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Developmental Disabilities

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Presentation on theme: "Developmental Disabilities"— Presentation transcript:

1 Developmental Disabilities
History of Developmental Disabilities Mental Retardation Pervasive Development Disorders Learning Disorders David E. Marshall, B.Ed. November 23, 2009 ©

2 History of Developmental Disabilities
Views In pre-recorded history there is only archaeological evidence to suggest how people were treated. Beck tells us: “Neanderthals are the first creatures known to have buried their dead. Evidence indicates that 60,000 years ago a man was buried on a bed of flowers accompanied by a wreath of flowers. Other graves were surrounded by a circle of stones or goat skulls. Remains of an amputee and an arthritic man have been found, indicating that they cared for their disabled.” (http://www.bamaed.ua.edu/spe300/History.html) Mackelprang and Salsgiver tell us: Neolithic tribes perceived people with disabilities as possessed by spirits. When the spirits were perceived as evil, escape routes were fashioned by drilling holes in the skulls of people who were thought to he possessed The Spartans, with their rugged individualism, abandoned young and old people with disabilities in the countryside to die. Plato, to whom Western culture owes much of its ethical framework, viewed people with disabilities as standing in the way of a perfect world: "the offspring of the inferior, or of the better when they chance to be deformed, will be put away in some mysterious, unknown place, as they should. " The Romans, who borrowed the concept of reciprocity from the Greeks, gave assistance to adult people with disabilities with the expectation that they would demonstrate thanks by not rioting. However, like the Greeks the Romans also abandoned disabled or deformed children to die.” (http://www.bamaed.ua.edu/spe300/History.html)

3 History of Developmental Disabilities (continued)
Kolstoe (1976) described eras of treatment as follows: Extermination: The Greek city states of Sparta and Athens permitted disabled persons to be killed if they could not contribute to their basic survival. Even birth marks were sufficient, apparently as bad omens, to warrant death. Ridicule: In some cultures the disabled were tolerated, but they were use for amusement as jesters and sometimes displayed for public view in zoos. It should be remembered, however, that even in this century there have been similar displays in carnival side shows. Asylum: Primarily as an outgrowth of churches, some persons were permitted care in monasteries, charity houses, poor houses, and asylums, although treatment centered on spiritual redemption. Education: Beginning with the work of Itard, a French physician influenced by Rousseau, the education of Victor, the "Wild Boy of Averyon" who was presumed to be a feral child (raised by animals), educational programs were begun. There eras are more or less arbitrary and there is considerable evidence of highly variable treatment in any given period. For Western civilization, however, there has been a gradual progression dating back to the Judeo- Christian tradition. Both in scripture and in attitude, people with disabilities were treated with suspicion and fear and an indication of God's displeasure. The term "affliction" was a protestant concept in America and came to shape the development of such terms as handicapped and later disabled. Earlier Jewish and Christian beliefs supported the notion that disabilities were punishments or demonic possessions, and later Calvinistic concepts of "pre-destination" sustained the belief that God punished people by means of birth defects and disabilities. Disabilities were retributions for the sins of parents. (http://www.bamaed.ua.edu/spe300/History.html)

4 History of Developmental Disabilities (continued)
Rousseau ( ) - condemned the poor treatment of children and devised a system of studies of 20 subjects Pestalozzi ( ) - first premise of Pestalozzi's approach is to treat each child individually Froebel ( ) - Froebel is famous for establishing the kindergarten system in Germany to help the lower class children who were less able than other children Stotzner a German teacher of the deaf, founded a school for slow learning children in 1867. Montessori ( ) (1) children are all different from each other and hence must be treated individually; (2) children must wish to learn; and (3) children are so constituted that given proper conditions they prefer educating themselves to any other occupations Dewey ( ) - “Learn by doing.” Kirk in 1963 coined the term “Learning Disabilities” - “children who have disorders in development of language, speech, reading, and associated communication skills.” (http://www.audiblox2000.com/book2.htm) “For centuries, such people were regarded as subhuman, a menace, or an object of dread. In ancient Greece, handicapped infants were left on mountaintops to die or were thrown from the cliffs. While this practice is abhorrent to modern sensibilities, some people argue that a similar view of disability is reflected in the common current practice of aborting a fetus shown at prenatal screening to have Down Syndrome or spina bifida.” Firestone & Dozios 2007

