Treatment Options

The person with a developmental disability needs a combination of interdisciplinary
services that are individually planned and coordinated and are of
lifelong duration or extended duration throughout the life cycle. Because
the causes and manifestations of developmental disabilities are so varied,
each affected person is unique and requires an individualized approach to
treatment and training. Each disability has specific needs that must be addressed
and accommodations that must be provided.

When a defect has been identified prenatally, fetal treatment may be possible
in order to prevent developmental disability. Some inborn errors of
metabolism respond to vitamin therapy given to the mother. Bone marrow
transplants and fetal surgery have also been performed.

Services for children from birth to two years of age provide special education
as well as access to specialists in the areas of speech and physical therapy,
psychology, medicine, and nursing. Assistive technology, physical adaptations,
and case management are also offered. Medical management,
monitoring, and consultation may be the responsibility of a developmental
pediatrician.

Early intervention may be home-based, or the child can be enrolled in a
center with a low child-to-teacher ratio. In either case, an Individual Family
Service Plan (IFSP) is developed which includes a statement of the child’s
present level of development, the family’s concerns, priorities, and resources,
major outcomes to be achieved, and the specific early intervention
services to be provided; identification of the coordinator responsible for implementing
the plan; and procedures for transition to preschool.

Among the equipment used in treating the child may be positioning devices,
wheelchairs, special car restraints, amplification devices, and ambulation
aids. Some children may require gastronomy tubes, tracheostomy
tubes, cardiorespiratory monitors, nasogastric tubes, ventilators, bladder
catheters, splints, or casting. They may be placed on antiepileptic medication,
antispasticity drugs, antireflux medications, antibiotics, respiratory
medications, or medications to influence mood and behavior.
The Individuals with Disabilities Education Act mandates comprehensive
educational services for children from three through twenty-one years of
age. Services are offered in a continuum of settings that are individually determined.

These settings may include hospitals, residential facilities, separate
day schools, homes, and public schools. Children are ideally placed in
what the law refers to as the least restrictive environment. An Individual Education
Plan (IEP) replaces the IFSP.

ADLs are a prime focus of the educational program. The goal is to promote
independence in such areas as eating, drinking, dressing, using the
toilet, grooming, and tool use, which, in turn, fosters self-esteem.
Facilitating language acquisition and communicative intent are critical to
any intervention program. Many developmentally disabled individuals will
need numerous stimulus presentations before acquiring a rudimentary vocabulary. For those children who continue to be nonverbal, alternative
communication systems such as sign language, use of pictures, and communication
boards are introduced to enable communicative interaction. Computers
with interface devices such as switches or touch-sensitive screens may
be introduced to children with cerebral palsy.

Children with developmental disabilities exhibit challenging behaviors
more often than typically developing children. After previously unrecognized
medical conditions are ruled out as causes, positive behavioral supports
at home and in school or traditional behavior management programs
aim to produce comprehensive change in those challenging behaviors.
Drugs that affect central nervous system function can also be helpful in
treating disruptive behaviors.

Newer treatment approaches include neurodevelopmental therapy and
sensory integration therapy. Neurodevelopmental therapy is widely used by
physical and occupational therapists. It emphasizes sensorimotor experience
to facilitate normal movement and posture in young developmentally
disabled children with cerebral palsy or other, related disorders. Sensory integration
is a normal process in which the child’s central nervous system
organizes sensory feedback from the body and the environment and makes
appropriate adaptive responses. Sensory integration therapy uses controlled
sensory input to promote those adaptive responses.

Adults with developmental disabilities are living longer than ever before.
Most have the ability to live happy, productive lives in their communities.
One component of treatment is transition planning. The Developmental
Disabilities Act of 1984 emphasizes the importance of employment of persons
with developmental disabilities and offers guidelines for providing supported
employment services. Other transition issues include sexuality, social
integration, recreation, and community residential options. Medical
and physical care plans are necessary because long-term consequences of
therapeutic interventions may occur. Movement disorders can result from
the prolonged use of neuroleptic medications, while bone demineralization
may be caused by the chronic use of certain anticonvulsants.