The Handbook of Intellectual Disability and Clinical Psychology Practice

Alan Carr, Christine Linehan, Gary O'Reilly, Patricia Noonan Walsh, John McEvoy, Alan Carr, Christine Linehan, Gary O'Reilly, Patricia Noonan Walsh, John McEvoy

• Publisher: Routledge
• Year: 2016
• eBook ISBN: 9781317576075
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

The Handbook of Intellectual Disability and Clinical Psychology Practice will equip clinical psychologists in training with the skills necessary to complete a clinical placement in the field of intellectual disability. Building on the success of the previous edition this handbook has been extensively revised. Throughout, the text, references, and website addresses and have been updated to reflect important developments since the publication the first edition. Recent research findings on the epidemiology, aetiology, course, outcome, assessment and treatment of all psychological problems considered in the book have been incorporated into the text. Account has been taken of changes in the diagnosis and classification of intellectual disability and psychological problems reflected in the AAIDD-11 and the DSM-5. New chapters on the assessment of adaptive behaviour and support needs, person-centred active support, and the assessment of dementia in people with intellectual disability have been added.

The book is divided into eight sections:

Section 1: Covers general conceptual frameworks for practice - diagnosis, classification, epidemiology and lifespan development.

Section 2: Focuses on assessment of intelligence, adaptive behaviour, support needs, quality of life, and the processes of interviewing and report writing.

Section 3: Covers intervention frameworks, specifically active support, applied behavioural analysis and cognitive behaviour therapy.

Section 4: Deals with supporting families of children with intellectual disability, genetic syndromes and autism spectrum disorders.

Section 5: Covers issues associated with intellectual disability first evident or prevalent in middle childhood.

Section 6: Deals with adolescent concerns including life skills training, relationships and sexuality.

Section 7: Focuses on residential, vocational and family-related challenges of adulthood and aging.

Section 8: Deals with professional issues and risk assessment.

Chapters cover theoretical and empirical issues on the one hand and practice issues on the other. They close with summaries and suggestions for further reading for practitioners and families containing a member with an intellectual disability. Where appropriate, in many chapters, practice exercises to aid skills development have been included.

The second edition of the Handbook of Intellectual Disability and Clinical Psychology Practice is one of a set of three volumes which cover the lion's share of the curriculum for clinical psychologists in training in the UK and Ireland. The other two volumes are the Handbook of Child and Adolescent Clinical Psychology, Third Edition (by Alan Carr) and the Handbook of Adult Clinical Psychology Practice, Second Edition (edited by Alan Carr & Muireann McNulty).

Section 1

Conceptual frameworks

Chapter 1

Diagnosis, classification and epidemiology

Alan Carr and Gary O’Reilly

Infants and children who show apparent developmental delays in achieving milestones such as those in Table 1.1 may be referred to clinical psychologists for assessment (Emerson et al., 2012). The main questions usually centre on whether the child’s developmental delay is significant, the degree and range of disabilities, and the child’s special educational and social needs. Later in childhood, adolescence and adulthood, referrals may be made to re-evaluate the nature and extent of such disabilities; the changing educational, vocational and social needs of the individual; and the requirement for appropriate supports and interventions. To address these sorts of clinical questions for individual cases, knowledge of the definitions, classification, course and outcome of intellectual disability is essential. To plan services for whole populations of people with intellectual disability, it is helpful to know the prevalence of intellectual disability, patterns of comorbidity, their course and outcome. In this chapter the diagnosis, classification, epidemiology, course and outcome of intellectual disability will be considered. Differential diagnosis in the field of intellectual disability will also be addressed. Throughout the chapter the term ‘intellectual disability’ will be used to refer to what was called ‘mental retardation’ in parts of the US, ‘learning difficulties’ in the UK, and ‘mental handicap’ in parts of Ireland and elsewhere. A discussion of the evolution of the term ‘intellectual disability’ is given in Schalock et al. (2007).

