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OT IN PEDIA
INTELLECTUAL DISABILITY & SPECIFIC LEARNING DISORDER
| Term | Definition 1 | Definition 2 | CONCEPTUAL 1 | CONCEPTUAL 2 | SOCIAL | PRACTICAL 1 | PRACTICAL 2 |
|---|---|---|---|---|---|---|---|
| INTELLECTUAL DISABILITY | ● Intellectual Developmental Disorder ● IQ is not the only basis for determining ID. Child must have deficits in adaptive functioning in the 3 domains too | ||||||
| INTELLECTUAL DISABILITY Disorder with onset during the developmental period that includes both: | ○ (1) intellectual and ○ (2) adaptive functioning deficits in conceptual, social, and practical domains (3 domains) | ||||||
| ID DIAGNOSTIC CRITERIA | ● Deficits in intellectual functions ● Deficits in adaptive functioning ● defined on the basis of adaptive functioning, and not IQ scores (criterion B) | ||||||
| ● Deficits in intellectual functions | ○ Reasoning, problem solving, planning, abstract thinking, judgment, academics, learning from experience ○ Confirmed by both clinical assessment and individualized, standardized intelligence testing | ||||||
| ● Deficits in adaptive functioning | ○ Resulting in failure to meet developmental and sociocultural standards for personal independence and social responsibility | ○ Limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community | |||||
| ID Onset: | during the developmental period | ||||||
| ID Severity Level: | ○ Mild ○ Moderate ○ Severe ○ Profound | ||||||
| ID THREE DOMAINS | ○ Conceptual ○ Practical ○ Social | ||||||
| Severity Level: MILD | ● School age: difficulties learning academic skills s/a reading, writing, math, time ● Adults: abstract thinking, EF , memory, functional use of acad skills – ex: money and time mgt | ● Immature social interactions – accurately perceiving social cues; ● More concrete communication, conversation and language; ● Difficulties in regulating emotion and behavior ● Limited social judgment | ● May function age-appropriately in personal care/ADL; ● Need some support with complex daily living tasks (ex: grocery shopping, transpo, meal prep, home management) | ● Recreational skills resemble typical peers with some help/support in organization ● Can acquire employment that do not emphasize conceptual skills ● Need support in health mgt and raising a family | |||
| Severity Level: MODERATE | ● Lag markedly ● Preschool: language and pre-acad skills develop slow ● School-age: slow progress in reading, writing, math, time, money ● Adults: at elementary level | ● Support is required for ALL of the use of acad skills in work and personal life ● Ongoing assistance needed | ● Spoken language is much less complex ● May not perceive or interpret social cues accurately ● Limited social judgment and decision-making ● Need significant and communicative support | ● Can take care of themselves (ADLs) but needed extended period of teaching and time to become independent; same with IADLs | ● Need ongoing support ● Employment is possible for jobs that require limited conceptual and communication skills with considerable support from work environment ●*maladaptive behavior is present – cause social problems | ||
| Severity Level: SEVERE | ● Attainment of conceptual skills is limited ADLs, IADLs; ● Little understanding of written language ● Extensive support needed | ● Limited spoken language ● May be single words or phrases, supplemented through augmentative means ● May understand simple speech and gestural communication | ● Requires support on all ADLs, IADLS; requires supervision at all times | ||||
| Severity Level: PROFOUND | involve the physical world rather than symbolic processes (Needs concrete physical object to learn) ● May use goal-directed behavior | ● May acquire matching and sorting skills non-symbolic communication (using visual perceptual skills only without understanding ) ● *motor or sensory impairments | ● Very limited understanding of symbolic communication ● May understand some simple instructions or gestures ● Expresses own desires and emotions through nonverbal, non-symbolic communication | ● Dependent on others for ALL aspects of occupations, although may participate on some (repetitive and simple) | |||
| More severe intellectual disability: | Delayed motor, language, and social milestones may be identifiable within the first 2 years of life | ||||||
| Mild Levels Intellectual disability | may not be identifiable until school age when difficulty with academic learning becomes apparent | ||||||
