• Intellectual disability, also known as an

intellectual developmental disorder, is

characterized by significant limitations in
intellectual functioning and adaptive
behaviors. Intellectual functioning refers to
a person's ability to learn, reason, solve
problems, and understand new information.
• Adaptive behaviors refer to a person's
ability to perform daily activities such as
self-care, communication, and social
interaction. Intellectual disability is usually
diagnosed in childhood and is defined as
having an intelligence quotient (IQ) score
of 70 or below. However, IQ scores alone
are not sufficient for a diagnosis of
intellectual disability.
 Etiology
1. Genetic Factors
• chromosomal abnormalities
• metabolic disorders
• cranial malformation
• gross diseases of brain
2. Prenatal factors
• infections
• endocrine disorders
• physical damage and disorders
• intoxication
• placental dysfunction
3. Perinatal factors
4. Postnatal factors
• infections
• accidents
• lead poisoning
5. Enviornmental and sociocultural factors
• cultural deprivation
• low socioeconomic status
• inadequate caretakers
• child abuse
 Types of intellectual disability

Intellectual disability is a neurodevelopmental

disorder that involves limitations in intellectual
functioning and adaptive behaviors. There are
several types of intellectual disabilities,
including:
• Mild intellectual disability: Individuals with
mild intellectual disability have an IQ score
between 50-70, and typically have mild
limitations in adaptive behaviors. They may be
able to live independently with support.
• Moderate intellectual disability: Individuals
with moderate intellectual disability have an
IQ score between 35-49, and typically have
moderate limitations in adaptive behaviors.
They may require some level of support to live
independently.
• Severe intellectual disability: Individuals
with severe intellectual disability have an IQ
score between 20-34, and typically have
severe limitations in adaptive behaviors. They
may require significant support to live in a
supervised setting.
• Profound intellectual disability: Individuals
with profound intellectual disability have an
IQ score below 20, and typically have very
severe limitations in adaptive behaviors. They
require constant care and supervision.
50-70
35-50
20-35
below 20
Signs & Symptoms of intellectual
disability
• Delayed developmental milestones
• Deficiency in cognitive function
• Reduced ability to learn or meet academic demands
• Expressive or receptive language problems
• Psychomotor skill deficits
• Neurological impairements
• Low self esteem,depression and labile moods
• Difficulty in communication
• Poor social skills
• Behavioral issues
• Poor memory
• Poor Self- care activities
• Irritability when frustrated or upset
• Acting out behavior
• Lack of curiosity
• Additional health problems such as seizures, vision
problems, hearing problems etc..
 Diagnosis
• History collection
• Physical examination
• Neurological examination
• Assessing milestones development
• Investigations
• Calculating the IQ
 Treatment
• Behavior management
• Enviornmental supervision
• Monitoring child developmental needs &
problems
• Programs that maximize speech,
language,cognitiveetc..
• Ongoing evaluation for overlapping
psychiatric disorders
• Family therapy
• Early intervention programs for children
aged less than 3 years
• Provide day schools
• Vocational training
 Prevention
 Primary prevention
Focusses on measures taken at the
early stage to decimate disability
a) measures at preconception
b) during gestation
c) at delivery
d) childhood
 Secondary prevention
Focusses on early detection and
treatment of preventable disorders.
 Tertiary prevention
The focus is to promote recovery as well
as to prevent further complications
 Legal Aspects
• Legal Aspects Concerning Persons with
Mentally retarded are treated as persons
with disabilities under Section 2 of the
Persons with Disabilities (Equal
Opportunities,Protection of Rights and
Participation) Act,1995 (PWD Act).
• The Rights of Persons with Disabilities
(RPWD) Act 2016 has replaced the
Person with Disabilities (PWD) Act 1995.
• Statutory provisions for the welfare of
mentally retarded persons are included in
PWD Act, 1995 and National Trust Act,
1999.
• Indian Railways and some State Govern-
ments have introduced schemes providing
travel facility for persons with disability.
• The Income-Tax Act allows deduction in
respect of maintenance including medical
treatment of a dependent who is a person
with disability which includes mental
retardation and mental illness under
Section 80DD.
 Care & rehabilitation
• Early detection & early stimulation of
mental handicaps
• Regular assessment
• Advice, support, & practical measures for
families
• Provision for education, training,
occupation or work
• Housing & social support to enable self
care
• Psychiatric & psychological services
• Residential care
• Specialist medical services
• Psychiatric services
Nursing management
Determine child's strengths and abilities to
develop a plan of care to enhance capabili-
ties. Nursing management is explained
under assessment, diagnosis, planning,
implementation and evaluation.
 Assessment
• Assessment of early infant behavior for
cognitive disability among high-risk
children should be closely done (e.g.,
children born to elderly primiparas, birth
trauma, etc.)
• Documentation of daily living skills.
• A careful family assessment for
information
• Psychological assessment
 Intervention
• The long-term goals for these children are
highly individualized and are dependent
on the level of mental retardation. Parents
should be involved in establishing realistic
goals for their child.
• Monitor the child's developmental level
and initiate supportive interventions such
as speech, language or occupational skills
as needed.
• Early intervention programs are essential
to maximize children's potential
development.This necessitates early
recognition and referral. Nurses have an
opportunity to evaluate children in the
nursery, in the clinic during well-baby
healthcare, in schools, and during acute
management.
• The nurse can participate in programs that
teach infant stimulation, activities of daily
living and independent self-care skills.
• Teach the child adaptive skills such as
eating, dressing, grooming and toileting.
• Develop a daily schedule for the child and
family
• A successful technique in treatment of
the mentally retarded is called operant
conditioning. It focuses on changing or
modifying the individual's response to
the environment by reinforcing certain
desirable patterns of behavior or
eliminating undesirable patterns. Reward the
child's accomplishments.
• In addition, learning social skills and
adaptive behavior assists the child in
building a positive self-image. For older
children and adolescents, assistance is
needed to prepare them for a productive
work life.
• Maintain a consistent and supervised
environment wih adequate environmental
stimulation.
• Prevent self-injury. Be prepared to
intervene if self-injury occurs. Monitor the
child for physical or emotional distress.
• Sexuality becomes a major concern as
these children may form emotional
attachment to those of the opposite sex
and have normal sexual desires. However,
their decision-making skills are limited.
Teaching contraceptive methods are
important to emphasize with both the child
and family.
• In all instances it is important for the nurse
to maintain a non-threatening approach.