16870 DKO causes and associated conditions related to ID · Careerforce – Issue 2.0 – Mar 2014 US 16870 DKO causes and associated conditions related to intellectual disability

Workbook

Demonstrate knowledge of causes and associated conditions related to intellectual disability

US 16870

Level 3 Credits 3

Name:

Careerforce – Issue 2.0 – Mar 2014 US 16870 DKO causes and associated conditions related to intellectual disability 3

Contents

What is intellectual disability? .......................................................................................... 7

Definitions of intellectual disability .................................................................................... 8

The New Zealand Disability Strategy ............................................................................... 9

The causes of intellectual disability ................................................................................ 10

Support needs ................................................................................................................ 17

Down’s syndrome .......................................................................................................... 21

Autism spectrum disorder .............................................................................................. 22

Cerebral palsy ................................................................................................................ 24

Spina bifida .................................................................................................................... 26

Prader Willi syndrome .................................................................................................... 27

Epilepsy ......................................................................................................................... 28


Before you start

Welcome to this workbook for US 16870:

Demonstrate knowledge of causes and associated conditions related to

intellectual disability

For this unit standard you will have:

this workbook.

an assessment.

In this workbook you will learn more about:

what an intellectual disability is.

what the causes of intellectual disabilities are.

characteristics of various conditions.

supporting a person with an intellectual disability.

How to use this workbook

This is your workbook to keep. Make it your own by writing in it.

Use highlighters to identify important ideas.

Do the learning activities included throughout this workbook. Write your answers in

the spaces provided.

You might find it helpful to discuss your answers with colleagues or your supervisor.

Finish this workbook before you start on the assessment.


Workbook activities

Learning activity

You will come across learning activities as you work through this

workbook. These activities help you understand and apply the

information that you are learning.

When you see this symbol, you are asked to think about what you

know. This may include reviewing your knowledge or talking to a

colleague.

When you see this symbol, it gives you a hint, tip or definition.

The glossary and study hints book has study hints for

all trainees. It also explains key words and phrases

from the compulsory unit standards for Foundation

Skills and Core Competencies.

You can download it from www.careerforce.org.nz or

order it from http://shop.careerforce.org.nz


Check your knowledge

Before you begin, think about intellectual disability.

In your own words explain what you know ‘intellectual disability’ to mean:

Write down what you need to know about intellectual disability and record any questions

you have about it.


What is intellectual disability?

Intelligence refers to general mental capacity, such as learning, reasoning, making

decisions, problem solving, and so on. Intelligence is measured by an intelligence

quotient (IQ) test. The average IQ is 100. A person is considered intellectually disabled if

they have an IQ below the 70 to 75 range.

Disability is not something individuals have. What individuals have are impairments - a

limitation to the way a person is able to function.

Limitations to intellectual or cognitive functioning affects thinking and processing

skills, like solving problems, understanding instructions, reasoning, analysing and

evaluating information.

There are several definitions of what an intellectual disability (ID) is. Each of them is

written by different organisations in different parts of the world. Each of them says that:

intellectual disability has its onset (beginning) in the early/developmental years and

is a life-long condition that cannot be cured.

people with an intellectual disability find it more difficult to learn and understand

than people without an intellectual disability. They are just a little slower than

average to learn new information or skills.

people with an intellectual disability may find it hard to use what they have learned

in practical ways. This is referred to as having difficulty with ‘adaptive behaviour’.

Adaptive behaviour or adaptive functioning are the life skills that people learn, so that

they can function in a safe and socially responsible manner in their everyday lives.

Because of this, people with an intellectual disability are likely to need help and support

with everyday living skills. Some people may need high levels of support, while other

people, with some support, are able to live quite independently.


Definitions of intellectual disability

The American Psychiatric Association (APA) publishes the Diagnostic and Statistical

Manual of Mental Disorders (DSM), used for diagnosis purposes. The fifth edition,

DSM-5, revises the previous editions’ definition of intellectual disability. www.dsm5.org/

Intellectual disability involves impairments of general mental abilities that impact adaptive

functioning in three domains, or areas. These domains determine how well an individual

copes with everyday tasks:

the conceptual domain includes skills in language, reading, writing, maths,

reasoning, knowledge, and memory.

the social domain refers to empathy, social judgment, interpersonal communication

skills, the ability to make and retain friendships, and similar capacities.

the practical domain centres on self-management in areas such as personal care,

job responsibilities, money management, recreation, and organizing school and

work tasks.