| ID DEVELOPMENT AND COURSE | ● May be co-existing with other disorders or syndromes | ||||||
| SPECIFIC LEARNING DISORDER Under Neurodevelopmental Disorders | ○ In DSM-5, along with ASD, ADHD and such | ||||||
| SPECIFIC LEARNING DISORDER | ● Specific deficits in an individual’s ability to perceive or process information efficiently and accurately ● first manifests during the years of formal schooling ● Persistent and impairing difficulties with learning foundational | academic skills in reading, writing, and/or math ● May occur in individuals identified as intellectually gifted ● Impairments in activities dependent on the skills, including occupational performance | |||||
| IMPAIRMENT IN READING | ● Specify if with word reading accuracy (understanding sounds/letters), reading rate or fluency, reading comprehension ● Previously known as dyslexia | ||||||
| DSM 5: | now known as SLD with impairment in reading | ||||||
| IMPAIRMENT IN WRITTEN EXPRESSION | ● Specify if with spelling accuracy, grammar and punctuation accuracy, clarity or organization of written expression ● Previously known as dysgraphia | ||||||
| IMPAIRMENT IN MATHEMATICS | ● Specify if with number sense, memorization of arithmetic facts, accurate or fluent calculation, accurate math reasoning ● Previously known as dyscalculia | ||||||
| IMPAIRMENT IN SEVERITY | ● Mild, Moderate, Severe ● No specific parameters = see how extensive the difficulties are for the kid (how many affected areas, how extensive is the participation deficit/difficulty in the context of the patient) | ||||||
| SIGNS | ● Parent or teacher ● Signs of difficulty much earlier in development s/a delays in the child’s skill development around language, attention and learning | ● Difficulties in understanding and following directions, or may have a short attention span or memory problems | |||||
| Manifested as P attention, memory, not listening (behavioral) | early years of kid with SLD | ||||||
| Signs of difficulty to integrate or process information accurately | = may look like can’t or won’t understand/remember instruction; lazy | ||||||
| ID & SLD EVALUATION; SUBJECTIVE | ● Interview, Standardized test/tools, clinical observations ● Assess all the domains in the OT practice ● Adaptive functioning ● Education ● Participation in prevocational and vocational activities | ||||||
| Education | ○ Ask where the child goes to school ○ school curriculum and approach ○ number of classmates, teacher: student to teacher ratio, environment, accommodations given, participation and academic and extracurricular activities | ||||||
| Participation in prevocational and vocational activities | ○ For older kids ○ Does the child have skills of IADLS ○ Does the child know how to manage finances? ○ Does the child help in the house? ○ Strengths and likes of the child that we can develop to strengthen for possible workplace in the future. | ||||||
| ID & SLD EVALUATION; OBJECTIVE | ● Occupations ● Motor planning ● Sensory perceptual skills ● Mental functions ● Language/communication ● FMS ● Academic skills | ● As an OT, you have to identify the client factor or performance skill deficit of the child for you to provide proper and appropriate interventions in an OT domain. ○ OTs look at occupational performance. | |||||
| Occupations | ADLs, IADLs, education, play, social participation | ||||||
| METHODS | - PDMS, BOTMP , VMI, TVPS - SENSORY PROFILE - SFA - HOME ASSESSMENT - SCHOOL ENVIRONMENT | ||||||
| PDMS, BOTMP , VMI, TVPS | ● For Motor skills, Visual perceptual skills, visual-motor integration | ||||||
| SENSORY PROFILE | ● Sensory-based ● Motor planning difficulties or sensory integration problems | ||||||
| SFA | ● Context-based assessment | ||||||
| HOME ASSESSMENT | ● Home visit | ||||||
| SCHOOL ENVIRONMENT | ● School visit ● See the environment: ● Observation | ||||||
| INTERVENTION | ● General considerations when providing interventions for ID and SLD: ○ Work with the interdisciplinary team to delineate roles and goals ○ May focus on functional skills embedded in occupations ○ May use multisensory approach | ○ Assistive technology ○ Peer-mediated learning ○ Seek / advocate for accommodations needed for school | |||||
| multisensory approach | ■ If a child is not able to understand a lesson or a concept such as reading or understanding a math concept through didactics such as teaching learning worksheets, you may highlight the use of visual, tactile, or proprioceptive/kinesthetic. | ■ Visual ■ Tactile ■ Prop/kinesthetic |
Created by:
avemaria