6/12- Cognitive Development

Question 1

Current views on intelligence:

• Multifaceted and ______ organized
• Some ______ impacts global functioning on cognitive tasks as well as special abilities
• A person’s __ is a general estimate of the sum of many different abilities

Answer 1

Current views on intelligence:

• Multifaceted and hierarchically organized
• Some general factor (g) impacts global functioning on cognitive tasks as well as special abilities
• A person’s IQ is a general estimate of the sum of many different abilities

Question 2

T/F: the max IQ score is 100

Answer 2

False; 100 is the average IQ

Question 3

Normal curve characteristics:

__% of population with scores within __ standard deviations of the mean ()

__ of the population have IQ scores within 1 SD of the mean ()

Answer 3

Normal curve characteristics:

• 95% of population with scores withNextin 2 standard deviations of the mean (70-130)
• 2/3 of the population have IQ scores within 1 SD of the mean (85-115)

Question 4

What is intellectual giftedness (“superior” range)?

Answer 4

Starts 2 SDs above the mean (> 130)

(Mental retardation less than 2 SDs below)

Question 5

What is the Flynn Effect?

Answer 5

• When a new version of an IQ test is normed, the standard scoring is set so that performance at the population median results in a score of IQ 100
• If test-takers are scored by a constant standard scoring rule, IQ test scores have been rising at an average rate of around three IQ points per decade.

Question 6

What are the Wechsler Scales?

Answer 6

Question 7

What are some nonverbal measures?

Answer 7

Wechsler Nonverbal Scale of Ability (WNV)

• Ages 4 yrs - 21 yrs 11 mo

Test of nonverbal intelligence- 3rd ed

• Ages 5-85

Universal Nonverbal Intelligence Test (UNIT)

• Ages 5 - 17 rs 11 mo

Question 8

Additional Assessments

Answer 8

Question 9

What is Stanford-Binet Intelligence Scale good for?

Answer 9

• Ages 2-5
• Good for assessing low end and very high end of intellectual functioning range

Question 10

What is Woodcock-Johnson II tests of Cognitive used for?

Answer 10

• Ages 2-90+
• Used most often by school districts

Question 11

What is Kaufman Brief Intelligence Test used for?

Answer 11

• Ages 4-90
• A quick measure of verbal and nonverbal intelligence

Question 12

What are the Differential Ability Scales used for?

Answer 12

• Ages 2.5 yrs - 17 yrs 11 mo
• More culturally unbiased measure
• Good for assessing African American, Asian, Hispanic, and non-White/Non-Hispanic children equally

Question 13

What are causes/risk factors for mental retardation/intellectual disability: Biomedical?

Answer 13

Bomedical:

- Chromosomal/genetic disorders: Down’s, William’s, Fragile X, Prader-WIlli

- Maternal risk factors: age, illness

- Premature birth or birth injury

- Traumatic brain injury

- Degenerative disorders

- Seizure disorders

Question 14

What are causes/risk factors for mental retardation/intellectual disability: Social?

Answer 14

Social:

- Poverty

- Domestic violence

- Lack of prenatal care

- Traumatic exposure: neglect, poverty, impaired caregivers

Question 15

What are causes/risk factors for mental retardation/intellectual disability: Behavioral?

Answer 15

Behavioral:

- Parental drug, alcohol, tobacco use

- Parental rejection or abandonment

• Trauma: abuse, neglect, domestic violence, danger

Question 16

What are causes/risk factors for mental retardation/intellectual disability: Educational?

Answer 16

Educational:

• Parental cognitive disability
• Lack of medical referrals for intervention
• Impaired parenting
• Inadequate special education/early intervention

Question 17

Characteristics/Diagnosis of Mental Retardation/Intellectual Disability in DSM5?

Answer 17

• Deficits in intellectual functions (e.g. problem-solving, planning, learning, etc.); generally full scale IQ < 70 (not enough alone!)
• Accompanied by significant limitations in adaptive functioning in at least 2 of the adaptive skill areas
• Onset prior to age 18- must have evidence of deficits in childhood and adolescence (unless talking about a traumatic brain injury)

Question 18

What are some of the adaptive behavior skill areas (2 required with deficits in intellectual functions for Dx of intellectual disability)?

Answer 18

• Communication
• Self-care
• Home-living
• Social/interpersonal skills
• Use of community resources
• Self-direction
• Functional academic skills
• Work
• Leisure
• Health
• Safety

Question 19

Levels of severity of Mental Retardation/Intellectual Disability? How determined?

Answer 19

(formerly based on range of IQ scores)

Now by level of adaptive functioning:

• Mild
• Moderate
• Severe
• Profound

Question 20

Level of severity: Mild?

Answer 20

• There may be no obvious differences in young children
• Differences often appear in academic settings for children and teens
• May be able to have a job with special training and supervision and may be able to live partially independently

Question 21

Level of severity: Moderate?

