INTELLECTUAL DISABILITY

PRESENTER: WA N N O R H A F I Z A H WA N H A S S A N
SUPERVISOR: DR NORZILA ZAKARIA
• Waseem is a 9-year-old boy who is currently
CASE STUDY
in third grade. He was referred to the school
psychologist by his teacher due to concerns
about his academic performance and
behaviour in the classroom. Waseem's
teacher reports that he struggles with basic
reading and math skills, and he often appears
to be distracted and unfocused during
lessons. Additionally, Waseem has difficulty
following classroom rules and frequently
interrupts his classmates.
THE NATURE OF INTELLECTUAL DISABILITY

• The most common developmental disability.

• Formerly referred to as "mental retardation" is characterized by a combination of
deficits in both cognitive functioning and adaptive behavior.
• The severity of the intellectual disability is determined by the discrepancy between the
individual's capabilities in learning and in and the expectations of the social environment.
(Project IDEAL, 2008)
AAMR
ADAPTIVE
SKILL AREAS
 TERMINOLOGIES
USED IN OTHER
COUNTRIES

Schroeder et al. Usage of the Term "Mental Retardation:"

Language, Image and Public Education. Kansas University
Center on Developmental Disabilities, 2002.
 DEFINITION &
CL ASSIFICATION
 DSM-IV-TR
Mental Retardation/ Intellectual
Disability in DSM - IV - TR is an Axis II
Disorder criteria that includes:
1) Intelligence Test Scores : 70 or
below
2) Adaptive Functioning : Concurrent
deficits or impairments in adaptive
functioning in at least 2 of the
following areas: communication,
self-care, home living,
social/interpersonal skills, use of
community resources, self-direction,
functional academic skills, work,
leisure, health, and safety
3) Age of Onset : before age 18 years
D S M I V- T R L E V E L S
OF M E NTA L
R E TA R DATION

1) Mild MR
 - 55-70 IQ
• - Adaptive limitations in 2 or
more domains
2) Moderate MR
• - 35-54 IQ
• - Adaptive limitations in 2 or
more domains
3) Severe MR
• - 20-34 IQ
• - Adaptive limitations in all
domains
4) Profound MR
• - Below 20 I0
• - Adaptive limitations in all
domains
DSM-5

• A disorder with onset during

the developmental period
that includes both
intellectual and adaptive
functioning deficits in
conceptual, social, and
practical domains.
DSM 5
*SEVERIT Y DETERMINED BY ADAPTIVE FUNCTIONING NOT IQ
ICD-11

• ICD-11 uses the term intellectual developmental disorders to indicate

that these are disorders that involve impaired brain functioning early
in life.
• A meta syndrome occurring in the developmental period analogous to
dementia or neurocognitive disorder in later life.
• There are four subtypes in ICD-11: mild, moderate, severe, and
profound.
GLOBAL DEVELOPMENTAL DELAY

• Diagnosed reserved for individuals under 5 when clinical severity

level cannot be reliably assessed.
• Diagnosed when an individual fails to meet expected developmental
milestones in several areas of intellectual functioning, and applies to
individuals who
1) are unable to undergo
2) systematic assessments of intellectual functioning, including
children who are too young to participate in standardized testing.
3) Requires reassessment after a period of time.
UNSPECIFIED INTELLECTUAL DISABILITY

• Diagnosed in individuals over 5 when assessment of the degree of intellectual disability by

means of locally available procedures is difficult or impossible because of:
a) associated sensory or physical impairments, as in blindness or prelingual deafness; locomotor
disability;
b) presence of severe problem behaviors or co-occurring mental disorder.
c) Should only be used in exceptional circumstances and requires reassessment after a period of
time.
 PREVALENCE
• Intellectual disability has an overall general population
1% prevalence of approximately 1%, and prevalence rates vary by
age

• Have mild intellectual disability

85%
• Prevalence for severe intellectual disability is approximately 6
6 per 1000 per 1,000

Male > • males are more likely than females to be diagnosed with both
mild MR (average male: female ratio 1.6:1) and severe MR

female (average male: female ratio 1.2:1)

*Significant regional inequalities in the prevalence of intellectual disability and trends from 1990 to 2019: a systematic analysis of GBD 2019.
ETIOLOGY
Prenatal Perinatal Postnatal
Biological (TBI,
Chromosomal Meningitis,
Anoxia
Disorders Nutritional
deficiency)

