Intellectual Disability

(Intellectual
Developmental Disorder)
The Nature of Intellectual
Disability
• Formerly called mental retardation in DSM-IV-TR
– Not preferred due to stigma
– Followed the guidelines of the American Association on Intellectual and Developmental
Disabilities (AAIDD)
• The AAIDD Definition of Intellectual Disability:
– Intellectual disability is characterized by significant limitations both in intellectual
functioning and in adaptive behavior as expressed in conceptual, social, and practical
adaptive skills
– This disability begins before age 18
– Five Assumptions Essential to the Application of the Definition
1. Limitations in present functioning must be considered within the context of community
environments typical of the individual’s age, peers, and culture
2. Valid assessment considers cultural and linguistic diversity as well as differences in
communication, sensory, motor, and behavioral factors
3. Within an individual, limitations often coexist with strengths
4. An important purpose of describing limitations is to develop profile of needed supports
5. With appropriate personalized supports over a sustained period, the life functioning of the person
with intellectual disability generally will improve
 The Nature of Intellectual
 Disability
An intellectual 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 the expectations of the social environment
 Significantly subaverage intellectual functioning- An intelligence
quotient (IQ) of approximately 70 or below (DSM IV-TR)
Intellectual Disability
(Intellectual Developmental Disorder)

© 2015 John Wiley & Sons, Inc. All rights reserved.

 DSM-5 criteria:
 Intellectual deficits (e.g., in solving problems, reasoning, abstract thinking) determined by
intelligence testing and broader clinical assessment
 Significant deficits in adaptive functioning relative to the person’s age and cultural group in
one or more of the following areas: communication, social participation, work or school,
independence at home or in the community, requiring the need for support at school,
work, or independent life
 Onset before age 18

 DSM-5 changes:
 There is explicit recognition that an IQ score must be considered within the cultural context
of a person
 Adaptive functioning must also be assessed and considered within the person’s age and
cultural group
 No longer distinguish among mild, moderate, and severe ID based on IQ scores alone
 Defining and Measuring Children’s
Intelligence and Adaptive Behavior

 General intellectual functioning is now defined by

an intelligence quotient (IQ or equivalent)
 ID is no longer defined on the basis of IQ
 Level of adaptive functioning is also important
 Adaptive functioning: how effectively individuals cope with
ordinary life demands and how capable they are of living
independently
Features of Intellectual
Disabilities

Clinical description - considerable range of abilities and
interpersonal qualities
 DSM-5 diagnostic criteria
 Deficits in intellectual functioning
 Concurrent deficits or impairments in adaptive functioning
 Below-average intellectual and adaptive abilities must be evident
prior to age 18
Diagnostic Criteria for Intellectual
Disability
Severity Level: Mild
 About 85% of persons with ID
 Typically not identified until early elementary years
 Overrepresentation of minority group members
 Develop social and communication skills
 Live successfully in the community as adults with
appropriate supports
Severity Level: Moderate
 About 10% of persons with ID
 Usually identified during preschool years
 Benefit from vocational training
 Can perform supervised unskilled or semiskilled work in
adulthood
Severity Level: Severe
 About 3%-4% of persons with ID
 Often associated with organic causes
 Usually identified at a very young age
 Delays in developmental milestones and visible physical
features are seen
 May have mobility or other health problems
 Need special assistance throughout their lives
 Live in group homes or with their families
Severity Level: Profound
 About 1%-2% of persons with ID
 Identified in infancy due to marked delays in development
and biological anomalies
 Learn only the basic communication skills
 Require intensive training for:
 Eating, grooming, toileting, and dressing behaviors
 Require lifelong care and assistance
Examples of Support Areas
Prevalence
 Approximately 1-3% of population (depending on cutoff)
 Twice as many males as females among those with mild
cases
 More prevalent among children of lower SES and children
from minority groups, especially for mild cases
 More severe levels - identified almost equally in different racial
and economic groups
Motivation
 Many children with mild ID are able to learn and attend
regular schools
 Often susceptible to feelings of helplessness and frustration
in their learning environments
 Children who have mild ID are able to stay on task and
develop goal-directed behavior
 With stimulating environments and caregiver support
Changes in Abilities
 IQ scores can fluctuate in relation to the level of impairment
 Major cause of ID affects the degree to which IQ and
adaptive abilities may change
 Slowing and stability hypothesis
 IQ of children with Down syndrome may plateau during middle
childhood, then decrease over time
Language and Social Behavior
 Development follows a predictable and organized course
 Characteristics displayed with Down syndrome
 The underlying symbolic abilities of children are believed to be
largely intact
 There is considerable delay in expressive language
development; expressive language is weaker than receptive
language
Emotional and Behavioral
Problems
 Rate is three to seven times greater than in typically
developing children
 Largely due to limited communication skills, additional
stressors, and neurological deficits
 Most common psychiatric diagnoses:
 Impulse control disorders, anxiety disorders, and mood
disorders
 Internalizing problems and mood disorders in adolescence
are common
Emotional and Behavioral
Problems (cont'd.)
 ADHD-related symptoms are common
 Self-injurious behavior (SIB)
 Can be life-threatening
 Affects about 8% of persons across all ages and levels of ID
Other Physical and Health
Disabilities
 Health and development are affected
 Degree of intellectual impairment is a factor
 Prevalence of chronic health conditions in ID population is
much higher than in the general population
 Life expectancy for individuals with Down syndrome is now
approaching 60 years
Chronic Health Conditions Among
Children With Intellectual Disabilities
Etiology of Intellectual Disability:
Neurological Factors

© 2015 John Wiley & Sons, Inc. All rights reserved.

