INTELLECTUAL DISABILITY (ID)

Ms. Asmita Dalvi

Clinical Psychologist
WHAT IS INTELLECTUAL DISABILITY
• A.A.M.R., 2002 : “A disability characterized by
significant limitation both in intellectual functioning and
in adaptive behavior as expressed in conceptual, social
and practical skills. This disability originates before the
age of 18 years”
 WHAT IS INTELLECTUAL DISABILITY
 Deficits in intellectual functioning: reasoning, problem
solving, planning, abstract thinking, judgment, academic
learning, and learning from experience
 Deficits in adaptive functioning that significantly hamper
conforming to developmental and socio-cultural standards
for the individual's independence and ability to meet their
social responsibility
 The onset of these deficits during childhood.”
COMPONENTS OF ID
• Sub normal Intellectual Functioning
• Problems in Adaptive Behaviour
• Developmental Period
INTELLECTUAL FUNCTIONING
• Global capacity to act purposefully, think rationally and
to deal effectively with one’s environment (Wechsler).

• Related to the spontaneous application of thinking and

problem solving strategies as well as volitional control of
their application to everyday situations
ADAPTIVE BEHAVIOUR
• Collection of skills that have been learned by people in
order to function in their daily lives to meet the
standards of personal independence and social
responsibility.
• Social
• Conceptual
• Practical
DEVELOPMENTAL PERIOD
• Evidence of significant limitations must appear prior to a
specific age, usually 18
BASICS
• Intellectual Disability = Intellectual Developmental
Disorders (ICD)
• Rosa’a Law: US federal law (2010) replacing the term
"mental retardation" with "intellectual disability" in
federal health, education, and labor statutes.
• The law was named after nine-year-old Rosa Marcellino,
and was part of a larger effort to end the use of the "R-
word" and promote inclusive language for people with
intellectual disabilities.
PREVALENCE
• 2-3% of population
• More males than females
• More prevalent in lower SES and in minority groups
 Especially for mild ID
 No differences for more severe levels
ASSUMPTIONS
• Limitation in present functioning must be considered
within the context of community environment typical of
the individual’s age, peer and culture.
• Valid assessment considers culture and linguistic
diversity as well as differences in communication,
sensory, motor and behavioural factors.
ASSUMPTIONS
• An important purpose of describing limitations is to
develop a profile of needed support.
• With appropriate personalized support over a sustained
period, the life- Functioning of a person with mental
retardation will generally improve.
RED FLAGS
Severity Specifiers
• 317 (F70) Mild
• 318.0 (F71) Moderate
• 318.1 (F72) Severe
• 318.2 (F73) Profound
CLASSIFICATION
Psychological Educational
• MILD • EDUCABLE
• MODERATE • TRAINABLE
• SEVERE • DEPENDANT
• PROFOUND • CUSTODIAL
MILD (IQ Range 50-69)
• Intermittent Support
• Slower in all areas of conceptual development, and social
and daily living skills.
• Can learn practical life skills, which allows them to
function in ordinary life with minimal levels of support.
MODERATE (IQ Range 35-49)
• Limited Support
• Can take care of themselves, travel to familiar places in
their community, and learn basic skills related to safety
and health.
• Self-care requires moderate support.
 SEVERE (IQ Range 20-34)
• Extensive Support
• Major delays in development
• Ability to understand speech is present, but communication
skills otherwise are limited
• Need supervision in simple daily routines and self-care, and in
social settings; and often need family care to live in a supervised
setting such as a group home.
PROFOUND (IQ Range < 20)
• Pervasive Support

• Often have congenital syndromes & physical limitations.

• Cannot live independently, and require close supervision and

help with self-care activities.

• Very limited ability to communicate.

