mhGAP Humanitarian Intervention Guide
(mhGAP-HIG)
Training materials
Intellectual
Disability
Intellectual disability (ID)
A. Introduction and assessment of ID
B. Management of ID
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Introduction
• Intellectual disability is characterized by limitations across
multiple areas of expected intellectual development (i.e.
cognitive, language, motor and social skills) that are not
reversible, though functioning can be improved with intervention.
• These conditions exist from birth or started during childhood.
Often they are diagnosed late.
• Intellectual disability interferes with learning, daily functioning
and adaptation to a new environment.
• How might a person present with an intellectual disability?
• Local beliefs about intellectual disabilities.
• More vulnerable to neglect, discrimination and abuse.
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Intellectual disability
and humanitarian crisis
• Why is it important to identify people with intellectual disabilities
in humanitarian crises?
• Persons with intellectual disabilities are extra vulnerable in a
humanitarian crisis:
More vulnerable to abuse and neglect
More likely to enter dangerous situations
May be abandoned during displacement because they are perceived
as being burdensome
More likely to be separated from caregivers on whom they rely for
most things.
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Assessment of intellectual
disability – overview
• Assessment question 1:
Does the person have an intellectual disability?
Significant delay in developmental milestones and
difficulties meeting the demands of daily life – Rule out
treatable or reversible conditions.
You must have the consent of the person before talking to
a carer.
• Assessment question 2:
Are there associated behavioural problems?
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Assessment question 1:
Does the person have an intellectual disability?
How do you review skills and functioning?
• Young children and toddlers:
Age-appropriate developmental milestones across all developmental areas
• Older children or adolescents:
School, managing schoolwork (learning, reading and writing) and everyday
household activities
• Adults:
Work and how they are managing their work and other daily activities
• Children, adolescents and adults:
Amount of help received to do daily activities (e.g. at home, school, work).
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Exercise: Developmental milestones
What are warning signs to watch for?
• By the age of ONE MONTH
• By the age of SIX MONTHS
• By the age of TWELVE MONTHS
• By the age of TWO YEARS
• By the age of THREE YEARS
• By the age of FIVE YEARS
• By the age of EIGHT YEARS
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Assessment question 1:
Does the person have an intellectual disability?
• Rule out treatable or reversible conditions that can mimic
intellectual disability:
Visual impairment
Hearing impairment
Problems in the environment
(such as abuse or neglect)
Malnutrition or hormonal deficiencies
Epilepsy.
• If a treatable problem is identified manage the treatable
problem and reassess.
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Providing a stimulating overview
(WHO and UNICEF 2012)
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Assessment question 2:
Are there associated behavioural problems?
Assess whether the person shows repeated
aggressive, disobedient or defiant behaviour:
• Not listening to carers
• Frequent and severe tantrums. Aggression and
self-harming behaviour when upset
• Eating non-organic materials (such as paint or
metal)
• Exhibiting reckless sexual or other problematic
behaviour.
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Video
Video: part 1
From the mhGAP-IG base course – DEV
module
• Pay attention to the questions asked by
the health-care provider in the video.
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ID assessment – role-play
• Groups of three – health-care worker, person seeking help, observer.
• Person seeking help: follow the case study.
• Health-care worker: assess the person for possible intellectual
disability.
• Observer: observe and provide feedback on:
Using principles of assessment
Using other GPC such as human rights, sexual health, etc.
Ability to identify the required information
Listening and communication skills
Overall interaction (warmth, empathy, body language, etc.).
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Intellectual disability (ID)
A. Introduction and assessment of ID
B. Management of ID
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Psychoeducation for intellectual disability
• Explain the disability:
Person and parents are not to blame.
Carers should have realistic expectations.
Carers should be kind and supportive.
Problem behaviour is not being “bad” or “naughty”,
but a way of communicating a need or an experience.
• Provide training on parenting skills:
Importance of self-care and hygiene activities
Get to know the person
Regular daily activities
Rewarding when behaviour is good
and taking away reward when behaviour is problematic
Respond to expressed need.
• Educate on person being vulnerable.
• Educate to avoid institutionalization.
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Activity
Discuss in groups:
• Group 1: How can community-based protection be
promoted for people with ID in a humanitarian
context?
• Group 2: In your context, how can inclusion of people
with ID be advocated for? Which situations are people
with ID excluded from, and how can they be
integrated?
• Group 3: In your context, what referral options are
available for people with ID?
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Basic management plan
1. Offer psychoeducation.
2. Promote community-based protection.
3. Advocate for inclusion in community activities.
Keep children in normal schools.
Encourage participation in social activities.
Assess community-based rehabilitation programmes.
4. Care for the carers.
5. Refer to a specialist in the case of concurrent
developmental conditions.
Irreversible motor impairment or cerebral palsy
Birth defects, genetic abnormalities or syndromes
6. Follow-up.
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Video
Video: part 2
From the mhGAP-IG base course – DEV module
What important messages did the health-care provider convey?
• Explained the child’s problem.
• Explained that understanding the cause of the developmental delay
• and predicting how fast the child would develop is very difficult.
• Suggested that follow-up visits with a specialist would help (if available).
• Explained that children can learn new skills and that the carer’s role is very
important.
• Acknowledged the carer’s concerns and frustrations.
• Explained the importance of “positive rewards” and discouraged harsh
punishment.
• Praised the carer’s efforts.
• Promoted support and resources for carers.
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ID management – role-play
• Groups of three – health-care worker, person seeking help,
observer.
• Person seeking help: follow the case study.
• Health-care worker: manage the condition according to the
mhGAP-HIG.
• Observer: observe and provide feedback on:
Using principles of management and other GPC
Ability to identify the required information
Listening and communication skills
Overall interaction (warmth, empathy, body language, etc.).
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Key points
• Intellectual disability is not reversible, but functioning can
be improved with appropriate care and intervention.
• People with ID may be at greater risk of a range of
problems (including abuse) and so require additional
attention during humanitarian emergencies.
• Rule out treatable problems.
• Provide education and support to carers.
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