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Understanding Intellectual Disability

"“The only disability in life is a bad attitude.” Scott Hamilton"
By: Lourdes Nena A. Cabison-Carlos, MDUnderstanding Intellectual Disability

Intellectual disability is a very challenging condition to diagnose in infants and young children. It refers to a below average intellectual function (or IQ) and a lack of or difficulty in acquiring skills necessary for daily living (also known as adaptive behavior). Because intellectual disability can range from mild to profound, a child might develop more slowly compared to children of the same age or he/she might need assistance in performing simple tasks.

What are the signs? 

Early identification of developmental and intellectual delay is the first step towards ensuring the best outcomes for infants at risk for social, emotional, intellectual and behavioral disorders. Some of the red flags and entail consult with your pediatrician are:

  • Delay in rolling over, sitting up or walking
  • Delay in speech development
  • Behavioral problems such as tantrums or hurting self/others
  • Delay in learning how to dress or feed self and potty training
  • Difficulty in making friends or interacting with schoolmates
  • Difficulty in remembering important things, reading or problem-solving

It is also important to keep in mind that while intellectual disability can occur alone, in some cases, it can present with other health problems. Keep an eye out for associated conditions such as autism, seizures, hearing problems or genetic diseases.

What causes intellectual disability?

  • Genetic or metabolic conditions such as Down's, Angelman and Fragile X syndrome
  • Prenatal illnesses such as infection, hypertension/pre-eclampsia and malnutrition can interfere with fetal brain development. Drug abuse and alcohol intake during pregnancy carry a consequence in the developing fetus
  • Preterm birth or a difficult delivery that affect the oxygen delivery to the brain
  • Infections after birth that can affect the brain, such as meningitis, measles, etc.
  • Traumatic head injury such as those seen in child abuse, vehicular accidents, etc.

How is it diagnosed?

The diagnosis is usually made before the child turns 18. There are usually three things that we have to look into when diagnosing intellectual disability: parent interview, observation of the child and formal testing. Cognitive ability or intellectual function is measured by IQ assessment; reasoning skills, problem-solving and academic learning. Adaptive skills are measured by standardized and culturally appropriate tests like socialization, personal independence and communication. If the child has only one deficit, he/ she is not considered intellectually disabled.

The diagnostic team is multi-disciplinary including a child psychiatrist, a neurodevelopmental specialist, geneticist and neurologist. Once diagnosed, the child will be classified into whether he/she has mild, moderate, severe or profound disability as described below:

  • Mild intellectual disability: These are individuals with an IQ of 50 to 70. Infants and young children until the age of 6 may be able to show normal social and communication skills. Motor skills might be impaired.
  • Moderate intellectual disability (IQ 35 to 49): Children with this condition can talk and communicate, but may have poor social awareness. They might also present with motor coordination problems.
  • Severe intellectual disability (IQ 20 to 34): Children with severe intellectual disabilities have limited speech and communication skills.
  • Profound intellectual disability (IQ less than 20): These children have very little motor coordination and often require a lifetime of nursing care.

What are the treatment options available?

Unfortunately, intellectual disability is an irreversible condition. Interventions for this condition involve proper education and training to improve the patient to live a full life.  The amount of help a child needs will depend on the level of disability and the resources present at home and in the community. Speech and occupational therapists, SpED teachers and other specialists might be needed depending on the needs of the child.

What can the family do to help?

Parents and family members can continue to encourage child’s independence with proper guidance and supervision. Positive feedbacks can boost their morale and will motivate them to learn further. Getting involved in group activities and social events will help familiarize them with the community.

Can intellectual disability be prevented?

Certain causes of intellectual disability are preventable, so the answer is a qualified yes. Exposure to lead, mercury and other toxins can be prevented by stricter government laws and avoidance of products that contain said chemicals. Alcoholic beverages and drugs should be avoided at all times by pregnant women.

What can the community do to help?

Aside from promoting a safe and healthy environment, we can push for laws that will protect individuals with intellectual disabilities. Open appropriate jobs opportunities to promote their independence and encourage them to be productive members of society. Health and homecare support should be provided appropriately for those who are severely disabled. But perhaps most important of all, let us help in removing the stigma associated with intellectual disability. 

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