CHILDREN WITH

INTELLECTUAL DISABILITY:
MILESTONES & CHALLENGES

DR. SOMI SUBHRA MUKHOPADHYAY

ASST. PROFESSOR, DEPT OF OPTOMETRY
EVERY CHILD IS SPECIAL
 PEOPLE WITH DISABILITIES ARE VULNERABLE
BECAUSE OF THE MANY BARRIERS WE FACE:
ATTITUDINAL, PHYSICAL, & FINANCIAL. ADDRESSING
THESE BARRIERS IS WITHIN OUR REACH & WE HAVE A
MERE DUTY TO DO SO…… BUT MOST IMPORTANT ,
ADDRESSING THESE BARRIERS WILL UNLOCK THE
POTENTIAL OF SO MANY PEOPLE WITH SO MUCH TO
CONTRIBUTE TO THE WORLD .
STEPHEN HAWKING
 WHO ARE SPECIAL CHILDREN?
OR WHO ARE CHILDREN WITH
DISABILITIES?

THOSE WHO HAVE ONE OR MORE CHRONIC PHYSICAL ,

DEVELOPMENTAL, BEHAVIOURAL OR EMOTIONAL CONDITIONS &
WHO ALSO REQUIRE HEALTH & RELATED SERVICES OF A TYPE OR
AMOUNT BEYOND THAT REQUIRED BY CHILDREN GENERALLY.
 FOUR MAJOR TYPES OF SPECIAL
NEEDS CHILDREN:-
 SENSORY IMPAIRMENT : BLIND, VISUALLY IMPAIRED, DEAF, HEARING ISSUES
 DEVELOPMENTAL DISABILITIES : DOWN’S SYNDROME, AUTISM, DYSLEXIA (LEARNING
DISABILITIES), ASPERGER’S SYNDROME ETC
 CONTD.

BEHAVIOURAL/EMOTIONAL ISSUES : ATTENTION DEFICIT

DISORDER (ADD), ATTENTION DEFICIT HYPERACTIVITY
DISORDER(ADHD), BIPOLAR DISORDER, OPPOSITIONAL
DEFIANCE DISORDER(ODD) ETC.

 PHYSICAL DISABILITIES : MASCULAR DYSTROPHY, MULTIPLE

SCLEROSIS, EPILEPSY, CYSTIC FIBROSIS, CEREBRAL PALSY ETC.
 SOME STATISTICAL DATA:-
• APPROXIMATELY 10% OF THE WORLD’S POPULATION LIVES WITH A DISABILITY.
• AN ESTIMATED 80% OF PEOPLEWITH DISABILITIES LIVE IN DEVELOPING COUNTRIES.
• AN ESTIMATED 15-20% OF THE WORLD’S POOREST PEOPLE ARE DISABLED.
• NO REHABILITATION SERVICES ARE AVAILABLE TO PEOPLE WITH DISABILITIES IN
DEVELOPING COUNTRIES.
• ONLY 5-15% OF PEOPLE WITH DISABILITIES CAN ACCESS ASSISTIVE DEVICES IN THE
DEVELOPING COUNTRIES.
• CHILDREN WITH DISABILITIES ARE MUCH LESS LIKELY TO ATTEND SCHOOL THAN
OTHERS.
• IN INDIA, THERE ARE 21 MILLION PEOPLE WITH DISABILITIES, 2.13% OF TOTAL
POPULATION (CENSUS 2001).
OPTOMETRY & SPECIAL NEEDS
CHILDREN
 ROLE OF OPTOMETRISTS IN REHABILITATION
OF SPECIAL CHILDREN
• TREATMENT FOR LEARNING RELATED VISION PROBLEMS LIKE ADD/ADHD,
DYSLEXIA, EYE TRACKING AND/OR EYE TEAMING AND READING PROBLEMS.

• DEVELOPMENTAL VISION EVALUATION FOR INDIVIDUALS WITH AUTISM,

ASPERGER’S OR PERVASIVE DEVELOPMENTAL DISORDERS (PDD)

• VISUAL REHABILITATION FOR PATIENTS WITH SPECIAL NEEDS SUCH AS

TRAUMATIC BRAIN INJURY (TBI), NEUROLOGICAL DISEASE AND/OR
DEVELOPMENTAL DELAYS INCLUDING CONCUSSIONS, AUTISM, STROKE,
WHIPLASH, CEREBRAL PALSY, MULTIPLE SCLEROSIS.

