Download Document

Definition of Developmental Disabilities
by
The Federal Developmental Disabilities Assistance and Bill or Rights Act
of 2000 (Public Law 106-402)
A Developmental Disability is a severe, chronic disability that:
is attributable to a mental or physical impairment or combination of mental
and physical impairments;
is manifested before the person attains age 22;
is likely to continue indefinitely;
results in the substantial functional limitations in 3 or more of the
following areas of major life activity:
self-care
receptive and expressive language
learning
mobility
self-direction
capacity for independent living
economic self-sufficiency
reflects the individual’s need for a combination and sequence of special
interdisciplinary or generic services, individualized support, and other
forms of assistance that are lifelong or of extended duration and are
individually planned and coordinated.
Definition of Developmental Disabilities
by
New York State Office of Mental Retardation and Developmental Disabilities
(1999)
Developmental disabilities are a variety of conditions that become apparent during
childhood and cause mental or physical limitation.
These conditions include pervasive developmental disorders such as
autism,
cerebral palsy,
epilepsy,
mental retardation,
and
other neurological impairments”
There are many causes of developmental disabilities that can occur before,
during or after birth. Those occurring before birth include genetic problems, poor
prenatal care, or exposure of the fetus to toxins including drugs and alcohol.
Difficulties during birth, such as restricted oxygen supply to the infant, or accidents
after birth can also cause traumatic brain injury resulting in developmental
disabilities. Longer-term postnatal causes include malnutrition and social
deprivation.
DSM IV: Disorders Usually First Diagnosed in Infancy,
Childhood or Adolescence
Mental Retardation (Coded on Axis II)
Learning Disorders
Motor Skills Disorder
Communication Disorders
Pervasive Developmental Disorders
Attention-Deficit and Disruptive Behavior Disorders
Feeding and Eating Disorders of Infancy or Early Childhood
Tic Disorders
Elimination Disorders
DSM IV Diagnostic Criteria for Mental Retardation
(Coded on Axis II)
A. Significantly subaverage intellectual functioning: an IQ of approximately 70 or
below on an individually administered IQ test (for infants, a clinical judgment of
significantly subaverage intellectual functioning).
B. Concurrent deficits or impairments in present adaptive functioning (i.e., the
person's effectiveness in meeting the standards expected for his or her age by his
or her cultural group) in at least two of the following areas: communication, selfcare, home living, social/interpersonal skills, use of community resources, selfdirection, functional academic skills, work, leisure, health, and safety.
C. The onset is before age 18 years.
Code based on degree of severity reflecting level of intellectual impairment:
317 Mild Mental Retardation: IQ level 50-55 to approximately 70
318.0 Moderate Mental Retardation: IQ level 35-40 to 50-55
318.1 Severe Mental Retardation: IQ level 20-25 to 35-40
318.2 Profound Mental Retardation: IQ level below 20 or 25 319 Mental
Retardation, Severity Unspecified: when there is strong presumption of Mental
Retardation but the person's intelligence is untestable by standard tests
DSM IV Diagnostic criteria for Learning Disorder
When individuals demonstrate abilities below the level that would be
expected given their age and grade level in school based upon an arbitrary
gap, they may be diagnosed with this mental disorder which should be
further specified according to the particular academic function affected:

Mathematics Disorder

Reading Disorder

Disorder of Written Expression

Learning Disorder NOS
DSM IV Diagnostic criteria for Learning Disorder
Mathematics Disorder:
A. Mathematical ability, as measured by individually administered
standardized tests, is substantially below that expected given the
person's chronological age, measured intelligence, and ageappropriate education.
B. The disturbance in Criterion A significantly interferes with
academic achievement or activities of daily living that require
mathematical ability.
C. If a sensory deficit is present, the difficulties in mathematical
ability are in excess of those usually associated with it.
Coding note: If a general medical (e.g., neurological) condition or
sensory deficit is present, code the condition on Axis III.
DSM IV: Motor Skills Disorder
Developmental Coordination Disorder
When a child's motor coordination falls substantially below that which
would be expected, and this cannot be accounted for by a known physical
illness or injury, this mental disorder may be diagnosed.
