Intellectual disability
Definition, Classification, Causes, and Characteristics
AVANI RAJESH KAMATH B
2nd BASLP
Definition
• Intellectual disability is a disability characterized by significant
limitations in both intellectual functioning and in adaptive
behavior, which covers many everyday social and practical
skills. This disability originates before the age of 18.
AAIDD (2002 )
(AAIDD, 2010)
• Significantly sub average general intellectual functioning existing
concurrently with deficit in adaptive behaviour and manifested during the
developmental period that adversely affects a child’s educationl
performance.”
An individual is considered to have an intellectual
disability based on the following three criteria:
• 1. Subaverage intellectual functioning: It refers to general mental capacity,
such as learning, reasoning, problem solving, and so on. One way to
measure intellectual functioning is an IQ test. Generally, an IQ test score
of around 70 or as high as 75 indicates a limitation in intellectual
functioning.
• 2. Significant limitations exist in two or more adaptive skill areas: It is the
collection of conceptual, social, and practical skills that are learned and
performed by people in their everyday lives.
• 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.
• 3. The condition manifests itself before the age 18: This condition is one
of several developmental disabilities-that is, there is evidence of the
disability during the developmental period, which is operationalized as
before the age of 18.
Causes of Intellectual disability
Familial/
Organic environmenta
l
Genetic
and chromosomal
Gross brain disease Infectious process
Complication of
Toxins and chemical
pregnancy and
delivery ORGANIC CAUSES agent
Nutrition and
Gestational disorder
metabolism
Genetic
and
chromosom
al
Gross brain Infectious
disease process
Complicati
on of Toxins and
pregnancy ORGANIC CAUSES chemical
and agent
delivery
Nutrition
Gestational
and
disorder
metabolism
Genetic and chromosomal
A) Down Syndrome (Trisomy 21):
1 in 700 to 1 in 800 live births.
Features:
• Small head circumference
• Small oral cavity with short, high , narrow palate.
• Small stature
• Malocclusion.
• Abnormal outer, middle and inner ear.
• Low tone
• Visual problems
• Low set ears.
B) Klinefelter syndrome(sex linked, XXY):
• Female characteristics
• Possible mental retardation
C) Cri-du-chat syndrome: (5p-)
• Cat like cry/high pitch cry
• Microcephaly, hypotonia
• Mental retardation
D) Fragile X syndrome:
• X linked genetic disorder caused by defect on FMR1 gene.
• Prevalence reported in two ways:
1) Full mutation
2) Permutation
a) Full mutation:
1 in 4,000 males and 1 in 6,000 females
Intellectual disability
b) Permutation:
1 in 129 to 250 females and 1 in 600 to 800 males.
Normal intelligence
Learning Disability
• e) Williams Syndrome:
missing genetic material on chromosome 7
1 in 10,000 to 1 in 15,000 live births
Detected genetic material includes the elastin gene (ELN) which
is essential for maintaining the elasticity of fibers and connective
tissue.
f) Angelman syndrome:
a nonprogressive neurological disorder.
affecting approximately 1 in 10,000 to 1 in 25,000 live births
resulting from a deletion of genetic material from the mother's
15th chromosome.
Genetic
and
chromoso
Gross mal
Infectious
brain
process
disease
Complicat
ion of Toxins and
pregnancy ORGANIC CAUSES chemical
and agent
delivery
Nutrition
Gestationa and
l disorder metabolis
m
Infectious processes:
a) Maternal rubella:
Cardiac defects, cataracts, hearing loss, microcephaly, possible
mental retardation.
b) Congenital syphilis:
Deafness, vision problem, possible epilepsy or cerebral palsy,
mental retardation.
Genetic
and chromosomal
Gross brain
Infectious process
disease
ORGANIC CAUSES
Complication of
Toxins and
pregnancy and
chemical agent
delivery
Gestational Nutrition and
disorder metabolism
Toxins and chemical agent:
a) Fetal alcohol syndrome:
Persistently deficient growth, low brain weight, facial abnormalities, cardiac
defects, mental retardation.
b)Lead poisoning:
Central nervous system and kidney damage, hyperactivity.
Genetic
and chromosomal
Gross brain
Infectious process
disease
ORGANIC CAUSES
Complication of
Toxins and
pregnancy and
chemical agent
delivery
Gestational Nutrition and
disorder metabolism
Nutrition and metabolism:
a)Phenylketonuria:
Reduced pigmentation, motor coordination problem, convulsion, microcephaly,
mental retardation
b)Tachy-Sachs disease:
• Progressive deterioration of nervous system, and vision, mental retardation,
death in preschool years.
c)Inadequate diet:
small stature, possible mental retardation.
