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CHILDREN WITH INTELLECTUAL DISABILITIES

Intellectual disability is defined as a disability that is characterized by significant limitation both

in intellectual functioning and in adaptive behavior as expressed in conceptual social and
practical adaptive skills. This disability originates before the age 18. When we understand
intellectual ability to be reasoning, planning, solving problems, thinking abstractly,
comprehending complex ideas, learning quickly and learning from experience then we would
understand that if there is intellectual disability then these elements are affected which are the
main issues involving children in this category.
Key elements in the definition and their meaning
Significant limitation in intellectual functioning (IQ): This refers to a person’s ability to learn,
reason, make decisions, and solve problems. In relation to academic it has to do with a student’s
capacity to perform age appropriate task and it is often measured with the use of standardized
intelligence test. IQ (intelligence quotient) is measured by an IQ test. The average IQ is 100,
with the majority of people scoring between 85 and 115. A person is considered intellectually
disabled if he or she has an IQ of less than 70 to 75.

Adaptive behaviors. This refers to the effectiveness with which the individual meets the
standards of personal independence and social responsibilities expected of is or her age and
social group. These are skills necessary for day-to-day life, such as being able to communicate
effectively, interact with others, and take care of oneself. Adaptive behavior comprises three skill
areas:
a. Conceptual skill: this has to do with language (receptive and expressive), literacy,
(reading and writing), money concept, time concept, number concept, and self-
directory skills (making choices, following schedules, initiating activities, seeking
assistance and solving problems).
b. Social skills: this involve interpersonal skills, responsibility, self-esteem (belief and
confidence in one’s abilities and values), gullibility (not easily deceived), naivete,
following rules, obeying laws
c. Practical skills: this includes activities of daily living (eating, transfer/mobility,
toileting, dressing), occupational skills, maintaining safe environment, and
instrumental activities, such housing keeping, transportation, taking medication,
money etc
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To measure a child’s adaptive behaviors, a specialist will observe the child’s skills and compare
them to other children of the same age. Things that may be observed include how well the child
can feed or dress himself or herself; how well the child is able to communicate with and
understand others; and how the child interacts with family, friends, and other children of the
same age. Intellectual disability is thought to affect about 1% of the population. Of those
affected, 85% have mild intellectual disability. This means they are just a little slower than
average to learn new information or skills. With the right support, most will be able to live
independently as adults.

Manifest before the age of 18: mental retardation can only happen from a life span of 0-18
years (the developmental period).

Notes about intellectual disabilities

1. It is a condition that is due to the nature of the brain’s development.
2. It is not a disease or psychiatric issue
3. It is incurable
4. It is not contagious
5. It does not progress or retrogress
6. It causes reduced capacity in intellectual functioning.

What are the signs of intellectual disability in children?

There are many different signs of intellectual disability in children. Signs may appear during
infancy, or they may not be noticeable until a child reaches school age. It often depends on the
severity of the disability. Some of the most common signs of intellectual disability are:
 Rolling over, sitting up, crawling, or walking late
 Talking late or having trouble with talking
 Slow to master things like potty training, dressing, and feeding himself or herself
 Difficulty remembering things
 Inability to connect actions with consequences
 Behavior problems such as explosive tantrums
 Difficulty with problem-solving or logical thinking
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In children with severe or profound intellectual disability, there may be other health problems as
well. These problems may include seizures, mood disorders (anxiety, autism, etc.), motor skills
impairment, vision problems, or hearing problems.

