- attributable to intellectual and/or physical impairment
- manifested before 18
- likely to continue
- needs special interdisciplinary care for extended duration
sever, chronic disability
*must result in 3 or more functional limitations (self-care, language, learning, mobility, self-direction)
what is replacing the term mental retardation?
intellectual disability
*signifiantly subaverage general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects child’s educational performance
what is the incidence of intellectual disability?
3% of US pop
(6-7 million ppl)
1-10 american families directly affected by it
what is the most common cause of intellectual disabilies?
- genetic conditions leading cause
- inborn error of metabolism
- prenatal influence (drugs)
- perinatal (prematurity)
- postnatal (poverty, toxins, trauma, culture deprivation)
- malnutrition
is ID a disease?
no it is a CNS disorder
-usually occurs with other abnormalities: epilepsy, cerebral palsy, craniofacial deformities, emotional and psychiatric problems, congenital heart disease, neuromuscular disorders
what are the general characteristics of ID?
- most are mild and function academically at the 6th grade level
- Mild ID can live in a community with minimal support
- not associated with shortened life span
- higher rates of seizure disorders, GI complicaitons, and respiratory diseases
comprehensive standardized assessment of adaptive behavior that is designed for ppl from 4 to 21 years old that is a precise diagnostic info around the cutoff point where an individual is deemed to have “significant limitations” in adaptive behavior
diagnostic adaptive behavior scale
*presence of such limitations is one of the measures of intellectual disability
what are the 3 domains of adaptive behavior scale?
- conceptual skills: literacy, self-direction, numbers, money
- social skills: self-esteem, gullibility, rules
- practical skills: activities of daily living, occupation
what is down syndrome?
- 47 chromosomes instead of 46
- extra partial or complete 21rst chromosome
- common identifiable cause of intellectual disability
what is the incidence of down syndrome?
- 3%
- risk inc with maternal age
- -.9/1000 if mom less than 33
- -38/1000 if mom greater than 44
how do you dx downs syndrome?
- prenatal test/amniocentesis
- physical exam
- chromosomal studies
what are some characteristic physical features of dow syndrome?
- obesity
- short stature
- hypotonia
- intellectual deficiency
- palmonplanar, keratosis, xerosis
- short broad hands
- inc GI issues
- celiac disease
- immunodeficiency
disease often found in down syndrome, represents a traumatic granuloma of anterior ventral tongue associated with natal and neonatal teeth
-is a red and white, deep, irregular ulcer, may have soft tissue enlargement, (heal in 7-14 days)
riga-fede disease
what is the tx of rida-fede disease?
ID cause, modify feeding position and device, smooth incisal surface, extract teeth, CHX rinse
what are some of the more common down syndrome dental conditions?
- gingivitis
- delayed eruption
- crowding
- transposition of canine and premolar
- enamel hypoplasia
- candidiasis
- sleep apnea
what are some medical considerations with down syndrome?
- higher incidence of congenital heart disease (VSD)
- upper respiratory infections, asthma, pneumonia
- acute leukemia
- diabetes and thyroid disease
what issue with the vertebrae is common for down syndrome pts?
atlantoaxial instability
if a down syndrome pt has hx of congential heart disease with or without surgery you should?
consult with cardiologist need for AHA infective endocarditis antibiotic prophylaxis
if a down syndrome pt has atlantoaxial instability you should?
consult with pediatrician to avoid risk of subluxation and cervical spine injury
if a down syndrome pt is at high risk for sedation complications it is most likely becasue….?
obesity, sleep apnea, and large tongue
*GA may be better option for comprehensive care
