The General Health Management Aspects of The Intellectually Challenged Child.

1. The General Health Management Aspects of The Intellectually Challenged Child.(ICC) The General Health Management Aspects of Trisomy 21 Downs syndrome Prof.Dott.EMMANUEL UDEMEZUE ONYEKWELU.CSci,CSciTeach,ChirB(Hons),MB(Hons)MD,MRQA,FRSA,FCILED,FRGS,FRSH,FRCEM,FRSPH,FRSB,DSc/PhD(Hon)

2. Definition: • Although intellectual function cannot be measured directly however it could be deduced by inference from the assessment of skills in a number of different executive and cognitive domains. • The most reliable, rapid and consistent indirect measure of evaluating intellectual function is by the Intelligence Quotient (IQ) test, albeit the results are inconsistent and are usually influenced by cultural and environmental factors.

3. Definition of Intellectual Challenge by the IQ Tests Standards • For a long time, IQ tests have been misappropriated and its interpretation biased by the zeal to re-enforce social, ethnic and cultural supremacy. • However, it is axiomatic that the original intent and purpose of IQ tests and still their only valid use is in the identification of children who would benefit from additional assistance.

4. Definition of Intellectual Challenge by the IQ Tests Standards • The application of an IQ test to a population produces the standard bell-shaped normal distribution curve. • The mean is set at a score of 100 and 2 standard deviations below the mean (which scores 70 on most tests) is usually defined as the lower limit of “normality”.

5. Definition of Intellectual Challenge by the IQ Tests Standards • The highest IQ score ever recorded • Ainan Celeste Cawley (IQ score: 263) • William James Sidis (IQ score: 250-300) • Terence Tao (IQ score: 225-230) • Marilyn Vos Savant (IQ score: 228) • Christopher Hirata (IQ score: 225) • Kim Ung-Yong (IQ score: 210) • Edith Stern (IQ score: 200+) • Christopher Michael Langan (IQ score: 190 – 210) • Garry Kasparov (IQ score: 194) • Philip Emeagwali (IQ score: 190) • Judit Polgar (IQ score: 170) • Albert Einstein (IQ score: 160 – 190) • Stephen Hawking (IQ score: 160)

6. Definition of Intellectual Challenge by the IQ Tests Standards • IQ is the numerical annotation of a persons scores after undertaking one of the several standardized tests to measure the intelligence level of individuals. • Originally, the intelligence quotient was calculated as the ratio of mental age and chronological age (IQ= MA/CA x 100, where MA is mental age, CA is chronological age). • However, today, intelligence scores are calibrated against values of actual population scores. Here is a graph that shows how people fare when they take an IQ test:

7. Definition of Intellectual Challenge by the IQ Tests Standards

8. Definition of Intellectual Challenge by the IQ Tests Standards • This is, as you can see, a bell-shaped curve. It depicts that most measurements fall in the middle, and fewer fall at points farther away from the middle. • This simply implies that most people’s IQ scores fall in and around the average range, while much less people score very low or very high. • The general score of 95% of the population from these tests ranges between 70 and 130. Since there are quite a few different classifications, the Stanford-Binet Scale of Human Intelligence is the most commonly used one and we shall use that as a reference. • According to this scale, people who have a score higher than 145 are considered geniuses.

9. Intelligence Quotients Assessments • About the ISIQ - Children's Version n • This Child IQ test is professionally designed for children ages 6-16 years old and takes about 40-60 minutes to complete. • A child does not have to complete the entire IQ test in one sitting. • You can use the results of the IQ test to determine your child's natural intellectual strengths.

10. Intelligence Quotient Testing • When the child is about to be given the Test , to take the full test, it is appropriate to set aside about one hour where you will be in a quiet and uninterrupted environment

11. Intelligence Quotient Testing • The ISIQ - Children’s Version is intended as a test that parents of young children and teenagers could use for assessing their childrens verbal intelligence. • Scores obtained could be employed by parents to improve their wards awareness,comprehension and planning for educational and career options. • The reports obtained could also be used by health and educational professionals in assessments for career planning, school placement and problem diagnosis. • Such as in when diagnosing ADHD, learning difficulties and dyslexia, it is crucial to exclude mental retardation.