CAUSES OF INTELLECTUAL DISABILITIES

The causes can be classified under the following categories: Socio-cultural differences,
biomedical factors, and behavioral factors.
Biomedical factors (Prenatal)
 Genetic syndromes (e.g., Down syndrome and Fragile X syndrome)
 Inborn errors of metabolism
 Brain malformation (e.g., microcephaly)
 Maternal disease (e.g., placental disease)
 Environmental influences (e.g., alcohol, other drugs, toxins, teratogens)

Chromosomal and genetic problems: chromosomes are threadlike bodies that carry the genes
that play the critical role in determining inherited characteristics. Defects resulting chromosomal
abnormalities are typically severe and accompanied by visually evident abnormalities. The vast
majority of humans have normal cell structures of 46 chromosomes arranged in 23 pairs and
developed without accident. Aberrations in chromosomal arrangements either before fertilization
(meiosis) or during early cell division (mitosis) can result in a variety of abnormal characteristics
for example, Down syndrome.
Metabolism and nutrition: metabolism problems are characterized by the body’s inabilities to
process certain substances that can be poisonous and damage tissues in the central nervous
system for example Phynylketonuria (PKU) in which the body is not able to process
phenylalanine a substance found in the food including milk ingested by infants. The inability to
break down phenylalanine results in an accumulation of poisonous substances in the body which
can cause varying degrees of intellectual disabilities.
Gestation disorder: gestation is the period of development in the mother’s womb. At this stage
disorders can set caused by maternal substance abuse which can result to low birth weight and
prematurity of the baby. Prematurity refers to infant delivered before 35 weeks from the first day
of the last menstrual period. Low birth weight characterizes babies that weigh 2.500 grams.
These have serious problem including mental retardation.
Perinatal
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 Labor and delivery–related events (leading to neonatal encephalopathy)

 Anoxia at birth

Post Natal Causes

Encephalitis: this has to do with toxic excesses. Reaction to certain toxic substances such as
lead, carbon monoxide as well as certain drugs can cause damage to the central nervous system
which can result to severe mental retardation (e.g., lead, mercury).
Traumas or physical accidents: these can occur either prior to birth (exposure to excessive
radiation) during delivery or after delivery
Socio-cultural factors: Socioeconomic status and diverse cultural backgrounds influence
children’s development. Some home situations offer children very few opportunities to learn,
additionally some even from the time when woman is pregnant (maternal malnutrition).
Infections (meningitis)
Seizure disorders
Severe and chronic social deprivation

CHARACTERISTICS OF INTELLECTUAL DISABILITIES

Individuals with ID have intellectual deficits as well as deficits in adaptive functioning in the
conceptual, social, and practical domains (APA, 2013).
Deficits in Intellectual Functions
 Language development
 Reasoning
 Problem solving
 Planning
 Abstract thinking
 Judgment
 Academic learning
 Learning from experience
Deficits in Adaptive Functioning
 Failure to meet developmental and sociocultural standards for personal independence and
social responsibility
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 Limited functioning in one or more daily life activities (e.g., communication, social
participation, and independent living) across settings in the home, school, work, and
community).
The signs and symptoms of adaptive functioning deficits across domains may include:
Conceptual Domain
 Slow language development (children learn to talk later, if at all)
 Slow development of pre-academic skills
 Difficulties in academic learning (reading, writing, mathematics)
 Difficulty understanding concepts of time and money
 Problems with abstract thinking (concrete approach to problem solving)
 Difficulties in executive function (i.e., planning, strategizing, priority setting, cognitive
flexibility)
 Problems with short-term memory
 Difficulties with functional use of academic skills such as money management and time
management
Social Domain
 Limitations in language and communication skills
o More concrete and less complex spoken language (if used), compared with peers
o Limited vocabulary and grammatical skills
o Receptive language that may be limited to comprehension of simple speech and
gestures
o Communication that may occur through non-spoken means only such as gestures,
signs, facial expressions, and other forms of augmentative and alternative
communication (AAC)
 Social Skills
o Immature social judgment and decision making
o Difficulty understanding peer social cues and social rules
o Emotional and behavioral regulation difficulties that may adversely affect social
interactions
Practical Domain
 Requiring different levels of support for daily life activities such as
o Personal care
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o Complex tasks (e.g., shopping, transportation, care organization, meals, money

management)
o Employment
o Health care and legal decisions
o Household tasks
o Recreational skills

