Intellectual Disability (Cognitive Impairment)

What is Intellectual Disability (Cognitive Impairment)?

Intellectual disability is a term that encompasses a diverse group of behavioral symptoms that manifest early in childhood, characterized by a disruption in intellectual functioning (with an IQ level below 70) and impaired adaptive skills (such as communication difficulties, difficulty meeting basic needs, and learning challenges). This condition is attributed to limited or delayed brain development. It is crucial to emphasize that children with intellectual disabilities experience emotions like any other children and are entitled to both medical and emotional support and care. As a society, it is our responsibility to learn about this condition and explore how we can improve the well-being of those affected.

Diagnosis of Intellectual Disability

Accurate diagnosis is achieved through a comprehensive psychological assessment that determines the individual's level of intelligence. However, intellectual disability can also be diagnosed in earlier stages, even when a child is unable to complete a psychological assessment, through developmental tests designed specifically for diagnosing cognitive impairment. Early identification of cognitive impairment in young children is crucial to tailor their upbringing and emotional and developmental support effectively. In cases where intellectual disability is associated with a known cause (e.g., syndromes, birth complications, brain injury), diagnosis can be made earlier due to accompanying symptoms. Identifying signs of intellectual disability in early childhood can prevent significant distress for the child and their family. It is important to recognize and be aware of the signs accompanying this disorder, which may include seizures, other neurological disorders, or various physical abnormalities in the case of syndromes, prompting parents to seek a diagnosis. Additionally, children with intellectual disabilities may exhibit various behavioral issues, such as repetitive behaviors, self-harm, irritability, decreased impulse control, or particularly poor concentration. Mild intellectual disabilities often manifest as behavioral problems, whereas severe cases are more frequently associated with autistic features.

Levels of Intellectual Disabilities

• Mild intellectual disability - (approximately 85% of those with intellectual disabilities) acquire language skills at a moderate pace, typically reaching a reasonable level of proficiency. Most of them can eventually learn to read, write, work, and support themselves. The IQ range for those with mild intellectual disability is between 55 and 69, and their intellectual abilities correspond to a 9 to 12-year-old level (equivalent to grades 3 to 7). It is important to note that there are individuals who fall on the border between mild intellectual disability and borderline intellectual disability (more commonly known as borderline intellectual functioning), making diagnosis more challenging. Those with borderline intellectual functioning are characterized by an IQ range of 70 to 79, and they may often go undiagnosed as they can achieve significant accomplishments without any assistance.
• Moderate intellectual disability - (approximately 10% of those with intellectual disabilities) acquire basic language skills at a slower pace. Some of them may acquire basic reading and social skills and can work in supervised settings. Their IQ typically falls between 40 and 54, corresponding to a 6 to 9-year-old level (equivalent to grades 1 to 4).
• Severe intellectual disability - acquire minimal language skills, often requiring significant support and intervention. They frequently experience motor difficulties and other developmental delays. Their IQ falls below 40, in the range of 30 to 39, and their intellectual abilities correspond to a 3 to 6-year-old level. After reaching adolescence, they can acquire basic life skills, although these remain significantly limited.

Causes of Intellectual Disability

Intellectual disability can result from both genetic and acquired factors. Genetic causes can be diverse, including chromosomal abnormalities or other hereditary factors. Acquired factors may be related to prenatal complications, birth complications, or early-life environmental factors.

Treatment and Goal Setting

The treatment of intellectual disability focuses on improving functional abilities and adaptation while preventing secondary health issues. It is essential to understand that children with intellectual disabilities often experience emotional disturbances and other medical problems that accompany the primary condition. Additionally, these children are at a heightened risk of maltreatment and exploitation by others who may take advantage of their vulnerable situation.
Over the years, research has emphasized the importance of early intervention for children with intellectual disabilities. The younger the child, the more flexible their brain development, offering the possibility of achieving higher goals through early intervention. Placement in an appropriate educational and vocational framework is essential to address disparities and frustrations while enabling tailored learning according to the child's level. Nevertheless, it is now understood that isolating a child from their natural environment should be avoided, and the goal is to provide care within the community whenever possible, without causing severe disruptions to the child's life or their surroundings.
In many cases, the aim is to find a specialized educational framework that can provide the child with a range of skills, including social, learning, and behavioral abilities. Various treatments may include behavioral therapy, cognitive-behavioral therapy (CBT), psychodynamic therapy, medication, and occupational therapy. Furthermore, involving parents and the family is crucial, and parental guidance and family therapy should be considered as part of the comprehensive treatment plan. Identifying sources of strength and setting achievable goals are essential elements of treatment planning. On a family level, it is vital to provide guidance on coping with emotions, adjusting expectations, and finding a balance between support and fostering independence. Most of the required treatments are provided through educational frameworks, provided that appropriate adjustments are made.