Intellectual Disability

Question 1

DEFINITIONS:

Answer 1

1. • Significant intellectual impairment with associated impaired ability to adapt to normal demands of daily living, onset usually prior to 18y.
     - IQ≤70/2 standard deviations below the mean(IQ=100) with significant impairment in adaptive functioning

Question 2

CLASSIFICATIONS:

1. Mild(85%)
2. Moderate(10%)
3. Severe(3-4%)
4. Profound(1-2%)

Answer 2

1. IQ 50-69, subtle difficulties, able to live independently and carry out unskilled/semi-skilled manual labour. usually identified only in later age, academic activities helped by educational programmes.
2. IQ 35-49, limited language and comprehension, impaired self-care and motor skills. Rarely able to live independently, may be able to work under supervision
3. IQ 20-34, marked motor impairment, minimal speech in early childhood, capable of only elementary self-care skills.
4. IQ<20, Severely limited communication, motor impairment, restricted mobility, incontinence. Often requires residential care

Question 3

AETIOLOGY:

Answer 3

1. Genetic
   - Down’s syndrome, Fragile X syndrome, Phenylketonuria etc
2. Neurodevelopmental
   - Autism
3. Prenatal
   - Infections
   - Substance use
   - Pregnancy complications
4. Perinatal
   - Birth trauma
   - Prematurity
5. Childhood factors
   - Infections
   - Trauma
   - Toxins
6. Environmental
   - Neglect
   - Malnutrition
   - Poor linguistic and social stimulation

Question 4

MANAGEMENT:

1. Prevention and detection
2. Family support
3. Education, training, occupation
4. Housing and social support
5. Medical care
6. Psychiatric care

Answer 4

1. • Genetic screening, prenatal testing, improved antenatal and neonatal care.
     - Secondary prevention prevents progression of disability through compensatory education and early interventions to reduce behavioural problems
     - If child, refer to paediatrician/CAMHS. If adult, refer to local intellectual disabilities team
2. Education, practical matters, psychological support
3. • Mainstream education if needs can be met
     - May need specialist schools and vocational guidance that better suit needs
     - Mainstream/supported employment(Remploy)
4. Assess daily living tasks, if severe difficulties, may need residential care
5. Communication difficulties, specialist nurses
6. • More caution with medication
     - Higher prevalence of co-morbid mental illness