INTELLECTUAL

DISABILITY
 Terminologies for the MR
• In Ghana people still call the intellectually
challenged people with derogatory names.
Among the Akans, they are referred to as
“Dee wanyini agya n’adwene ho”
“esalbato” by the Gonjas, “jerigu-jerigu”
by the Dagombas, asoviwo/susudidi by
the Ewes ‘buulu’ by the Gas and among
the Fantis, gymi-gyimi (Avoke, 1997).
Terminologies cont.
• Same derogatory terminologies were
used in the queen’s language, notable
among them are: IMBECILE,
MORON, IDIOT just to mention
but a few. This was the case because
of the misconceptions people had
about the MR.
Terminologies cont.
• Today more acceptable
terminologies that are explored will
include;
 INTELLECTUALLY CHALLENGED,
COGNITIVE CHALLENGED,
INTELLECTUALLY DISABLED etc.
 definition
• The American Association of
Mental Retardation (AAMR, 1992)
proposed a new definition which is
accepted worldwide:
 Definition
 Mental Retardation refers to substantial
limitations in present functioning. It is
characterized by significant Sub Average general
intellectual functioning, existing concurrently
with related limitation in two or more of the
following applicable adaptive skill areas:
communication self care, home living, social
skills, community use, self direction, health or
safety functional academics, leisure or work.
Intellectual disability manifest before the
developmental period (0- 18 years).
Sub Average intellectual functioning
• This in simple terms means the
cognitive functioning of the
person is far below expectation
compared with that of his peers
or age mates. In most cases two
standard deviations below the norm
is referred to as sub-average int.
functioning
Limitation in adaptive
behaviour/skills
• This means a fundamental
difficulty – learning or
performing certain daily living
skills as mentioned in the
definition. Refer to cases 1 and 2
 Manifest during the developmental
period
• The developmental period is from
conception to age 18 (0-18 years). If
therefore an individual functions normally
until 18 years and shows a decline
afterwards, that individual is diagnosed as
suffering from a form dementia (loss of
memory) brain damage rather than mental
retardation.
 CHARACTERISTICS
• EDUCATIONAL

• They learn very little or not

at all
• Difficulty in relating what is
learned to real life situations
• Limited vocabulary
SOCIAL BEHAVIOUR
• Engage in non purposeful activity

• Easily frustrated with task

• Exhibit temper tantrums

• Exhibit emotional liability

• Exhibit Echolalia
 Physical characteristics
• Excessive dental decay and very
poor oral hygiene.
• Unusual large tongue
• Webbed toes and fingers
CLASSIFICATION ACCORDING TO (I Q)

LEVEL 1Q TERMINOLOGY EXPECTATIONS

SCORE

Capable of basic academic

MILD 55-70 EDUCABLE
subjects up to advance
elementary levels.
Able to attain self-help skills,
MODERATE 40-54 TRAINABLE
communication skills and social
adjustment.

Can attain basic communication

SEVERE
SEVERE 25-39
and self-skills.

PROFOUND 0 - 24 VEGETABLES With intensive training may learn

basic self-help and
communication skills
 NEW Classification
• This is nit based on IQ test but based on the
strengths, weaknesses and in most cases the
support the individual requires.
1. Intermittent NEED
• Such individuals do not require constant
support, but may require support on short term
basis. Eg, helping the individual to look for
job when he is thrown out of job.
 2. Limited support/Need
• Such individuals require certain support
consistently over time.
• Eg. Handling of cash
• Time limited support for employment training
• Refer to Kojo Armah’s case (p.42). Kojo needs
to be supported to walk and he can do a lot of
things on his own.
 3. Extensive support
• Needs daily support in most aspects of their
lives. E.g. Long term job support

• NOTE: Intermittent, limited and extensive

may not be needed in all life areas of these
individuals.
 4. PERVASIVE SUPPORT
• Individuals under this category require
constant, high intensity support for all aspects
of their lives. Such individuals require support
on a daily basis across ALL life areas.
• CLINICAL CLASSIFICATION
• Down’s syndrome
• Hydrocephaly
• Microcephaly
• Cretinism
• Fragile x
• Epilepsy
• Phenylketonuria (PKU)
DOWN SYNDROME
• This condition can also be called
Mongolian Idiocy or Trisomy 21
which is a type of intellectual
disability which is largely due to
chromosomal aberration. Down’s
syndromes have 47 chromosomes
instead of 46 or the 23 pairs. This
is because the 21st chromosome
becomes 3 instead of a pair hence
the name Trixomy 21.
 MOSAICISM

• Another type of disability is

Mosaicism which is as a result of
errors in cell division. Mosaicism had
45 chromosomes instead of the
normal 46 or 23 pairs of
chromosomes. Mosaicism is very rare.
CHARACTERISTICS OF DOWN SYNDROMES