5 Scriptures Related to Developmental Disabilities
Proverbs 31:8-9 (New Living Translation) 8 Speak up for those who cannot speak for themselves; ensure justice for those being crushed. 9 Yes, speak up for the poor and helpless, and see that they get justice. Jeremiah 22:16 (New Living Translation) 16 He gave justice and help to the poor and needy, and everything went well for him. Isn’t that what it means to know me?” says the Lord. Matthew 25:40 (New Living Translation) ‘I tell you the truth, when you did it to one of the least of these my brothers and sisters, you were doing it to me!’ Can you think of other scriptures that tell us to help, support, teach those who have developmental disabilites?

6 Causes of Developmental Disabilities
Causes of developmental disabilities are either organic, environmental, or a combination of genetic and environment. Genetic Chromosomal abnormalities, such as trisomies, are the cause of a number of developmental disabilities. The majority of first term miscarriages are the result of these abnormalities. (Dr. Ilse Santizo – Obstetrician/Gynaecologist – John Hopkins) Parental screening is generally carried out. There are several methods that are used. Amniocentesis: 11th - 18th weeks of pregnancy – Cells in the amniotic fluid are cultured in a lab – 99.4% diagnostic accuracy – 0.5% chance of infection or miscarriage Chorionic Villus Sampling (CVS): 10th - 12th weeks of pregnancy - acquiring cells from the placenta – less accurate than amniocentesis – 1 – 5 % chance of miscarriage Environmental Maternal infections such as Rubella (German Measles), HIV, Alcohol use, and other drugs 75 – 90% of children who acquire HIV have developmental disabilities Fetal Alcohol Syndrome (FAS) has been increasing dramatically in recent years

7 Education of Those with Developmental Disabilities
Mainstreaming and special education classes are both used in the education of children with developmental disabilities and learning disabilities. Most education systems use an approach of inclusion as much as possible however in the subject areas that the student struggles in, special classes seem to be the answer. The use of labels has fallen into disfavor. There is a push in many schools and school districts to teach that all students have relative abilities and disabilities. It has been difficult for many to consider that those with developmental disabilities have sexual desires, just as others and struggle with the idea of them becoming parents. They need to be taught about sex for this reason as well as to protect themselves from catching venereal diseases or being abused or assaulted sexually. De-institutionalization is becoming more and more the norm presently as it is seen that those with developmental disabilities fare better in community settings.

8 Mental Retardation Mild Mental Retardation DSM-IV-TR 317
Moderate Mental Retardation DSM-IV-TR 318 Severe Mental Retardation DSM-IV-TR 318.1 Profound Mental Retardation DSM-IV-TR 318.2 “The essential feature of Mental Retardation is significantly subaverage general intellectual function (criteria A) that is accompanied by significant limitations in adaptive functioning in at least two of the following skill areas: communication, self- care, home living, social/interpersonal skills, use of community resources, self- direction, functional academic skills, work, leisure, health and safety (criteral B). The onset must occur before age 18 (criteria C).” (DSM-IV-TR p. 41) Mental retardation is caused by pathological processes affecting the functioning of the central nervous system. Classification using the most recent classification system of the American Association on Mental Retardation (AAMR) includes assessment on five dimensions: I: Intellectual Abilities, II: Adaptive Behavior, III: Participation, Interactions, and Social Roles, IV: Health, V: Context