Psychosocial
Toxic metabolic (Adverse living
syndrome and Low Birth Weight conditions, lack of
intoxications early cognitive
stimulation)

Maternal Child Abuse

Infections & Neglect

Developmental
Disorders of Brain

Inborn errors of
Metabolism
POSSIBLE CAUSES OF MENTAL RETARDATION

17
DIAGNOSIS
CLINICAL ASSESSMENT
• History: pre- and perinatal, medications,
developmental, family, consanguinity
• Psychiatric interview: Speech, thinking, mood
• Physical examination: minor physical anomalies,
facial features, growth trajectory, measurements
• Neurological examination: gait, coordination,
sensations, reflexes, tone, motility
COMMON PRESENTATIONS OF INTELLECTUAL DISABILIT Y BY AGE

• Dysmorphic syndromes
Newborn • Major organ system dysfunction

• Failure to interact with environment

Early Infancy (2-4 mo) • Concerns about vision and hearing impairment

Later Infancy (6-18 mo) • Growth motor delay

Toddlers (2-3 yr) • Language delay/ difficulty

• Language delay/ difficulty

Preschool (3-5 yr) • Delays in fine motor skills (colouring, drawing, cutting)

• Academic underachievement
School years (>5 yr) • Behaviour difficulty (attention, anxiety, mood, conduct, etc)
INVESTIGATIONS

• Chromosomal studies
• Lab
• EEG
• Neuroimaging
• Hearing, Eye and speech evaluation
• Psychological assessment
PSYCHOLOGICAL ASSESSMENT
Cognitive Adaptive
Ability Behaviour
Assessment Assessment

Vineland II Adaptive
WISC Series (WISC IV, Behavior Scales
WAIS II, WPPSI) (Sparrow, Cicchetti, &
Balla, 2005)

Adaptive Behavior
Assessment System 2nd
Stanford-Binet V Edition (ABAS - II)
(Harrison & Oakland,
2003)

Woodcock-
Johnson Test of
Cognitive Abilities

Bayley Scales of
Infant
Development

Kaufman
Assessment
Battery for
Children
COMORBIDITY
• Co-occurring mental, neurodevelopmental, medical, and physical conditions are frequent in
intellectual disability, with rates of some conditions (e.g., mental disorders, cerebral palsy, and
epilepsy) three to four times higher than in the general population.
• Different studies in the review showed that among children with mental
retardation, autism is present in about 25%, ADHD in about 10%, and
cerebral palsy in 7-30%, depending on the severity of mental retardation.
• Among adults with Down's Syndrome, dementia is the most common
cause of mortality and morbidity, and research from The Netherlands
has found that often it has an earlier age of onset (8.9% in 45-49 year
old age-group compared to the general population
COMORBIDITY
The most common co-occurring mental and neurodevelopmental
disorders are:
• attention-deficit/hyperactivity disorder
• depressive and bipolar disorders
• anxiety disorders
• autism spectrum disorder
• stereotypic movement disorder (with or without self-injurious
behavior)
• impulse-control disorders
• major neurocognitive disorder
MANAGEMENT
• Biological, psychological, social, and developmental dimensions
should all be considered when designing a treatment plan for an
individual with intellectual disability.
• Treatment plan includes attention to
1) Psychoeducational
2) Psychotherapy
3) Psychopharmacologic interventions.
PARENTS’ COUNSELLING

Following points are noteworthy in this contest (Madhavan, 1990).

• The 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 to the parents.
• Attitude such over protection ie., 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.
PARENTS COUNSELLING

• The attitude of rejection, that is ignoring the child thinking that he is good for nothing should be
changed so that the child can be helped to learn by systematic training.
• The parents should be made aware of what they may expect of their child
• Some patents suffer from guilt feeling assuming that they are responsible for their child's
condition. It should be explained that the condition is due to causes over which parents have no
direct control.
• The counselor should explain the effectiveness and role of the parents and other family members
in training a mentally retarded.
• Some parents believe that training a mentally retarded child needs specialized skills and they
may not be able to train their child. Parents should be explained that training a mentally retarded
child dose not need complex skills and repeated training in simple steps, they can be taught.
• Parents should be helped to learn the skills in training through demonstrations and observstions
INDUALIZED EDUCATION PROGRAM (IEP)

