DEVELOPMENTAL DISABILITIES:
A developmental disability is a disability that is manifested before the person reaches adulthood, which constitutes a substantial disability to the affected individual, and is attributable to mental retardation or related conditions which include cerebral palsy, epilepsy, autism or other neurological conditions when such conditions result in impairment of general intellectual functioning or adaptive behavior similar to that of a person with mental retardation.
Dr. Frank Cushing has consulted with school districts, parents and community agencies including Goodwill Industries, Growth Enterprises, Milestone, Center for Hope, Goldie Floberg Home, and dozens of group homes for developmentally disabled (DD)adults since 1972. He and Dr. Kyle Cushing have conducted over 1000 evaluations on DD clients from ages 2 to 80 and regularly make recommendations regarding educational and programming needs, life skills development, behavior management and residential placement.
Evaluations of persons suspected of delayed development consist of intellectual assessment (I.Q. testing), measures of adaptive behavioral functioning, and specialized motivational and personality testing to ascertain the client's actual level of functioning. Such assessments assist in determining what services the client may qualify for and what rehabilitation needs are present. When appropriate, the psychological report in such cases will include recommendations for speech and language development services, occupational or physical therapy, individual and/or family psychotherapy, or behavior management training as needed.
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DEVELOPMENTAL DELAYS AND MENTAL RETARDATION:
A developmental delay is the slowed or impaired development of a child who is under five years old, and who is at risk of having a developmental disability because of the presence of one or more of the following:
-Chromosomal conditions associated with mental retardation,
-Congenital syndromes and conditions associated with delay in development,
-Metabolic disorders,
-Prenatal and perinatal infections and significant medical problems,
-Low birth weight infants weighing less than 1,200 grams,
-Postnatal acquired problems known to result in significant developmental delays, or:
-A child less than 5 years old who is delayed in development by 1.5 standard deviations or more in one or more of the following areas; communication, self-help, social-emotional, motor skills, sensory development or cognition, or:
-A child less than 3 years of age who lives with one or both parents who have a developmental disability.
Psychological testing can help determine to what extent, if any, a child's development has been delayed. If the child is deficient in adaptive behavior, the services needed so that child can reach his/her optimal level of functioning can be determined by the evaluation. Adaptive behavior means that the person has overall adaptive behavior which is significantly limited in two or more skill areas (communication, self-care, home living, social skills, community use, self direction, health and safety, functional academics, leisure, and work) as measured by an instrument which is standardized, appropriate to the person's living environment, and administered and clinically determined by a qualified professional psychologist.
What is mental retardation?
Mental retardation is characterized both by a significantly below-average score on a test of mental ability or intelligence (IQ) and by limitations in the ability to function in areas of daily life, such as communication, self-care, and getting along in social situations and school activities (Adaptive Behavior). Mental retardation is sometimes referred to as a cognitive or intellectual disability.
Children with mental retardation can and do learn new skills, but they develop more slowly than children with average intelligence and adaptive skills. There are different degrees of mental retardation, ranging from mild to profound. A person's level of mental retardation can be defined by their intelligence quotient (IQ), or by the types and amount of support they need.
People with mental retardation may have other disabilities as well. Examples of these coexisting conditions include cerebral palsy, seizure disorders, vision impairment, hearing loss, and attention-deficit/hyperactivity disorder (ADHD). Children with severe mental retardation are more likely to have additional disabilities than are children with mild mental retardation. Mental retardation is the most common developmental disorder.
Mental retardation can start anytime before a child reaches the age of 18 years. It can be caused by injury, disease, or a brain abnormality. These causes can happen before a child is born or during childhood. For many children, the cause of their mental retardation is not known. Some of the most common known causes of mental retardation are Down's syndrome, fetal alcohol syndrome, and fragile X syndrome, all of which occur before birth. Other causes that take place before a child is born include genetic conditions (such as Cri-du-chat syndrome or Prader-Willi syndrome), infections (such as congenital cytomegalovirus), or birth defects that affect the brain (such as hydrocephalus or cortical atrophy). Other causes of mental retardation (such as asphyxia) happen while a baby is being born or soon after birth. Still other causes of mental retardation do not happen until a child is older. These may include serious head injury, stroke, or certain infections such as meningitis.
In order to properly diagnose mental retardation, measures of intellectual functioning (IQ) AND measures of adaptive behavior are necessary. Thus, a thorough evaluation of the person's cognitive, behavioral, social and emotional functioning is needed in order to ensure the proper diagnosis has been made and to appropriately program for their academic and living skills needs. For more information about such comprehensive evaluations, contact either Dr. Cushing at(815) 968-5342 or via e-mail at frank@doctorcushing.com or kyle@doctorcushing.com
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AUTISIC DISORDERS, ASPERGER'S SYNDROME AND Pervasive Developmental Disorders-Not Otherwise Specified (PDD-NOS):
AUTISM:
Autism, once thought to be caused by a failure to bond with parents, particularly the mother, is now known to be a complex neurological disorder affecting social interaction, communication, and sensory processing. Autism is a developmental disability which occurs in approximately 15 out of every 10,000 individuals (This is the most commonly quoted statistic, but if all Pervasive Developmental Disorders (PDD) including Asperger's Syndrome and PDD-NOS are included then the incidence is much higher.) and is four times more common in boys than girls.
