Intellectual Disability/ Mental Retardation: Level IV Tutorial 2015/2016 DR J. Kamau

Intellectual Disability/ Mental
Retardation
Level IV Tutorial 2015/2016
Dr J. Kamau
Introduction
• Intelligence
– Sum of those aspects of mental life that relate to
general cognitive abilities necessary for appraising
and adapting to the environment
– Intelligence seems to be normally distributed
within the population
– Is under both genetic and environmental control
Introduction…
• Neurodevelopmental disorders
– Starts early in infancy and childhood
– impairment and delay in central nervous system
– the course is fairly stable compared to other
mental disorders which can remit and escalate
– Include:
• Intellectual disability
• Autism spectrum disorders
• Attention Deficit Hyperactivity disorder
ID Definition
• Abnormal intellectual development may be due
to slowness in development ( retardation, delay)
or distortions in development, or both
• Intellectual disability is a consequence of
intellectual impairment
• Intellectual disability is a “disability characterized
by significant limitations in both intellectual
functioning and in adaptive behaviour, which
covers many everyday social and practical skills”
ID Definition…
Adaptive functioning/skills
- There are three sets of adaptive skills;
• conceptual skills- reading, numbers, money, time,
and communication skills
• practical life skills- feeding, bathing, dressing,
occupational skills, and navigational skills.
• social skills- understanding and following social
rules and customs, obeying laws, and detecting the
motivations of others in order to avoid
victimization and deception
ID Definition
• The impairment should be global, of early
onset and long term
• The child’s IQ should be less than 70
• The child should be functionally impaired in
every day life skills
• * IQ tests are standardized tests, designed to
have a mean of 100 and a standard deviation
of 15.
…
• Classification of intellectual disability by IQ
• Mild 50-55 to 70 (account for 85 % of ID)
• Moderate 35-40 to 50-55 (10% of ID)
• Severe 20-25 to 35-40 (3-4% of ID)
• Profound below 20 or 25 (1-2% of ID)
Prevalence
• 2-3% of the general population score in the
mild ID (IQ 50-70)
• Moderate to profound (IQ<50) occurs in 3-4
per 1000 children
• More boys than girls in special schools for
learning disabilities
Aetiology
• Genetic
– Chromosomal abnormalities
• Trisomy 21
• Trisomy 13
• Trisomy 18
• Cri-du chat syndrome
– Metabolic disorders
• Phenylketonuria
• galactosemia
Aetiology
• Prenatal
– Maternal illnesses
• Rubella, syphyllis, toxoplasmosis
• Endocrine disorders
• malnutrition
– Toxins
• Lead, alcohol
– Placental dysfunction
• Perinatal causes
– Birth asphyxia
– Prematurity complications
– Kernicterus
Aetiology
• Post natal
– Head Injury (accidental / non accidental)
– Toxins
– CNS infections
– Seizures
– Environmental deprivation
• idiopathic
Clinical Features
• First identified or suspected antenatally if there
is known family history of a genetic disorder
associated with ID, or both parents have ID
• May be identified soon after delivery when a
condition known to be associated with ID is
identified e.g. Down Syndrome
• Biochemical screening identification soon after
birth can identify children with hypothyroidism,
phenylketonuria
Clinical Features
• Diagnosis may be delayed at times for several
years until the consequences of generalised
development become obvious. E.g. where
physical features are subtle and degree of
impairment is mild or moderate (autism,
fragile X syndrome)
• Severity of ID, social circumstances and
sometimes underlying aetiology influence
mode of presentation
Clinical Features
• Features include
– Delayed gross motor milestones in the first year of life
(* can be unreliable influenced by familial and cultural
factors
– Delayed social milestones such as smiling, attachment
behaviour
– Speech and language delay
– Deafness may be suspected due to lack of response to
sound, lack of appropriate words
– Failure to make educational progress
Clinical Features
• Clinical features will depend more especially
on:
– Severity of the impairment
– Associated physical and psychiatric conditions
– Quality of care and education received
– Aetiology of the intellectual disability
Clinical Features
• Mild: appearance unremarkable, normal language, can live
independently as adults, need help coping with family
responsibilities
• Moderate: Language is affected with simple speech. Activities
of daily living acquired over time e.g. dressing, feeding,
attention to hygiene. Problems with extended activities like
handling money and directions
• Severe: development greatly slowed. Look after themselves
eventually after close supervision. Engage in simple social
activities
• Profound: dependent even for simple activities of daily living.
Assessment
• Four components
• Assessment is not a-once-and-for-all exercise.
1. Investigation of the cause
• Frequently not possible
• Basic right to know
• Provide relief
• Assists in focusing towards the future
• A treatable cause may be found
• Amniocentesis, routine biochemical tests, physical
examination may reveal stigmata consistent with an obvious
chromosomal abnormality
Assessment
2. Identification of associated physical and
psychiatric problems
• Sensory disorders are common in children with ID
• General physical and neurological examination.
Cerebral palsy can occur in 25% of children with
moderate to severe ID
• Behavioural and emotional problems: ADHD (10% of
mod-severe ID), Autism spectrum disorders,
• Self injurious behaviour (10-15% of severe ID)
Assessment
3. Determination of level of functioning
• General intelligence
• Speech and language
• Gross and fine motor development
• Sensory issues
• Social and personal development
Assessment
4. Assessment of family functioning, care,
expectations and coping capacity
• A major source of difficulty is mismatch between the
child’s abilities and potential, and parental perceptions of
what the child is and is capable of.
Management
Important components
• Breaking the news
• Counselling on promotion of development
• Dealing with associated disabilities and
behavioural problems
• Advising on appropriate education
• Genetic counselling where applicable
• Providing social and emotional support

Intellectual Disability/ Mental Retardation: Level IV Tutorial 2015/2016 DR J. Kamau

Uploaded by

Copyright:

Available Formats

Intellectual Disability/ Mental Retardation: Level IV Tutorial 2015/2016 DR J. Kamau

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Intellectual Disability/ Mental Retardation: Level IV Tutorial 2015/2016 DR J. Kamau

Uploaded by

Copyright:

Available Formats

Intellectual Disability/ Mental

You might also like