12. Intelligence Quotient Testing • Description and Design.The ISIQ - Children's Version is a 201-item multiple choice measure of verbal intelligence designed for children ages 6 to 16. The test items were written to measure a range of ability from a mentally slow 6 year old to a bright 16 year old.It has about 40 items for each of five of the content areas measured: information, similarities, arithmetic, comprehension and vocabulary. Similar to the Wechsler Intelligence Scale for Children, 3rd and 4th Editions (Verbal WISC III and WISC IV), the ISIQ - Children's Version results are reliable and accurate. Indeed, the reliabilities hold up very well across all ages from 6 through 16. For example, the mean reliability of the section scores for 10 year olds is 0.84. For the same five Wechsler III tests for 10 to 11 year olds the mean is 0.81. The total reliability of the ISIQ test for 10 year olds is 0.96, computed by the Kuder-Richardson 21 formula. For the WISC III total it is 93. The Cronbach alpha reliability coefficients for the ISIQ total verbal I.Q. for 14 year olds is .97 while the same measure for 14 year olds on the WISC III total verbal I.Q. is .95.

13. IQ Testing • The Wechsler tests are highly regarded and widely used by clinical psychologists globally and were most frequently chosen for comparative analysis. • The author is very familiar with the Wechsler tests, having administered them in his clinical practice for several years, He is familiar with test design, having constructed clinical, industrial and research tests for about three decades.

14. IQ TESTING • A multiple-choice format was chosen to permit Internet administration and automatic, computer scoring. Each item has 5 options, four that are possible answers and one for "I don't Know". • There is only one correct answer for each item. When a child misses 5 items in a row, that section of the test is discontinued and the next begun. • Test-takers are urged to be serious and complete the entire test carefully. Young children should be guided by an adult to assure reliable and valid scores. • Scores do not vary substantially by gender, ethnic group or nationality, suggesting that the test is relatively culture-free and free of ethnic bias for English-speaking children with access to the Internet.I.Q. scores are calculated by the standard deviation formula with a mean I.Q. set at 100 and standard deviation of 15. • Certificate of intelligence quotient that can be printed for personal use. • Scores are given in terms of both I.Q. and percentile levels for all five sections and the total score. The printed Test Report provides a description of verbal intelligence, reliability data and recommended interpretation of scores.

15. IQ TESTING • Norms: • The test norms are periodically updated and are currently based on a sample of over 100,000 children from around the world. As there are no substantial differences in scores by gender, scores are based on comparison of the test taker's scores with those of other children the same age.Value: • Determining if a child is gifted or has special needs can give parents a valuable insight into their child's emotional, academic and social development - this children's IQ test can be immensely helpful in determining if your child has special needs or is eligible for higher placement in school. • Research has shown that one of the first steps to raising a gifted child is to have him or her take an IQ test along with other forms of testing to determine his or her strengths, weaknesses and abilities. • In today's crowded educational environment, parents cannot rely solely on their child's school to determine if their child is gifted or would benefit from being placed in a special academic environment. Parents should take the initiative as early as possible by having their children take an intelligence test.

16. IQ TESTING • In many school districts, the best way for a child to get a quality education is to be admitted into the gifted classes or attend a special magnet school. Unfortunately, these programs often have limited enrollments so countless parents compete for a few, coveted spots. • Further, parents who are looking to get their children into these programs often need to provide proof that their child belongs in a special or gifted program.For years IQ testing was often an expensive and time-consuming process affordable by only the wealthiest of parents. The process needed to be administered by a licensed and trained child psychologist who charges A substantial amount for a basic assessment. This is no longer the case. The ISIQ - Children's Version is a valid and accurate assessment of a child's intelligence quotient and just as accurate as the Wechsler IQ tests for children. Several parents globally employ the ISIQ - Children's Version to quickly and affordably determine their child's level of intelligence.

17. IQ Testing • A high IQ doesn’t necessarily indicate than a child is smart. • Having a high IQ does not necessarily mean that the person is intelligent or very smart. The problem with IQ tests is that although they’re pretty good at assessing our deliberative skills (which involve how we use our working memory and reason), but they are not able to assess our inclination to use them when the situation demands. This is a very important difference. Intelligence is about brain power whereas rational thinking is about control. • Some people who are intellectually able do not bother to engage very much in analytical thinking and are inclined to rely on their intuitions. “Other people will check out their gut feeling and reason it through and make sure they have a justification for what they’re doing. • A high IQ is like height in a basketball player. It is certainly a crucial trait, provided all other ‘things’ are equal. But if all other things aren’t equal, then the player needs a lot of more than just height in order to be a good basketball player. Similarly, there is a lot more to being a good thinker than having a high IQ.

18. Definition of Intellectual Challenge by the IQ Tests Standards • Having seen the list of the people with the highest IQ in the world. • It would be worthwhile to remark that IQ tests are not necessarily all that accurate in estimating someone’s overall intelligence, even if they are good markers for specific cognitive skills, such as mathematical ability and logical reasoning.

19. The definition of intellectual Challenge • The definition of Intellectual Challenge used by the American Association of Mental Difficulty • (AAMD) reflects these issues: • Significantly Subaverage General Intellectual Functioning, • Existing concurrently with Deficits in Adaptive Behaviour & • Manifested during the Developmental Period. • Intellectual Challenge is further subdivided by the World Health Organisation into: • Mild (IQ 50-70) • Moderate (IQ 35-49) & • Profound (IQ below 20) categories.

