Previously called Mental Retardation. Some of the major causes are discussed. Management

1. Intellectual
Disabilities
Dr. Shewikar El Bakry
Ass. Prof. Psychiatry
Banha University

4. 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 and
the expectations of the social
environment.
(Project IDEAL, 2008)

5. Definition
• Deficits in IQ and adaptive functioning
• IQ of 70 or below
– Measured by standard scales
• Wechsler, Stanford-Binet, Kaufman
• Impairments in Adaptive Functioning
– Effective coping with common life demands
– Ability to meet standards of independence
– Measured by standard scales
• Vineland, AAMR Adaptive Behavior Scale

6. The Nature of Intellectual Disability
“ Intellectual disability is a term
used when a person has certain
limitations in mental functioning
and skills such as communicating,
taking care of himself/herself
and social skills.
These limitations cause a child
to learn and develop more
slowly than a typical child.

7. Definitions for Intellectual Disability
“Significantly sub-average
general intellectual functioning,
existing concurrently with
deficits in adaptive behavior and
manifested during the
developmental period, that
adversely affects a child’s
educational performance.”
IDEA (Individuals with Disabilities Education Act)

8. Conceptual skills—language and literacy; money,
time, and number concepts; and self-direction.
Social skills—interpersonal skills, social
responsibility, self-esteem, gullibility, naïveté
(i.e., wariness), social problem solving, and the
ability to follow rules/obey laws and to avoid
being victimized.
Practical skills—activities of daily living (personal
care), occupational skills, healthcare,
travel/transportation, schedules/routines,
safety, use of money, use of the telephone.

9. 9
AAMR
Adaptive Skill
Areas

10. Prevalence
• 1% (1 – 3% in developed countries)
• The prevalence of ID due to biological factors is
similar among children of all SES; however, certain
etiological factors are linked to lower SES (e.g.,
lead poisoning & premature birth)
• More common among males (1.5:1)
• In cases without a specifically identified biological
cause, the MR is usually milder; and individuals
from lower SES are over-represented

11. Distribution

12. CAUSES

13. Etiology and Classifications of Intellectual Disability
PRENATAL
CAUSES
PERINATAL
CAUSES
POSTNATAL
CAUSES
1. Chromosomal
Disorders
2. Inborn Errors of
Metabolism
3. Developmental
Disorders of Brain
Formation
4. Environmental
Influences
1. Anoxia
(complete deprivation of
oxygen)
2. Low birth weight
(LBW)
3. Syphilis and
herpes simplex
1. Biological
2. Psychosocial
3. Child Abuse and
Neglect

14. 14
Possible Causes of Mental Retardation

15. PRENATAL CAUSES

16. Congenital intellectual disability
and microcephally
Involves heart defects, hearing
loss, and abnormalities of
fingers and hands. Short
stature
Manifest self-injurious behavior
and limited speech and
stereotypy
PRENATAL CAUSES
Cornelia de Lange
Syndrome

17. (Pierangelo & Giuliani,2007)
Difficulty swallowing and
sucking
Low birth weight and
poor growth
Unusual facial features
and epicanthal fold
broad flat nose
Hyperactive, aggressive,
and repetitive
movements
PRENATAL CAUSES
Cri-du-Chat
Syndrome

18. Also referred to as trisomy 21
Usually not an inherited
condition
The most common type of
chromosomal disorder
It involves the anomaly at the
21st set of chromosomes.
People with DS exhibits
unusual facial features and
with broad hands with short
fingers
PRENATAL CAUSES
Down’s Syndrome

19. (Pierangelo & Giuliani, 2007)
Sterility in men
Decreased IQ
Poor coordination
Skeletal abnormalities
Poor coordination
PRENATAL CAUSES
Klinefelter’s
Syndrome

20. Prader-Willi Syndrome
Inherited from father
Infants are lethargic and have
difficulty eating but eventually
becomes obsessed with food
as they grow hoarding and
obsessive
The leading genetic cause of
obesity.
People with Prader-Willi
syndrome are at risk for a
variety of other health
problems such heart
defects, kidney
PRENATAL CAUSES

21. Turner’s Syndrome
Normally found in females
Persons with Turner’s
syndrome has webbing of
the neck, puffiness or
swelling of the hands and
feet
Associated with heart
defects and kidney
problems
PRENATAL CAUSES
(Pierangelo & Giuliani,2007)

22. William’s Syndrome
Caused by the absence of
material on the seventh
pair of chromosome.
People with William’s
syndrome exhibit heart
defects and “elfin” facial
features.
Their unusual sensitivity
to sound makes them
competent in music and
language despite of their
low IQ level.
PRENATAL CAUSES

23. Fragile X Syndrome
Most common known hereditary
cause of intellectual disability
Associated with X chromosome in the
23rd pair of chromosomes
Occurs less often in females
Persons with Fragile X Syndrome have
behavior and emotional problems
and poor socialization skills
They become anxious when routines
are change
They have unusual facial features
PRENATAL CAUSES
(Hallahan & Kauffman,2003) (Piearangelo & Giuliani, 2007)

24. PRENATAL CAUSES

25. Galactosemia - inability of the
body to use simple sugar
galactose
Hunter Syndrome – defective
breakdown of chemical
mucopolysaccharide.
Phenylketonuria (PKU) – inability
of the body to convert
phenylalanine to tyrosine)
Tay-Sachs Disease – absence of
Hex-A enzyme.
PRENATAL CAUSES
(Piearangelo & Giuliani, 2007)
Can be prevented through an
early detection (e.g. newborn
screening) and can be treated
by providing a special diet
program.