9 Mental Retardation (continued)
Intelligence Intelligence Quotient (I.Q.) has generally been measured through standard intelligence tests but much controversy has come in recent years due to a few reasons: 1. Tests do not take into account: sensory, motor and language deficits 2. Subject unfamiliarity with test situation 3. Tests (Wechsler Scales & earlier editions of Stanford-Binet) not standardized with lower I.Q. scores Borderline (I.Q. of 70 to 75) (Firestone 2007) Mild (I.Q. of 55 to 70) Moderate (I.Q. of 40 to 55) Severe (I.Q. of 25 to 40) Profound (I.Q. of 10 to 25) Prevalence 3 - 16% of the population (depending upon cut off I.Q.) Percentage of total population of Mentally Retarded People: Mild 85% - Moderate 10% - Severe 3-4% - Profound 1-2%

10 Mental Retardation (continued)
Measuring Adaptive Behavior Measures: Vineland Adaptive Behavior Scales (2nd ed.) Adaptive Behavior Assessment System (2nd ed.) Scales of Independent Behavior – Revised (norms to 80 years of age) Scales are either filled out during interview with parents, teachers or caregivers or checklists completed by client. Adaptive behaviors are generally clustered under four domains: Communication, Daily/Personal Living Skills, Socialization/Social Interaction, and Motor Skills.

11 Down Syndrome Description & Development Education & Intervention
Degree of intellectual impairment can range from mild to severe. Dementia is common in those over 40. The Dementia Scale for Down Syndrome (DSDS) was developed in British Columbia in to detect and rate the severity of dementia in those who cannot follow instructions or are nonverbal. Education & Intervention Education and early intervention contribute to the development and adaptive functioning of those with Down Syndrome. Many individuals are able to learn reading, writing and number skills. They also commonly develop basic living skills. (song) (video)

12 Fragile X Syndrome Description & Development Education & Intervention
Fragile X Syndrome is the second most common chromosomal abnormality, next to Down Syndrome and the most common hereditary cause of mental retardation. There are common cognitive, behavioral and physical symptoms. These features are less pronounced in females. Intellectual levels in males vary from moderate mental retardation to normal levels of intelligence. Declines in intellect are common about the time of puberty. Males show deficits in sequencing information but strengths in simultaneous processing of information. Only one third of females are affected intellectually but have deficits in problem solving, short term memory, planning, and understanding mathematical concepts. These individuals generally have few problems related to daily living. Males do have difficulties with socialization and communication. Attention deficits, hyperactivity, anxiety, aggression and autistic-like behaviors such as over sensitivity, aversion to being touched, self harm and other sensitivities are also common. Education & Intervention Visual educational techniques seem to be the best for those with Fragile X Syndrome.

13 Fragile X Syndrome (continued)
Prevalence Carriers may be affected or unaffected. Affected Unaffected Male 1 in 700 to 1 in 1000 1 in 2000 Female 1 in 400

14 Pervasive Developmental Disorders
Pervasive indicates that a condition permeates the entire development of the individual. (http://medical- dictionary.thefreedictionary.com/pervasive) Autism DSM-IV-TR Aspergers DSM-IV-TR Child Disintegrative Disorder DSM-IV-TR Rett Syndrome DSM-IV-TR Those with autism are generally socially unresponsive. They communicate either in a very limited style or unusually. Lack of eye contact is also quite common. Self stimulation including hand flapping, rocking and spinning are frequent activities for these individuals. They may also self injure by head banging or hand biting. Sameness in environment and routine is essential for these people and they have obsessive interests in particular objects. One third of those with autism do not speak. Those that do speak have clear intonation and good vocabularies but unusual tones and content. About half of the individuals with autism have significant psychiatric and/or behavioral problems including depression, anxiety and aggression towards themselves and others. Sensory impairments and epilepsy are also common. Individuals with autism are generally over sensitive to some environmental stimulation such as being touched but under sensitive to other stimuli such as sound. The development of functional speech is imperative by age five in order for these individuals to become fully functional. Children with autism rarely initiate social interaction. Frequently when they do speak they repeat what has been said (echolalia) or they mix up pronouns – using he/she to refer to themselves. Prevalence: Ranges from 4 to 22 per 10,000 births – Three to four times more common in males – 25% of individuals have normal intelligence – small proportion of the rest have exceptional ability in one area (savants) – 10% fully integrated into the community.

