Objectives. Contribution of environmental factors to intellectual and developmental disabilities (I/DD). Factors contributing to increased risk of toxic chemical exposure in children to include children with I/DD. The effects of lead, mercury, and environmental tobacco smoke exposure on children.Strategies to prevent, minimize, and/or manage exposure in children with I/DD.Translation of research findings to clinical practice..
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1. Lessons about Toxic Chemical Exposures from Persons with Intellectual and Developmental Disabilities
Carolyn Graff, PhD, RN
2. Objectives Contribution of environmental factors to intellectual and developmental disabilities (I/DD).
Factors contributing to increased risk of toxic chemical exposure in children to include children with I/DD.
The effects of lead, mercury, and environmental tobacco smoke exposure on children.
Strategies to prevent, minimize, and/or manage exposure in children with I/DD.
Translation of research findings to clinical practice.
3. Causes of Intellectual and Developmental Disabilities Prenatal (genetic, metabolic, teratogens)
Complex or multifactorial
Perinatal (infections, hypoxia, injury)
Postnatal (infections, trauma, tumors, hypoxia, environmental agents)
4. Prevalence of Genetic Disorders*
6. Neurotoxicants: Data and Research Studies Known Neurotoxicants
Polychlorinated biphenyls (PCBs)
EPA testing on a few chemicals
No testing on majority of chemicals
8. Chemical Exposures and Developmental Outcomes Timing
Periods of developmental vulnerability
9. Chemical Exposures and Developmental Outcomes The effects vary depending on the timing, dose, and frequency of exposure.
Genetics, nutrition, infections, social environment also influence developmental outcomes.
The relationship between exposure and developmental outcomes is complex.
10. Factors Contributing to Increased Risk of Exposure in Infants and Children Prenatal and postnatal exposure
Higher intake per kilogram of weight
Immature and developing organs and systems
Higher metabolic rates
Behavioral patterns conducive to exposure
11. Child with I/DD at Risk for Toxic Chemical Exposures Behaviors Persisting Past a Developmentally Appropriate Age
Engages in hand-to-mouth activity
Mouths or chews on objects such as clothing or furniture
Continues mouth breathing
12. Child with I/DD at Risk for Toxic Chemical Exposures Communication Skills
Has difficulty communicating to others about how exposure occurred
Has difficulty communicating to others about symptoms of exposure
13. Child with I/DD at Risk for Toxic Chemical Exposures Motor Skills
Requires assistance when washing hands
Requires assistance to move away from irritating fumes
Spends long periods of time indoors year round
Requires carrying or lifting by adults
Crawls, sits, or lies on the floor when indoors
14. Child with I/DD at Risk for Toxic Chemical Exposures Nutrition
Has a dietary restriction or diet self-restriction
Has a higher metabolic rate
Engages in pica
15. Child with I/DD at Risk for Toxic Chemical Exposures Health Problems Related to Intellectual and Developmental Disability
Has frequent respiratory illnesses
Has signs/symptoms similar to those resulting from exposure
16. Status of Developmental Toxicity Testing for the 2,863 Chemicals Produced Above 1 million pounds/year
17. Toxic Chemicals: Where to Start? Making a Difference . . .
Nicotine (Environmental Tobacco Smoke)
18. Effects of Lead Exposure Low IQ
Failure to complete school
Trouble with the law
19. Association of Teacher Ratings With Student Lead Burden
20. Sources of Lead Ingestion
Food or drinking water
21. Sources of Lead Items containing lead that are brought into the home
Folk and traditional medications
Metallic toys and trinkets
(MMWR, March 23, 2006, 55,1-2)
22. Strategies to Minimize and Manage Lead Exposure Lead screenings
Remove sources of lead
23. Lowering of the CDC’s Recommended Action Level for Blood Lead in Children
24. High Dose Effects of Mercury: Prenatal Exposure Severe cognitive impairment
Swallowing and sucking problems
25. Low Dose Effects of Mercury: Prenatal Exposure Impairments (at age 7-9) of:
Visual spatial skills
26. Sources of Mercury Contaminated fish
Power plant emissions
Fluorescent light bulbs (broken)
Folk rituals and home remedies
27. Strategies to Prevent and Minimize Mercury Exposure Avoid fish known to have high levels of methylmercury
Remove items containing mercury from home
Contact local fire department or environmental clean-up company to clean up mercury spills
28. Effects of Environmental Tobacco Smoke (ETS) Physical
Lower respiratory illnesses
Altered lipid profiles
Serous otitis media
29. Effects of Environmental Tobacco Smoke (ETS) Developmental
Deficits in math
Deficits in reading
Deficits in visuospatial reasoning skills
30. Strategies to Prevent ETS Exposure “Smoke Free” Environment
Smoking Cessation Programs
Proactive Health Care Professionals
31. Challenges For Health Professionals Most health professionals have limited knowledge of sources of toxic chemicals and their effects.
Environmental history forms do not take into account the abilities and limitations of children with I/DD.
Health professionals and caregivers may attribute signs and symptoms of toxic chemical exposure to the I/DD and overlook potential for exposure.
32. Challenges For Health Professionals No single research study has examined the effects of toxic chemical exposure on persons with I/DD.
A paradigm shift is needed. . .from thinking that chemical exposures occur at the factory or on the farm to. . .everyone carries “a body burden” of toxic chemicals in their blood, urine, fat, and breast milk.
34. Environmental History CH2OPS
35. Practice that Protects Assess for specific risks during well-child health care visits
Prioritize problems that pose the greatest risk
Assess resources and capabilities of parent or caregiver
Start small – “doing the doable”
(Allison D. Davis, 2005)
36. Resources National Library of Medicine – Environmental Health and Toxicology, Specialized Information Services http://sis.nlm.nih.gov/enviro.html
Pediatric Environmental Health ( 2nd Ed) available at www.aap.org/bookstore
Physicians for Social Responsibility http://www.psr.org/home.cfm?id=environment
The National Environmental Education and Training Foundation http://www.neetf.org/Health/index.htm
University of Maryland School of Nursing http://www.EnviRN.umaryland.edu
37. Challenges for Researchers and Scientists Examine the effects of chemicals on children and adults with I/DD
Examine multiple or poly-chemical exposures in persons with I/DD
NICHD, NIEHS, CDC collaborative research efforts to explore toxic chemical exposures in I/DD population
38. Research/Science and Health Care Research/Science
Health Care Practice
Health Care Practice
39. Acknowledgements Laura Murphy, EdD, Boling Center for Developmental Disabilities, College of Medicine, University of Tennessee Health Science Center
Shirley Ekvall, PhD, RD, University of Cincinnati, Department of Nutritional Services
Michelle Gagnon, MPH, former Director of the Environmental Health Initiative, AAIDD
Ted Schettler, MD, MPH, Science and Environmental Health Network
Laura Abulafia, MHS
Environmental Health Initiative
American Association on Intellectual and Developmental Disabilities
http://ehinitiative.org The AAMR Environmental Health Initiative