• Short and stubby fingers and toes

• Abnormal of thick eyelids
• Slanting eye shape
• Protruding tongue
• Small or low sets of ears
• Abnormal palm lines
• Infections – the eye (lack of
antiseptic enzyme LIPSONE which
fights infections.
 How to detect DS
 One way of detecting Down syndrome
is called AMNIOCYNTESIS which is a
clinical process of inserting a needle
into the amniotic sac (which keeps
the baby) to extract a little amniotic
fluid for lab test to detect traces of
Down syndrome in the foetus. This is
undertaken around the 16th week (4
months) of pregnancy. (cannot be
corrected)
 Cretinism
• A metabolic problem or
disorder which could result
in intellectual disability.
There are 2 types
• Congenital hypothyroidism
• Acquired Hypothyroidism
Congenital hypothyroidism
• Congenital hypothyroidism occurs
when the thyroid gland fails to
develop or function properly. In 80
to 85% of cases, the thyroid gland
is absent, abnormally located, or
severely reduced in size
(hypoplastic). In the remaining
cases, a normal-sized or enlarged
thyroid gland is present, but
production of thyroid hormones is
decreased or absent.
• If untreated, congenital
hypothyroidism can lead to

intellectual disability and abnormal

growth.
Acquired Hypothyroidism
Acquired hypothyroidism is a
condition where the thyroid gland
makes too little or no thyroid
hormone.
Acquired hypothyroidism can be
caused by both thyroid disease
(primary hypothyroidism) and
hypothalamic-pituitary disease
(central hypothyroidism
 CHARACTERISTICS

• Look small for their ages

• Have low basal forehead
• Low body temperature

• Delayed dentition

• Frequently get annoyed

 Hydrocephaly
• This is an abnormally big head that
contains fluid (cerebro-spinal fluid)
that forces the head of the child to
expand until it reaches its fullest size.
 Characteristics

Abnormally big head

Protruding eye balls

Veins on the head

 Microcephally
• The head of the micro cephalous is
abnormally too small and for that
matter has a very small brain.
• Characteristics
• Abnormally small head
• Severely retarded
• Speech/communication problems
What to note:

• Mental retardation is a condition

that is the nature of the brain’s
development
• It is not a disease or psychiatric
issue
• It is incurable
• It is not contagious
• It does not progress or
retrogress
• It causes reduced capacity
in intellectual functioning.
 CAUSES OF MENTAL RETARDATION
Prenatal:
Chromosomal & Genetic problems
Maternal malnutrition
Drug and alcohol use
Maternal stress
Diseases
Rh- incompatibility
Maternal accident
Metabolic disorders
Toxoplasmosis
Age of mother (too young or too old mum)
Exposure to excessive radiations.
Diseases of the mother (measles, syphilis, paediatric
AIDS etc).
Peri-natal period
• Difficult / delayed labour (breech delivery) leading
to oxygen deprivation
• Heavy sedation
• Breech delivery
• Transverse birth
• Anoxia ( inadequate supply of oxygen to the brain)
• Wrong use of forceps or assisted deliveries.
• Maternal mortality
• Fall of baby
• Narrow pelvic of expectant mother.
Post-natal period (Childhood factors)
• Accidents
• Head injuries
• Childhood diseases
• Nutrition defects
• Infections
• Lead/ food poisonings (lead students to mention
some sources of lead and other food poisons).
• Socio- cultural influences
Prevention
• Healthy life style prior and during
pregnancy
• Antenatal clinic attendance
• Genetic counseling
• Adequate nutrition for infant
• Hygienic living environment
 MANAGEMENT STRATEGIES
• Select learning goals and objectives that
are functional for the child’s lives
• Teach in the environment in which the
child will be required to use the skills
• Create miniature shops for teaching
practical and functional activities
 MANAGEMENT
STRATEGIES
• Teach using many examples
• Actively engage the child in the
learning activity through
questioning
• Systematically, introduce the
components of the task bit by
bit (task analysis).
MANAGEMENT STRATEGIES
• Provide child with
pictures with or without
words
• Use objects to guide the
child identify concepts
• Underline or highlight key points before
the child reads the material
• Reduce the amount of information on a
page
• Avoid subjecting the child to
uncomfortable reading situations
(reading aloud in groups, reading with
time limits, etc).
MANAGEMENT STRATEGIES
• Give the child more time to finish
and to discover things by self.
• If possible, provide mnemonic
devices to facilitated concept
learning
MANAGEMENT STRATEGIES
• Rewards the efforts made in
reading
• If possible, transfer concepts into
poems, songs, rhymes, etc