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Important Context for Counselling People With Developmental Disorders

A developmental disorder begins in childhood. It involves significant limitations in both intellectual capacity and the ability to carry out everyday activities.

The term developmental disorder covers a variety of conditions. Synonyms include cognitive disability and intellectual disability. The terms mental retardation and mental handicap are no longer considered acceptable.

3 criteria determine a developmental disorder:

  1. The person shows significantly below-average intellectual capacity. This is measured by performance on an intelligence test, which measures:
    • Reasoning
    • Problem solving
    • Planning
    • Abstract thinking
    • Judgment
    • Ability to learn in school using traditional teaching methods
    • Ability to learn through experience, trial and error, and observation
  2. The disorder began before age 18.

  3. The person shows limitations in 2 or more of the following adaptive skill areas:
    • Communication
    • Social skills
    • Independence at home and in the community
    • Functioning at school or work

Considering these different skill areas makes it possible to recognize a range of services that clients might need.

Types of developmental disorders

People with developmental disorders often:

  • Have limited intellectual capacity
  • Are slower to learn and prefer reliable and consistent processes and activities
  • Have a simple, unsophisticated understanding of things; this can be seen as a gift rather than a gap (such as when it results in common sense)
  • Benefit most from informal training or learning through real-life activities
  • Have a coexisting condition, such as impairment of their sight, hearing, or physical abilities

Autism spectrum disorder (ASD)

Autism spectrum disorder (ASD) is a lifelong neurological disorder. It affects how the brain processes information.

In the past, autism might have been described as Asperger’s syndrome (AS), pervasive developmental disorder–not otherwise specified (PDD-NOS), autistic disorder, childhood disintegrative disorder (CDD or Heller’s syndrome), or Rett syndrome. This was roughly their order of severity, from mildest to most severe.

The lines between these diagnoses were blurry, at best. In 2013, the Diagnostics and Statistical Manual of Mental Disorders (DSM-5) merged the first four into autism spectrum disorder levels 1 to 4. Rett syndrome, which is caused by genetic mutations, is now recognized as distinct from ASD.

The term spectrum refers to a continuum of severity or developmental impairment. The conditions of children and adults with ASD cover a wide spectrum. They have differences in:

  • Number and kinds of symptoms
  • Severity of symptoms (mild to severe)
  • Age of onset
  • Levels of functioning
  • Challenges with social interactions

According to the Autism Society of Canada, “Individuals with ASD have varying degrees of difficulty in social interaction and communication and may show repetitive behaviours and have unusual attachments to objects or routines.”

People with ASD often have trouble with:

  • Communication
  • Social interaction
  • Learning
  • Behaviour
  • Perceptions
  • Interests
  • Activities

Learning delays are rarely part of level 1 ASD. Overall, 40% of people with ASD are of average or above-average intelligence. People with level 1 ASD may do well in school and work in mainstream jobs.

Children are now screened for ASD around age 2. Before screening became routine, many people grew up not knowing they were autistic. A growing number of these adults are now being diagnosed with level 1 ASD. Before receiving the right diagnosis, they may hear they have a mood, anxiety, or personality disorder. They may be told they have an eating disorder, a learning disorder, or attention deficit hyperactivity disorder (ADHD).

Adults with autism can be hyper focused, highly attentive to details, and easily emotionally dysregulated. It can be more difficult to diagnose ASD in women than men. Women tend to hide their symptoms and conform to social expectations even when they don’t understand or agree with them. Ongoing problems with communication, social interactions, and extreme sensitivity can eventually lead them to seek diagnosis.

Whether diagnosed in childhood or adulthood, all people with ASD need encouragement and support.

Fetal alcohol spectrum disorder (FASD)

Fetal alcohol spectrum disorder (FASD). If a woman drinks alcohol while pregnant, she risks causing a range of serious problems for her baby.

FASD is not a diagnosis. It is an umbrella term that covers multiple conditions:

  • Fetal alcohol syndrome (FAS). This was the first form of FASD discovered.
  • Partial FAS (pFAS). This involves some but not all the traits of full FAS.
  • Alcohol-related neurodevelopmental disorder (ARND). This involves serious problems with the central nervous system (CNS) but need not include growth deficits or facial abnormalities.
  • Alcohol-related birth defects (ARBD). This refers to heart, kidney, bone, vision, hearing, and immune problems. It usually occurs with other forms of FASD.
  • Neurobehavioural disorder. This is associated with prenatal alcohol exposure (ND-PAE). This is a new diagnosis in the DSM-5 that involves impairments in thinking and memory, behaviour and mood, and basic self-care issues.