• REHABILITATION OF VISUALLY IMPAIRED CHILDREN.

 SIGNS AND SYMPTOMS OF A VISION PROBLEM
IN SPECIAL NEEDS CHILDREN
• SKIPS/REPEATS LINES WHEN READING
• OMITS SMALL WORDS WHEN READING
• POOR READING COMPREHENSION
• HOMEWORK TAKES LONGER THAN IT SHOULD
• REDUCED VISUAL ATTENTION
• TROUBLE KEEPING ATTENTION ON READING
• DIFFICULTY COMPLETING ASSIGNMENTS ON TIME
• DIFFICULTY COPYING FROM BOARD
• BURNING, ITCHY, WATERY EYES
• TILTS HEAD/CLOSES ONE EYE WHEN READING
• CLOSES OR COVERS ONE EYE
 CONTD.
• ONE EYE TURNS IN OR OUT
• AVOIDS NEAR WORK/READING
• UNABLE TO LISTEN AND LOOK AT SAME TIME
• HOLDS READING MATERIAL TOO CLOSE
• POOR HANDWRITING
• CLUMSY/KNOCKS THINGS OVER
• CAR/MOTION SICKNESS
• UNUSUAL NECK AND BODY POSTURES
• VISUAL PERCEPTUAL PROBLEMS
• UNCONTROLLED EYE SHAKING (NYSTAGMUS)
• VISUAL PROCESSING DELAYS
 FOLLOWING CONDITIONS OFTEN HAVE VISION
PROBLEMS
• ALBINISM
• CEREBRAL PALSY
• DOWN SYNDROME
• AUTISM SPECTRUM DISORDERS
• DYSLEXIA
• GENETIC AND CHROMOSOMAL ANOMALIES
• NEUROMUSCULAR DISORDERS
• DEVELOPMENTAL DISABILITIES
• BRAIN INJURY
INTELLECTUALLY DISABLED
 INTELLECTUAL DISABILITIES
 INTELLECTUAL DISABILITY ALSO KNOWN AS MENTAL RETARDATION IS A
GENERALIZED NEURODEVELOPMENTAL DISORDER CHARACTERIZED BY
SIGNIFICANTLY IMPAIRED INTELLECTUAL AND ADAPTIVE
FUNCTIONING WITH LATE COGNITIVE ABILITIES & MOTOR SKILLS
(DELAYED MILESTONES).
 A PERSON IS CONSIDERED INTELLECTUALLY DISABLED IF HE OR SHE HAS
AN IQ OF LESS THAN 70 TO 75.
 INTELLECTUAL DISABILITY AFFECTS ABOUT 2–3% OF THE GENERAL
POPULATION. 75-90% OF THE AFFECTED PEOPLE HAVE MILD
INTELLECTUAL DISABILITY. NON-SYNDROMIC OR IDIOPATHIC CASES
ACCOUNT FOR 30–50% OF CASES. ABOUT A QUARTER OF CASES ARE
CAUSED BY A GENETIC DISORDER, AND ABOUT 5% OF CASES ARE
INHERITED FROM A PERSON'S PARENTS. CASES OF UNKNOWN CAUSE
AFFECT ABOUT 95 MILLION PEOPLE AS OF 2013.
 SIGNS & SYMPTOMS:-
• DELAYS IN REACHING OR FAILURE TO ACHIEVE MILESTONES IN
MOTOR SKILLS DEVELOPMENT (SITTING, CRAWLING, WALKING)
• SLOWNESS LEARNING TO TALK OR CONTINUED DIFFICULTIES
WITH SPEECH AND LANGUAGE SKILLS AFTER STARTING TO
TALK.
• DIFFICULTY WITH SELF-HELP AND SELF-CARE SKILLS (E.G.
GETTING DRESSED, WASHING, AND FEEDING THEMSELVES)
• POOR PLANNING OR PROBLEM SOLVING ABILITIES
• BEHAVIOURAL AND SOCIAL COMMUNICATION PROBLEMS.
• FAILURE TO GROW INTELLECTUALLY OR CONTINUED INFANT-
LIKE BEHAVIOUR.
 CONTD.
• PROBLEMS KEEPING UP IN SCHOOL.
• FAILURE TO ADAPT OR ADJUST TO NEW SITUATIONS.
• DIFFICULTY UNDERSTANDING AND FOLLOWING SOCIAL
RULES.
• LATE REACTIONS TO SURROUNDING INCIDENTS.
• PROBLEMS IN EXPRESSING THEIR THOUGHTS, NEEDS
AND/OR FEELINGS.
• UNCONTROLLED ANGER (MOOD DISORDER).
• FORGETFULNESS.
 ETIOLOGY:-
• GENETIC CONDITIONS LIKE DOWN SYNDROME, KLINEFELTER SYNDROME, FRAGILE X
SYNDROME (COMMON AMONG BOYS), NEUROFIBROMATOSIS, CONGENITAL
HYPOTHYROIDISM, WILLIAMS SYNDROME, PHENYLKETONURIA (PKU), AND PRADER–
WILLI SYNDROME.
• PROBLEMS DURING PREGNANCY LIKE FOETAL ALCOHOL SPECTRUM DISORDER,
RUBELLA INFECTION.
• PROBLEMS AT BIRTH SUCH AS NOT GETTING OXYGEN LEADING TO BRAIN DAMAGE.
• EXPOSURE TO CERTAIN TYPES OF DISEASE OR TOXINS. DISEASES LIKE WHOOPING
COUGH, MEASLES, OR MENINGITIS CAN CAUSE INTELLECTUAL DISABILITY IF MEDICAL
CARE IS DELAYED OR INADEQUATE.
• IODINE DEFICIENCY –CRETINISM
• NONE OF THE ABOVE- IN TWO-THIRDS OF ALL CHILDREN WHO HAVE INTELLECTUAL
DISABILITY, THE CAUSE IS UNKNOWN.
SEVERITY OF INTELLECTUAL
DISABILITY:-
 IS INTELLECTUAL DISABILITY DETERMINED BY
JUST AN IQ TEST?
NO.
THERE ARE THREE MAJOR CRITERIA FOR INTELLECTUAL DISABILITY:
SIGNIFICANT LIMITATIONS IN INTELLECTUAL FUNCTIONING,
SIGNIFICANT LIMITATIONS IN ADAPTIVE BEHAVIOUR, AND
ONSET BEFORE THE AGE OF 18.