Answer 21

• Skills lag behind same-age peers throughout development
• May need help acquiring basic skills for daily living (e.g. hygiene, safety, household chore)

– may need supervised housing

• May work in sheltered environment or with extensive support and supervision

Question 22

Level of severity: Severe?

Answer 22

• Little or no communication skills;
• Sensory impairments
• Need extensive supports throughout life in most domains

Question 23

Level of severity: Profound?

Answer 23

• Minimal functioning; limited understanding of others/world
• No independence; usually need supervision and nursing care

Question 24

How does American Association on Intellectual and Developmental Disabilities (AAIDD) classify Mental Retardation/Intellectual Disability? (and 5 assumptions)

Answer 24

Significant limitations both in intellectual functioning and adaptive behavior as expressed in conceptual, social, and practical skills which are apparent prior to the age of 18;

Definition applied within context based on 5 assumptions:

1. Limitations are considered within the context of the person’s environment and culture

2. Assessment should consider cultural and linguistic diversity as well as differences in communications, sensory, motor, and behavioral factors

3. Limitations often coexist with strengths

4. You must develop a profile of needed supports

5. With appropriate personalized supports, the functioning of the person with the intellectual disability will generally improve

Question 25

How is academic achievement affected by learning disabilities?

Answer 25

- Individual's achievement on individually administered standardized tests of academic performance are substantially **below (2 SDs)** that are expected for age, schooling, and level of intelligence - **Smaller discrepency (between 1-2 SDs) between IQ and achievement** can also be used especially if IQ performance may have been compromised by a **comorbid** disorder, medical condition, or other factor

Question 26

What are some assessments for academic achievement and learning disabilities?

Answer 26

- Woodcock-Johnson IV Tests of Achievement - Wechsler Individual Achievement Test- II ed - Wide Range Achievement Test- 4th ed

Question 27

What is the **Individuals with Disabilities Education Act (IDEA**)? Problems?

Answer 27

Federal law that requires school districts to provide a **free and appropriate education** to students with disabilities - Not based on discrepancy model of DSM - **Based on "educational need"** (School use **Response to Intervention (RTI)** method to determine if the student has received high quality instruction prior to a label of "learning disability")

Question 28

What does **Section 504 of the Rehabilitation Act** of 1973 say?

Answer 28

Specifies that **no program that receives federal money can discriminate** against a person with a disability - Requires that students have an **equal opportunity to participate** in all school activities - Some children who do not qualify for Special Education under IDEA may still receive accommodations and modifications under Section 504

Question 29

Populations encompassed by IDEA and Section 504?

Answer 29

IDEA children are a smaller subset of 504 children

Question 30

IDEA = ____ education S504 = ____ education Process (flowchart)

Answer 30

**IDEA** = **Special** education **S504** = **Regular** education

Question 31

Assessment for guiding treatment involves what categories?

Answer 31

- Medical Hx - Psychosocial Evaluation - Physical Examination - Laboratory Examination

Question 32

Coordination of care needs to involve what?

Answer 32

- Parents/guardians and extended family - Pediatricians/primary care physicians - Daycare providers/babysitters/teachers - Mental health professionals - Community supports (church, neighbors, after-school programs, etc.)

Question 33

DDx for mental retardation/intellectual disability?

Answer 33

- Autism/Pervasive Developmental Disorders - Communication disorders - Attention-Deficit/Hyperactivity Disorders - Trauma Related Disorders - Sensory deficits - Hearing and vision impairments - Physical mobility limitations - Environmental deprivation

Question 34

Characteristics of Autism/Pervasive Developmental Disorders?

Answer 34

**Autism/Pervasive Developmental Disorders** (Old name = Asperger's) - May have intellectual and cognitive deficits too - Language delays - Social delays/impairments (poor eye contact, few or no friendships) - Fixed/perseverative interests - Stereotyped behaviors and motor movements - Sensory sensitivities - Emotional understanding of self and others - Ruled-out through comprehensive history and evaluation of adaptive and developmental functioning

Question 35

Characteristics of Communication Disorders?

Answer 35

- Delays restricted to expressive and/or receptive language - Ruled out through testing (speech/language pathologists; psychologists- use of nonverbal IQ measures)

Question 36

Characteristics of Attention-Deficit/Hyperactivity Disorders?

Answer 36

- Often comorbid with learning disabilities - Age inappropriate problems with attention, impulsivity, hyperactivity - Often have problems with peers and adults - May seem to lack common sense and good problem-solving/decision-making skills - Comprehensive evaluation needed to rule-out medical causes and better evaluate cognitive abilities

Question 37

Characteristics of Trauma-Related Disorders?