In the DSM-5, the terms ARND and ARBD replaced the term FAE (fetal alcohol effects).

Overall, FASD can include:

  • Heart, kidney, and bone problems
  • Difficulty with vision and hearing
  • Reduced immune function
  • Growth deficits before and after birth, including height, weight, and head size
  • Facial abnormalities
  • Structural or functional damage to the CNS

CNS damage can cause problems including:

  • Poor physical coordination
  • Attention and memory deficits
  • Speech and language delays
  • Intellectual deficits and learning disabilities
  • Hyperactivity
  • Reasoning and judgment
  • Behaviour and anger management
  • Difficulties with problem solving

As a person with FASD goes through life, secondary disabilities can arise, such as:

  • Mental health issues (ADHD, depression, anxiety, and conduct disorders)
  • Trouble at school (suspension, expulsion, or dropping out)
  • Trouble with the law or authorities (arising from aggressive behaviour or because they’re easily manipulated to do things that they don’t know are illegal)
  • Victimization by others
  • Alcohol or drug abuse problems
  • Inappropriate sexual behaviour (especially if they’ve experienced sexual abuse)
  • Problems with employment, independent living, and parenting

Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is considered both a developmental and a neurological disability. For information on ADHD, see Important Context for Counselling People With Physical and Neurological Conditions.

Inclusion of persons with developmental disorders

Inclusion means helping everyone take part in everything. No one is left out. Community inclusion means offering community-based supports to make choices possible. It means actively including people with developmental disorders in the community, where they can contribute and be respected for their contribution.

Since school systems expanded their special education services in the 1970s, young people with developmental disorders have expected and planned to work after graduation. Inclusion means they can do so in an integrated setting.

Inclusion moves persons with developmental disorders away from sheltered living and working environments and into the community. This includes education, employment, and community living arrangements. This movement is supported by government policies, funding, and resources.

Inclusion has been a part of Canadian society for many years. But older people with developmental disorders or those coming from outside of Canada may not have had life experiences that foster a belief in themselves. They may not picture a future that includes education, work, and recreation in the community. They may not expect or prepare to work and have a career. Likewise, employers and coworkers may still not be prepared for inclusion. They may need more knowledge and experience.

People with developmental disorders now receive more support to overcome barriers to employment. Government policy takes more active measures to encourage them to work while receiving support such as health benefits.

Inclusion of people with developmental disorders in a diverse workforce makes sound economic sense. They bring unique skill sets and a valuable perspective to the workplace. They and their friends and relatives are a significant potential customer base for businesses that employ them.

You can help these clients enter the workplace in 2 ways. First, you can help them become aware of their assets and ways to use them. Second, you can help employers become aware of the great potential for employing them.

Social and life management skills

Experiences in inclusive settings allow clients to build social and life management skills. These skills are valuable in the competitive workforce. Inclusion in education helps clients build relationships with community members. These people may then become allies in career building.

Barriers and challenges

A developmental disability can have many effects on a person’s major life activities. The following list identifies the extremes:

A developmental disorder can have many effects on a person’s major life activities. The following list identifies the extremes:

  • Self-care. Clients may have trouble with activities such as eating, preparing food, or maintaining hygiene. They may need help with personal care.
  • Receptive or expressive language. Clients may have limited or no use of their voice. They may be unable to express ideas or understand abstract ideas. They may need help with communication. This can include visual means of communication and adaptive technologies that use artificial intelligence and mobile devices.
  • Learning. Clients may be slower to learn or unable to do routine age-appropriate academic activities. They may need special programs and attention.
  • Mobility. Clients may have impaired fine or gross motor skills. They may need help from people or devices.
  • Self-direction. Clients may have trouble choosing among options. They may need help with making decisions.
  • Capacity for independent living. Clients may have a limited ability to relate to the community to satisfy personal, social, and health needs. They may also have trouble with travel to and from work or recreational outings. Clients may need in-home support, such as training on health and safety, hygiene, and daily living activities. They may also need help learning to use supports to manage independent travel.
  • Economic self-sufficiency. Clients may have trouble getting a job and staying above the poverty line. They may benefit from help learning to use supports, adaptations, and accommodations to hold positions in a traditional workplace.
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