 Down syndrome
 Chromosomal trisomy 21: an extra copy of chromosome 21
 47 instead of 46 chromosomes
 Fragile-X syndrome
 Mutation in the fMRI gene on the X chromosome
 Recessive-gene disease
 Phenylketonuria (PKU)
 Maternal infectious disease, especially during first trimester
 Cytomegalovirus, toxoplasmosis, rubella, herpes simplex, HIV, and
syphilis
 Lead or mercury poisoning
Prenatal, Perinatal, and Postnatal
Causes
 Prenatal: genetic disorders and accidents in the womb
 Perinatal: prematurity and anoxia
 Postnatal: meningitis and head trauma
Risk Factors
 Four major categories of risk factors
 Biomedical
 Social
 Behavioral
 Educational
Risk Factors (cont'd.)
Inheritance and the Role of the
Environment
 Genetic influences are potentially modifiable by
environment
 Genotype: a collection of genes that pertain to intelligence
 Phenotype: the expression of the genotype in the
environment (gene-environment interaction)
 Inheritance and the Role of the
Environment
(cont'd.)
 Heritability describes the proportion of the variation of a
trait attributable to genetic influences in the population
 Ranges from 0% to 100%
 The heritability of intelligence is about 50%
 Major environmental variations affect cognitive
performance and social adjustment in children from
disadvantaged backgrounds
Genetic and Constitutional
Factors
 Chromosome abnormalities
 Down syndrome is usually the result of failure of the 21st pair
of the mother’s chromosomes to separate during meiosis ►
causes an additional chromosome
 Fragile-X syndrome is the most common cause of inherited
ID
 Prader-Willi and Angelman syndromes
 Both are associated with abnormality of chromosome 15
Genetic and Constitutional
Factors (cont’d.)
 Single-gene conditions: inborn errors of metabolism
 Excesses or shortages of certain chemicals which are
necessary during developmental stages
 Cause of 3-7% of cases of severe ID
 Phenylketonuria results in lack of liver enzymes necessary to
metabolize phenylalanine
 Can be treated successfully
Neurobiological Influences
 Adverse biological conditions
 Examples: infections, traumas, and accidental poisonings
during infancy and childhood
 Fetal Alcohol Spectrum Disorder (FASD)
 Estimated to occur in one-half to two per 1000 live births
 Teratogens increase risk of ID
Social and Psychological
Dimensions
 Least understood and most diverse factors causing ID
 Environmental influences and other mental disorders
account for 15-20% of ID
 Deprived physical and emotional care and stimulation of the
infant
 Other mental disorders accompanied by ID, such as autism
 Parents are critically important
Prevention, Education, and
Treatment
 Child’s overall adjustment is a function of:
 Parental participation, family resources, social supports, level
of intellectual functioning, basic temperament, and other
specific deficits
 Treatment involves a multi-component, integrated strategy
 Considers children’s needs within the context of their
individual development, their family and institutional setting,
and their community
Treatment of
Intellectual Disability

© 2015 John Wiley & Sons, Inc. All rights reserved.

 Residential treatment
 Small to medium-sized community residences
 Behavioral treatments
 Language, social, and motor skills training
 Method of successive approximation to teach basic self-care skills in severely
retarded
 e.g., holding a spoon, toileting
 Applied behavioral analysis
 Cognitive treatments
 Problem-solving strategies
 Computer-assisted instruction
Prenatal Education and
Screening
 ID related to fetal alcohol syndrome, lead poisoning,
rubella) can be prevented if precautions are taken
 Prenatal programs for parents caution about use of alcohol,
tobacco, drugs, and caffeine during pregnancy
Psychosocial Treatments
 Early intervention
 One of the most promising methods for enhancing the
intellectual and social skills of young children with
developmental disabilities
 Carolina Abecedarian Project provides enriched environments
from early infancy through preschool years
 Optimal timing for intervention is during preschool years
Behavioral Approaches
 Initially seen as a means to control or redirect negative
behaviors
 Association for Behavior Analysis (ABA) Task Force
advocates that:
 Each individual has the right to the least restrictive effective
treatment and the right to treatment that results in safe and
meaningful behavior change
Cognitive-Behavioral Therapy
 Self-instructional training and metacognitive training
 Verbal instructional techniques
 Teaching the child to be strategical and metastrategical
Family-Oriented Strategies
 Help families cope with the demands of raising a child with
ID
 Some ID children and adolescents benefit from residential
care or out-of-home placement
 The inclusion movement integrates individuals with
disabilities into regular classroom settings
 Curriculum is adapted to individual needs
Thank You