This document provides an overview of intellectual disability (ID). It begins with definitions and causes of ID including prenatal, perinatal, and postnatal factors. Specific genetic syndromes like Down syndrome and Fragile X syndrome are discussed. The approach involves a detailed history, physical exam, IQ assessment using tests like the WISC, and basic investigations. Management aims to improve quality of life through treating medical conditions, nutrition, education/therapy, and supportive services. Prognosis depends on severity of ID. Prevention focuses on identifying issues early and addressing factors like nutrition and healthcare access.

1. APPROACH TO INTELLECTUAL
DISABILITY
DR.D.RASIKAPRIYA
MD PEADIATRICS
FIRST YEAR

2. OBJECTIVES
• INTRODUCTION
• CAUSES
• INTELLIGENCE TESTING
• APPROACH TO
DIAGNOSIS
• MANAGEMENT
• PROGNOSIS
• PREVENTION

3. INTRODUCTION
• Problem encountered in almost all clinical
setting
• Other terms- Mental retardation, General
learning disorder and Intellectual impairment.
• 20% children scholastically backward.[Indian J
Pediatr;72(11) : 961-967]
• Occurs in 2-3% of the general
population[INDIAN PAEDIATRICS]

4. DEFINITION
• American association on intellectual and
developmental disability measures- 3 domain:
1. Intelligence
2. Adaptive behavior
3. System of supports afforded the individual.

5. Contd..
• Clinically – disability characterized by
significant limitations both in intellectual
functioning and in adaptive behavior as
expressed in conceptual, social and practical
adaptive skills.
• Originates before 18 years.

6. ETIOLOGY
• PRENATAL: Chromosomal, specific syndromes,
Neurodegenerative, Familial MR, Acquired,
Unspecified syndromes, Brain anomaly
• PERINATAL: Perinatal asphyxia, Meningitis
with hydrocephalus, Hypothyroid due to
Mother’s TPO Ab, Preterm and Low birth
weight.
• POSTNATAL: Brain tumor (Glioma), Infantile
tremor syndrome

8. ETIOLOGY
MEDICAL PROBLEMS 1.Syndromes
2.Malnutrtion and nutritional deficiencies
3.Worm infestations
4.Hearing and visual impairment
CHRONIC PROBLEMS 1. Asthma and allergic rhinitis
2. Epilepsy
3. Cerebral palsy
4. Leukemia and lymphoma
5. Sickle cell anemia and thalasemia major
6. Type 1 DM, Congenital hypothyroidism
7. Habitual snoring
BELOW AVERAGE
INTELLIGENCE
Usual have history of developmental delay
NEUROBEHAVIORAL
DISORDERS
Specific learning disability, ADHD, Autism, Tourette
syndrome
EMOTIONAL PROBLEMS Chronic neglect, sexual abuse, parents getting divorced
or losing sibling

9. Contd..
POOR SOCIOCULTURAL HOME
ENVIRONMENT
Poverty, Parent attitude
PSYCHIATRIC DISORDER Depression or psychosis
ENVIRONMENTAL CAUSES Noisy area, Too much television viewing

10. Contd…
• IDIOPATHIC
• Syndromes : Down syndrome,
Fragile X syndrome,
Williams syndrome,
Noonan syndrome,
Rett syndrome,
Angelman syndrome.

11. DOWNS SYNDROME
• Also referred to as
trisomy 21
• *Usually not an inherited
condition
• *The most common type
of chromosomal disorder.
• *People with DS exhibits
unusual facial features
and with broad hands
with short finger

12. FRAGILE X SYNDROME

13. APPROACH
• History- detailed
• Physical examination
• IQ assessment
• Basic investigation
• Imaging
• Genetic evaluation
• Management

14. PRESENTATION
• Present to us during infancy or preschool as
developmental delay or poor school
performance.
• Congenital hypotonia, Seizures, feeding
problem, or other symptoms associated with
CNS malformation.
• Impairment in adaptive functioning – usual
presenting features.

