Milena was a 6-year-old girl who was referred to her school psychologist by her
ID: 3487934 • Letter: M
Question
Milena was a 6-year-old girl who was referred to her school psychologist by her pediatrician. Milena was diagnosed with Down syndrome when she was an infant. Her pediatrician wanted Milena’s cognitive and academic achievement skills to be reassessed before she began kindergarten this academic year. Milena’s gestation and delivery were uncomplicated. However, Milena was born with a congenital heart defect that required several surgeries. Milena showed physical features associated with Down syndrome. For example, she had a small nose with a flat nasal bridge, almond-shaped eyes, and broad hands with short fingers. Each of her palms had a single transverse crease rather than the many folds seen in most children. Milena showed delays in achieving developmental milestones, especially in the areas of gross motor functioning (e.g., sitting up, walking), fine motor skills (e.g., feeding and dressing herself), and expressive communication (e.g., saying her first words, using two- or three-word phrases). Fortunately, Milena’s parents became active in her education and in a local support group for the caregivers of children with Down syndrome. Milena participated in occupational therapy and speech–language therapy as a toddler and attended a full-day enrichment preschool for children with special needs. Results of the WISC-V indicated that Milena’s full scale IQ was 57, falling in the low range of intellectual functioning. Milena performed better on tests assessing her visual–spatial reasoning and nonverbal fluid reasoning than tests assessing her verbal comprehension skills. Her preschool teacher said that she often learned better through demonstrations and “hands-on” learning than from verbal instruction. Milena showed good eye contact when speaking with others, obeyed classroom rules, and enjoyed playing with other children. Also, with extensive practice, she learned to perform most self-care skills such as bathing, dressing, and cleaning her room. On the other hand, Milena continued to show problems learning her numbers, the alphabet, and the value of money. Her reading skills were poor and her handwriting was mostly illegible. Interpersonally, Milena presented as a charming girl who loved to play with her classmates and spend time with her parents. Her favorite hobbies included soccer, playing with her dog, and helping her parents cook meals. Her parents called her “the cheerful robin” because of her tendency to get up early in the morning and her friendly, social disposition.
Please answer the following questions in complete sentences.
1. List the three DSM-5 domains of adaptive functioning. Then, describe Milena’s functioning on each of these three domains.
2. DSM-5 identifies four levels of severity for children with intellectual disability. Which level of severity best describes Milena’s functioning?
3. According to Zigler’s classification system, what is the difference between organic and cultural–familial intellectual disability? Which classification best describes youths with Down syndrome like Milena?
4. How do Milena’s delays in gross motor, fine motor, and communication skills support the similar sequence hypothesis?
5. What is the behavioral phenotype for children with Down syndrome? How many aspects of this phenotype does Milena show?
6. What caused Milena’s disability? Did she inherit Down syndrome from her parents?
7. What prenatal tests might Milena’s mother have taken to determine the risk that Milena would be born with Down syndrome? Which of these tests carries the greatest risk to the fetus?
8. Milena’s school psychologist would likely use the results of her assessment to generate an IEP for Milena. What is an IEP?
9. If you were Milena’s teacher, how might you use principles of universal design to help Milena learn to read and perform mathematics?
10. In what way might having a child with a known genetic disorder, like Down syndrome, be easier than having child with a developmental disability of unknown origin?
Explanation / Answer
1. The three criteria for adaptive functioning are adaptive reasoning, in three domains: conceptual, social, and practical. In the practical domain, Melina shows good performance on self care skills. For the social domain, she is very adaptive as indicated by her friendly and social disposition. In terms of her conceptual domain however, she needs significant improvement as she shows problems in learning her numbers, the alphabet, and the value of money.
2. Milena falls in the 'Mild' category of intellectual disability which is used for IQs ranging from 55 to 75.
3. Milena seems to have a cultural-familial clear cause for her intellectual disability, as there is no evidence of genetic and constitutional factors, such as chromosome abnormalities, single gene conditions, and neurobiological influences. Also, her disability is mild which is unlikely in cases of organic intellectual disability.
4. Milena's case does seem to support the hypothesis because she has been able to pickup on gross motor, fine motor and communication skills with extensive practice, even though it might be slightly delayed in comparison to those children who do not show any intellectual disability.
Please post the other questions separately.