
mood; and unusual responses to sensory experiences. Poor motor coordination
may also be present, especially in individuals diagnosed with Asperger's
Syndrome (an autistic spectrum disorder).
Healthcare providers should be aware that persons with autistic disorders
may experience alterations in the processing of sensory stimulation. Sensations
of touch, hearing, smell, and taste may be perceived very differently
by a person with autism than others. An individual may demonstrate a higher
tolerance for pain, yet at the same time experience "light"
touch or loud sounds as painful or intolerable. Avoidance of tactile sensory
stimulation may be quite significant in some individuals with autism-thus
it may be necessary to modify examination procedures. It is also very
important for providers to consider the potential for increased pain tolerance
when conducting diagnostic evaluation of persons with autism.
Another important issue to consider when working with individuals having
autistic disorders revolves around communication. Persons with autism
frequently display differences in communication skills. Nonverbal communication
may be used extensively, depending on the level of autistic expression
and/or presence of mental retardation. It is important to understand that
many seemingly unrelated behaviors may express communicative intent in
individuals with autism. Several helpful strategies exist for relating
to persons with autism. One strategy is to use pictorial scripts, such
as social stories, which help explain to the patient what will happen
during the examination. Another helpful strategy involves the demonstration
of procedures on another person, typically a parent.
Huebner,
R.A., and Dunn, W. (2001). Introduction and basic concepts. In Huebner,
R.A., (Ed.), Autism: A sensorimotor approach to management (pp.
3-40). Gaithersburg, MD: Aspen Publishing, Inc.
For further information on autism see:
Autism Q&A from the National Institute of Child Health and Human Development
(NICHD): www.nichd.nih.gov/publications/pubs/autism/QA/index.cfm
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Cerebral Palsy
Cerebral Palsy is "an umbrella term for a group of non-progressive,
but often changing, motor impairment syndromes secondary to lesions or
anomalies of the brain arising in the early stages of its development"
(Kuban and Leviton, 1994). Congenital cerebral palsy (90% of cases) may
be caused by inadequate blood or oxygen supply to the unborn child, illness
during pregnancy, premature birth, birth trauma, etc. Acquired cerebral
palsy (10% of cases) may be caused in the first few months after birth
by head trauma, infections (encephalitis, meningitis, herpes simplex,
cytomegalovirus), exposure to toxic substances, severe malnutrition, child
abuse, etc.
A wide variety of associated conditions may or may not exist for persons
with cerebral palsy, but several of the most common include:
- Seizure disorders
- Vision impairment
- Speech impairment
- Hearing impairment
- Scoliosis
- Tonal problems
- Bladder problems (urinary tract infection)
- Excessive drooling
- Poor nutrition
- Depression
- Joint contractures
- Hip dislocation
- Joint, muscle or other pain
- Skin breakdown
- Gastrointestinal problems (oral motor dysfunction, gastroesophageal
reflux, esophagitis, gastritis, ulcers, constipation and bowel obstruction)
- Pneumonia
- Osteoporosis
Developmental
disabilities: Resources for healthcare providers. (n.d.). Retrieved
November 2002, from the Developmental Disabilities Health Information
Network Web site: http://www.ddhealthinfo.org/ggrc/doc2.asp?ParentID=2850
Several things are of primary consideration when treating individuals
with cerebral palsy. First is that while many individuals with cerebral
palsy also have mental retardation, the majority do not. It is important
to recognize that an individual may have normal, or above normal intelligence
even if he or she is unable to speak or communicate that level of intelligence
in a more conventional way. Second is that persons with cerebral palsy
often have various levels of speech impairment and may use augmentative
communication devices, nonverbal communication, slow or difficult to understand
speech, or a combination thereof. Third, cerebral palsy is often accompanied
by various levels of mobility impairment. The person may require the use
of a wheelchair, braces or other adaptive equipment. Being aware of these
considerations beforehand and preparing appropriately will lessen the
chance for awkward or inaccessible office situations.
Both speech and mobility considerations will be elaborated upon later.
Remaining cognizant of both the potential for and possible severity of
speech and mobility impairment in persons with cerebral palsy will help
the health care provider in addressing these issues.