20. The definition of intellectual Challenge by the Intelligence Quotient(IQ Tests) • Significantly Subaverage General Intellectual Functioning is usually interpreted to imply more than two standard deviations below the mean IQ. • Existing concurrently with Deficits in Adaptive Behaviour reflects the limitations of IQ testing and the need to take into account how a person functions in everyday life. • Manifested during the developmental period excludes disabilities that result from cerebral insults occurring in adult life.

21. Prevalence of intellectual disability • Prevalence estimates for intellectual disabilities vary from 1-7% with most figures being in the range of 1.5-3%. • This discrepancy in the range figures is due to differences in the • Definition of Intellectual Disability, • Differences in Methodology & • True differences in Prevalence. • Some studies use 75 rather than 70 as the lower limit of normal. • Examination of the normal distribution curve illustrates that this variation will dramatically increase the number of children included

22. Prevalence of intellectual Challenge. • Case detection could be achieved by: • [I]-Notification. • [II]-Registration of children enrolled for a service • (both of which are likely to underestimate true prevalence)

23. Prevalence of intellectual Challenge. • Casedetection could be by field based total population screening using IQ test. • Although the later method is most reliable, but given the immense financial, practical and ethical considerations, it is often not employed.

24. Prevalence of intellectual Challenge. • Prevalence estimates often indicate higher rates for school-age children than for older or younger children . • This fact is more likely to reflect difficulties of detection rather than true variation

25. Prevalence of intellectual Challenge. • Children with intellectual difficulties are more likely to present with problems at school than as preschoolers or school leavers. • This fact is buttressed by an English Language study amongst children aged 5 to 14 years where a prevalence figure of 0.34 and 2.53 was computed for IQ levels between 0-49 and 50-70 respectively.

26. Prevalence of intellectual Challenge • In a closely related endevour, two Scandinavian studies proffered concordance figures . • In the first Scandinavian study, the sample population involved students aged between 8 to 12 where prevalence figures of: • 0.3 ----------------- IQ ranges of 0-49 • and • 0.37----------------IQ ranges of 50-70

27. Prevalence of Intellectual Challenge. • In the second Scandinavian study amongst 14 year old aged prevalence figures of 0.63 and 0.56 were deduced for IQs ranges 0-49 and 50 -70 respectively. • Also furthermore, a North American Study employing children aged between 7-10 computed a prevalence figure of 0.32 for children in the IQ range of 0-49.

28. Aetiology of intellectual Challenge • Early discussion on causation focused on the organic versus non-organic aspects and on the effects of environmental factors. • Some children may be classified as intellectually disabled simply because they fall, naturally, at the lower end of the normal distribution curve.

29. Aetiology of intellectual Challenge • Whilst others are intellectually disabled as a result of malformation, organic injury. OR • Social environmental factors are normally associated with mild intellectual disability although they may be a contributing factor in more severely affected children.

30. Aetiology of intellectual Challenge A specific organic cause could be found in: 70-90% of children with moderate and severe intellectual disability. The importance of determining the aetiology has been highlighted by several authors because it provides a basis for accurate: [I]-Genetic counselling. [II]-Prediction of outcome. [III]-Preventive strategies and [IV]-Parental support.

31. Aetiology of intellectual Challenge • It is always helpful to grieving families to comprehend why their child is disabled. • Several epidemiological studies, emanating from the Scandinavia: • Demonstrated that the aetiology is most certain for the severely to the profoundly intellectually impaired children • Compared to : • The mildly to moderately severely affected children

32. Aetiology of intellectual Challenge • In this study involving the very severely and profoundly affected cases of intellectual difficulties in childhood: • Prenatal factors implicated—55% Whereas in the same magnitude of cases in the moderate to the moderately severely affected the causal mechanisms were largely • Idiopathic---------------55%

33. Aetiology of intellectual Challenge • In the severely to the profoundly affected subsets: • Idiopathic factors------- 18% • Perinatal factors -------- 15% • & • Postnatal factors ------- 11% • contributed this% of cases in this range.

34. Aetiology of Intellectual Challenge • As for the moderately and the moderately severely affected of cases in this IQ range category: • Prenatal------------------------------- 23% • Perinatal------------------------------ 18% and • Postnatal causes-------------------4%

35. Aetiology of intellectual Challenge • The same range of factors are implicated in the aetiology of milder forms of intellectual difficulties. • Although the proportions in which a specific cause could be identified is much more diminutive.

