Intellectual disabilities in children and adults manifestations, risk factors and management

1. Psychopathology of
Intellectual Disability

2. 2

3. 3

4. 4

6. 6

7. Introduction cont.
• Intellectual Disability (ID) is the most common developmental disability
• It is not an illness or a disease
• It affects about 2-3% of the general population
• People with ID find it hard to meet the ordinary challenges associated with
daily life
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8. Learning
outcomes
At the end of the
presentation, you must be
able to:-
• Explain the concept:
Intellectual Disability (ID)
• Describe the classification of
ID
• Discuss the etiology of ID
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9. Explanation
of the
concept: ID
• A disability characterized by
significant limitation in both
intellectual (cognitive)
functioning and adaptive
functioning
• Intellectual functioning -
reasoning, learning & problem
solving
• Adaptive functioning –
conceptual, social & practical
skills
• Manifests during the
developmental period, before
the age of 18 years
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10. 10

11. Explanation
of the
concept: ID
cont.
• Intellectual functioning is measured by
Intelligence Quotient (IQ)
• Adaptive functioning is measured by level
of competencies in its 3 domains: social &
communication, academic functioning,
vocational skills
• A person with ID has a sub-average IQ of 70
or below
• Has an adaptive functioning below age
expectation
11

12. • DO YOU KNOW
YOUR IQ LEVEL ????
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13. 13

14. 14

15. 15

16. DON’T TRY THIS
AT HOME!
1
6

17. 17

18. 18

19. Classification
ID is classified according to
severity
• Mild ID
• Moderate ID
• Severe ID
• Profound ID
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20. Mild ID
• Represent about 85% of all cases of
ID
• IQ range of 50-70
• Not easily diagnosed at a young age
• Minimal retardation
• Psychomotor skills are usually
unaffected
• Slight problems with coordination
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21. Mild ID
cont…….
Characteristics on different ages
Preschool age (0-5 years)
Can develop social and communication skills
Have minimum sensorimotor retardation
Not easily distinguished from normal
School age (6-20 years)
Can learn up to 6th grade
Can be guided towards social conformity
Adult (21 years +)
Can achieve vocational skills as adults
Can function well in a structured, sheltered
setting
Capable of independent living
May need assistance and guidance when under
unusualstress
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22. Moderate ID
• Represent about 10% of all
cases of ID
• IQ range of 35-50(49)
22

23. Moderate ID
cont…..
Characteristics on different ages
Preschool age (0-5 years)
Can talk or learn to communicate
Have poor social awareness
Have fair motor development
Profits from self-help train
Need moderate supervision
School age (6-20 years)
Are unable to progress beyond 2nd to 3rd grade
Can profit from training in social and occupational
skills
May learn to travel alone in familiar places
Adult (21 years +)
Can do unskilled or semiskilled work under
sheltered conditions
Can function well in a structured, sheltered setting
Need supervision and guidance when under mild
stress
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24. Severe ID
• Represent about 4% of all cases of ID
• IQ range of 20-35
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25. Severe ID
cont……
Characteristics on different ages
Preschool age (0-5 years)
Minimal speech
Little or no communication skills
Poor motor development
Need complete supervision
School age (6-20 years)
Unable to benefit from academic or
vocational training
Can talk or learn to communicate
Can be trained in elemental health habits
Can profit from systemic habit training
Adult (21 years +)
Can develop self protection skills under
controlled conditions
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26. Profound ID
• Represent about 1- 2% of all cases
of ID
• IQ of less than 20
• May have other physical disorders
26

27. Profound ID
cont……
Preschool age (0-5 years)
Gross disability
Minimum functioning in sensorimotor areas
Needs total nursing care
Needs constant aid and supervision
School age (6-20 years)
Unable to benefit from academic or vocational
training
Can have some motor development present
May respond to minimal one-to-one self help
training
Adult (21 years +)
Can have some motor and speech development
No capacity of independent functioning
Need total physical care
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28. Etiology
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Genetic factors
Acquired and developmental factors
Acquired childhood disorders
Environmental & Sociocultural Factors