A. Performance in daily activities that require motor coordination is
substantially below that expected given the person's chronological age and
measured intelligence. This may be manifested by marked delays in
achieving motor milestones (e.g., walking, crawling, sitting), dropping
things, "clumsiness," poor performance in sports, or poor handwriting.
B. The disturbance in Criterion A significantly interferes with academic
achievement or activities of daily living.
C. The disturbance is not due to a general medical condition (e.g., cerebral
palsy, hemiplegia, or muscular dystrophy) and does not meet criteria for a
Pervasive Developmental Disorder.
D. If Mental Retardation is present, the motor difficulties are in excess of
those usually associated with it.
Coding note: If a general medical (e.g., neurological) condition or sensory
deficit is present, code the condition on Axis III.
DSM IV Diagnostic Criteria for Communication Disorders
These mental disorders of childhood affect listening, language and speech.
These include the following specific disorders:
Expressive Language Disorder
Mixed Receptive-Expressive Language Disorder
Phonological Disorder
Stuttering
Communication Disorder NOS
DSM IV Diagnostic Criteria for Communication Disorders
Expressive Language Disorder:
A.
The scores obtained from standardized individually administered measures
of expressive language development are substantially below those obtained
from standardized measures of both nonverbal intellectual capacity and
receptive language development. The disturbance may be manifest clinically
by symptoms that include having a markedly limited vocabulary, making
errors in tense, or having difficulty recalling words or producing sentences
with developmentally appropriate length or complexity.
B. The difficulties with expressive language interfere with academic or
occupational achievement or with social communication.
C. Criteria are not met for Mixed Receptive-Expressive Language Disorder or a
Pervasive Developmental Disorders.
D. If Mental Retardation, a speech-motor or sensory deficit, or environmental
deprivation is present, the language difficulties are in excess of those
usually associated with these problems.
Coding note: If a speech-motor or sensory deficit or a neurological condition is
present, code the condition on Axis III.
DSM IV Diagnostic Criteria for Pervasive Developmental Disorders
Severe impairment pervades broad areas of social and psychological
development in children with these mental disorders .
These include the following specific disorders:
Autistic Disorder
Asperger’s Disorder
Childhood Disintegrative Disorder
Rett’s Disorder
Pervasive Developmental Disorder NOS
DSM IV Diagnostic Criteria for Pervasive Developmental Disorders
Autistic Disorder :
In children with this Pervasive Developmental Disorder there is substantial
delay in communication and social interaction associated with development
of "restricted, repetitive and stereotyped" behavior, interests, and activities.
A. A total of six (or more) items from (1), (2), and (3), with at least two from
(1), and one each from (2) and (3):
(1) qualitative impairment in social interaction, as manifested by at least two
of the following:
(a) marked impairment in the use of multiple nonverbal behaviors such as
eye-to-eye gaze, facial expression, body postures, and gestures to regulate
social interaction
(b) failure to develop peer relationships appropriate to developmental level
(c) a lack of spontaneous seeking to share enjoyment, interests, or
achievements with other people (e.g., by a lack of showing, bringing, or
pointing out objects of interest)
(d) lack of social or emotional reciprocity
DSM IV Diagnostic Criteria for Pervasive Developmental Disorders
Autistic Disorder :
(2) qualitative impairments in communication as manifested by at least one
of the following:
(a) delay in, or total lack of, the development of spoken language
(not accompanied by an attempt to compensate through alternative modes
of communication such as gesture or mime)
(b) in individuals with adequate speech, marked impairment in the
ability to initiate or sustain a conversation with others
(c) stereotyped and repetitive use of language or idiosyncratic
language
(d) lack of varied, spontaneous make-believe play or social imitative
play appropriate to developmental level
DSM IV Diagnostic Criteria for Pervasive Developmental Disorders
Autistic Disorder :
(3) restricted repetitive and stereotyped patterns of behavior, interests, and
activities, as manifested by at least one of the following:
(a) encompassing preoccupation with one or more stereotyped and
restricted patterns of interest that is abnormal either in intensity or focus
(b) apparently inflexible adherence to specific, nonfunctional
routines or rituals
(c) stereotyped and repetitive motor mannerisms (e.g., hand or
finger flapping or twisting, or complex whole-body movements)
(d) persistent preoccupation with parts of objects
B. Delays or abnormal functioning in at least one of the following areas, with
onset prior to age 3 years:
(1) social interaction,
(2) language as used in social communication, or
(3) symbolic or imaginative play.