The American Association on Intellectual and Developmental Disabilities (AAIDD)

[formerly the American Association on Mental Retardation (AAMR)] definition focuses on

rehabilitation.

‘Intellectual disability is a disability characterised by significant limitations in both

intellectual functioning and in adaptive behaviour, which covers many everyday

social and practical skills.’ http://aaidd.org/intellectual-disability/definition

This disability originates during the developmental period and is regarded by AAIDD as

before the age of 18.

The AAIDD stresses that additional factors must be taken into account, such as the

community environment.

The Seven Counties Services has a website with

a lot of information about intellectual disability.

www.sevencounties.org/

http://www.sevencounties.org/


The New Zealand Disability Strategy

The way that disability is perceived has changed over the years. Intellectual disability

was once called mental retardation.

Disability, for most of the 20th Century, was considered in the medical model concept.

This model assumes medical care and management of the condition is required, with

disability being ‘something wrong’ and that had to be ‘fixed’. This ‘fix’ was often

residential accommodation where the special needs of the person could be met

alongside others with similar needs.

The prevailing model is the social model of disability, as has been adopted in the New

Zealand Disability Strategy. This view is that disabled people are unable to fully

participate in society because of limitations placed upon them by society systems.

The Disability Strategy provides a framework to guide government agencies making

policy and services impacting on disabled people. It has a vision and presents a

long-term plan for changing New Zealand from a disabling to an inclusive society. It has

been developed in consultation with disabled people and the wider disability sector, and

reflects many individuals' experiences of disability.

New Zealand will be inclusive when people with impairments can say they live in:

'A society that highly values our lives and continually enhances our full participation.'

Disabled people will be integrated into community life on their own terms, their abilities

will be valued, their diversity and interdependence will be recognised, and their human

rights will be protected. Achieving this vision will also involve recognising the principles of

the Treaty of Waitangi.

New Zealand Disability Strategy is available for reading online or for downloading.

www.odi.govt.nz/resources/publications/new-zealand-disability-strategy.html

The Disability Strategy is also available in an easy read version, a pictorial version, an

audio version, a braille version and a video in New Zealand Sign language.

You can learn more about physical disability in the

Careerforce workbook for Unit Standard 16871.


The causes of intellectual disability

Intellectual disability can be caused by a number of factors, either before birth, during or

immediately following birth, or in childhood. In some cases the cause is known, but in

nearly half of the cases the cause of the intellectual disability is unknown.

Causes before birth

An intellectual disability can be caused before a child is born, because of:

genetic factors.

chromosomal factors.

other factors.

Genetic/hereditary factors

‘Genetic’ means that the condition is passed

down from parents to a baby. A healthy person

with no symptoms may be a carrier of genetic

information that may result in their children

having an intellectual disability. For example,

cystic fibrosis, where most often the parents

each carry one copy of the altered gene but do

not show signs and symptoms of the disorder. It is thought that

spina bifida and autism may also have a genetic link.

Chromosomal factors

Any change in the normal structure or number of chromosomes can

result in intellectual disability. For example, Prader Willi syndrome

and Down’s syndrome – neither of these are usually inherited from

parents.

Other factors

Other factors such as trauma, poisoning, or a serious illness while

the mother is pregnant can cause an intellectual disability. For

example, foetal alcohol syndrome is caused by drinking excessive

amounts of alcohol during pregnancy, which can affect the foetus at

critical stages of development.


Learning activity

For each of the three causes record the main characteristics of the

cause, and its possible effects on a baby before birth.

Cause Main characteristics Possible effects

Chromosomal

Genetic

Other


Causes during birth

Intellectual disability can be caused during or

immediately after birth. There are a number of

ways that this can occur. These include:

premature birth.

prolonged labour.

trauma.

a lack of oxygen (known as asphyxia

or anoxia).

multiply births.

The impact of the disability on the baby will be

different for each, depending on the severity of the

damage.

Short term effects for the baby

Minimum physical contact due to incubation.

The lack of oxygen to the brain means a baby requires support with oxygen.

Inability to suck means a baby requires tube feeding and intravenous support.

Inability to regulate body temperature means a baby will need support to

maintain body temperature.

These all require intervention if the baby is to survive.