26. PRENATAL CAUSES

27. Microcephalus
The intellectual disability
usually ranges from
severe to profound.
There is no specific
treatment and life
expectancy is low.
PRENATAL CAUSES
(Hallahan & Kauffman,2003)

28. Hydrocephalus
Results from an
accumulation of
cerebrospinal fluid inside
or outside the brain.
The degree of intellectual
disability depends on
how early the condition
is diagnosed and treated.
PRENATAL CAUSES
(Hallahan & Kauffman,2003)

29. PRENATAL CAUSES

30. Maternal Malnutrition and
Infection
Fetal Alcohol Syndrome
(FAS)
Lead exposure
Illicit drug exposure
Exposure to Radiation
Rubella (German measles)
PRENATAL CAUSES

31. PERINATAL CAUSES

32. Anoxia
(deprivation of
oxygen)
Low birth weight
(LBW)
Syphilis and herpes
simplex
PERINATAL CAUSES
(Hallahan & Kauffman,2003)

33. POSTNATAL CAUSES
Environmental and
Psychosocial Problems

34. Nutritional Problems
Adverse living
conditions
Inadequate health care
Lack of early cognitive
stimulation
POSTNATAL CAUSES
Environmental and
Psychosocial Problems

35. Child abuse and neglect
Traumatic Brain Injury
Meningitis or Encephalitis
Lead Poisoning
POSTNATAL CAUSES
Environmental and
Psychosocial Problems

36. 36
Assessing Intellectual Ability
and Adaptive Behavior
• Assessing Intellectual Ability (IQ testing)
– Problems:
• Potential for cultural bias
• Flexibility of IQ scores
• Overemphasis on IQ scores
• Assessing Adaptive Behavior
– Considers the context of the individual’s
environment and cultural influences
– Often measured by direct observation, interviews,
behavior rating scales

37. How Are ID Classified?
• Severity (Used in schools since the 1980s and
based on IQ)
– Mild = 50 to 70-75, Moderate = 35 to 50
– Severe = 20 to 35, Profound = Below 20
• AAMR Levels of Support Needed
– Intermittent
– Limited
– Extensive
– Pervasive

38. Diagnosis
• History: pregnancy, labour, medications.
• family, consanguinity
• Psychiatric interview: Speech, thinking, mood
• Physical examination: face , eyes, ears, tongue, teeth,
• skin, thyroid, measurements
• Neurological examination: gait, coordination,
• sensations, reflexes, tone, motility

39. Investigations
• Chromosomal studies
• Lab
• EEG
• Neuro imaging
• Hearing, Eye and speech evaluation
• Psychological assessment

40. Comorbid Conditions
for Persons with
Intellectual Disabilities

41. Most Commonly Associated
Axis I Disorders
• ADHD
• Mood Disorders
• Pervasive Developmental Disorders
• Stereotypic Movement Disorders
• Schizophrenia
• Mental Disorders due to a GMC
• Epilepsy

42. PLACEMENT
PROGRAMS
for Persons with
Intellectual Disabilities

43. For children with mild intellectual disability, readiness and functional academic
skills are present and thus can be placed into Inclusion Programs.
Educational placement programs for children with moderate to severe
intellectual disability can be more tedious. Curriculum and materials for these
children should be age-appropriate, which should help develop independent
behavior within the child.
Individualized Education Program (IEP) is designed to cater the special
educational needs of special children. This is a useful and common vehicle to
develop skills and educate children with intelletual disabilities who are in
more severe cases.
Behavior Therapy Programs may also be employed, as they are very useful in
altering behavior by lessening distruptive or inappropriate actions of a
particular child.
Alternative Programs can also be incorporated in a child’s special education
process. Such programs would include vocational training, physical education,
theatre, music, etc.

44. Unlike preschool programs for
children at risk, in which the
goal is to prevent intellectual
disability from occurring,
programs for infants and
preschoolers who are already
identified with intellectual
disability are designed to help
them achieve as high a
cognitive level as possible
(Hallahan & Kauffman, 2003).
PLACEMENT PROGRAMS
Early Childhood

45. These programs gives more
emphasis on conceptual and
language development and
usually involves speech and
physical therapists most
specially when children have
multiple disabilities.
PLACEMENT PROGRAMS
Early Childhood

46. How Do I Teach Students with
Intellectual Disabilities?
• Direct instruction with clear objectives, advance
organizers, “think-aloud” model, guided practice,
independent practice, post-organizers
– Focus on task analysis
– Focus on sequencing tasks for recognition, recall,
reconstruction
– Focus on presentation and practice, including use
of prompts
• Generalization

47. Most authorities agree that
although the degree of
emphasis on transition
programming should be
greater for older than for
younger students, such
programming should begin
in the elementary years
(Hallahan & Kauffman,
2003).
PLACEMENT PROGRAMS
Transition to Adulthood

48. Transition programming for
individuals involves two
related areas; first,
community adjustment to
acquire a number of self-
help skills and second,
employment to lead to a
meaningful job.
PLACEMENT PROGRAMS
Transition to Adulthood

49. 49
Family Issues
• Families with a child with mental retardation
may experience a wide range of concerns and
often rely on a support network made up of
friends and family members in addition to
parent organizations and professional groups.

50. Medical Therapy
• SSRI (fluoxetine, sertraline, proxetine)
• Antipsychotics
(Risprdone, olanzapine, aripiprazole)
• Alpha 2 agonists (clonididne)
• Lithium
• Anticonvulsants