C. The disturbance is not better accounted for by Rett's Disorder or
Childhood Disintegrative Disorder.
DSM IV Diagnostic Criteria for Pervasive Developmental Disorders
Asperger’s Disorder :
In children with this pervasive developmental disorder language, curiosity,
and cognitive development proceed normally while there is substantial delay
in social interaction and "development of restricted, repetitive patterns of
behavior, interests, and activities."
A. Qualitative impairment in social interaction, as manifested by at least two
of the following:
(1) marked impairment in the use of multiple nonverbal behaviors
such as eye-to-eye gaze, facial expression, body postures, and gestures to
regulate social interaction
(2) failure to develop peer relationships appropriate to
developmental level
(3) a lack of spontaneous seeking to share enjoyment, interests, or
achievements with other people (e.g., by a lack of showing, bringing, or
pointing out objects of interest to other people)
(4) lack of social or emotional reciprocity
DSM IV Diagnostic Criteria for Pervasive Developmental Disorders
Asperger’s Disorder :
B. Restricted repetitive and stereotyped patterns of behavior, interests, and
activities, as manifested by at least one of the following:
(1) encompassing preoccupation with one or more stereotyped and
restricted patterns of interest that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional
routines or rituals
(3) stereotyped and repetitive motor mannerisms (e.g., hand or
finger flapping or twisting, or complex whole-body movements)
(4) persistent preoccupation with parts of objects
DSM IV Diagnostic Criteria for Pervasive Developmental Disorders
Asperger’s Disorder :
C. The disturbance causes clinically significant impairment in social,
occupational, or other important areas of functioning.
D. There is no clinically significant general delay in language (e.g., single
words used by age 2 years, communicative phrases used by age 3 years).
E. There is no clinically significant delay in cognitive development or in the
development of age-appropriate self-help skills, adaptive behavior (other
than in social interaction), and curiosity about the environment in
childhood.
F. Criteria are not met for another specific Pervasive Developmental Disorder
or Schizophrenia
DSM IV Diagnostic Criteria for Attention-Deficit and Disruptive
Behavior Disorders
Attention-Deficit/Hyperactivity Disorder
Combined type
Predominantly Inattentive Type
Predominantly Hyperactive-Impulsive Type
Attention-Deficit/Hyperactivity Disorder NOS
Conduct Disorder
Oppositional Defiant Disorder
Disruptive Behavior Disorder
DSM IV Diagnostic Criteria for Attention-Deficit and Disruptive
Behavior Disorders
A. Either (1) or (2):
(1) inattention: six (or more) of the following symptoms of inattention have
persisted for at least 6 months to a degree that is maladaptive and
inconsistent with developmental level:
(a) often fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities
(b) often has difficulty sustaining attention in tasks or play
activities
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to
finish school work, chores, or duties in the workplace (not due to
oppositional behavior or failure to understand instructions)
(e) often has difficulty organizing tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that
require sustained mental effort (such as schoolwork or homework)
(g) often loses things necessary for tasks or activities (e.g., toys,
school assignments, pencils, books, or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities
DSM IV Diagnostic Criteria for Attention-Deficit and Disruptive
Behavior Disorders
(2) hyperactivity-impulsivity: six (or more) of the following
symptoms of hyperactivity-impulsivity have persisted for at least 6
months to a degree that is maladaptive and inconsistent with
developmental level:
Hyperactivity
(a) often fidgets with hands or feet or squirms in seat
(b) often leaves seat in classroom or in other situations in
which remaining seated is expected
(c) often runs about or climbs excessively in situations in
which it is inappropriate (in adolescents or adults, may be limited
to subjective feelings of restlessness)
(d) often has difficulty playing or engaging in leisure
activities quietly
(e) is often "on the go" or often acts as if "driven by a
motor"
(f) often talks excessively
DSM IV Diagnostic Criteria for Attention-Deficit and Disruptive
Behavior Disorders
Impulsivity
(g) often blurts out answers before questions have been
completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g., butts into
conversations or games)
B. Some hyperactive-impulsive or inattentive symptoms that caused
impairment were present before age 7 years.