Characteristics

Babies whose intellectual disabilities are caused during birth may have some of the

following characteristic:

informed lungs and/or heart.

difficulty feeding (sucking).

inability to regulate body temperature.

a bluish tint to their skin due to breathing problems.

small size and low birth weight.

being tired and distressed.

showing difficulty in responding to stimuli.

blue lips and pale skin.

shallow breathing.

poor muscle tone.

tissue damage (swelling, bruising, bleeding).


Possible long term effects

Significant below average intelligence often leads to difficulties in reasoning,

thinking, learning new skills and tasks, memory, understanding, concentration,

literacy and numeracy.

Shortcomings in everyday life skills such as physical activities of daily living,

dressing, washing, toileting and tying shoelaces.

Significant development delays of:

gross motor skills - sitting, walking, crawling, running, jumping.

fine motor skills - picking things up, and coordination.

communication - understanding others, and communicating needs.

social - sharing and playing, taking turns, understanding social rules.

Overall this may result in:

brain damage.

failure to thrive.

sensory difficulties (hearing and visual problems).


Learning activity

Choose two possible causes of an intellectual disability during birth and

record the main characteristics of the cause and its possible effects

on a baby.

Cause one:

Main characteristics

Effect on baby

Cause two:


Effect on baby


Causes during childhood

Intellectual disability can also occur in the developmental years of a child’s growth. AAIDD

defines this as before the age of 18.

Some of the factors that may cause intellectual disability during childhood are listed

below, though these do not always result in an intellectual disability:

head injuries from accidents and falls.

brain tumours.

illnesses such as meningitis, or encephalitis which can damage the brain.

severe allergic reactions or poisoning.

severe malnutrition, which can stop the brain from developing (if it occurs at critical

periods).

Sometimes when the cause of the disability is not known it is referred to as ‘general

developmental delay’ or as ‘intellectual disability’.

The impact of the disability on the child will be different for each individual, depending on

the severity of the impairment and the age that it occurred. Some of the support needs

might include:

re-teaching skills that the child had already developed but has lost as a result of their

illness/trauma.

adapting skills to accommodate the child’s changed level of ability. For example,

teaching a new way of communicating if speech has been lost.

adapting resources and aids that the child requires.

providing extra support for the child to learn concepts.

providing extra support in encouraging social interaction and development.


Learning activity

Choose two possible causes of an intellectual disability during

childhood. Record the main characteristics of the cause and the

impact of these on the day-to-day support needs of a person.

Cause one:


Impact on support needs

Cause two:


Impact on support needs


Support needs

More important than knowing the cause of the disability is knowing how the disability

impacts on each individual person, and how to support them in the best way.

A person who has an intellectual disability will need ongoing support throughout their life.

The support a person requires will change as the person develops from childhood into

adulthood.

The support for a person with an intellectual disability must be holistic, person-centred

and take into account the person’s strengths.

The most important support is to enable the person to participate in the ordinary aspects

of life that people with an intellectual disability sometimes take for granted.

These are the most important factors for the person:

to have friends.

to go places.

to go to school/get a job.

to have a home with people they chose to live with.

to communicate with others.

Support areas you may be involved in include:

activities of daily living (ADL), which are basic self-care tasks.

instrumental activities of daily living (IADL) requiring more complex skills, like

preparing meals.


Associated conditions

There are many conditions that are associated with intellectual disability.

’Associated’ means that a person who has this condition is more likely to also have an

intellectual disability.

Some of the conditions are always associated with intellectual disability. Some of the

people with these conditions may not have an intellectual disability.

A person with an intellectual disability may have specific support needs related to their

particular condition. These associated conditions can include the following.

Down’s syndrome

Autism spectrum disorder

Cerebral palsy.

Spina bifida

Prada Willi syndrome.

Epilepsy

There are a wide variety of needs

that a person may benefit from

support in.

These could include physical,

social, and cognitive support

needs, among other things.



Learning activity

Think about a person you currently support. How do you support the

physical, cognitive and social needs of the person? Provide some

examples.

Physical supports

Cognitive supports

Social supports


Down’s syndrome

Down’s syndrome is caused by a chromosomal factor, giving a third copy of

chromosome 21 inside each of the body’s cells, instead of the usual two copies. Down’s

syndrome is recognisable at birth because of typical physical characteristics and

diagnosis will be confirmed by chromosome analysis.

