¢ Outline Chapter 28
The New Face of
Developmental Disabilities
¢ What is the relationship between developmental disabilities and other medical conditions?
¢ Sickle Cell Disease
Autosomal recessive disorder, results in the production of an abnormal hemoglobin
Crescent-shaped cells
Most common in those with sub-Saharan African ancestry
Prevalent in 1 in 2,647 births
41 states screen newborns at birth
Includes neurological complications and abnormal immune functioning
¢ Clinical manifestations of Sickle Cell Disease
Anemia
Jaundice
Gall stones
Restrictive lung disease
Pulmonary hypertension
Retinopathy
Leg ulcers
Delays in physical growth and sexual maturation
¢ Developmental and behavioral manifestations of Sickle Cell Disease
Developmental disability in cognitive and academic domains
High proportion born into low socioeconomic status
Produces family stress,
Increased school absenteeism
Behavior problems (aggression, oppositional defiant disorder, conduct disorder, depression)
¢ Treatment
Penicillin to prevent bacterial infections
Bone marrow transplantation
Regular doctor visits, immunizations, documentation of spleen size/baseline blood counts
Medication for pain management
Life expectancy significantly increases with early identification and individualized therapies
Cancer and Brain Tumors
¢ Most common: leukemias (blood cell cancers) and central nervous system (CNS) tumors
¢ 2,000 children under 15 diagnosed in U.S. each year
¢ More frequent in boys
¢ Peak incidence: 2–6 years of age
¢ Symptoms include anorexia, fatigue, bone pain, irritability, fever, persistent and severe headache, vomiting
¢ Treatment for Cancer and Brain Tumors:
Bone marrow transfussions
Central Nervous System prophylactic treatment to prevent relapses
Maintenance of chemotherapy for 2–3 years
Affects academic progress in reading and math
Poor neurocognitive outcomes
Psychological adjustment problems
Survival rate is nearly 80%
For Cancers in the Central Nervous System, survival depends on tumor type
Greatly decreased mortality and morbidity
Challenges in continuing academic education (repeat grades) and adult employment
Human Immunodeficiency Virus/ HIV
¢ It is a viral infection transmitted by sexual contact, blood exposure/needles, mucous membrane exposure, mother-to-child, contaminated blood products
¢ Transmission can be prevented in 98% of cases
¢ Severe clinical presentation: AIDS
¢ Clinical manifestations of HIV
During Infancy: enlargement of lymph glands, enlarged liver, poor weight gain, diarrhea, pneumonia, thrush
During Childhood: recurrent bacterial infections, chronic swelling of parotid, lymphocytic interstitial pneumonia (LIP), progressive neurologic deterioration
Biomedical factors: amount of viral load, age at time of infection, clinical symptoms at diagnosis, and treatment
Biosocial factors: prenatal drug exposure, malnutrition, prematurity, poverty, neglect, family stress, developmental disabilities
Behavior problems: learning deficits, hyperactivity, impulsive-hyperactive behavior, conduct disorder, and anxiety
Society challenges related to stigma…….
¢ Treatment
Highly active antiretroviral therapy (ART)
In developing countries ART is not available
Prognosis worst in children who have opportunistic infections, encephalopathy, or wasting syndrome
75% mortality rate before age 3
Chronic Kidney Disease
¢ It is a progressive and irreversible loss of renal (kidney) function
In Children affects neurodevelopment and cognitive function
Can result from congenital causes, acquired diseases, and genetic disorders
Prevalence is15 per million, twice as many boys as girls
Symptoms include anorexia, vomiting, weakness, fatigue, and deficits in neurocognitive function
¢ Clinical manifestations
Kidney no longer able to balance electrolytes, filter waste from blood, and regulate blood pressure
Stages 1 and 2: renal function deteriorates
Can produce Polyuria (excessive passage of urine), oliguria (decreased passage of urine), anuria (absence of urine), edema (abnormal accumulation of fluid in body tissues), hypertension (elevated blood pressure), hematuria (blood in urine), proteinuria (protein in urine)
¢ Treatments include nutritional and hormonal support for growth failure, and preparation for renal replacement therapy
¢ Kidney transplantation
¢ Management of condition as there is no cure, but can have improvements with medical treatment
¢ For children, school needs to support academics due to poor physical, social, emotional, and educational functioning