15 Pervasive Developmental Disorders - Autism (continued)
(song) (song) (video) Rainman movie made in 1988

16 Pervasive Developmental Disorders Aspergers
Aspergers DSM-IV-TR Description & Development - Higher functioning autistic people with fewer symptoms and higher I.Q. - Poor social skills - Adaptive skills and interest in the environment generally normal for age (video) (video)

17 Child Disintegrative Disorder
Child Disintegrative Disorder DSM-IV-TR Description & Development - similar to autism but deterioration starts several years into regular development - children are generally able to speak in sentences before onset Etiology & Treatment - likely neurobiological cause

18 Rett Syndrome Rett Syndrome DSM-IV-TR 299.80 Description & Development
- Similar to autism but unique patterns of cognitive and functional deterioration Four Stages Stagnation: 6 to 18 months from onset – motor development slows and muscles weaken + loss of interest in play and environment Rapid Destructive: 1 to 3 years from onset – hand use reduced to stereotyped movements – Wringing, clapping, mouthing – autistic symptoms + irritability, insomnia, expressive language lost, seizures, self injury Third Stage: 2 to 10 years from onset – functioning at severe stage of mental retardation – lack of co-ordination (ataxia) + poor movement control (apraxia) – progressive rigidity + scoliosis (curvature of the spine) + teeth grinding (bruxism) Fourth Stage: 10 years or more from onset – progressive muscle wasting, rigidity, retardation of growth – expressive and receptive language abilities lost - multi-disciplinary team approach including teacher, psychiatrist, psychologist, language specialist, occupational and physical therapist Prevalence 1 in 15,000 - Primarily affects females (video)

19 Pervasive Developmental Disorders
Etiology - biological or organic base - abnormal levels of serotonin in 30 – 50 % of children with autism - prenatal infections – for example rubella - problems during pregnancy or delivery - brain scans show larger and heavier brains + abnormalities in brain structures Treatment - biological based treatments have not been found to be effective and yet frequently treatment of choice - nutritional supplements have also been used but little data is available about their effectiveness - behavior interventions – reinforcement of appropriate behavior, aversive stimuli, extinction and combinations have been used - electric shock therapy was previously used to quickly decrease self harm and aggression -social skills training and language interventions have been effective

20 Learning Disorders Prevalence: 2 to 10 %
“Learning disorders are diagnosed when the individual's achievement on individually administered, standardized tests in reading, mathematics, or written expression is substantially below that expected for age, schooling, and level of intelligence.” (DSM- IV-TR) The school drop out rate is significantly higher for students with learning disabilities. There is a high comorbidity of learning disabilities with certain psychological disorders including: Depression, Dysthmia, Oppositional Defiant Disorder, Conduct Disorder, Attention-Deficit / Hyperactivity Disorder, and Pervasive Disorders including Aspergers. Some people may develop learning disorders due to genetic or medical problems. It is important to take the individual's culture into consideration when testing his/her I.Q. There are other factors aside from learning disabilities that can affect scholastic performance. These include cultural setting, teacher quality, familial problems such as economic concerns, and lack of opportunity for learning for various reasons. Medical problems including those affecting sight and hearing should also be taken into consideration. Mathematics and written expression disorders are almost always found in students with reading disorders. Learning disabilities are very likely to be genetic. Prevalence: 2 to 10 %

21 Learning Disorders (continued)
Reading Disorder DSM-IV-TR Problems may exist in the areas of accuracy, speed, and comprehension. Oral reading problems may include distortions, substitutions or omissions of words. Disorder of Written Expression DSM-IV-TR 315.2 Writing disorders commonly include poor handwriting; spelling, grammatical, and punctuation problems, and poor paragraph organization and development. Standardized tests are difficult to construct to test for writing disorders for obvious reasons. They have been created to test spelling and could test grammar and punctuation receptively but not creatively. Mathematics Disorder DSM-IV-TR 315.1 Language problems are perhaps the most common reason for mathematics disorders. These can range from the comprehension of symbols to understanding written problems. Attention and memory are also common problems for those with mathematics disorders.

