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Intellectual Disability

Dr. Joslin DogbeConsultant Paediatrician/Public Health

Specialist

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OUTLINE

General Consideration

Intellectual Function

Standardized Intelligent TestAdaptive Behaviour

Definition of ID

EpidemiologyEarly Warning Signs

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OUTLINE

Classification

Aetiology

Clinical AssessmentInvestigation

Management

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INTELLIGENCE

Intelligence is genetically andEnvironmentally determined.

Discuss

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What is intelligence?

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Intellectual Function

Defined by standardized tests thatmeasure the ability to reason interms of Intelligence Quotient (IQ)

Mental Age Chronological Age x 100

Average intelligence: IQ of 100 (85 to115).

http://www.answers.com/topic/intelligence-quotienthttp://www.answers.com/topic/intelligence-quotient

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IQ

IQtests were created as an attempt tomeasure a person's abilitiesincluding:

Language

NumeracyProblem-solving

http://en.wikipedia.org/wiki/Intelligence_quotienthttp://en.wikipedia.org/wiki/Numeracyhttp://en.wikipedia.org/wiki/Languagehttp://en.wikipedia.org/wiki/Numeracyhttp://en.wikipedia.org/wiki/Problem-solvinghttp://en.wikipedia.org/wiki/Problem-solvinghttp://en.wikipedia.org/wiki/Problem-solvinghttp://en.wikipedia.org/wiki/Problem-solvinghttp://en.wikipedia.org/wiki/Numeracyhttp://en.wikipedia.org/wiki/Languagehttp://en.wikipedia.org/wiki/Numeracyhttp://en.wikipedia.org/wiki/Intelligence_quotient

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IQ

Factors like depression, languagebarriers and cultural differences canyield low IQ scores. Why?

Intelligence of a 15yrs old isindistinguishable from that of anadult

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STANDARDISED INTELLIGENCE TESTS

Administered by qualified

psychologists.

Are subject to error and should

support clinical findings.

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STANDARDISED INTELLIGENCE TESTS

Bayley Scalefor children under 2 yearsof age.

Stanford-Binettest for ages 2-4years.

Wechsler Preschool and Primary for ages3yrs 10mo to 6yrs 7mo.

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STANDARDISED INTELLIGENCE TESTS

Denver(Screening only). Grossassessment of developmental

achievements for children up to 5years.

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ADAPTIVE BEHAVIOUR

Skills needed to live independently

Daily living skills-getting dressed,using the bathroom, feeding oneself

Communication skills-understanding what is said and beingable to answer

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ADAPTIVE BEHAVIOUR

Social skills with peers, familymembers, spouses, adults etc.

Use of community resources

Health & Safety

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ADAPTIVE BEHAVIOUR

Self-direction

Job-related skills.

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ADAPTIVE BEHAVIOUR

Assessment of adaptive behavior:

Compare functional abilities of a childto those of similar ages living in thesame environment

Structured interviews in communities

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ID

Definition

A developmental disability that firstappears in childhood or adolescence

before the age of 18 and may persistthroughout adulthood

A diagnosis of ID is made if an individualhas an intellectual functioninglevelwell below average as well as significantlimitations in two or more adaptive skill

areas.

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Can you mention one adaptivebehaviour?

What factors should be taken into

consideration to make the diagnosisof ID?

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EPIDEMIOLOGY

Symptoms of ID may not appear tilllater in childhood. Why?

Some cases of mild ID are not

diagnosed before preschool.

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EARLY WARNING SIGNS

May learn to sit up, crawl, walk laterthan other children.

Learn to talk later.

Difficulty in :

Remembering things

Understanding social rules

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EARLY WARNING SIGNS

Difficulty in:

Discerning cause and effect

Logical thinkingSolving problems

Persistence of infantile behavior

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DIAGNOSIS

Criteria for diagnosing ID: IQ score below 70

Significant limitations in TWO ormore areas of Adaptive Behavior

Evidence that the limitations

became apparent in childhood.

(Diagnostic and Statistical Manual of Mental Disorders(DSM-IV)

http://en.wikipedia.org/wiki/Adaptive_behaviorhttp://en.wikipedia.org/wiki/Childhoodhttp://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disordershttp://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disordershttp://en.wikipedia.org/wiki/Childhoodhttp://en.wikipedia.org/wiki/Adaptive_behavior

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CLASSIFIC ATIONMILD ID(IQ 50-70)

Most are not identified before school.

They are considered educable, and in

many instances, are able to blend intosociety with minimal or no protectivecustody.

They require some supervision andsupport, special educational and trainingfacilities.

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MILD ID(IQ 50-70) cont

Socially they are often immature andunsophisticated, with a poorlydeveloped capacity for social

interaction.

Are usually free from gross physicaldefects, but with a higher thannormal incidence of epilepsy.

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MODERATE ID (IQ 35-50)

Are trainable

Require protective custody.

Have obvious motor or languagedelays.

Given adequate support and training,

mildly and moderately retarded adultscan live with varying degrees ofindependence.

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SEVERE AND PROFOUND ID

SEVERE ID:The severely retarded child (IQ 35-20)

Is trainable, but to a lesser degree

PROFOUND ID:

The profoundly retarded child (IQ < 20)Usually require continuous care.

This group includes the most severelydeformed, non-ambulatory, and minimally

communicative.

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AETIOLOGY

GENETIC CAUSES:

Chromosomal abnormalities comprisethe largest group of known geneticcauses. The most common are the

Trisomies (Down syndrome)

X-linked MR (Fragile-X syndrome)

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DOWN SYNDROME

COMMONESTGENETIC CAUSEOF ID

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FRAGILE-X SYNDROME

Next to Downsyndrome.

Males are affectedmore than females

Clinical features-prominent jaws andears,large head, flatfeet, seizures,scoliosis.

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FRAGILE-X SYNDROME

Macro-orchidism

Recurrent otitismedia

Refractive errorsMitral valveprolapse

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GENETIC METABOLIC CAUSES

MPS

PHENYLKETONURIA

GALACTOSAEMIATAY-SACHS

ETC.

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INTRAUTERINE CAUSES

Congenital malformations

Complications of pregnancy

Maternal malnutritionDrugs

Radiations

Congenital infections

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DRUGS (ALCOHOL)

FOETAL ALCOHOLSYNDROME

Microcephaly,

Micrognathia,

Smooth philtrum

Thin smooth upper lip

Cardiac defectsTremulous

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POSTNATAL CAUSES

ENDOCRINOPATHIES

METABOLIC DISORDERS

TRAUMAINFECTIONS

MALNUTRITION

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CULTURAL-FAMILIAL

Low Family Intelligence

Low Socioeconomic Status

Dysfunctional infant-caregiverinteraction

Family disorganisation

Parental PsychopathologyParental substance abuse

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CLINICAL ASSESSMENT

Developmental delay

Evidence of genetic syndromes

Serious family problems and neglect maybe evident.

Speech, language, motor, seizuredisorders and behavior problems

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INVESTIGATIONS

CHROMOSOMAL ANALYSIS

X-RAYS

CT SCAN

EEG

URINE AND BLOOD AMINO ACID ANDENZYME STUDIES

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MANAGEMENT

Prevention

Accurate diagnosis provides prognosisand the foundation of genetic counseling

A screening program for early detection of

errors of metabolism

Stimulation programs

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MANAGEMENT cont.

Providing treatment of associated medical,emotional, and behavior problems.

Protection against injuries.

Providing support and psychotherapy for

the family.

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