16. DETAILED HISTORY:
• Prenatal ,Perinatal and Postnatal history.
• Medication during pregnancy
• Infancy - recurrent unexplained illness or
seizures or loss of psychomotor skills-
metabolic disorder.
• Family history – 3 generation pedigree chart.
• History and information should collected from
classroom teacher- social functioning, child’s
behavior and academic difficulties.
• About environment, socio-cultural, emotional.

17. PHYSICAL EXAMINATION
• GENERAL- PICCLE
• HEAD TO TOE- neurocutaneous marker,
abnormal pigmentation, dermatoglyphics
• Dysmorphic features – face, hand, feet and
genitalia – ANEUPLOIDY.
• ANTHROPOMETERY- head circumference.
• SYSTEMIC EXAMINATION- mainly neurological
examination.

19. TEAM WORK UP
• Ophthalmologist, ENT and clinical
psychologist.
• Behavioral phenotype- observing cognitive,
language and social skills.
• Counselor – to take detailed family and school
environment to rule out stress related
problems.
• Child psychiatrist – depression or anxiety
• IQ assessment

20. IQ ASSESSMENT
• Wechsler Intelligence Scale for children test
• Stanford Binet Intelligence scale – child’s level
of intelligence
• Special educator assess – child’s academic
achievements – standard educational test

21. EKTHA JAIN
CLINICAL PSYCHOLOGIST
DEPT OF PSYCHIATRY
MGMCI

23. ASSESSMENT & ANALYSIS
1
•CASE HISTORY
2
•QUALITATIVE ANALYSIS
3
•QUANTITATIVE ANALYSIS

24. DETAILED CASE HISTORY
PRENATAL BIRTH DEVELOPMENTAL
MILESTONES

25. QUALITATIVE ANALYSIS
• BEHAVIORAL OBSERVATION
• BODY LANGUAGE
• SPEECH
• RAPPORT ESTABLISHMENT
• ADJUSTMENT TO THE ENVIRONMENT
• INTERACTION OBSERVED BETWEEN THE CHILD
AND THE PARENT
• EYE CONTACT
• ATTENTION

26. QUANTITATIVE ANALYSIS
ASSESSMENTS
INTELLIGENCE TEST
BATTERIES
INDIVIDUAL TESTS AND
SCALES

27. TEST BATTERIES
• WESCHLER’S INTELLIGENCE SCALE FOR CHILDREN
(WISC)
• STANDFORD-BINET IQ TEST
• BINET-KAMAT TEST OF INTELLIGENCE (BKT)
• KAUFFMAN ASSESSMENT BATTERY FOR
CHILDREN (K-ABC)
• BHATIA’S BATTERY OF PERFORMANCE
INTELLIGENCE TEST
• STANDARD PROGRESSIVE MATRICES (SPM)

28. NAME OF THE
TEST
AGE
GROUP
FUNCTIONS TIME
TAKEN
ADVANTAGES/
DISADVANTAGES
WISC &
Adaptation -
Malin
6-16
5-15
•Verbal comprehension,
•Visuo-spatial
• Fluid reasoning
•Working memory
•Processing speed
45-65
Minutes
• Equal importance
given to Verbal and
Performance
• Technical in
administration
BKT 3-22 • Language
• Memory
•Social intelligence
•Conceptual thinking
•Reasoning
•Visuo-motor
40-60
Minutes
•Applicable to all age
groups for children
•Importance given to
verbal than to
performance
CPM
SPM/RPM
5-11
8-65
•Abstract reasoning
•Non-verbal reasoning
30-45
Minutes
• Child with speech
issues can also do the
test. Applicable for all
age groups
BHATIA’S 11-60 •Working memory
•Non-verbal reasoning
•Conceptual thinking
•Processing speed
35-45
minutes
•Applicable for Illiterate.
Free of language
barriers
•Only performance
battery