C. Some impairment from the symptoms is present in two or more settings
(e.g., at school [or work] and at home).
D. There must be clear evidence of clinically significant impairment in
social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of a
Pervasive Developmental Disorder, Schizophrenia, or other Psychotic
Disorder and are not better accounted for by another mental disorder (e.g.,
Mood Disorder, Anxiety Disorder, Dissociative Disorders, or a Personality
Disorder).
DSM IV Diagnostic Criteria for Feeding and Eating
Disorders of Infancy or Early Childhood
A. Feeding disturbance as manifested by persistent
failure to eat adequately with significant failure to gain
weight or significant loss of weight over at least 1
month.
B. The disturbance is not due to an associated
gastrointestinal or other general medical condition (e.g.,
esophageal reflux).
C. The disturbance is not better accounted for by
another mental disorder (e.g., Rumination Disorder) or
by lack of available food.
D. The onset is before age 6 years.
DSM IV Diagnostic Criteria for Feeding and Eating
Disorders of Infancy or Early Childhood
Pica
Rumination Disorder
Feeding Disorder of Infancy or Early childhood
DSM IV Diagnostic Criteria Tic Disorders
Tourette’s Disorder
Chronic Motor or Vocal Tic Disorder
Transient Tic Disorder
Tic Disorder NOS
DSM IV Diagnostic Criteria for Tic Disorders
Tourette's Disorder
A. Both multiple motor and one or more vocal tics have been
present at some time during the illness, although not
necessarily concurrently. (A tic is a sudden, rapid, recurrent,
nonrhythmic, stereotyped motor movement or vocalization.)
B. The tics occur many times a day (usually in bouts) nearly
every day or intermittently throughout a period of more than 1
year, and during this period there was never a tic-free period
of more than 3 consecutive months.
C. The onset is before age 18 years.
D. The disturbance is not due to the direct physiological
effects of a substance (e.g., stimulants) or a general medical
condition (e.g., Huntington's disease or postviral
encephalitis).
DSM IV Diagnostic Criteria for Elimination Disorders
Encopresis
With Constipation and Overflow
Incontinence
Without Constipation and Overflow
Incontinence
Enuresis
DSM IV Diagnostic Criteria for Other Disorders of Infancy,
Childhood or Adolescence
•Other Disorders of Infancy, Childhood, or
Adolescence:
•Selective Mutism
• Separation Anxiety Disorder
• Reactive Attachment Disorder of Infancy or
Early Childhood
• Stereotypic Movement Disorder
• Disorder of Infancy, Childhood, or
Adolescence NOS
Early Optimism and Over-promise
(1836-1850)
A report made by the British Government in 1858 concluded the following:
1. Guggenbuhl was guilty of deceiving people by calling his establishment KretinenHeilanstalt (treatment center for cretins), since at most one third of the inmates were
cretins. The report went as far as to accuse Guggenbuhl of "smuggling in" normal
children to present as cured.
2. Normal children were kept from attending the public schools by housing them at
Abendberg.
3. Not a single cretin had ever been cured.
4. There was no medical supervision. The director was away from four to six months
each year and made no provisions for a substitute.
5. While at first well-trained instructors had been employed, Abendberg had been
without a teacher for several years.
6. Heating facilities, nutrition, water supply, ventilation in dormitories, and clothing
were inadequate.
7. The director never kept records of the munificent donations received.
8. No records were kept about the patients' progress.
Realistic Optimism of Dr. Samuel Howe
(1850-1870)
In 1846 Howe convinced the Massachusetts legislature to allocate $2500/year
for the teaching and training of ten retarded children.