Characteristics

Many characteristics are attributed to Down’s syndrome, but any one person will only

have some of them as each person is different, with a unique appearance, personality

and set of abilities. The extent to which a person shows the physical characteristics of

the syndrome is no indication of their intellectual capacity. Usual characteristics are:

intellectual disability - delays in learning and development.

characteristic facial features - but each person also closely resembles their parents

and family.

low muscle tone.

increased risk of heart defects.

digestive problems such as reflux.

hearing loss.

reduced activity of the thyroid gland (hyperthyroidism).

increased risk of early onset of Alzheimer’s Disease.

Support needs

Physical supports

Physiotherapy and occupational therapy related to muscle tone, movement and

co-ordination.

Speech and language therapy to help with speech clarity, development of language,

comprehension and alternative strategies for communication.

Medical support to monitor/manage health problems, ie heart difficulties or reflux.

Regular exercise.

Support and aids for hearing impairment as required.

Support with physical tasks such as dressing, and daily living skills.

Cognitive supports

More time to learn new things, such as skills, concepts.

Targeted teaching plans.

Additional supports may be required at school, such as teacher aid support.

Social supports

Facilitating opportunities to build and maintain friendships.

Support with accessing community activities.

Finding and holding a meaningful job.


Autism spectrum disorder

The exact cause of autism spectrum disorder (ASD) is not known, but there does appear

to be a genetic link. The parents may not themselves have ASD, but the combination of

the parents’ genes may have an impact.

What we do know is that ASD is a neurological condition and is related to the way the

brain works. It causes its effects because of the way that the brain processes the

information it receives. The brain has difficulty in making sense of the information that

comes into it, which leads to the characteristics which are commonly seen in ASD.

Characteristics

ASD is a relatively new term that covers a group of conditions (including autism,

Asperger’s syndrome, and pervasive developmental disorder) which have key aspects in

common. Everyone who is diagnosed with ASD shares three sets of characteristics:

difficulty in understanding and using verbal and non-verbal communication in a

typical way.

impairment in the ability to understand social behaviour, which affects their ability to

interact with other people.

impairment in the ability to think and behave flexibly which may be shown in

restricted, obsessional or repetitive activities.

Difficulty communicating

Some examples of this are:

some people with ASD do not learn to speak.

some people with ASD may use an odd accent or unusual grammar.

some people with ASD might repeat words or phrases (this is known as echolalia).

Difficulty interacting


difficulty in reading other people’s facial expressions.

difficulty in understanding and making sense of social ‘rules’, such as not

interrupting, turn taking or what subjects to talk about with particular people.

for some people understanding the ‘social world’ is so challenging that they avoid it

and become very isolated.

Difficulty thinking or behaving flexibly


many people with ASD have difficulty making sense of changes because they are

not always good at recognising what impact the change will have. This is stressful

for them. For example, a change in support worker at the last minute can make

them uncertain of what to expect because they cannot think flexibly enough to know

what the outcome will be.


wanting to keep things the same, such as routines, support workers, meals, clothes,

or the route to drive to work. This relates to having difficulties with change. People

with ASD often prefer to keep things predictable so they know what to expect.

doing repetitive activities such as lining up items, talking about a special topic a lot,

or collecting things - again this can be a way for people with ASD to create some

predictability, or control, when everything around them seems very unpredictable.

Sensory difficulties

Many people with ASD also have some sensory difficulties, meaning that they can be

either oversensitive or under sensitive to some sensory stimuli. This includes hearing,

vision, smell, touch, taste, balance and awareness of body movements. For example, a

person with ASD may be very sensitive to loud noises and find them hard to cope with,

and another person with ASD may particularly enjoy a smell and seek that smell.

Although these features are characteristic of all people with ASD, there is a range of

severity. Some people with ASD have an intellectual disability, but not all. There are also

people who have only some of the characteristics, and may be referred to as having

‘features of ASD’.

Support needs

Physical support

Maintaining an environment that meets the sensory needs of the individual,

including avoiding troublesome sensory experiences.

Support with daily living skills as required - this will be different for each person.

Occupational therapy related to difficulties with coordination and daily living skills if

appropriate.

Relaxation and stress management.

Cognitive support

Structured and logical approaches to teaching/learning concepts and skills.

Use of visual strategies to support learning as appropriate.

Communication support (including speech and language therapy) to develop

communication skills as appropriate.

Maintaining predictable routines.

Informing of change in ways that make sense to the person.

Social support

Aiding the learning of social rules in logical ways.

Making opportunities to develop and maintain friendships.