29. SUB-TESTS IN WISC
SIMILARITIES PICTURE CONCEPTS
VOCABULARY CODING
COMPREHENSION LETTER-NUMBER SEQ
(INFORMATION) MATRIX REASONING
BLOCK DESIGN SYMBOL SEARCH
DIGIT SPAN (PICTURE COMPLETION)
(CANCELLATION) (WORD REASONING)
(ARITHMETIC)

30. Individual tests and scales
Name of the test Age group Functions Time taken Advantages/
Disadvantages
Seguin Form
board test
3 to 15 years • Speed and
accuracy
• Activity level
10 seconds –
1 minute
•Easy task
•Limited to Eye-hand
co-ordination
Vineland Social
Maturity scale
1 to 18 years • Social maturity
• Adaptation to
environment
10 minutes • Growth of Daily
tasks measured
•Not culture specific
Developmental
psychopathology
checklist for
children
1-15 years •Social contact
•Fine motor
•Language
•Gross-motor
10 minutes •Detectes severe
developmental
problems
•IQ cannot be
achieved
quantitatively

32. CALCULATION OF IQ

37. FACTORS THAT HINDER ASSESSMENT
• COMPREHENSION CAPACITY OF THE CHILD
• MOTIVATION OF THE CHILD
• PARENT’S MOTIVATION TO ASSESS THE CHILD
• ATTENTION LEVEL OF THE CHILD
• ENVIRONMENTAL DISTRACTIONS
• TIMINGS WHEN THE TESTS ARE
ADMINISTERED

42. INVESTIGATION
Highly suggested Dependent on clinical findings
Banded karyotype
Chromosome Microarray
Cerebral imaging
Molecular study for fragile X Metabolic studies including thyroid
function studies
Electroencephalogram
Disease- specific molecular or molecular
cytogenetic studies
Specimens for Metabolic
screening
Test
Blood Aminoacids, Homocysteine, Acylcarnitine
profile
Urine Organic acids, GAA/ creatinine
metabolites, Mucopolysaccharide screen,
Oligosaccharide screen

44. MANAGEMENT
• AIM- To provide support to people with MR
and their families and to assist them in creating
personally satisfying lives.
• Most causes of intellectual disability are not
treated directly

45. Key features of management of MR
• Key aim is to improve or maximize quality of life
• Establish an etiology. Rarely will the condition be
curable or treatable
• Anticipate future medical problems (management of
Genetic syndromes)
• Intervene early
• Review the patient at regular intervals
• Explore long term placement options at an early stage

46. Contd..
• Modify behaviours that may harm the
individual, place stress on primary care givers
and minimize the chances of involvement in a
day program
• Adopt a family- focused approach looking at
the needs of parents and siblings
• Awareness of the role of prevention
• Act as an advocate for those with MR

48. KEY POINTS IN CONVEYING
• ATTITUDE
• LOCATION
• PERSONNEL
• LANGUAGE
• CONTENT
• QUESTIONS
• SUPPORT

49. MANAGEMENT
• Treat appropriate medical condition
• Nutritional supplements
• Treating chronic diseases and monitoring
• In SpLD – remedial education
• In Autism and ADHD- psychiatric consultation
for counseling, behavior modification and
medications like methlyphenidate
atomoxetine

50. PROGNOSIS
• Mild MR - Acquire Social and Vocational skills adequate
for minimum self- support
• Moderate MR
- communication skills during early childhood and
travel to familiar places
- unskilled or semiskilled work under supervision
during adulthood
• Severe MR
- talk and do elementary self- care skills during
school years
- perform simple tasks under supervision when
adults
- vocational support provide dignified & productive
work and leisure pursuits.

51. PREVENTION
• Training teachers to identify behavioral problems
• Providing good antenatal and perinatal and well
baby clinics
• Universal use of idionized salts and school
feeding programmes
• Pediatric De worming
• Nutritional supplements
• Regular screening programmes for vision and
hearing in schools

53. CONCLUSION
• Early indentification
• Determination of an underlying etiology
• Prompt provision of rehabilitation or support
services
• Being an advocate for the parents or caregiver
and helping them to advocate rights for their
child

54. THANK U
Thank you