22 Reading Test Marry Hatter Ladle Limb Marry hatter ladle limb
Itch fleas worse widest snore. An ever-wear debt Marry win Door limb worse shorter gore. Oiled Murder Harbored Wen tutor cardboard Toe garter pore darker born. Wenchy gut dare Door cardboard worse bar An soda pore dark hat known. Pitter Paper Pitter Paper peeked or parker peckled paupers Or packer peckled paupers pitter paper peeked Aft Pitter Paper peeked or packer peckled paupers Ware aster packer peckled paupers debt pitter paper peeked? Anguish Languish (http://www.crockford.com/wrrrld/anguish.html)

23 Reading Test (continued)
The following is a parody: The European Union(EU) has just announced an agreement whereby English will be the official language of the EU rather than German, which was the other possibility. As part of the negotiations, the British Government conceded that English spelling had some room for improvement and has accepted a 5-year phase-in plan that would become known as "Euro-English". In the first year, "s" will replace the soft "c". Sertainly, this will make the sivil servants jump with joy. The hard "c" will be dropped in favour of "k". This should klear up konfusion, and keyboards kan have one less letter. There will be growing publik enthusiasm in the sekond year when the troublesome "ph" will be replaced with "f". This will make words like fotograf 20% shorter. In the 3rd year, publik akseptanse of the new spelling kan be expekted to reach the stage where more komplikated changes are possible. Governments will enkourage the removal of double letters which have always ben a deterent to akurate speling. Also, al wil agre that the horibl mes of the silent "e" in the languag is disgrasful and it should go away. By the 4th yer people wil be reseptiv to steps such as replasing "th" with "z" and "w" with "v". During ze fifz yer, ze unesesary "o" kan be dropd from vords kontaining "ou" and after ziz fifz yer, ve vil hav a reil sensibl rite n styl. Zer vil be no mor trubl or difikultis and evrivun vil find it ezi tu understand ech oza. Ze drem of a united urop vil finali kum tru. Und efter ze fifz yer, ve vil al be speking German like zey vunted in ze forst plas.

24 Writing Test Copy the definition of the term “learning disability” using your non- writing hand. “A learning disability (LD) is a neurologically-based difficulty processing information. It is not a lack of intelligence. People with learning disabilities have average to above average intelligence but their brains process information in a different way from the average person. Their disability is invisible but affects many aspects of their lives. Over 80% of learning disabilities relate to language and language processing. Others relate to the processing of numbers. People with learning disabilities may have difficulty with attention, memory, reasoning, coordination, speaking, reading, writing, spelling, calculation, social skills or emotional development.” Learning Disabilities Association of Alberta (http://www.ldaa.ca/ld/index.aspx)

25 Memorize the 19 Times Table
Arithmetic Test Memorize the 19 Times Table 19X0=0 19X1=19 19X2=38 19X3=57 19X4=76 19X5=95 19X6=114 19X7=133 19X8=152 19X9=171 19X10=190 19X11=209 19X12=228 19X13=247 19X14=266 19X15=285 19X16=304 19X17=323 19X18=342 19X19=361

26 Bibliography American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. DSM-IV-TR (4th ed., text revision). Washington, DC. Firestone, P & Dozios, D. J. A. (2007). Developmental Disorders. Abnormal Psychology – Perspectives 3rd Edition. Toronto: Pearson - Prentice Hall. ( ). Marsh G.E. II, McFadden A. C., McGee T. (n.d.). History (of Special Education). Retrieved: November 22, 2009, from No Author. (n.d.). History of Learning Disabilities. Retrieved: November 22, 2009, from Mosby's Dental Dictionary, 2nd edition. (2008) Elsevier, Inc. from:

27 Web Sites for Further Information
Developmental Disabilities Developmental Disabilities Resource Centre of Calgary Down Syndrome Down Syndrome: Health Issues Learning Disabilities Learning Disabilities Association of Alberta


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