Functional Impairment
The diagnosis of ID requires evidence of impairments in real life (adaptive) skills; thus, all
people with ID demonstrate functional impairment. These adaptive abilities relate to such things
as understanding rules, the ability to navigate the tasks of daily living, and participation in
family, school, and community activities. Various assessments of such skills are available,
assessment of these skills helps to plan remediation, i.e., teaching specific skills and working on
generalization of skills.
Communication Patterns
Individuals with ID and associated language and communication disorders may demonstrate
signs and symptoms of spoken and written language disorders across the domains of phonology,
morphology and syntax, semantics, and pragmatics. Individuals with ID are a heterogeneous
group; communication abilities vary and may be non-symbolic (e.g., gestures, vocalizations,
problem behaviors) and/or symbolic (e.g., words, signs, pictures) for examples of typical
communication patterns of individuals with cerebral palsy, Down syndrome, fetal alcohol
syndrome, and Fragile X syndrome, all of which most commonly co-occur with ID.

CLASSIFICATIONS OF SEVERITY
The terms “mild,” “moderate,” “severe,” and “profound” have been used to describe the severity
of the condition. This approach has been helpful in that aspects of mild to moderate ID differ
from severe to profound ID.
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Mild to Moderate Intellectual Disability: The majority of people with ID are classified as
having mild intellectual disabilities. Individuals with mild ID are slower in all areas of
conceptual development and social and daily living skills. These individuals can learn practical
life skills, which allows them to function in ordinary life with minimal levels of support.
Individuals with moderate ID can take care of themselves, travel to familiar places in their
community, and learn basic skills related to safety and health. Their self-care requires moderate
support.

Severe Intellectual Disability: Severe ID manifests as major delays in development, and

individuals often have the ability to understand speech but otherwise have limited
communication skills (Sattler, 2002). Despite being able to learn simple daily routines and to
engage in simple self-care, individuals with severe ID need supervision in social settings and
often need family care to live in a supervised setting such as a group home.

Profound Intellectual Disability: Persons with profound intellectual disability often have
congenital syndromes (Sattler, 2002). These individuals cannot live independently, and they
require close supervision and help with self-care activities. They have very limited ability to
communicate and often have physical limitations. Individuals with mild to moderate disability
are less likely to have associated medical conditions than those with severe or profound ID.

TREATMENT AND OUTCOMES

Treatments for ID generally fall into three main categories: (1) treatments that address or
mitigate any underlying cause of ID, such as restricting phenylalanine in the diet of patients who
have phenylketonuria; (2) treatments of comorbid (existing alongside) physical and mental
disorders with the aim of improving the patient's functioning and life skills, and (3) early
behavioral and cognitive interventions, special education, habilitation, and psychosocial
supports.

Guidelines for the assessment and management of ID generally focus on psychosocial

interventions. Challenges vary with the age of the individual and the level of impairment as well
as with the presence of other associated conditions. Because individuals with ID can manifest
the full range of psychiatric disorders, medications can sometimes help manage these disorders.
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These disorders frequently respond to standard psychiatric treatment, i.e., medication and
psychosocial support, although in the main ID makes treatment more complex.
Summarily
 Historically, intellectual disability has been defined by significant cognitive deficits,
typically established by the testing of IQ and adaptive behaviors. There are no laboratory
tests for ID; however, many specific causes and genetic factors for ID can be identified
through laboratory tests.
 Males are more likely than females to be diagnosed with ID. Poverty is a risk factor for
ID, especially for mild ID.
 The functional impairments associated with ID are generally lifelong. However, there are
functional supports that may enable an individual with ID to function well and participate
in society.
 As a diagnostic category, IDs include individuals with a wide range of intellectual
functional impairments and difficulties with daily life skills. The levels of severity of
intellectual impairment and the need for support can vary from profound to mild.
 Comorbidities, including behavioral disorders, are common.
 Treatment usually consists of appropriate education and skills training, supportive
environments to optimize functioning, and the targeted treatment of co-occurring
psychiatric disorders.