What is Intellectual disability? Explained

In the previous post we learned about Sensory Impairment. A person with intellectual impairment has speech, language, mental, or physical abilities that are either underdeveloped or slow to develop. This blog gives more details length on the definition, causes, and management of this disability.

At the end of this blog, the reader will:

Learn enough about the definition and meaning of intellectual disability.
Understand the underlying causes of intellectual impairment.
Recognize the various degrees of intellectual incapacity.

Introduction
Meaning and Definition of Intellectual Disability
Developmental Delay
Levels of Intellectual Disability
Types of Intellectual Disability
Prevalence of Intellectual Disability
Causes of Intellectual Disability
Causes of Developmental Delay
Management
Summary

Introduction

One of the most prevalent disabilities during the developmental stage is intellectual disability. Disability is defined by Braddock and Parish (2002) as the way that other people interpret impairment in a social context. Intellectual impairment is a relatively new word. In many nations, it largely has supplanted the term "mental retardation." The term "developmental delay" is used in Canada and the USA to describe lifelong problems brought on by weakened mental capacity. The phrase "mental retardation," which was once popular, is still occasionally used. The terms "mental retardation" and "retarded" have been used by the World Health Organization (W.H.O.) in the International Classification of Diseases (ICD-10), but a change is being considered (ICD-11).

Meaning and Definition of Intellectual Disability

It is a persistent and irreversible competence illness that affects people and necessitates expert diagnosis, treatment, and management. This disorder is distinguishable by its severe intellectual delay and deficiencies in adaptive behaviour. Such people will have a tough time adjusting to their circumstances. It can also be distinguished by the existence of decreased social functioning, which began before the age of 18, and considerably diminished intelligence, which makes it difficult to comprehend new or complex knowledge. The term "intellectual disability" describes deficiencies in adaptive and cognitive functioning that start throughout the developmental stage. It is a cognitive, functional, and developmental disability.

The terms "mental retardation" are still used in the International Classification of Diseases (ICD-10) and DSM-IVTR, but their use is discouraged. "Learning disability" and "mental handicap" are two more terms that are utilised. Another such term is "developmental delay." However, in the rights-based era, all of these terms are viewed negatively.

"Mental retardation is a disability characterised by significant limitations both in intellectual functioning and in adaptive behaviour as expressed in conceptual, social, and practical adaptive skills," according to the American Association of Mental Retardation (AAMR) definition of the term in 2002. This condition started before the age of 18.

This mental disorder is diagnosed in people who, from whatever cause, have intelligence below an arbitrary level beginning before adulthood and whose adaptive functioning is impaired in any of a variety of areas, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM IV (1994)]. (American Psychiatric Association, 1994).

The four classifications used by the International Statistical Classification of Diseases and Related Health Problems (ICD-10: World Health Organization, 1992) to identify intellectual disability range from mild to profound. (ICD 10) If a person's IQ is between 50 and 69, they have a minor intellectual impairment. A person with a moderate intellectual disability has an IQ score between 35 and 49. If the IQ falls between 20 and 34, the intellectual disability is classified as severe. Individuals with an IQ of less than 20 fall into the final group, known as profound intellectual disability.

The phrase "Intellectual Disability" refers to a condition marked by significant limitations in both intellectual functioning (reasoning, learning, problem solving) and adaptive behaviour, which includes a variety of everyday social and practical skills, according to the Rights of Persons with Disability Bill 2012, India (PWD Bill).

Developmental Delay

The Developmental Disabilities Act (Pub. L. 106-402) defines a developmental disability as a severe, long-term impairment caused by a mental or physical impairment, or by a combination of those impairments, that manifests before the person turns 22 years old, is likely to last forever, and causes significant functional limitations in three or more of the following major life activities:

self care,
receptive and expressive language,
learning,
mobility,
self-direction,
apacity for independent living, and
economic self-sufficiency;

Reflects the individual’s need for a combination and sequence of special, interdisciplinary, or generic services, individualized supports, or other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated. If a kid under the age of ten has developmental delays that are likely to achieve the aforementioned standards without assistance, that child may be diagnosed with an intellectual or developmental disability.

Every child is anticipated to reach specific developmental milestones at various phases of growth. By the age of one, the kid can sit alone, by the age of two, the child can walk without assistance, by the age of three, the child can combine words into rudimentary sentences, etc. Developmental milestones are attained by children at their own rate. Normal minor, transient delays are not alarming. A developmental delay is a continuing or repeated delay in achieving milestones. Motor, cognitive, and verbal development all have milestones.

Levels of Intellectual Disability

Based on IQ tests, levels of intellectual disability are divided into mild, moderate, severe, and profound. These levels provide some guidance as to the amount of support someone may require, but how well a person functions in daily life also depends on things like personality, coping mechanisms, and additional disabilities like physical, social, or sensory impairments, as well as what is expected of them in various situations.