THE IQ TEST IS A MAJOR TOOL IN MEASURING INTELLECTUAL

FUNCTIONING, WHICH IS THE MENTAL CAPACITY FOR LEARNING,
REASONING, PROBLEM SOLVING, AND SO ON.
 CONTD.
OTHER TESTS DETERMINE LIMITATIONS IN ADAPTIVE
BEHAVIOUR, WHICH COVERS THREE TYPES OF SKILLS:

 CONCEPTUAL SKILLS—LANGUAGE AND LITERACY; MONEY,

TIME, AND NUMBER CONCEPTS; AND SELF-DIRECTION
 SOCIAL SKILLS—INTERPERSONAL SKILLS, SOCIAL
RESPONSIBILITY, SELF-ESTEEM, GULLIBILITY, WARINESS,
SOCIAL PROBLEM SOLVING, AND THE ABILITY TO FOLLOW
RULES, OBEY LAWS, AND AVOID BEING VICTIMIZED
 PRACTICAL SKILLS—ACTIVITIES OF DAILY LIVING (PERSONAL
CARE), OCCUPATIONAL SKILLS, HEALTHCARE,
TRAVEL/TRANSPORTATION, SCHEDULES/ROUTINES, SAFETY,
USE OF MONEY, USE OF THE TELEPHONE.
ASSESSMENT:-
• INTELLECTUAL DISABILITY IS
DIAGNOSED THROUGH THE USE

