pediatrics
Intellectual Disability
Introduction
Intellectual disability is characterized by significantly subaverage intellectual functioning (often expressed as an intelligence quotient<70 to 75) combined with limitations of adaptive functioning (ie, communication, self-direction, social skills, self-care, use of community resources, and maintenance of personal safety), along with demonstrated need for support. Management consists of education, family counseling, and social support. Intellectual disability is considered a neurodevelopmental disorder. Neurodevelopmental disorders are neurologically based conditions that appear early in childhood, typically before school entry, and impair development of personal, social, academic, and/or occupational functioning. They typically involve difficulties with the acquisition, retention, or application of specific skills or sets of information. Neurodevelopmental disorders may involve dysfunction in one or more of the following: attention, memory, perception, language, problem-solving, or social interaction. Other common neurodevelopmental disorders include Attention-Deficit/Hyperactivity Disorder (ADD, ADHD) , Intellectual disability must involve early-childhood onset of deficits in both of the following: Intellectual functioning (eg, in reasoning, planning and problem solving, abstract thinking, learning at school or from experience) Adaptive functioning (ie, ability to meet age- and socioculturally appropriate standards for independent functioning in activities of daily life) Basing severity on IQ alone (eg, mild, 52 to 70 or 75; moderate, 36 to 51; severe, 20 to 35; and profound,<20) is inadequate. Classification must also account for the level of support needed, ranging from intermittent to ongoing high-level support for all activities. Such an approach focuses on a person’s strengths and needs, relating them to the demands of the person’s environment and the expectations and attitudes of the family and community. About 3% of the population functions at an IQ of<70, which is at least 2 standard deviations below the mean IQ of the general population (IQ of 100); if the need for support is considered, only about 1% of the population has severe intellectual disability. Severe intellectual disability occurs in families from all socioeconomic groups and educational levels. Less severe intellectual disability (requiring intermittent or limited support) occurs most often in lower socioeconomic groups, paralleling with observations that IQ correlates best with success in school and socioeconomic status rather than specific organic factors. Nevertheless, recent studies suggest that genetic factors play roles even in milder cognitive disabilities. 