Mild intellectual disability

An IQ between 50 and 70 is regarded as having a minor intellectual impairment. Such a person can communicate verbally in normal settings and typically maintains complete independence in their personal care. Due to the possibility that people with borderline disabilities do not interact with service providers, it can be challenging to identify this population. The behavioural, emotional, and social challenges, as well as the treatment requirements, of persons with mild intellectual disabilities generally resemble more those of people with normal intelligence than they do the unique issues of people with moderate and severe intellectual disabilities.

Moderate intellectual disability

An IQ score between 35 and 50 is regarded as having a mild intellectual impairment. These individuals have delayed motor abilities, slow cognition, and self-care needs supervision. Individuals in this category take longer to master language usage and understanding, which limits their ultimate success. The development of motor skills and self-care is also delayed, and some people require supervision their entire lives. These people are typically completely mobile and physically active, and the majority exhibit signs of social development in their capacity to make contact, engage in simple social interactions, and communicate with others.

Severe intellectual disability

A severe intellectual disability is defined as an IQ between 20 and 35. There is a marked impairment of motor skills, clinically significant damage to Central Nervous System

Profound intellectual disability

According to estimates, those who fall under this category have IQs that are below 20, which significantly restricts their capacity to comprehend or follow instructions. Most of these people are unable to move or have very limited mobility, are incontinent, and can only use very basic nonverbal communication techniques. They are unable to meet their own basic needs and are dependent on regular care and monitoring.

Types of Intellectual Disability

Some of the main types of Intellectual disability are:

ADHD: One of the most prevalent childhood diseases, Attention Deficit Hyperactivity Disorder (ADHD), can persist throughout adolescence and adulthood. Symptoms include a lack of ability to concentrate and pay attention, a lack of ability to manage behaviour, and hyperactivity (overactivity)
Autism: Autism is described as a severe behavioural disease with early start that is characterised by intense self-stimulation and withdrawal. It has a negative impact on a child's academic achievement because it has a major impact on verbal and nonverbal communication as well as social interaction, which is typically visible before the age of three. Other traits that are frequently linked to autism include stereotyped behaviour and repetitive behaviour, aversion to environmental change or change in daily routines, and regular sensory stimuli. It is also a neurological condition that impairs a child's capacity for language comprehension, play, social development, and interpersonal relationships.
Asperger’s Syndrome (AS): The developmental disease known as Asperger's Syndrome is marked by issues with social interactions and interpersonal relationships. Nowadays, Asperger's Syndrome is acknowledged as a rather widespread intellectual disability. AS has a significant negative effect on kids and their families. Additionally, it is recognised as an intellectual condition and is thought to be a mild form of autism.
Learning Disabilities: The term "learning disability" refers to a group of children and does not represent any particular deficit or dysfunction of the kid, nor does it describe any particular academic or achievement issue. The term helps people identify and categorise kids that need extra help. "Specific learning disability" refers to a dysfunction in one or more of the fundamental psychological processes involved in using language, whether spoken or written, which may show up as faulty listening, speaking, reading, writing, spelling, or mathematical computation skills. The word covers a variety of diseases, including dyslexia, developmental aphasia, brain damage, and mild brain dysfunction.
Down syndrome: A person with it is born with an extra copy of the chromosome 21. Along with intellectual impairments, individuals with Down syndrome may also experience physical issues. Every person with Down syndrome who is born is unique. With a prevalence of 1 in 650 live births in almost every country, it is the most prevalent cause of severe mental disability.
Tuberose Sclerosis: A uncommon hereditary condition called tuberous sclerosis causes benign tumours to develop in the brain and other organs. Those who have the moderate version of the illness might lead completely normal lives, and the diagnosis might not be discovered until one of their offspring is diagnosed with the severe type. The severe type, which can damage several organ systems, is characterised by significant behavioural problems, epileptic seizures, and developmental delays.
Fragile X syndrome:With an estimated prevalence of 1 instance of relatively milder mental disability in every 1000 males and 1 case in every 200 females, this condition is the most prevalent cause of hereditary mental handicap. Males with moderate to severe mental disability, long thin faces with prominent jaws, wide protuberant ears, macroorchidism, and autistic traits are the main characteristics. The Fragile X mutation is caused by a repeated CGG triplet sequence in the responsible gene, FMR-1. While everyone with a complete mutation has a slight increase in CGG repeats, all moms of children with Fragile X are carriers (a large increase in CGG repeats is intellectual disability).