Offering specific advice and guidance about social interactions.

Allowing time away from stressful social situations as required.

Making time for relaxation.


Cerebral palsy

Cerebral palsy is caused by damage to one or more specific areas of the brain, usually

occurring while a foetus is developing, or, during birth or, shortly following birth or, in

infancy.

Cerebral palsy describes a group of specific conditions which affect movement and

posture. ‘Cerebral’ refers to the brain and ‘palsy’ to muscle weakness and poor control.

A person with cerebral palsy has damage to areas of the motor areas of the brain, which

control movement. This results in permanent difficulty sending messages from the brain

to control different muscles.

The type of cerebral palsy will depend on the area of the brain damaged and can cause

mild impairment (such as difficulty walking) through to significant impairment requiring a

high level of support and assistance with mobility.

Characteristics

A characteristic of a cerebral palsy is a person may experience weak and stiff muscles or

uncontrolled movements. Movements may appear stiff and jerky because the muscles

are contracted and tense, even though they are weak. ‘Spasticity’ describes the tone of

muscles or how tight they are. Coordination may be affected which can result in

problems with balance and coordinating movement.

People with cerebral palsy can have problems such as weakness, stiffness, muscles

spasms, unwanted muscle movements, floppiness, an awkwardness of movement,

slowness, shakiness and difficulty with balance.

In mild cerebral palsy, the person may be slightly affected in one arm or leg and the

problem may be barely noticeable.

Cerebral palsy can affect the way a person walks, for example, on their toes, with an

unsteady or ‘scissored’ gait, or dragging one leg.

When the effects of cerebral palsy are more severe the person may have a lot of

difficulties, with the whole body affected. For example, some people with cerebral palsy

will have difficulty talking, walking or using their hands. Some will be unable to sit up

without support and will require help to do most everyday tasks.

Some people with cerebral palsy have an intellectual disability, but not all.


Support needs

Physical support

Physiotherapy related to mobility, muscle spasms.

Support with physical and daily living activities depending on the level of decreased

mobility.

Possible use of a wheelchair, or other physical aids.

Environmental adaptations such as shower rails, ramps. An occupational therapist

will help with this.

Specialist medical intervention if medical problems exist.

Cognitive support

Individualised support with learning and education depending on the need.

Possible speech and language therapy to develop language and clarity of speech,

as required.

Technology and aids to assist learning if writing and other physical tasks related to

learning are difficult.

Social support

Assisting with community access and transportation as required.

Facilitating opportunities for friendships as required.

Taking opportunities to discuss disability issues.


Spina bifida

Spina bifida occurs in the six weeks of pregnancy when the spinal column doesn’t close

completely. The exact cause is unknown but it is believed that genetics and some

environmental factors may play a role.

Spina bifida is a physical disability. Most people with spina bifida do not have an

intellectual disability. Some people with spina bifida may have difficulty with some

specific aspects of learning, such as reasoning and problem solving, organisation,

sequencing skills, or memory, without having an intellectual disability.

Characteristics

The effects of spina bifida are different for every person. The effects can include:

full or partial paralysis, requiring some mobility aids.

bladder and bowel control difficulties and urinary tract infections.

orthopaedic difficulties.

loss of sensation which can make it difficult to recognise pressure, friction, or

temperature changes.

neurological problems, which can affect learning.

latex allergy.

hydrocephalus (or fluid on the brain). The person must have surgery to insert a

‘shunt’ which stays in place for life and helps drain the fluid. Care needs to be taken

to avoid blockages, infections or disconnection.

Support needs

Physical supports

Specialist medical intervention related to hydrocephalus, mobility, bladder and

bowel, orthopaedic problems.

Support with physical activities depending on the level of decreased mobility.

Possible use of a wheelchair or other physical aids.

Avoidance of latex (if allergy exists).

Environmental adaptations such as shower rails, ramps.

Cognitive supports Learning support as appropriate for the individual - this will be different for each person.

Social supports

Community access and transportation as required.

Facilitating opportunities for friendships.

Opportunities to discuss disability issues.


Prader Willi syndrome

Prader Willi syndrome (PWS) is a chromosomal condition caused by changes in the 15th

chromosome. Half of the people with PWS have a deletion on the 15th, while others have

chromosome errors that keep key genes from working.