Genetic
and chromosomal
Gross brain
disease Infectious process
ORGANIC CAUSES
Complication of
Toxins and
pregnancy and
chemical agent
delivery
Gestational Nutrition and
disorder metabolism
Gestational disorder:
a)Hydrocepahalus:
o Enlarged head caused by increased volume of cerebral -spinal fluid, visual
defects, epilepsy, mental retardation.
b)Cerebral malformation:
Absence or underdevelopment of cerebral cortex and resultant mental
retardation.
c)Craniofacial anomalies:
malformed skull and associated mental retardation
• Neonatal complications : Low birth weight/ prematurity, Anoxia
(oxygen deprivation) , Birth trauma, Breach presentation , Prolonged
delivery
Genetic
and
chromosomal
Gross brain Infectious
disease process
ORGANIC CAUSES
Complication of
Toxins and
pregnancy and
chemical agent
delivery
Gestational Nutrition and
disorder metabolism
Complicaton of pregnancy and delivery:
a)Extreme immaturity or preterm infant:
Low birth weight, higher prevalence, of central nervous system issues
.
b)Exceptionally large baby:
possible birth injury to central nervous system.
c)Maternal nutritional disorder:
low birth weight, higher prevalence, of central nervous system disorders.
Genetic
and chromosomal
Gross brain
Infectious process
disease
ORGANIC CAUSES
Complication of
Toxins and
pregnancy and
chemical agent
delivery
Gestational Nutrition and
disorder metabolism
Gross brain disease:
a)Tumors and tuberous sclerosis
• Tumors in heart, seizures, tuberous "bumps" on nose and cheeks, mental
retardation.
b)Huntington disease:
• Degenerative neurological functioning evidenced in progressive dementia
and cerebral palsy.
Causes of Intellectual disability
Familial/
Organic environmenta
l
2)Familial and environmental causes
One proposal (Luria, 1963) is that there are
three types:
1)
Either or both parents of a child with an intellectual disability
about 35 percent of all individuals with intellectual disabilities.
2)
• The parents are not intellectually disabled, but the intellectual disability is
genetically inherited
• another 35 percent of the total.
• In contrast to organic intellectual disabilities, which may also be genetic,
inherited familial intellectual disability is not associated with a currently
known syndrome and produces less severe developmental disabilities.
3)
• Intellectual disability is due to extreme environmental deprivation—about 5
percent of the total.
• Deprivation, poor housing and diet, poor hygiene and lack of medical
attention can affect the development of the child adversely although exact
effect of each is unknown and varies with each child.
Characteristics of people Intellectual
Disability
General Cognition
• Vary physically and emotionally, as well as by personality, disposition,
and beliefs.
• Apparent slowness in learning may be related to the delayed rate of
intellectual development.
• If specific educational supports are implemented, few researches indicate
children with intellectual disabilities may achieve at the same rates but
overall remain behind their peers
Learning and Memory
• Children with intellectual disabilities may have difficulty distinguishing
and attending to relevant questions in both learning and social situations
(Saunders, 2001).
• The problem is not that the student will not pay attention, but rather that
the student does not understand or does not filter the information to get to
the salient features.
Adaptive Skills
• A child with intellectual disabilities may have difficulty in both learning
and applying skills for a number of reasons, including a higher level of
distractibility, inattentiveness, failure to read social cues, and impulsive
behaviour.
LANGUAGE CHARACTERISTICS IN
INTELECTUAL DISABILITY
PHONOLOGY
• Phonological rules are similar to those of preschoolers developing
typically but reliance on less mature forms, though capable of more
advanced once.
• Individuals with profound retardation vocalize less than individuals
developing normally.
• Individuals with less retardation babble in a fashion similar to that of
chronologically age matched peers
• Difficulties with speech production (articulation) are more common
among children with ID than TD Children.
• A number of researchers have studied the articulation deficiencies of the
mentally retarded population (Bangs, 1961; Schiefelbusch, 1963;
Spradlin, 1963; Wolfensbergsd Mein, & O’Connor, 1963).
• They demonstrated that a majority of institutionalized and/or severely
retarded persons exhibit articulation disorders (Yoder & Miller, 1972).
• Articulation errors are more common.
• Most frequent errors is deletion of consonant.
• Errors are likely to be inconsistent.
• Patterns of errors are similar to those of nonretarded children or children
with a functional delay.
• Individuals who are mentally retarded use the same phonological process
as TD children but with greater frequency (Klink, 1986).
• The most phonological process exhibited by individuals with ID are
reduction of consonant clusters and final consonant deletion (Klink et
al, 1986).
Morphology
• Same order of morphological acquisition/ morpheme
development has been reported for both the ID and the TD
population, but the pattern seems to be delayed.