Prevalence of Intellectual Disability

About 1% of people worldwide are considered to have intellectual disabilities. 85 percent of people affected have a modest intellectual handicap. According to data from the 2001 Census, about 21 million Indians are affected by some form of disability. This equates to 2.1% of the total population. 10.3 percent of this population has this kind of handicap. Additionally, it was discovered that the prevalence of this handicap is higher in girls than in males during the NSSO study in 2002. In rural India, there are 4.34 lakh men who have intellectual disabilities, compared to 6.995 lakh women. Urban males make up 1.824 lakh of the population, while urban females make up 2.951 lakh (NSSO Survey, 2002)

Causes of Intellectual Disability

Sometimes the cause or reason is unknown. However, more than half are brought on by prenatal (prenatal), perinatal (perinatal), and postnatal (postnatal) causes (postnatal).

Prenatal: These are impairments that develop before to birth. These can result from illnesses that affected the mother while she was pregnant or from genetic incompatibilities between the parents. Intellectual disability in children can also be caused by chromosomal issues, genetic abnormalities, syndromes including Williams Syndrome and Prader-Willi Syndrome, illnesses of the mother during pregnancy, and use of drugs, alcohol, toxins, and other substances during pregnancy.
Perinatal factors: These are birth defects that develop over time. This may be caused by a prolonged shortage of oxygen brought on by a respiratory tract obstruction, brain injury sustained during birth or as a result of forceps misuse or premature birth, trauma experienced after birth, biochemical abnormalities such as low blood sugar levels, or other factors. Low birth weight babies are more likely to experience these postpartum problems.
Postnatal factors: These impairments develop after birth. Intellectual disability can also result from severe neglect or abuse, infections, head traumas, poisoning, close calls with drowning, excessive hunger, and exposure to hazardous substances like lead.

Causes of Developmental Delay

Developmental delay can be caused by a number of reasons, including inheritance, prenatal complications, and premature birth. Sometimes the cause is unknown. Some disorders, such as Down syndrome, have a genetic basis. Premature birth, as well as infection or other complications during pregnancy and childbirth, might result in developmental delay. Autism spectrum disorders, cerebral palsy, foetal alcohol spectrum disorders, Landau-Kleffner syndrome, and myopathies, including muscular dystrophies, are all examples of developmental delays.

Management

People with intellectual disabilities were once secluded, separated from society, and housed in facilities designed specifically for them. Today, there is a significant shift in this paradigm. Changes in views, administration, and treatment of the intellectually challenged began universally approximately fifteen to twenty years ago. The practise of institutionalising people with intellectual disabilities has given way to the practise of Community Based Rehabilitation (CBR). The CBR paradigm requires the assistance of family, community, and linked services such as health and education.

A social worker plays a vital role in teaching families about the benefits of intellectually impaired people enjoying a "ordinary life" in the community and in assisting them in doing so. Supporting people in living everyday lives entails taking into account all facets of life, including employment and companionship. As Gilbert (1985, p.74) emphasised, this necessitates both practical and emotional input, as well as a personal counselling role and creative application of casework abilities.

The needs of a child with developmental delay are the same as those of any other youngster. A warm, safe, and supportive environment benefits all children. They must feel accepted for their unique set of abilities and flaws. This is vital for self-esteem growth, which creates confidence in mastering new abilities. Children with delays learn in the same way as all other children, but it takes them longer to gain new skills.

There is a strong need for serious concentration and drive in raising legislative awareness among families of people with intellectual disabilities. For this objective, various print and non-print modalities will be used, so that even illiterate people can profit from the information presented.

Children with developmental delays can benefit from a wide range of experiences in their families and communities. The social worker counsels and supports families who have special needs children. There is also information regarding early intervention programmes and entitlements, as well as assistance in locating the most appropriate services. The social worker can also help parents who want to meet others who have had similar experiences.

Each state's health department implements preventive, early detection, and early intervention programmes for babies at risk and/or children with developmental delays. In addition, a variety of non-profit organisations in the country provide assistance to newborns, children, and their families. Institutes such as the National Institute of Mentally Handicapped (NIMH) offer dedicated early intervention units as well as family outreach programmes. NGOs also run a number of training programmes for professionals across the country. The Rehabilitation Council of India has approved the NIMH's postgraduate diploma programme in early intervention and diploma programme in early childhood special education (RCI). Empowering family members and collaborating with them appears to be the country's trend and priority.

The Department of Education, Ministry of Human Resource Development (MHRD), implements Integrated Education of Disabled Children (IEDC), which aims to teach children with disabilities in regular schools. Special schools educate students with intellectual disabilities, with an emphasis on functional skills and independent living skills. There is no centralised curriculum or certifying board of education for children with mental retardation, as there is for children with other sensory and motor disorders. As a result, it gives the instructor planning flexibility, but there are no standards against which the programme may be evaluated.

The social worker can also serve as a connection and educator in raising knowledge about the different resources available in India for children with intellectual disabilities today. There is also the essential component of family counselling services that the social worker can provide.

Summary

This article provides a brief overview of understanding intellectual disability, including the definition of intellectual disability and developmental delay, its meaning, the various levels of intellectual disability, prevalence, causes of intellectual disability and developmental delay, and finally its management.