Intellectual Disabilities

A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills, manifested during the developmental period, which contribute to the overall level of intelligence, i.e. cognitive, language, motor, and social abilities

Aetiology

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Co-morbidities

  • People with ID are 3 x more likely to experience another psychiatric disorder than the general population

Clinical presentation

Severity of ID

  • Borderline ID - IQ 70-84
    • Mental age 12 to under 15 years
  • Mild ID - IQ 50-69
    • Mental age 9 to under 12 years
    • Most common
    • Delayed speech - able to use everyday speech
    • Full independence - self care, practical and domestic skills
    • Difficulties in reading and writing
    • Capable of unskilled or semi-skilled work
    • Problems if social or emotional immaturity
    • Rarely organic aetiology
  • Moderate ID - IQ 35-49
    • Mental age 6 to under 9 years
    • Slow with comprehension and language
    • Limited achievements
    • Delayed self care and motor skills
    • Simple practical tasks - often with supervision
    • Usually fully mobile - physically active
    • Discrepant profiles
    • Majority organic aetiology
    • Epilepsy and physical disability common
  • Severe ID - IQ 20-34
    • Mental age 3 to under 6 years
    • Generally more marked impairment than in moderate ID and achievements more restricted
    • Epilepsy
  • Profound ID - IQ < 20
    • Mental age less than 3 years
    • Severe limitation in ability to understand or comply with requests or instructions
    • Little or no self care
    • Often severe mobility restriction
    • Basic or simple tasks may be acquired

Investigations

  • Psychometric assessment - most commonly used Wechsler Adult Intelligence Scale (WAIS)
  • Diagnosis based on clinical findings

Management

Psychological treatment

  • Behavioural e.g. teach/improve basic skills, relaxation techniques
  • CBT
  • Psychodynamic therapy - relationships

Pharmacological treatments

  • Comorbid physical disorders - epilepsy, constipation
  • Atypical responses - decreased or increased sensitivity, paradoxical reactions
  • Evidence base often lacking

Other supportive measures

  • Therapeutic environment - general and specific support
  • Psychoeducation - patient and carers
  • Social - unmet needs, support network
  • Communication - hearing aids, glasses, Pictorial, Makaton