MILD
MODERATE
SEVERE & PROFOUND
 0 – 5 yrs 6 – 20 yrs 21 yrs and above
Gross retardation; minimal
Some motor development Some motor and speech
capacity for functioning in
present; may respond to development; may achieve very
Profound sensorimotor areas; needs
minimal or limited training limited self-care; needs nursing
nursing care; constant aid
in self-help care
and supervision required
Can talk or learn to May contribute partially to self-
Poor motor development;
communicate; can be trained maintenance under complete
speech minimal; generally
in elemental health habits; supervision; can develop self-
Severe unable to profit from
profits from systematic habit protection skills to a minimal
training in self-help; little or
training; unable to profit useful level in controlled
no communication skills
from vocational training environment
Can talk or learn to Can profit from training in
May achieve self-maintenance
communicate; poor social social and occupational
in unskilled or semiskilled work
awareness; fair motor skills; unlikely to progress
under sheltered conditions;
Moderate development; profits from beyond second-grade level in
needs supervision and guidance
training in self-help; can be academic subjects; may learn
when under mild social or
managed with moderate to travel alone in familiar
economic stress
supervision places
Can develop social and Can usually achieve social and
Can learn academic skills up
communication skills; vocational skills adequate to
to approximately sixth-grade
minimal retardation in minimal self-support, but may
Mild level by late teens; can be
sensorimotor areas; often need guidance and assistance
guided toward social
not distinguished from when under unusual social or
conformity
normal until later age economic stress
CAUSES
• Prenatal Causes (Chromosomal Abnormalities; Genetic
Disorders; Infection in mother in first trimester;
maternal diseases like diabetes, hypertension; exposure
to radiation; congenital defects of CNS).
• Perinatal Causes (Premature birth; low birth weight;
hypoxia; head trauma; severe jaundice in neonate; etc)
• Postnatal Causes (Malnutrition; infections in the child;
repeated fits; head trauma)
• Down Syndrome
▫ Langdon Down - 1866. Most common cause of ID
▫ Mongoloid (slanted eyes, epicanthal folds, flat nose).
▫ Trisomy 21
▫ Incidence – 1 in 700 birth.
▫ Moderately to severely impaired
▫ Language functions are relatively weak, social skills are relative strengths
▫ Abundant neck skin; a small, flattened skull; high cheekbones; protruding
tongue; hands broad and thick; fingers short and curved inward
• Fragile X Syndrome
 Second most common cause of ID
 Mutation on the x chromosome at fragile site (xq27.3).
 Occurs in 1/1000 males and 1/2000 females.
 Large, long head and ears; short stature,
 ID ranges from mild to severe.
 High rate of ADHD, learning disorders, and pervasive developmental
disorders.
Prader-Willi Syndrome
Result from a small deletion involving chromosome 15.
Prevalence: <1 of 10,000.
Compulsive eating behaviour and often obesity
Intellectual disability
Small stature; small hands and feet.
Often have oppositional and defiant behaviour.
Cat's Cry (Cri-du-Chat) Syndrome
Lacks part of chromosome 5.
Severely impaired.
Microcephaly, Low-set ear
Cat-like cry caused by laryngeal abnormalities.
Other Chromosomal Abnormalities
Phenylketonuria
 Severely impaired.
 Inability to convert phenylanine to paratyrosine due to lack of
phenylalanine hydroxylase.
 Early diagnosis is important.
Neurofibromatosis: NF1 gene located on Chromosome 17
 Cafe au lait spots on the skin and neurofibromas, including optic
gliomas and acoustic neuromas.
 Mild ID, ADHD and speech delay common.
Tuberous Sclerosis
 Non cancerous tumors grown throughout the body.
 Seizure, Neurodevelopmental delays and disorders
Lesch-Nyhan Syndrome
Deficiency of an enzyme involved in purine metabolism.
ID, microcephaly, seizures, and spasticity.
Adrenoleukodystrophy
Demyelination of the cerebral white matter resulting in visual and
intellectual impairment, seizures, spasticity, and progression to
death.
Other Enzyme Deficiency Disorders
Hartnup disease.
Glycogen storage disease.
Galactosemia.
Acquired childhood Disorders
Infection – encephalitis and meningitis (Measles).
Head trauma – head injury.
Drowning.
Exposure to lead.
Intracranial tumors.
Environmental and Sociocultural Factors
Deprivation of nutrition and nurturance.
Poor medical care and poor maternal nutrition.
Teenage pregnancies.
Family instability, frequent moves, and multiple but inadequate
caretakers.
Emotional deprivation.
CONDITIONS MISTAKEN FOR ID
• Early Infantile Autism
• Child with Hearing Impairment
• Child with Emotional Disturbances
• Cultural Deprivation and Lack of Stimulation
• Specific Learning Disabilities
• Childhood Psychosis
• Child with Visual Handicap
• Child with Physical Handicap
COURSE AND PROGNOSIS
• Underlying intellectual impairment does not improve,
yet the level of adaptation can be influenced positively by
an enriched and supportive environment.

• More the comorbid mental disorders, more guarded is

the overall prognosis.
IDENTIFICATION & MANAGEMENT
SCREENING: Interviews/ Checklist/ Schedules

ASSESSMENT: Medical, Psychological, Special Educational,

Speech & Language, Associated disorders

DIAGNOSIS OF M R

INTERVENTION: Medical, Behavioural, Psychosocial,

Educational, Speech & Language Therapy, Physical Therapy,
Occupational Therapy

EVALUATION
PSYCHOLOGICAL ASSESSMENT
• The intellectual functioning and adaptive behaviour are
assessed using a combination of test and schedules.
• Measurement of the overall level of general intellectual
functioning.(IQ)
• Assessment of adaptive behaviour
• Developmental assessment (DQ)
TREATMENT
• Primary Prevention
Eliminate/reduce conditions leading to ID development.
Increase the general public’s knowledge and awareness.
Mental and child health care.
Family and genetic counseling.
Proper prenatal and post natal care with various
supplementary enrichment programs.
TREATMENT
• Secondary and Tertiary Prevention
Hereditary metabolic and endocrine disorders (PKU and
hypothyroidism) - dietary control or hormone
replacement therapy.
Emotional and behavioural difficulties requiring
psychiatric treatment.
TREATMENT
• Education for child
 Training in adaptive skills, social skills and vocation.
 Group therapy.
• Therapy
 Behavior therapy – to minimize aggressive and destructive
behaviour.
 Cognitive therapy – for dispelling false beliefs.
• Social Intervention
 To improve sense of social isolation and social competence.
 Special Olympics – enhance social interaction and general self
esteem.
• Institutionalization or residential care
 PARENTAL COUNSELLING
• Child's actual condition should be explained in simple words to the parents.
• Misleading, giving false information or building false hopes in parents must
be avoided.
• Information regarding professional help for treating associated conditions
like seizures, hyperactivity, psychosis etc. must be made available.
• Attitude of over protection i.e. doing everything for the child and shielding
them from any challenging situation, should be corrected as it hinders the
development of whatever capacities the child may have.
 PARENTAL COUNSELLING
• Attitude of rejection (ignoring the child thinking that he is good for nothing)
should be changed.
• Parents should be made aware of what they may expect of their child.
• Some parents feel guilty assuming that they are responsible for their child's
condition. No direct control over causes should be explained.
• Explain the effectiveness and role of the parents and other family members
in training.
• Parents should be helped to learn the skills in training their children
through demonstrations and observations.
THANK YOU!