developmental disabilities

DEVELOPMENTAL DISABILITIES

Sam Lazuardi

Developmental Disabilities (DD)- 1 National Institute of Child Health and Human Development (NIH)

• Are birth defects that cause lifelong problems with how a body part or system works, incl :

• 1.Nervous syst (NS) D affecting how the brain, sp cord & NS function. They cause mental re-tardation (Down Sy & Fragile X sy) & also cause learning & behavioral disorders (autism).

• 2.Sensory-related D, which cause vision, hearing & sight problems

Developmental Disabilities (DD)- 2National Institute of Child Health and Human Development (NIH)

• 3.Metabolic disorders (PKU), which affect how the body processes the material it needs to function

• 4.Degenerative disorders (Rett sy), which might only become apparent when children are older & can cause physical & mental problems

Developmental Disabilities (DD)- 3National Institute of Child Health and Human Development (NIH)

• Most DD have no cure, but you can often treat the symptoms

• Physical, speech and occupational therapy might help

• Special education classes and psychological counseling can also help

DEVELOPMENTAL MILESTONES (DM)

• Skills such as taking a first step, smiling for the first time, waving ‘bye bye’ are called DM

• Children reach M in how they play, learn, speak, behave & move (crawling, walking) & develop at their own pace

• If your child is not meeting the M for his age, there could be a problem with his develop-ment -> D monitoring -> D screening

DEVELOPMENTAL SCREENING (DS)

• The doctor might ask some questions or talk and play with the child to see how he plays, learns, speaks, behaves and moves

• A delay in any of these areas could be a sign of a problem

• The American Academy of Pediatrics recom-mends children to be screened during regular visits at : 9, 18, 24 or 30 months

THE IMPORTANCE OF DS

• In the US, about 13 % of children 3 – 17 yrs of age have DD such as autism, mental retarda-tion and attention deficit /hyperactive disor-der

• Fewer than half of children with DD are iden-tified before starting school, by which time significant delays already might have occurred and opportunities for treatment might have been missed

EARLY INTERVENTION (EI) - 1

• Early intervention services help children from birth through 3 yrs of age learn important skills

• Services incl. therapy to help the child talk, walk and interact with others

• Early Intervention is a system of services that help babies and toddlers with DD learn the basic and brand new skills that develop during the first 3 years of life , such as :

EARLY INTERVENTION (EI) - 2

• Physical (reaching, rolling, crawling and walking)• Cognitive (thinking, learning, solving problems)• Communication (talking, listening, understan-

ding)• Social/emotional (playing, feeling secure, and

happy)• Self-help (eating & dressing)

CAUSES AND RISK FACTORS - 1

• DD begin before a baby is born, but some hap-pen after birth because of injury, infection or other factors

• A complex of mixed factors incl. genetics, pa-rental health and behavior (smoking, drinking) during pregnancy, complications during birth, infections during pregnancy or very early in life, exposure to high toxins (Pb).


• 25 % of hearing loss due to CMV infections during pregnancy, complications after birth and head trauma

• Intellectual disability cause due to alcohol sy, genetic & chromosomal condition (Downs sy & fragile X sy) and infections during pregnancy (toxoplasmosis)

• Autism spectrum disorder (ASD) due to ASD in the family


• Low birth weight, premature birth, multiple birth & infections during pregnancy associated with many DD

• Untreated newborn jaundice can cause kern-icterus -> cerebral palsy, hearing & vision & teeth problems -> early detection & treatment

• Obese pregnancy -> lower language score

THINGS YOU NEED TO KNOW ABOUT BIRTH DEFECTS (BD) - 1

• BD affect 1 in 33 babies every year and cause 1 in 5 infant death. For many babies born with BD, there is no family history of the condition

• All women who can become pregnant should take a vitamin with folic acid (FA) every day. FA helps a baby’s brain and spine develop very early in the first mo of pregnancy when a women might no know she is pregnant


• Many BD are not found immediately at birth. Some are easy to see (cleft lip), but heart defects are not

• Tests (USG & amniocentesis) can detect BD before the baby is born (Spina bifida, heart defects, Down Sy) -> prenatal care & screening

• Most cause of BD unkown. • Smoking, alcohol & other drugs, medicines,

chemicals, infectious diseases during pregnancy linked to BD


• BD prevention : take FA, regular medical check ups, control diabetes & obesity, have tests for infectious diseases and get vaccinations, do not smoke & drink or other drugs

• Prevent infections during pregnancy : wash hands often, especially after using bathroom, touching raw meat, uncooked eggs, unwashed veggies, handling pets, gardening or caring small children

WHO IS AFFECTED

• DD occur among all racial, ethnic & socioeco-nomic groups

• US : one in six (15 %) of children age 3 – 17 have 1 or more DD, such as :