29. Genetic factors
• Chromosomal abnormalities and
aberrations
• Inherited genes
• Errors when genes combine
• Predisposing factors for chromosomal
disorders
Advanced maternal age
Increased age of the father
X-ray radiation
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30. 30

31. 31

32. Acquired and developmental factors
Prenatal
period
Perinatal
period
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33. 33

34. 34

35. Prenatal Period
• Maternal chronic illnesses and conditions affecting the foetus’s CNS
i.e. Uncontrolled diabetes, anemia, emphysema, hypertension
• Long term use of alcohol and narcotic substances
• Maternal infections during pregnancy - viral infections – cause fetal
damage
• Rubella (German Measles) and Syphilis – cause congenital
malformations & ID
• Cytomegalic Inclusion Disease - lead to jaundice, microcephaly or
hydrocephaly, hepatosplenomegaly & intracerebral calcification
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36. Prenatal Period
cont….
• Herpes Simplex – transmitted
transplacentally or during birth
causing abnormalities
• Toxoplasmosis – parasitic disease
transmitted to the fetus causing
mild to severe ID
• HIV – may influence the developing
brain
• Fetal Alcohol Syndrome – due to
regular prenatal alcohol exposure
(clinical picture of a child with FAS)
• Prenatal drug exposure to opioids,
e.g. heroin - results in small infants
and withdrawal symptoms
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37. Complications
of pregnancy
Toxemia of pregnancy & and
uncontrolled maternal
diabetes – hazardous to the
fetus
Maternal malnutrition –
prematurity & complications
Vaginal haemorrhage,
placenta previa, placenta
abruption & cord prolapse –
anoxia & fetal brain damage
Use of Lithium during
pregnancy
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38. PERINATAL PERIOD
Premature infants and infants
with low birth weight – at risk
for intellectual impairment
Infants who sustain intracranial
hemorrhages or cerebral
ischemia – at risk for cognitive
abnormalities
Socioeconomic deprivation
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39. 39

40. Acquired
childhood
disorders
• Infections affecting cerebral integrity
Encephalitis
Meningitis – treated late affect cognitive
development
Septicaemia
• Head trauma / injury– motor vehicle
accidents, household accidents, child
maltreatment
• Asphyxia due to near drowning – result in
brain damage
• Long-term exposure to Lead – compromised
intelligence
• Intracranial tumors, surgery &
chemotherapy – affect brain function
40

41. Environmental
& Sociocultural
Factors
• Deprivation of nutrition and
nurturance
• Compromised prenatal period
due to poor medical care and
poor maternal nutrition
• Teenage pregnancy – associated
with obstetrical complications,
prematurity and low birth
weight
• Poor postnatal medical care,
malnutrition, exposure to toxins
and physical trauma
• Child neglect and inadequate
caretaking– deprive emotional
nurturance
41

42. Severity of ID is directly
proportional to the timing and
duration of the trauma and the
degree of exposure
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43. 43

44. • Describe the DSM-5-TR Diagnostic Criteria
for Intellectual Disability
• Explain the physical assessment of people
with ID
• Study developmental characteristics of ID
by Degree of Severity (table in Townsend)
44
Take me
home!!!!!!

45. Summary
• ID – Impaired cognitive and adaptive functioning
• Classification – mild, moderate, severe & profound
• Etiology – genetic, acquired & developmental, acquired childhood
disorders and environmental & sociocultural factors
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46. 46

47. Conclusion
• Children with ID learn more slowly than a
typical child
• They may take longer to learn language,
develop social skills and take care of their
personal needs.
47

48. • Sadock, B.J. & Sadock, V.A. (latest edition). Synopsis of Psychiatry:
Behavioural Sciences/ Clinical Psychiatry. Philadelphia: Lippincott
Williams & Wilkins.
• Uys, L & Middleton, L. (Latest edition). Mental Health Nursing: a
South African Perspective. Cape Town: Juta and Company Ltd.
• Towsend, M.C. (Latest edition). Psychiatric Mental Health Nursing.
Philadelphia: Davies Company.
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