After a successful experimental period, and institution was incorporated in
1848 under the name “Massachusetts School for Idiotic and Feeble-Minded
Youth”. It is now known as the Walter E. Fernald State School.
Howe can be considered the father of institutional care in the US and the
one who advocated most explicitly that acting upon the problem of mental
retardation was a public responsibility.
Howe’s efforts were followed by the establishment of additional training
schools throughout the US through the 1870s
Difficulties in Coping with Urban Life
and the Shift to Custodial Care
(1870-1890)
Quotes from documents Cited by Wolfensberger, W. (1969). The origin and
nature of our institutional models. In Robert Kugel & Wolf Wolfensberer (Eds.) Changing
patterns in residential services for the mentally retarded. Washington, D.C.: President’s
Committee on Mental Retardation.
“Give them an asylum with good and kind treatment; but not a
school.”
“A well-fed, well-cared-for idiot, is a happy creature. An idiot
awakened to his condition is a miserab le one.”
“They must be kept quietly, safely, away from the world; living
like the angels in heaven, neither marrying nor given in
marriage.”
Difficulties in Coping with Urban Life
and the Shift to Custodial Care
(1870-1890)
Dangerous Trends in Institutional Development
Isolation: Protection of the deviant from the non-deviant
Institutions were removed from population centers to pastoral
surroundings described in idyllic terms, eg. “Garden of Eden”,
“happy farm”
Enlargement: Benefits the retardates by congregating large
numbers so that the could “be among their own type.”
Economization: Began with noble sentiment about the virtue of
work for the retarded, but gave way to the view that they should be
working to diminish the economic burden on the public.
Social Darwinism and the eugenic alarm
(1890-1914)
H. H. Goddard's 1912 report of the Kallikak family
Martin Kallikak, a soldier of the Revolution, produced an illegitimate son with a
retarded tavern girl. This son turned out to be retarded, too, and went on to produce
a line of
prostitutes,
alcoholics,
epileptics,
criminals,
pimps,
retardates,
and infant casualties.
Martin himself went on to marry a respectable woman of a good family and left
progeny all of which were representative of the most respectable citizens
Social Darwinism and the eugenic alarm
(1840-1914)
H. H. Goddard's 1912 report of the Edward’s family
Jonathan Edward's family was contrasted to the Jukes and the Kallikaks, since he left
285 college graduates,
of whom 65 became college professors,
13 college presidents,
more than 100 lawyers, and
30 judges
Social Darwinism and the eugenic alarm
(1840-1914)
Three main alternatives for “purging from the blood of
the race innately defective strains:



Marriage laws
Sterilization
Segregation
Slow development of community
alternatives: Post-World-War I to 1950
Specialized training through public schools
Heavy emphasis on community integration and supervision
Colony plan –prototypes of half-way houses and sheltered workshops
Beginnings of government support for families
Parole plan: retarded people were permitted to live in the community under the
supervision of a social worker who took a personal interest in integrating them into the
community
Renewed Enthusiasm:
1950 – Present
National Association for Retarded Children: Advocacy group wielded great influence
at local and national levels
Medical advances aiding survival of babies with biological defects
Local groups of parents developed community-based alternative services
1961: President Kennedy appointed panel to review conditions for retarded and
presented: “A Proposed Program for National Action to Combat Mental Retardation
Landmark legislation: Maternal and Child Health and Mental Retardation Planning
Ammendments Act (1963)
Application of behavior analysis to overcome learning and behavior problems
experienced by people with developmental disabilities
Provisions of the Willowbrook Consent Decree
Designating steps, standards and procedures to protect residents from abuses such a/J
seclusion, corporal punishment, degradation, medical experimentation, and routine use of
restraints.
Six scheduled hours of program activity each weekday for all residents.
Educational programs for residents including provision for the specialized needs of
the blind, deaf and multi-handicapped.
Well-balanced nutritionally adequate diets.
Dental services for all.
No more than eight residents living or sleeping in a unit.