Definition

Three definitions of intellectual disability are given in Table 1.2 on page 6. These are taken from three widely used classification systems: ICD-10, DSM-5 and AAIDD-11. ICD-10 is the tenth edition of the World Health Organization’s International Classification of Diseases (WHO, 1992, 1993, 1996). Chapter V of ICD-10 covers the classification of mental and behavioural disorders, including mental retardation, the term used in ICD-10 for intellectual disability. DSM-5 is the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (APA, 2013). AAIDD-11 is the eleventh edition of the American Association on Intellectual and Developmental Disabilities manual, Intellectual Disability: Definition, Classification, and Systems of Supports (AAIDD, 2010). Also included in Table 1.2 in the column summarizing the ICD-10 definition of intellectual disability is reference to the disability model described in ICF. ICF is the World Health Organization’s International Classification of Functioning, Disability and Health (WHO, 2001). This is included in the table under ICD-10 because it is the model used by WHO to conceptualize disability arising from ICD-10 diagnoses including intellectual disability. The ICF model of intellectual disability is presented diagrammatically in Figure 1.1 on page 8. A diagram of the model on which the AAIDD-11 definition is based is presented in Figure 1.2 on page 8.

Table 1.1 Milestones in the first five years

Month	Gross motor	Fine sensorimotor	Language	Adaptive behaviour
1m	Partial head control Primitive reflexes	Clenches fists	Alert to sounds Makes sounds	Fixates objects and follows 90°
2m	Good head control Lifts chin when prone			Follows 180° Smiles responsively
3m	Lifts chest off bed Fewer primitive reflexes	Holds hands open Reaches towards objects Pulls at clothing	Coos	Follows 360° Recognizes mother
4m	Swimming movement	Hands come to midline	Laughs aloud Produces different sounds for different needs	Shakes rattle Anticipates food Belly laughs
5m	Rolls over stomach to back Holds head erect		Orients towards sound Blows raspberry	Frolics when played with
6m	Anterior propping response	Transfers objects Holds bottle Palmer grasp	Babbles Recognizes friendly and angry voices	Looks after lost toy Mirror play
7m	Bounces when standing Sits without support	Feeds self biscuit	Imitates noise Responds to name	Drinks from cup
8m	Lateral propping responses	Rings bell Radial raking grasp	Uses non-specific ‘MAMA’ Understands ‘NO’	Shows separation anxiety Tries to gain attention
9m	Crawls		Recognizes familiar words	Mouths objects
10m	Stands with support	Plays with bell	Says specific ‘MAMA’ and ‘DADA’	Waves ‘BYE BYE’ Plays ‘PAT-A-CAKE’
11m	Cruises around objects	Uses pincer grasp	Follows gesture command	Puts on some clothes Takes turns
1y	Makes first steps Can sit down without help	Throws objects Puts objects in containers Tries to build a tower out of two blocks Turns through pages of a book by flipping many at a time	Says two or three specific words Comprehends several words Tries to imitate animal sounds	Follows a fast-moving object Searches for objects that are hidden Develops attachment to security blanket
1y 3m	Climbs stairs	Marks with pencil	Speaks word-like sounds	Indicates when wet Spoon-feeds Gives kisses Imitates household jobs
1y 6m	Runs stiffly Handedness is determined Able to jump in place Able to get onto chairs without assistance Walks up stairs with one hand held	Plays with toys constructively Scribbles Imitates lines Puts objects in form board Builds a tower of three to four blocks Turns pages two or three at a time	Speaks monologues with many word-like sounds Uses 10 words Points to one picture in a book Follows two-step commands	Places objects in form board Parallel play Takes off shoes Does puzzles Frequently imitates Feeds self
2y	Walks up and down stairs with both feet on each step Can run with better coordination Kicks ball without losing balance Picks up objects while standing without losing balance	Imitates vertical lines Builds a tower of six blocks Turns pages one at a time Turns doorknob	Vocabulary of about 300 words Uses ‘I’ Says ‘YES’ and ‘NO’ Identifies four body parts Can form three-word sentences	Puts on shoes Indicates toilet needs
3y	Can briefly balance on one foot Walks up the stairs with alternating feet	Builds a tower of more than six blocks Places small objects in a small opening	Vocabulary of hundreds of words Composes sentences of three to four words Frequently asks Who? What? When? Where? Why? and How? questions	Can put on all clothes Only requires assistance with laces, buttons and fasteners in awkward places Plays imaginatively Reduction in separation anxiety Daytime control over bowel and bladder
4y	Hops on one foot without losing balance	Throws a ball overhand Cuts out a picture using scissors	Vocabulary over 1,500 words Composes sentences of four to five words Can use the past tense Uses words they do not understand Uses vulgar words	Can count to 4 Sings simple songs Increased aggressive behaviour Tells personal family matters to others Has imaginary playmates Distinguishes between two objects based on one criterion (such as size, weight, etc.)
				Believes that their thoughts and emotions can make things happen Lacks moral concepts of right and wrong
5y	Skips and jumps with good balance Stands on one foot with eyes closed	Ties shoelaces Draws a square	Vocabulary over 2,100 words Uses sentences of six to eight words Names coins Names primary colours	Can count to 10 Decreased aggressiveness Childhood fears weaken Accepts the validity of others’ perspectives Identifies with the parent of the same sex