For more information about cerebral palsy:
General reading:
http://gait.aidi.udel.edu/res695/homepage/pd_ortho/clinics/c_palsy/cpweb.htm
Aging and cerebral palsy:
http://www.cpconnection.com/Aging/index.htm
Reference
Kuban,
K., & Leviton, A. (1994). Cerebral palsy. New England Journal of
Medicine, 330(3), 188-195.
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Down Syndrome
Down syndrome is caused by a chromosomal defect and is marked by certain
distinctive physical characteristics as well as typically some level of
intellectual disability. Current estimates place the prevalence of Down
syndrome at 1 in 700 persons. Persons with Down syndrome are highly susceptible
to a number of other medical conditions including hearing deficiency,
congenital heart disease, thyroid problems, obesity, atlantoaxial instability
and early onset of Alzheimer's disease. Persons with Down syndrome are
also at higher risk for leukemia.
In addition to these considerations, persons with Down syndrome often
have some level of communication impairment. Understanding and facilitating
nonverbal communication may be necessary to effectively relate to persons
with Down syndrome.
Because individuals with Down syndrome frequently have some level of
intellectual disability, the physician must make every effort to assure
that the patient fully understands the instructions being given to him
or her. This may be less of an issue for a child who is accompanied by
an adult. However, remembering to speak in terms that the person can easily
understand (without being condescending) and verifying that the patient
has understood any instructions are important considerations of which
to be aware.
One idea to ensure that patients understand instructions is to write
the instructions out for the patient and verbally go over them. Another
idea is to arrange a follow up call to remind and make sure that the patient
is following the instructions.
For more information about Down syndrome:
Health Care Guidelines for Individuals with Down Syndrome: http://www.denison.edu/dsq/health96.html
General Medical Overview: http://ddhealthinfo.org/ggrc/doc2.asp?ParentID=3168
National Association for Down Syndrome, http://www.nads.org
National Down Syndrome Society, 800-221-4602, http://www.ndss.org
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Mental Retardation
Mental retardation is the most common developmental disability. The definition
according to the American Association of Mental Retardation is "a
disability characterized by significant limitations both in intellectual
functioning and in adaptive behavior as expressed in conceptual, social,
and practical adaptive skills". This disability originates before
age 18. The following five assumptions are essential to the application
of this definition:
- Limitations in present functioning must be considered within the context
of community environments typical of the individual's age peers and
culture.
- Valid assessment considers cultural and linguistic diversity as well
as differences in communication, sensory, motor and behavioral factors.
- Within an individual, limitations often coexist with strengths.
- An important purpose of describing limitations is to develop a profile
of needed supports.
- With appropriate personalized supports over a sustained period, the
life functioning of the person with mental retardation will generally
improve." (p. 1)
(Source: Mental Retardation: Definitions,
Classifications and Systems of Supports (2002). Washington: American Association
of Mental Retardation)
The 2002 AAMR definition of mental retardation emphasizes the types and
intensities of supports (e.g., personal, assistive technology, environmental)
that a person needs to live a fulfilled and productive life in typical
community settings (home, a job, friends, recreational activities, etc.).
Unlike previous conceptions of mental retardation, which focused almost
exclusively on deficits, limitations and all that a person cannot do,
the 2002 definition emphasizes that the functional capabilities of all
persons can improve with carefully designed, individualized supports,
and that all people are capable of living in the community with the provision
of such supports.
Want to know more general information about developmental
disabilities? Administration for Children and Families: http://www.acf.dhhs.gov/programs/add/
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Spina Bifida
Spina bifida is caused by the failure of the spine to close completely
during the first month of pregnancy. Persons with spina bifida often experience
paralysis, hydrocephalus, learning disabilities and swallowing problems.
Of the four major developmental disabilities discussed here, spina bifida
is the least likely to affect such areas as speech and cognition (although
some degree of learning disability is fairly common). Persons with spina
bifida are likely to use wheelchairs or other ambulatory aids. As such,
the accommodations needed to appropriately treat a patient with spina
bifida will likely be physical in nature. See the section below on physical
accommodations.
The nationwide prevalence of spina bifida is estimated to be approximately
1 in 2,000; however in Kentucky prevalence estimates are slightly higher
due to dietary deficiencies in folic acid and hereditary factors.
General Medical Information about spina bifida: http://ddhealthinfo.org/ggrc/doc2.asp?ParentID=3173
Spina Bifida Association of America: http://www.sbaa.org/
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