A minimum of two hours of daily recreational activities-indoors and out-and
availability of toys, books, and other materials
Provisions of the Willowbrook Consent Decree
Eyeglasses, hearing aids, wheelchairs and other adaptive equipment where needed. ).
Adequate and appropriate clothing.
Physicians on duty 24 hours daily for emergency cases.
A contract with one or more accredited hospitals for acute medical care.
A full-scale immunization program for all residents within three months.
Compensation for voluntary labor in accordance with applicable minimum wage laws.
;..
Correction of health and safety hazards, including covering radiators and team
pipes to protect residents from injury, repairing broken windows, and removing cockroaches
and other insects and vermin.
Developmentally Disabled Assistance
and Bill of Rights Act
(1975)
I. Persons with developmental disabilities have a right to appropriate treatment, services and
habilitation for such disabilities.
II. The Federal Government and the States both have an obligation to assure that public funds are
not provided to any institutional or other residential programs for persons with developmental
disabilities that—
A. Does not provide treatment services, and habilitation which is appropriate to the
needs to such persons or
B. Does not meet the following minimum standards:
1. Provision of a nourishing, well-balanced daily diet to the persons with developmental disabilities
served by the program
2. Provision to such persons of appropriate and sufficient medical and dental services
3. Prohibition of the use of physical restraint on such persons unless absolutely necessary and
prohibition of the use of such restraint a punishment or a s a substitute for a habilitation
program
4. Prohibition on the excessive use of chemical restraints on such persons and the use of such
restraints as punishment or as a substitute for a habilitation program or in quantities that
interfere with services, treatment, or habilitation for such persons.
5.Permission for close relatives of such persons to visit them at reasonable hours without prior
notice
6. Compliance with adequate fire and safety standards as may be promulgated by the Secretary of
Health, Education, & Welfare.
Americans with Disabilities Act
1990 (Public Law 101-336)
Purposes:
I. to provide a clear and comprehensive national mandate for the elimination of discrimination
against individuals with disabilities;
II to provide clear, strong, consistent enforceable standards addressing discrimination
against individuals with disabilities;
III. to ensure that the Federal Government plays a central role in enforcing the standards
established in this Act on behalf of individuals with disabilities;
IV. to invoke the sweep of congressional authority, including the power to enforce the
Fourteenth Amendment and to regulate commerce, in order to address the major areas of
discrimination faced day to day by people with disabilities
Reasons fro the ebb and flow of mental health ideology
Caplan (1969)
Acceptance of ideas has little to do with their intrinsic value. Community-oriented reforms did not
succeed in the past for the following reasons:
1. A shortage of manpower to implement programs, which in part
reflects inadequate training facilities.
2. A shortage of resources associated with the low priority accorded
the mentally ill by the public and their legislators.
3. Theories concerning the etiology and treatment of mental disorder favored exciting
new ideas and fads. At the turn of the century, the intellectual and scientific community
was buzzing with new ideas in neuropathology and psychoanalysis. Optimistic treatment
modalities linking patients back to their home communities were considered unrealistic
and "old-fashioned.“
4. The naivete and lack of understanding of psychiatrists about problems of community
dynamics that complicated the implementation of their programs. Theories of psychic
functioning cannot be formulated in a vacuum. Factors in the social, political, economic,
and scientific milieu affect the manner in which theories are developed as well as the
success of their implementation.
Reasons fro the ebb and flow of mental health ideology
Caplan (1969)
Acceptance of ideas has little to do with their intrinsic value. Community-oriented reforms did not
succeed in the past for the following reasons:
5. The tendency of psychiatrists to embrace panaceas and to hail each change as
the solution to all difficulties. The system was oversold to the public and to
fellow professionals. When shortcomings were revealed, there was a pendulum
swing in the opposite direction with the entire system being jettisoned.
6. When public complaints about the failure of optimistic promises
started to surface, psychiatrists tended to deal with such outside pressure by
evasion rather than by direct confrontation. Psychiatrists retreated into their
professional guild and lost touch with the realities of community life.
7. Faddish theories were entirely untested. By the time the shortcomings of
expensive plans had been realized, so much propaganda and money had been
spent that it was difficult to abandon or replace them.