OF STANDARDIZED TESTS OF
INTELLIGENCE (TESTING A
PERSON’S I.Q.) AND

ADAPTIVE BEHAVIOUR
(THE ABILITY OF A PERSON
TO FUNCTION AND

PERFORM EVERYDAY
LIFE ACTIVITIES).
 CONTD.
• INTELLIGENCE TESTS:
oKAUFMAN’S TEST SCALE;
oRAVEN’S TEST SCALE;
oWECHSLER INTELLIGENCE SCALE FOR
CHILDREN;
oWECHSLER ADULT INTELLIGENCE
SCALE;
oSTANFORD BINET INTELLIGENCE SCALE;
oWOODCOCK JOHNSON TESTS OF
COGNITIVE ABILITY.
 CONTD.
• ADAPTIVE FUNCTIONING TESTS:
o VINELAND ADAPTIVE BEHAVIOUR SCALES (VABS);
o ADAPTIVE BEHAVIOUR ASSESSMENT SYSTEM (ABAS);
o INVENTORY FOR CLIENT AND AGENCY PLANNING (ICAP);
o SCALES OF INDEPENDENT BEHAVIOUR (SIB)
 LEARNING & ACADEMICS:-
• ENSURE UNDERSTANDING-SHORT & SIMPLE
SENTENCES.
• PERSONALIZED CONCENTRATION ON EACH & EVERY
CHILDREN.
• PRACTICE & REPETITION.
• ENCOURAGING & SUPPORTIVE LEARNING
ENVIRONMENT.
• REINFORCEMENT.
• USE MNEMONICS.
• ELABORATE REHEARSAL & CLUSTERING.
• TEACH WITH HANDS-ON MATERIALS & PRACTICAL
EXPERIENCES.
• VISUAL SUPPORTS.
• INVOLVE FAMILIES.
• REVIEW IN SMALL ORDERED STEPS.
THANK YOU
 DELAYED MILESTONES
 CHILDREN REACH DEVELOPMENTAL MILESTONES AT
THEIR OWN PACE.
 DEVELOPMENTAL DELAY-ABSENCE OF AGE-SPECIFIC
DEVELOPMENTAL BEHAVIOURS.
 DELAY IN REACHING LANGUAGE, THINKING, AND
MOTOR SKILLS MILESTONES IS CALLED DEVELOPMENTAL
DELAY.
 IT IS IMPORTANT TO RECOGNIZE WHEN A CHILD MAY
NOT BE DEVELOPING IT AT AN AVERAGE AGE.
 FEATURES:-
• BLIND OR VISUALLY IMPAIRED CHILDREN- DELAYED EXPLORATION
SKILLS & TAKE LONGER TIME TO WALK.
• DELAYED SMILE.
• DIFFICULTY TO UNDERSTAND PROPERTIES OF OBJECTS & SHAPES.
• DEAF CHILDREN-DELAYED LANGUAGE MILESTONES.
• BEHAVIOURAL PROBLEMS- POOR SOCIAL INTERACTIONS OR
SLEEPING-WAKING DIFFICULTIES.
• DYSMORPHIC IN NATURE.
 WARNING SIGNS:-
• LATE SMILING.
• DELAYED VISUAL RECOGNITION.
• LATE CHEWING/GAGGING.
• PERSISTENT RECIPROCAL KICKING.
• LACK OF PRIMITIVE REFLEXES.
• ALTERED VOCALIZATIONS.
• VOICE DUALITY.
• LACK OF INTEREST & CONCENTRATION
• BLIND OR DEAF.
• AIMLESS OVER ACTIVITY.
• NEUROMUSCULAR OVER ACTIVITY.
• EMOTIONAL DEPRIVATION.
 SOME CONDITIONS WITH DELAYED
MILESTONES:-

• CEREBRAL PALSY
• DOWN SYNDROME
• ADD / ADHD
• BIPOLAR DISORDER
• MENTAL RETARDATION
• LEARNING DISORDERS (DYSLEXIA)
• TRAUMATIC BRAIN INJURY
• RETT SYNDROME.
• DOWN SYNDROME IS THE MOST COMMON
GENETIC CAUSE OF INTELLECTUAL DISABILITY.