• ADHD, Autism Spectrum disorders, cerebral palsy, hearing loss, intellectual disability, learning disability, vision impairment and other Developmental Delays

DD IS INCREASING IN US

• About 1 in 6 children had DD in 2006 – 2008 showed that prevalence of DD has increased 17.1 % from 1997 - 2008

• Males had twice the prevalence of any DD than females and more specifically had higher prevalence of ADHD, autism, learning disabi-lities, stuttering / stammering and other DDs

• Children from families with income below the federal poverty level had a higher prevalence

REGULAR EXERCISE BENEFIT FOR DD

• Physical Activity Guidelines provides guidance to help people with DD age 6 and older to improve their health through appropriate physical activity each day, since they have a tendency to live less active lifestyles

NUTRITION FOR PERSONS WITH DD

• People with DD often have a higher tendency of being obese than people in the general population

• General recommendations include : • Eat a diet low in saturated fat• Watch portion control• Read labels to choose foods that comprise a

healthful diet

BRAIN DEVELOPMENT- National Center for infant, toddlers and families

• The human brain begins forming very early in prenatal life, 3 weeks after conception

• Brain development is a lifelong project• The brain in a child is more plastic, more open

to learning and enriching influences, but also more vulnerable to developmental problems (impoverished and un-nurturing)

NATURE VERSUS NURTURE -1

• Genes (G) and Environment (E) interact at every step of brain development

• G are responsible for basic wiring plan, for-ming all of the neurons & general connections between different brain regions, while E is res-ponsible for fine-tuning those connections, helping the child adapt to the particular E (cul-tural, family, school, peer group).

NATURE VERSUS NURTURE -2

• Our brains are programmed to recognize human speech, to put words and meaning together and to pick up the grammatical rules of ordering words in sentences.

• However, the particular language each child masters, the size of his vocab and the exact dialect – accent he speaks are determine by his social E in which he is raised.

• Genetic potential is necessary, but DNA alone cannot teach a child to talk

DOES EXPERIENCE CHANGE THE ACTUAL STRUCTURE OF THE BRAIN ?

• Brain development is ‘active-dependent’• Every experience, excites certain neural circuits &

leaves others inactive. Those that are consistent-ly turned on over time will be strengthened, while those that are rarely excited may be dropped away -> cells that fire together, wire together

• Elimination of unused neural circuits referred to as ‘pruning’, making the remaining work more quickly & efficiently

CRITICAL PERIOD IN BRAIN DEVELOPMENT

• Pruning is more common in early childhood• Babies require normal visual input or they may

suffer permanent impairment• Crossed eyes will fail to develop full acuity if it is not

promptly corrected• Critical period for language learning begins around 5

yrs of age and ends around puberty• Individuals who learn a new language after puberty

almost always speak it with a foreign accent

There is no critical periods in the development of every brain function-1

• In visual development : 2 visual abilities :• Acuity (the perception of fine detail) and bin-

ocularity (the coordinated use of both eyes), which is important for depth perception, do depend on normal visual experience as a child, whereas 2 other visual abilities (color and pe-ripheral vision) are not impaired by visual problems in early life

There is no critical periods in the development of every brain function-2

• In language development, the ability to perceive and produce individual speech sounds (incl. grammar and phonology) are more sensitive than vocabulary size to a child’s experience with language in the first few yrs of life

• A child’s social-emotional development depends on a positive, nurturing attachment to a primary caregiver, based on the higher frequency of se-rious behavioral problem among children who were severely neglected during the first year or more of life

Why does the developing brain undergo these critical periods ?

• Between infancy and early grade school yrs, some 50 % more over-produce connections will be preserved in adulthood

• Through pruning, the brain becomes better tuned to meet the challenges of his particular environment

• Kittens that are deprived of all vision in the first months of life show a delayed critical period for visual experience, beginning from the time their deprivation ends

When is the brain fully developed-1

• Our brain are continually re-shaping them-selves to meet the demands of everyday life

• In spite of the great number or neurons pre-sent at birth, brain size itself increases more gradually, a newborn’s brain is about one quarter the adult’s size

• It grows to about 80 % of adult size by 3 yrs of age & 90 % by age 5


* Brain growth is largely due to changes in the neurons, each brain cell begins as a tiny sam-pling and gradually sprouts its hundreds of long, branching dendrites, which serve as the recei-ving point for synaptic input from other neurons* A newborn’s brain works considerably more slowly than an adult’s, transmitting information some sixteen times less efficiently


• The speed of neural processing increases dra-matically during infancy – childhood, reaching its maximum at about 15 yrs

• The increase is due to gradual myelination of the long wires connecting one neuron to another neuron’s dendrites

• Myelination begins around birth and is most rapid in the first yrs but continues as late as 30 yrs of age

