pediatrics
Intellectual Disability
Treatment of Intellectual Disability
Early intervention program Multidisciplinary team support Treatment and support needs depend on social competence and cognitive function. Referral to an early intervention program during infancy may prevent or decrease the severity of disability resulting from a perinatal insult. Realistic methods of caring for affected children must be established. Family support and counseling are crucial. As soon as intellectual disability is confirmed or strongly suspected, the parents should be informed and given ample time to discuss causes, effects, prognosis, education and training of the child, and the importance of balancing known prognostic risks against negative self-fulfilling prophecies in which diminished expectations result in poor functional outcomes later in life. Sensitive ongoing counseling is essential for family adaptation. If the family’s physician cannot provide coordination and counseling, the child and family should be referred to a center with a multidisciplinary team that evaluates and serves children with intellectual disability; however, the family’s physician should provide continuing medical care and advice. A comprehensive, individualized program is developed with the help of appropriate specialists, including educators. A multidisciplinary team includes Neurologists or developmental-behavioral pediatricians Orthopedists Physical Therapy (PT) and Speech Therapy and audiologists (who help with language delays or with suspected hearing loss) Nutritionists (who help with treatment of undernutrition) Social workers (who help reduce environmental deprivation and identify key resources) Psychologists (who oversee planning of behavioral interventions) Affected children with concomitant mental health disorders such as depression may be given appropriate psychoactive drugs in dosages similar to those used in children without intellectual disability. Use of psychoactive drugs without behavioral therapy and environmental changes is rarely helpful. Every effort should be made to have children live at home or in a community-based residence. Living at home with the family is usually better for the child than alternative placements unless marked behavior difficulties require a higher level of supervision than the family can provide. The family may benefit from psychologic support and help with daily care provided by day care centers, homemakers, and respite services. The living environment must encourage independence and reinforce learning of skills needed to accomplish this goal. Whenever possible, children with intellectual disability should attend an appropriately adapted day care center or school with peers without cognitive disability. TheIndividuals with Disabilities Education Act (IDEA), the primary US special education law, stipulates that all children with disabilities should receive appropriate educational opportunities and programs in the least restrictive and most inclusive environments. TheAmericans with Disability ActandSection 504 of the Rehabilitation Actalso provide for accommodations in schools and other public settings. As people with intellectual disability reach adulthood, an array of supportive living and work settings is available. Large residential institutions are being replaced by small group or supported individual residences matched to the individual's functional abilities and needs. 