Answer 37

- Fear and worry about the safety of self, family, friends - Anxiety related to future possible trauma - Increased activity level - Decreased concentration and attention - Increased irritability - Changes in sleep or appetite - Withdrawal - Angry outbursts - Aggression - Aches and pains - Decline in grades - Problems with peers - Substance abuse, dangerous behaviors, unhealthy sexual behaviors **TRAUMA HAS A HUGE IMPACT!!!**

Question 38

**Case: Jose, 8 yo Hispanic male** - CC: referred for psychological testing by his therapist to aid in diagnostic clarification - Mother had concerns about academic performance - **Developmental** Hx: exposed to drugs and alcohol in utero, hx of neglect and physical abuse by biological mother, CPS custody at age 3, adopted at 4 - Speech and motor delayed at time of placement, but rapid improvements with services through ECl-- all within expected range by age 5 - No significant Hx of illness, LOC, etc. - **Social/emotional** Hx: easily frustrated, threatened his mother with a knife last year and was briefly hospitalized, Hx of nightmares (decreased over past 3 yrs), seen weekly in outpt therapy, previously Dx'd with PTSD and Oppositional Defiant Disorder - **Educational**: Hx of aggression during kindergarten towards other students, always an A/B student; performs better in smaller classroom - **Medical**: no current health concerns per pediatrician What Psychological/cognitive tests can be done? **Results: Individual Achievement Tests** - Reading: 37% - Math: 615 - Written language: 70% - Oral language: 94% **- Total Composite: 66%** **Results: Intelligence Scale for Children:** - Verbal comprehension: 50% - Perceptual reasoning: 66% - Working memory: 47% - Processing Speed: 79% **- Full Scale: 66%** **_Diagnosis?_** **_Recommendations?_**

Answer 38

IQ test (WISC-IV) Academic achievement (WIAT-II) **Emotional functioning:** - General behavioral/emotional screeners ----Achenbach Child Behavior Checklist (CBCL) and Teach Report Form (TRF) ---- Beck Youth Inventories: depression, anxiety, anger, disruptive behavior, self-esteem - Continuous Performance Test (children) - Trauma Symptom Checklist for Children **Diagnosis: Depressive Disorder; Not Otherwise Specified** **Recommendations:** - Continue individual and family therapy - Work w/ a child psychiatrist regarding possible medication options - School evaluation to determine if he meets criteria for Special Education under the Emotional Disturbance label

Question 39

**Case: John, 4 yo Caucasian male** - Referred by family doctor - Kicked out of preschool due to aggression - Cannot identify colors, letters, or numbers (a little concerning, but not awful for this age) - Calls people by the wrong name - **Developmental** Hx: pre-term labor during 4th mo of gestation, carried to full-term with steroid tx, fine motor and toileting delays - **Emotional/social** hx: aggression towards siblings and peers, easily upset and difficult to soothe, Hx of flapping, spinning, poor eye contact, preservative interests - **Medical** Hx: good health, Hx of sleep disturbance and some tremors in hands- sleep study found no clinical result; examiner noted possible muscle weakness in R side of face **- Psychological/cognitive**: IQ test (WPPSI-III), Adaptive Behaviors (ABAS-II), General Behavior/emotional screener (CBCL), Autism-specific screens (ASDS, CARS2) **Results: IQ Test** - Verbal: 4% - Performance: 0.2% - Processing Speed: 5% - **Full Scale IQ: 2% (68 composite)** **Results: Adaptive Behavior Assessment:** composite: 0.2% **Diagnosis?** **Recommendations?**

Answer 39

**Diagnosis: Autistic Disorder; Mild Mental Retardation** - Had markers of autism as well as impaired intellectual functioning (so **both** diagnoses) **Recommendation:** - Further medical evaluation regarding possible neurological concerns - Autism-specific supports for family - Evaluation by school for PPCD program - Occupational therapy - Individual and family therapy - Re-evaluation of functioning in 1-2 yrs

Question 40

**Case: Beth, 17 yo African American female** - Referred for testing by psychiatrist and parents to aid in determining current level of functioning - Previously diagnosed with ADHD and has been treated with Vyvanse - Parents concerned about her apparent lack of age-typical social interactions and cognitive functioning; concerned about her ability to go to college - Developmental Hx: pregnancy and delivery without complication, good attachment with parents, devo milestone all within normal limits, no significant medical Hx - School/education: 12th grade, receives accommodations based on previous ADHD diagnosis, involved in extracurricular activities - **Social/emotional** Hx; parents perceive her as emotionally immature and socially isolated (does not ask to go out on weekends); Beth says she has friends and communicates mostly online and through texting, generally positive mood, no behavior problems, no sleep or appetite problems, no trauma history - **Medical** Hx: in good health per recent physical exam from pediatrician - **Psychological/Cognitive**: (picture) Results**: Adult Intelligence composite** = 14% Results**: Woodcock-Johnson Test of Achievement total** = 7% **Diagnosis?** **Intervention?**

Answer 40

**Diagnosis:** **- Mathematics Disorder** (no evidence of ADHD present) **Recommendations:** - Educational modifications and accommodations for mathematics disability - Assistance from school in determining appropriate options for secondary education and/or vocational training - Family therapy to work on communication difficulties between Beth and her parents