Table 1.2 Diagnosis of intellectual disability

DSM-5	ICD-10/ICF	AAIDD-11
Intellectual disability (intellectual developmental disorder) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social and practical domains. The following three criteria must be met: A. Deficits in intellectual functions, such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning, and experiential learning, confirmed by both clinical assessment and individualized standardized intelligence testing.	For a definite diagnosis of mental retardation there should be a (A) reduced level of intellectual functioning resulting in (B) diminished ability to adapt to the daily demands of the normal social environment. The assessment of intellectual level should be based on clinical observation, standardized ratings of adaptive behaviour and psychometric test performance.	Intellectual disability is characterized by significant limitations in (A) intellectual functioning and in (B) adaptive behaviour as expressed in conceptual, social, and practical adaptive skills. (C) This disability originates before age 18. For a diagnosis there must be
B. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without support, the adaptive deficits 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.	Mild mental retardation • An IQ of between 50 and 69. • Children may have some learning difficulties in school. In adults, a mental age of 9 to 12 years. • Many adults will be able to work, maintain good social relationships and contribute to society.	• A standardized intelligence test score 2 standard deviations below the mean • A standardized rating of adaptive behaviour in one or more domains (conceptual, social or practical) 2 standard deviations below the mean Five assumptions are entailed by this definition 1. Limitations in present functioning must be considered within the context of community environments typical of the individual’s age peers and culture.
C. Onset of intellectual and adaptive deficits occur during the developmental period. (For specification of mild, moderate, severe and profound levels of intellectual disability see DSM-5 pp. 33–36.)	Moderate mental retardation • An IQ of between 35 and 49. • Most children will show marked developmental delays but most can learn to develop some degree of independence in self-care and acquire adequate communication and academic skills. In adults, a mental age of 6 to 9 years. • Adults will need varying degrees of support to live in the community. Severe mental retardation • An IQ of between 20 and 34. • A mental age of 3 to 6 years. • Likely to result in continuous need for support.	2. Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor and behavioural factors. 3. Within an individual, limitations often coexist with strengths. 4. An important purpose of describing limitations is to develop a profile of needed supports.
	Profound mental retardation • An IQ of below 20. • A mental age less than 3 in adults. • Severe limitations in self-care, continence, communication and mobility. Model of intellectual disability In ICF, functioning and level of activity or disability is determined by • Health status (disease or disorder) • Bodily functions and structures (impairments) • Participation (restrictions) • Environmental factors (barriers and hindrances) • Personal factors (demographic profile) Diagnosis coded on Axis III for children Diagnosis coded on Axis I for adults	5. With appropriate personalized supports over a sustained period, the life functioning of the person with mental retardation generally will improve. Model of intellectual disability The definition is based on a model in which level of individual functioning is defined by status on 5 factors. • Intellectual abilities • Adaptive behaviour • Health • Participation, interactions & social roles • Social co...

Table of contents

• Cover Page
• Halftitle Page
• Title Page
• Copyright Page
• Table of Contents
• List of figures
• List of tables
• List of boxes
• Contributors
• Foreword and acknowledgements
• Section 1 Conceptual frameworks
• Section 2 Assessment frameworks
• Section 3 Intervention frameworks
• Section 4 Infancy and early childhood
• Section 5 Middle childhood
• Section 6 Adolescence
• Section 7 Adulthood
• Section 8 Professional issues
• Index