36. Examples of Possible causes of Intellectual Challenge. • Prenatal Factors associated with intellectual disabilities could be • [A]-Chromosomal abnormalities • such as but not limited to: • [i]-Downs Syndrome • [ii]-Trisomy 18 • [iii]-Cri du Chat syndromes. • [iv]-Sex chromosome abnormalities.

37. Examples of Possible causes of Intellectual Challenge. • [B]-Genetic such as but not only • [i]-Fragile-X-syndrome. • [ii]-Tuberous Sclerosis. • [iii]-Neurofibromatosis. • [iv]-Metabolic & storage disorders. • [C]-Dysmorphic syndromes • [D]-Prenatal Infections. • [E]-Teratogens such as Drugs and Toxins.

38. Examples of Possible causes of Intellectual Disability. • Perinatal Factors associated with intellectual disabilities include but not limited to: • [A]-Perinatal hypoxia and • [B]- Asphyxia • [C]- Trauma • [D]-Infections • [E]-Biochemical abnormalities.

39. Examples of Possible causes of Intellectual Challenge. • Postnatal Factors implicated in intellectual Challenge include but are not limited to: • [A]-Trauma • [B]-Hypoxia • [C]-Meningitis • [D]-Encephalitis • [E]-Poisons.

40. Diagnosis of Intellectual Challenge: • With regards to the diagnosis of intellectual disability, there are two major tasks: • [I]-To establish that an intellectual disability is present, and • [II]-To identify the cause of the intellectual disability.

41. Diagnosis of Intellectual Challenge: • Does the child have an intellectual Disability? If yes • Children with intellectual disabilities may present in the following four ways: • [A]-In the neonatal period with recognizable malformations which are usually associated with intellectual disability (such as Downs syndrome) • [B]-With developmental delay. The more severe the delay the earlier these children are likely to present.

42. Diagnosis of Intellectual Challenge • [C]-As a result of surveillance of infants at increased risk of developmental problems( such as infants with a very low birth weight) • [D]-With feeding or behavioural problems which on investigation are found to be associated with intellectual disability.

43. Diagnosis of Intellectual Challenge: • The diagnosis of the presence of Intellectual Challenge relies on a high index of suspicion followed by comparison of the child’s performance with age appropriate norms. • Retrospective collections of developmental milestones are seldom useful, but • Milestones recorded at the time (often in infant welfare books) & • Comparisons with siblings at similar ages are valuable. • Once a developmental delay is suspected it is appropriate to use a developmental screening test such as the Denver Developmental Screening Test

44. Diagnosis of Intellectual Challenge • These tests are useful in that they compare the child’s development with a population of normal children at the same age & • They examine all aspects of development. • Their limitations are that they are not precise & • They are of limited value once a specific disability has been identified. • They are no more than a screening test. Once a disability is suspected more detailed & specific testing & investigation is required.

45. Aetiological Diagnosis of Intellectual Challenge in Childhood-(ICC) • The History should include: • A Family Pedigree, • Details of The Pregnancy, • Birth &Neonatal History • Birth Weight, • Length & Head Circumference • Early Feeding Habits. • Psychomotor Development & • Specific Illnesses(Icterus etc)

46. Aetiological Diagnosis of Intellectual Challenge in Childhood-(ICC) • The examination should record growth especially: • Head circumference. • In a child with microcephaly, • Serial head circumference measurements may indicate the stage in the child’s life when the cerebral insult occurred.

47. Aetiological Diagnosis: In Intellectual Challenge of Childhood.-ICC. • The child’s general responsiveness, • the presence of dysmorphic features & • Any abnormalities of skin pigmentations should be noted. • Full neurological examination should include assessment of vision& hearing. • If there is a significant developmental delay it may be preferable to obtain specialist assessment of these functions.

48. Aetiological Diagnosis: In Intellectual Challenge of Childhood--ICC. • General physical examination should particularly include a search for other congenital abnormalities. The history & examination will often lead to a specific aetiological diagnosis or at least limit the range of possibilities. • Evaluations for most children with idiopathic moderate or severe intellectual disability warrant a chromosome analysis.

49. Aetiological Diagnosis for Children with Intellectual Challenge. • Chromosomal analysis&cytogenetics studies(which should include examination for fragile-X-syndrome and computed tomography. • (CT) and screening tests on the urine for metabolic abnormalities. • Given the opportunity and availability all newborns infants are routinely tested for Phenylketonuria and hypothyroidism

50. Aetiological Diagnosis for Childrenwith Intellectual Challenge. • In specific instances: • Serology for Congenital Infections Tests of Thyroid Functions • Urinalysis for Mucopolysaccaridosis • Serum Creatinine Phosphokinase • A maternal Guthrie Test For maternal Phenylketonuria & • Other specific tests for rare disorders will need to be considered.