• It is a written plan that outlines the special education and related services a child needs to
succeed in school. An IEP team, including parents, teachers, and other specialists, can create an
individualized plan for a child with ID to address their academic, social, and adaptive needs.
E D U C AT I O N A L P L A C E M E N T
PROGRAM
• Unlike preschool programs for
children at risk, in which the goal
is to prevent intellectual disability
from occurring, programs for
infants and preschoolers who are
already identified with intellectual
disability are designed to help
them achieve as high a cognitive
level as possible (Hallahan &
Kauffman, 2003).
 PLACEMENT PROGRAMS
Early Childhood

These programs gives more

emphasis on conceptual and
language development and
usually involves speech and
physical therapists most
specially when children
have multiple disabilities.
 PLACEMENT PROGRAMS
Transition to Adulthood

Most authorities agree that

although the degree of
emphasis on transition
programming should be
greater for older than for
younger students, such
programming should begin in
the elementary years (Hallahan
& Kauffman, 2003).
PLACEMENT PROGRAMS
Transition to Adulthood

Transition programming
for individuals involves
two related areas; first,
community adjustment to
acquire a number of self-
help skills and second,
employment to lead to a
meaningful job.
BEHAVIORAL TREATMENTS

The backbone of any treatment programme is educational with formal instruction in the skills which
includes:
1) Independence and self-help skills-
• These include the basic skills of everyday life, such as feeding, dressing, or managing stairs or, at a
higher level, the use of public transport, and how to care for clothes, shop, and budget.
• Acquiring these skills gives a sense of achievement as well as of increased independence.
2) Communication skills-
• Frustration of living in an uncomprehending world frequently contributes to disturbance as the person
falls back on various forms of attention-seeking or violent behaviour to get their message across.
• It is helped by an easier and more effective means of communication.
• This may range from simple gestures (such as pulling at the trousers to indicate the need for
toileting), through a system of pointing to symbols or pictures, to complex signing which can convey
abstract concepts such as emotional states.
• Behavioral therapies are demonstrably effective in managing many
maladaptive behaviors, particularly aggression and self-injury, in
persons with intellectual disability.
• Teaching appropriate habits and skills. These can include basic skills
such as dressing, continence, communication, and establishing a
normal pattern of sleep; or, at a more sophisticated level, training in
social skills, copingskills, dating skills, and assertiveness.
• The unlearning of other maladaptive forms of behaviour.
• Positive reinforcement for desired behaviors and benign punishment
(e.g., loss of privileges) for objectionable behaviors have been helpful.
TASK ANALYSIS

• To train a person in any skill, there are certain common basic principles to
be followed. Initially the skill must be broken down in to small sequential
steps. This is called 'Task Analysis'.
• For example, a simple task Wearing slippers' - the major sub tasks
1) identifying one's own slippers,
2) identifying right and left slipper
3) inserting the correct foot in one slipper and
4) inserting the other foot in its slipper.
• Thus one has to perform all of these subtasks to complete the act of
wearing slipper based on the task analysis the child should be trained.
PHARMACOTHERAPY

• Individuals with severe intellectual disability are often prescribed psychotropic medications
(like stimulants, antidepressants, and antipsychotics) to manage the symptoms or comorbid
conditions such as attention deficit hyperactivity disorder (ADHD), anxiety, or mood disorders
associated with intellectual disability.
 SSRI (fluoxetine, sertraline, proxetine)
 Antipsychotics (Risperidone, olanzapine, aripiprazole)
 Alpha 2 agonists (clonididne)
 Lithium
 Anticonvulsants
INTELLECTUAL
DISABILITY IN FILMS

• In the 1993 film What’s Eating Gilbert Grape, Leonardo DiCaprio’s

Arnold “Arnie” Grape showcases the stigma surrounding intellectual
disability.
• The 1994 film Forrest Gump shows Tom Hank essay the role of an
intellectually disabled man navigating the challenges of life, love, and
several professions.
• The 1999 film The Other Sister follows a young woman’s attempt to
overcome her mental disability with determination and ambition.
• On a slightly different note, the 1988 Rain Man features Dustin
Hoffman as Raymond Babbitt, an autistic savant with exceptional
memory skills. The film, besides highlighting one of the greatest
psychiatric marvels of all time, provided insights into the ‘brighter side’
of the spectrum of intellectual abilities.
THANK YOU