Developing brain nutrition - 1

• Brain development is most sensitive to a baby’s nutrition between mid-gestation and 2 yrs of age

• Malnourished (deprived of adequate calories & protein) throughout this period, causes smaller brains, because of reduced dendritic growth, reduced myelination and have fewer glia (supporting cells which continue to form after birth and are myelin producers


• They will suffer from behavioral and cognitive deficits, incl. slower language & fine motor development, lower IQ & poorer school per-formance

• Baby’s birth weight & brain size do depend on the quality of mother’s nutrition during preg-nancy

• Pregnant women should gain 20 % of their ideal pre-pregnancy weight & requires an extra 300 cal per day incl. 10 -12 grams of protein


• After birth, brain growth depends on the qua-lity of the child’s nutrition

• Breast milk : best nutrition for brain growth, provided they receive some from of Fe suppl starting from 6 mo of age, Fe def linked to cognitive deficits, as Fe is critical for main-taining adequate # of O2 carrying rbc neces-sary to fuel brain growth


• They also need a high level of fat (50 % of the calories) until 2 yrs of age for the rapid pace of myelination in early life

• Whole cow’s milk -> after the 1st birthday & after age 2 -> transitioning to a heart-healthy level or fat ( no more than 30 % of total cal), incl. lo-fat cow’s milk (1 – 2 %)

PRENATAL DEVELOPMENT

• Brain development begins with the formation & closure of the neural tube (NT)

• The NT forms from the neural plate, 16 days after conception

• The plate lengthens, start folding up, forming a groove around 22 days post-conception.

• By 27 days the tube is fully closed & begin its transformation into the brain and spinal cord

NEURAL TUBE DEFECTS (NTD) -1

• If, during this 4th week after conception, the tube fails to seal the head end, a anencephaly (lack of cerebral cortex) results & is always fatal

• If the tube fails to seal its lower end, the defect is spina bifida (SB), part of the sp cord may develop outside the spine & is highly vulnerable to damage

• SB range from symptomless to highly disabling (paralysis, sensory loss & loss of bladder – bowel function)

NEURAL TUBE DEFECTS (NTD) -2

• SB can be prevented -> 400 microgram folic acid 1 mo before conception till the end of the first trimester of pregnancy

IMPORTANT INFLUENCES ON BRAIN DEVELOPMENT PRENATALLY

• Good nutrition of the mother• Alcohol & smoking should be avoided, as they

impair the formation & wiring of brain cells• Some chemical & radiation are harmful• Infections : rubella, varicella, CMV, toxoplas-

mosis, syphilis, GO, genital herpes• Prevent with strict hygiene (wash hands fre-

quently, avoid sick friends, don’t share food)

POSTNATAL DEVELOPMENT

• By birth, only the lower portion of the CNS (sp. cord & brain stem) are very well developed :

• 1.kicking, grasping, crying, sleeping, rooting, feeding

• 2. Primitive reflexes :doll’s eye maneuver, moro or startle response, stepping reflex

• 3.Vital body functions: breathing, heartbeat, circulation, sleeping, sucking, swallowing

PARENTS’ ROLE IN BABY’S BRAIN DEVELOPMENT

• Infants prefer human stimuli : your face, voice, touch and even smell over everything else

• Parents are programmed to love & respond to our babies’ cues

• Because brain development is dependent on early experience -> right kind of nurturing

• Infants who are conversed with a lot of verbal interaction -> more advanced linguistic skills

IMPORTANT CHANGES IN THE BRAIN AFTER BIRTH - 1

• The cerebral cortex produces most of its synaptic connections after birth in a massive burst – exuberant period -> color vision, pincer grasp & strong attachment to parents

• By 2 yrs : synaptic exuberant begins earlier in primary sensory regions (visual & primary touch area) & later in the temporal & frontal lobes (higher cognitive & emotional functions)


• In the middle elementary school yrs until end of adolescence, the number of synapses gra-dually declines down to adult levels

• Children’s brain are working very hard during the period of exuberant that corresponds to various critical periods of mental development

• Myelination to process information efficiently, begins in the primary motor & sensory areas:


• Eyes, ears, nose, skin and mouth – and then progresses to ‘higher order’ or association regions that control the more complex inte-gration of perception, thoughts, memories and feelings

• Myelination continue throughout childhood into a person’s 20 & appears to be largely ‘hard wired’ & is badly influenced by severe malnutrition

DIFFERENCES IN THE DEVELOPMENT OF BOYS’ AND GIRLS’ BRAINS -1

• Men’s brain tend to be more lateralized, the 2 hemispheres operate more independently during specific mental tasks (speaking)

• Females tend to use both hemisphere more equally

• Males tend to have slightly larger brains• Girls are more advanced in sensory & cogni-tive

development (vision, hearing, memory, smell & touch)