Often people with autism appear to be in a world of their own, unaffected by their surroundings. To a certain extent this may be true; lower functioning autistic people are often unaware of expected behaviors, communication, and other people. Autism affects development of reasoning, social interaction, and communication skills; most autistic children and adults have deficits in verbal and nonverbal communication. Autistic individuals may engage in repeated body movements (hand flapping, rocking), have unusual responses to people, and show fascination with objects. Most people with autistism are resistant to changes in routine or in their environment and many be hyper- or hypo-sensitivities to touch, sound light or other stimuli.
Autism occurs along a spectrum, meaning that the symptoms and characteristics can occur in a variety of combinations, from mild to severe. No two individuals with autism are exactly alike, even in the way their autism shows itself. In the DSM-IV, the manual used by professionals to diagnose mental disorders, autism falls under the category of Pervasive Developmental Disorders, which includes Autism, PDD-NOS (not otherwise specified), Asperger's syndrome and Rett's syndrome. All of these conditions are often referred to as "autistic spectrum disorders."
The causes of autism are unknown, although there is much speculation and research conducted into this mysterious disorder. Some people maintain that autism is caused by metabolic or immune disturbance, while there is also evidence for a genetic component.
Autism is diagnosed through observation of a child's communication, behavior, and development. It is often difficult to find a professional with sufficient experience to properly assess and diagnose autism in a child and even more difficult to find someone willing and able to diagnose an adult. It is important to have a child assessed as early as possible because early intervention makes the biggest difference to the final outcome for anyone with a developmental disability such as autism.
Not all autistics are the stereotypical isolated, rocking child which often comes to mind. Some mildly affected individuals may become independent adults who marry, hold jobs, and raise children. They may experience more difficulties with regulating social interaction and appear awkward. While 70-80% of those diagnosed with autism also test as mentally retarded, many high functioning autistics have average or above average IQ's.
At the "high functioning" end of the spectrum are Asperger's syndrome, Pervasive Developmental Disorder - Not otherwise specified (PDD-NOS), and high functioning autism. At this end of the spectrum, autistic symptoms blend with "normal" behaviour and development. They are all characterised by typical autistic characteristics but to a milder or limited degree. The distinction between these conditions is unclear at best, however, there are some differences.
HIGH FUNCTIONING AUTISM:
High Functioning Autism (HFA) is not a clearly defined diagnosis. Rather, it is a label given when someone meets (or met as a child) the diagnostic criteria for autistic disorder but is able to speak and has an average or above average IQ. The primary distinction between HFA and Asperger's syndrome is early development - primarily of language. High functioning autistics are often mis-labelled with Asperger's Syndrome if speech is adequate at the time of assessment.
ASPERGER'S SYNDROME:
Asperger's syndrome (AS) is a type of high functioning autistic spectrum disorder in which there is no clinically significant delay in language and an IQ of at least average (often higher). Although people with AS learn to speak at or near the usual age, they usually have an odd style of speech and difficulties with nonverbal communication. Many people with AS have fine and/or gross motor skill delays although this is not necessary for a diagnosis. People with AS also frequently have difficulties with math and with organizational skills.
PERVASIVE DEVELOPMENTAL DISORDER NOT OTHERWISE SPECIFIED:
PDD-NOS is the diagnosis given when a child or adult has significant autistic-like traits but does not meet enough of the criteria for a diagnosis of a specific PDD such as autistic disorder or Asperger's syndrome. The autistic characteristics of someone with PDD-NOS can vary in number, severity, or age of onset. While most people with PDD-NOS are high functioning, some are severely affected but have too few of the necessary characteristics for another diagnosis.
COMMON MISPERCEPTIONS ABOUT AUTISTIC SPECTRUM DISORDERS:
It is a common misperception that all autistics are identified and labelled in childhood as some high functioning autistics and people with Asperger's syndrome are able to compensate for their disability sufficiently to avoid identification. High functioning autistics may be considered learning disabled, eccentric, awkward, "nerdy," immature, too mature, gifted, lazy, or a combination of these. While some of these labels may be accurate, none of them adequately define the problems faced by a person with autism, or the appropriate treatment for these difficulties.
The difficulties of people with high functioning autistic spectrum disorders are similar in some ways to those with more severe forms of autism, but they are also different. The main problems are usually around socialization and social communication. High functioning autistics often appear to the unfamiliar observer to be simply awkward or eccentric but the difficulties are much more profound. As with other forms of autism, the best outcomes are achieved with early and appropriate intervention.
Drs. Frank and Kyle Cushing have considerable experience in differentially diagnosing all of the above conditions and are able to provide recommendations for the best ways to educate and integrate people who suffer from these difficulties into as mainstream a life as possible.
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