Characteristics

Prader Willi syndrome has been described as a two-stage syndrome. In the first, or

‘failure to thrive’ stage, weight gain is slow and developmental milestones (both physical

and intellectual) are delayed. The baby tends to be ‘floppy’ due to low muscle tone.

The second stage, ‘thriving too well’ emerges as muscle tone improves. There is a

compulsion to eat and an obsession with food, usually between the ages of two and four,

but sometimes later. People with PWS do not receive messages from their brain to tell

them that they are full, because the central nervous system is not functioning correctly.

They feel constantly hungry, which is hard to live with. Without environmental controls,

serious weight gain occurs in 95% of people with PWS.

Some other characteristics of Prader Willi syndrome are:

hypotonia (lack of muscle tone) in the young child.

hypogonadism (incomplete development of sexual characteristics).

intellectual disability (though this varies).

physical characteristics appear in most individuals. Among these are a narrow

forehead, short stature as adults, almond-shaped eyes, small hands and feet.

Support needs

Physical support

Individualised weight management, with support from specialists.

Regular exercise.

Keep food locked away so that temptation is avoided. A person with PWS can

literally eat themselves to death, so this unusual strategy is often very important.

Physiotherapy or occupational therapy as appropriate.

Cognitive support

Educational support related to the person’s needs is different for each person.

Maintaining meal routines so the person has some control over food availability.

Helping the person learn to manage their own diet as appropriate.

Social support

Relaxation and fun that is not related to food.

Ensuring friends/family are consistent in their approach to food when they are

around the person.

Keeping busy and having interests so that there are plenty of distractions.


Epilepsy

Epilepsy is caused by damage to specific parts of the brain. It is not always known what

causes this damage, but in some cases it can occur following a head injury or stroke.

People with intellectual disabilities can be more at risk of developing epilepsy. In some

cases epilepsy and intellectual disabilities can both be a part of another condition.

People with Down’s syndrome are at an increased risk of developing epilepsy in later life.

Characteristics

A person with epilepsy has the tendency to have recurrent seizures. A seizure is the

result of a sudden burst of excess electrical activity in the brain which causes messages

within the brain to become temporarily halted or mixed up. The type of seizure a person

has depends on the area of the brain where this activity occurs. There are around 40

different types of seizure and a person may have more than one type. These range from

brief absent moments, to episodes of losing consciousness, falling to the floor and

convulsing. The person may or may not be conscious of a seizure.

Epilepsy can be life-threatening and people with epilepsy have an increased risk of

accidental death, for example, by drowning. Most people with epilepsy are able to

manage their condition with medication, and most lead an ordinary life.

Support needs

Physical support

Everyone you support with epilepsy will have a support plan, which you must know and

be confident in carrying out. It will include things such as:

a medication regime.

an explanation understanding what can trigger a seizure for that person.

details of how to keep the person safe when they are having a seizure.

first aid procedures.

when to call for an ambulance.

instructions about how to support the person after their seizure.

Cognitive support

The person may miss learning opportunities while having a seizure or recovering from

one, so support is required to help them to catch up. In very severe cases the epilepsy

may impact on the person’s ability to learn and they may benefit from specialist support.

For example, extra help at school, memory aids, visual aids to help aid understanding.

Social support

Know how to protect the person’s dignity if they have a seizure in public.

Support the person to feel confident and capable.


Learning activity

Choose three conditions associated with intellectual disabilities.

Complete the table for each of the conditions you have chosen.

Condition ONE

Cause

Characteristics (at least two)

Support needs

Physical

Social

Cognitive

Condition TWO

Cause


Continued on next page


Condition TWO continued

Support needs

Physical

Social

Cognitive

Condition THREE

Cause


Support needs

Physical

Social

Cognitive


Completion and assessment

Congratulations!

You have come to the end of the workbook. Please check over all the activities in this

workbook to make sure you have completed them.

Your assessment is next.

You need to complete the assessment successfully to be credited with this unit standard.

Acknowledgements

Careerforce thanks the people who have contributed to this workbook by:

researching and validating content.

providing advice and expertise.

testing the activities.

sharing personal experiences.

appearing in photographs.

The images contained in these workbooks are visual illustrations only and are not representative of

actual events or personal circumstances.

Creative Commons

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www.careerforce.org.nz

Careerforce – Issue 2.0 – Mar 2014

16870 DKO causes and associated conditions related to ID · Careerforce – Issue 2.0 – Mar 2014 US 16870 DKO causes and associated conditions related to intellectual disability

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