• Girls tend to be more socially-attuned – responding more readily to human voices or faces or crying in response to another infant’s cry & lead boys in the emergence of fine motor & language skills

• Boys catch up by age 3, to out-perform in one cognitive area : visual- spatial integration (jig-saw puzzles & hand-eye coordination) prefer activities like climbing & pushing trucks


• Males tend to perform better on task like mental rotation, while females tend to per-form better at certain verbal tasks & at identi-fying emotional expression in another per-son’s face

• Parents compensate the different tendencies:• Boy -> lots of conversation & word play• Girl -> jigsaw puzzle & building a block tower

PREGNANCY AND SUBSTANCE ABUSE

• Smoking during pregnancy passes nicotine & ca causing drugs to your baby -> risk of still-birth and premature birth

• Alcohol -> life-long physical & behavioral problems in children, incl fetal alcohol sy

• Illegal drugs can cause underweight babies, birth defects or withdrawal symptoms after birth

SECONDHAND SMOKE

• Pregnant women : spontaneous abortions, stillbirth, sudden infant death sy after birth

• Children : acute respiratory infections, ear problems, severe asthma, meningitis, premature death

ADHD

• According to 2010 US survey : 1 in 10 Ameri-can children has ADHD – a 22 % increase from 2003 – twice as many boys than girls

• Five dietary factors to address if your child has ADHD : to much sugar, gluten sensitivity, too few beneficial bacteria (‘probiotics the new prozac’), animal sourced omega-3 deficiency, food additives & GMO ingedients.

How to optimize your child’s gut flora

• Avoid processed, refined foods as they promote the growth of pathogenic bacteria, yeast, fungus – processed foods are also high in sugar , grains (gluten), artificial additives

• Eat traditionally fermented, unpasteurized foods

• Use a high quality probiotic supplement• Beware of the hidden hazards of glyphosate

(most widely used pesticide)

Additional strategies to relieve ADHD

• Clear house of dangerous pesticides• Avoid commercial washing detergents &

cleaning products • Spend more time in the nature• Investigate sensory therapy and emotional

wellness tools

PEROKOK INDONESIA

• 70 % PEROKOK ADALAH ORANG MISKIN• PEROKOK KRN KECANDUAN -> EGOIS, EMO-

SIONAL, TERPENTING ROKOK, MAKANAN DLL NO 2 -> KELUARGA TERMASUK ANAK KURANG GIZI, SAKITAN, PENDIDIKAN TERLANTAR DAN MENDERITA AKIBAT 2ND HAND SMOKE

• ANAK PEROKOK MISKIN MENDERITA KURANG GIZI DAN RETARDARI MENTAL RINGAN

PEROKOK PASIF LEBIH CEPAT ALAMI KERUSAKAN OTAK – Science Daily, 11 Jan 2013

• China adalah negara dg tingkat perokok ter-besar di dunia, sekitar 350 juta orang

• DR Ruoling Chen, survei pd 6000 orang diatas 60 th di 5 provinsi di China

• Dilakukan penelitian gabungan King’s College London dan Universitas Kesehatan Anhui

• Perokok pasif berisiko demensi lebih cepat• WHO : hanya 11 % negara : ruang bebas asap

rokok di dunia

PP TEMBAKAU – Perlindungan tak total – Kompas, 12 Jan 2013

• PP no 109 2012 seharusnya disahkan 2010• Menkes : harus PP Khusus, krn tembakau ter-

masuk zat adiktif & hrs diatur spt UU narkotika lain dan mgd 4000 zat racun, dimana 60 di-antaranya penyebab kanker -> melindungi penduduk usia produktif, anak, remaja & ibu hamil

• Diharapkan pengawasan utama dari masyarakat sendiri

11.4 Balita Indo terpapar ROKOKMetrotvnews, 17 Jan 2013

• Nafsiah Mboi : PP no 109 2012 : bahan aditif tembakau utk lindungi Indo dr bahaya rokok

• 200.000 or Indo meninggal / th akibat 61 jt perokok aktif

• 92 jt terpapar asap rokok, 78 % (usia 13-15 th) di tempat umum, 69 % di rumah sendiri

• Penerimaan bea cukai rokok Rp 55 triliun, se-dang biaya pengobatan Rp 231 triliun (2012) utk peny jantung, stroke, kanker & 25 peny lain

American Idol’favorite overcomes Tourette’s, Asperger’s

• James Durbin appeared on the 10th season of ‘American Idol’

• Durbin was bullied by his peers, causing him to drop out of high school

• Singer says his wife and child ‘balance’ him , keep him motivated

Hillary Clinton receives a football helmet in a State Department meeting From Deputy Secretary Tom Nides, 7 Jan 2013

developmental disabilities

Documents