Syntax
• The overall sequence of development of syntactic structure is similar for
the mildly ID and TD population ;however the rate is slower (Ingram,
1972)
• The sentence length and complexity increase with development (Graham
& Graham, 1971)
• Reliance on less mature word order, though capable of more advanced.
• Even at equivalent mental age levels, however, individuals with retardation
appear to use shorter, less complex sentences than their TD peers.
• Difficulty with complex grammar
• Uses simple verb phrases and noun phrases
• Compared to Typically Developing children, children with mild intellectual
disabilities master bound morphemes in approximately the same order but at a
slower rate
• In spontaneous speech, children with intellectual disabilities relied on "and"
as the only form of clausal linkage.
• They also produced significantly fewer question forms (interrogative
reversals and "wh-" questions)
• Used only developmentally simple question forms
Semantics
• Mentally retarded individuals exhibit poorer receptive language skills than their TD peers,
(Abbeduto, Furman, & Davies, 1989).
• Rely more on concrete word meaning.
• One of the clearest expressions of lexical concreteness is in the comprehension of idioms
(e.g., "got cold feet," "broke her heart)Slow vocabulary growth
• Limited use of semantic units.
• Reliance on context to extract meaning
• Poor sentence recall as compared to peer group.
Pragmatics
• Delayed gestural requesting
• May take less dominant conversational role
• Less capable of requesting for clarification when communication
breakdown happens.
• Children with intellectual disabilities, especially those who are severely
impaired, rarely uses language to initiate social contact and tend to
receive responsive communicative roles (Bedrosin & Prutting, 1978).
• The children with intellectual disabilities tend to show less per interaction
when placed in group (Beveridge, 1976)
• Persists issues with imperative commands
• Some researchers have suggested that deficits in TOM manifest themselves
differently across different syndromes.
• TOM refers to an individual's ability to understand and interpret another
person's knowledge and beliefs, particularly when they are different from
one's own perspectives (Baron-Cohen, 1989a, 2000), and that it is thought to
be one hallmark of social cognition.
• Abbeduto et al. (2001) reported that TOM was more impaired in individuals
with DS as compared to individuals with FXS(Fragile X Syndrome).
• Thomas and Karmiloff-Smith (2003) reported that children with children
with Williams syndrome performed relatively well on TOM tasks.
• Abbeduto et al. (2004) suggested that the use of false-belief tasks may be
problematic when used with children and adolescents who have
intellectual disabilities.
• Turn-taking difficulties are not considered to be generally characteristic of
children with intellectual disabilities, even though certain individuals may
exhibit problems, especially in situations that suspend or vary the usual
patterns of conversation (Abbeduto & Hesketh, 1997).
• They are able to maintain topics in conversations, but they do so primarily
with acknowledgments (e.g., "yeah," "uh huh," "okay").
• They remain deficient in their ability to extend topics by providing new
information or new shading on the current subject of discussion.
• Children with intellectual disabilities do not generalize behaviors well
outside the teaching environment.
• A child with severe intellectual impairment was taught to use iconic
pictographs (Bliss symbols) by his classroom teacher and to sign by his
speech-language pathologist.
• He reportedly used both systems effectively but only in the settings in
which they were taught (Nietupski, Scheutz, Sr Ockwood, 1980).
Motivation
• Lacking motivation
• Past experiences of failure and the anxiety generated by those failures
may make them appear to be fewer goals directed and lacking in
motivation. The result of failure is often learned helplessness.
Academic Achievement
• Mild to moderate intellectual disabilities lead to persistent problems in
academic achievement.
• Children with mild intellectual disabilities are better at decoding words
than comprehending their meaning (Drew & Hardman, 2007) and read
below their own mental-age level (Katims, 2000).
• Children with intellectual disabilities may be able to learn basic
computations, but may be unable to apply concepts appropriately in a
problem-solving situation (Beirne-Smith et al., 2006).
• Children with moderate or severe intellectual disabilities can be taught
academics as a means to gain information, participate in social settings,
increase their orientation and mobility, and make choices (Browder,
Ahlgrim-Delzell, Courtade-Little, & Snell, 2006).
Physical characteristics
• Children with intellectual disabilities with differing biological etiologies, may exhibit
coexisting problems, such as physical, motor, orthopedic, visual and auditory
impairments, and health problems (Hallahan & Kauffman, 2006).
• A relationship exists between the severity of the intellectual disabilities and the extent
of physical differences for the individual (Drew & Hardman, 2007; Horvat, 2000).
• The majority of children with severe and profound intellectual disabilities have
multiple disabilities that affect nearly every aspect of intellectual and physical
development (Westling & Fox, 2004).
