How Do I Know if My Child Has an Intellectual Disability?

Intellectual disabilities are identified based on two main diagnostic criteria. Mental handicap is the first requirement. The IQ test is used to determine this. Having severely restricted mental capacities is problematic in many ways. The first problem is that it takes more work to pick up. Second, exercising discretion and good judgement is challenging. In a third point, it does not provide simple answers to issues. That people are more likely to become victims is the fourth effect.

Inadequate adaptive functioning is the second diagnostic criterion. The ability to care for oneself in a responsible and safe manner while living on one's own is called adaptive functioning. There are three fundamental skill-sets that everyone needs. One is the ability to think abstractly. Language, reading, math, telling time, and the ability to direct one's own actions all fall under this category. The other group consists of interpersonal abilities. These abilities aid in fostering positive relationships with others. Skills that can be directly applied to real-world situations make up the third category. You'll need these abilities for your own well-being, to find and keep a job, and to keep yourself and others safe.

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How Do I Know If My Child Has an Intellectual Disability?

It's crucial to get help as soon as possible if you want your child to develop to her full potential. If you are concerned that there may be an issue, discuss it with your child's doctor. Additional screening and evaluation may be recommended, and you may be referred to a developmental-behavioral paediatrician for this purpose.

Intellectual disability manifests itself in a wide variety of ways. Here are some things kids might:

• Differentially late in sitting, crawling, or walking
• Learn to speak later or have difficulty speaking
• Having difficulty understanding social rules
• Not able to foresee the results of their actions
• Struggle to find solutions
• Have difficulty thinking logically

About developmental delays:

Your child's doctor may initially diagnose a developmental delay. Your kid may get an ID later on, but for now, it's impossible to tell. Early indicators of developmental delay are present in 100% of children with ID, however not all children with a delay grow up to have ID. A child may not be diagnosed with an ID until he or she begins school and has difficulty keeping up with their peers academically.

Signs and Symptoms of Intellectual Disability

Defining Characteristics

People with ID struggle not just intellectually but also in the areas of social and practical adaptive functioning.

Deficits in Intellectual Functions

• Language development
• Reasoning
• Problem-solving
• Planning
• Abstract thinking
• Judgment
• Academic learning
• Learning from experience
• Deficits in Adaptive Functioning
• Failure to meet personal independence and social responsibility developmental and sociocultural standards
• Impairment in one or more areas of everyday life, including but not limited to communication, social involvement, and independent living, in all environments, including but not limited to the home, the classroom, the workplace, and the community.

The severity of ID is determined by the amount of assistance required for adaptive functioning, or the execution of essential daily tasks. Adaptive functioning impairments across domains can manifest in a variety of ways, and the DSM-5 lists some of them.

Conceptual Domain

• Slow language development (children learn to talk later, if at all)
• Slow development of pre-academic skills
• Difficulties in academic learning (reading, writing, mathematics)
• Difficulty understanding concepts of time and money
• Problems with abstract thinking (concrete approach to problem-solving)
• Challenges with the various facets of executive function, such as organisation, forethought, decision-making, and the ability to shift gears quickly, can indicate a deeper problem.
• Problems with short-term memory
• Difficulties in applying learned concepts in real-world settings, including difficulties with financial and time management

Social Domain

• Limitations in language and communication skills
• To a greater extent than their contemporaries, the speaker avoids using overly abstract language.
• Limited vocabulary and grammatical skills
• A language that can only send and receive simple signals, both verbal and nonverbal.
• Alternate and supplementary methods of communication that do not include the use of spoken language (AAC)
• Social Skills
  • Lack of maturity in social contexts and decision-making
  • Inability to read and respond to social cues and social norms among peers
  • Impairments in emotional and behavioural regulation that may have a negative impact on interpersonal relationships

Practical Domain

• Needing varying degrees of assistance with basic tasks like
  • Personal care
  • Complex activities including grocery shopping, driving, caring for others, cooking, and budgeting are examples.
  • Employment
  • Health care and legal decisions
  • Recreational skills
  • Household tasks

Communication Patterns

It is possible for people with ID and related language and communication disorders to exhibit symptoms of difficulties with phonology, morphology and syntax, semantics, pragmatics, and other aspects of spoken and written language. For more on the cognitive and linguistic challenges, alternative modes of communication (such as augmentative and alternative communication devices), behavioural, social, and emotional issues faced by people with language disorders, check out the articles on spoken and written language disorders, respectively (the latter is still in development).

Communication skills among people with ID are diverse and can range from nonsymbolic (e.g., gestures, vocalisations, problem behaviours) to symbolic (e.g., signs) (e.g., words, signs, pictures). Examples of typical communication patterns of people with ASD, cerebral palsy, Down syndrome, foetal alcohol syndrome, and Fragile X syndrome, all of which frequently co-occur with ID, can be found in Communication Characteristics: Selected Populations With an Intellectual Disability.

Levels of intellectual disability

The IQ and maturity level of your child will determine the level of ID your child falls into.

Mild intellectual disability

Some of the symptoms of mild intellectual disability include:

• learning to talk slowly yet doing so effectively once they do
• being completely self-sufficient in self-care as they age
• having difficulties with reading and writing
• social immaturity
• increased difficulty with marriage or parenting responsibilities
• taking advantage of specialised education plans
• having an IQ range of 50 to 69

Moderate intellectual disability

If your child has a moderate ID, they may exhibit some of the following symptoms:

• are slow to comprehend and use language
• may encounter communication difficulties
• can learn fundamental reading, writing, and counting abilities
• are generally unable to live alone
• can frequently get around on their own to familiar locations
• can take part in various types of social activities
• generally having an IQ range of 35 to 49

Severe intellectual disability

Symptoms of severe ID include:

• noticeable motor impairment
• severe damage to or abnormal development of their central nervous system
• generally having an IQ range of 20 to 34

Profound intellectual disability

Symptoms of profound ID include:

• inability to comprehend or follow requests or instructions
• possible immobility
• incontinence
• very basic nonverbal communication
• inability to care for their own needs independently
• the need for constant help and supervision
• having an IQ of less than 20

Other intellectual disability

These individuals typically have some form of physical impairment, such as deafness, mutism, or inability to speak. Your child's paediatrician may be unable to perform screening tests due to these circumstances.

Unspecified intellectual disability

Your child may exhibit ID symptoms if they have an unidentified ID, but the severity of their handicap will be unknown to their doctor.

What are the causes of intellectual disability?

Origins of ID can occur at any point during or after a person's development. It's possible to avoid the effects of some prenatal causes (such environmental factors). 45% of ID can be traced back to genetic factors (Batshaw, Roizen, & Lotrecchiano, 2013). The two most common genetic causes of ID are Down syndrome and Fragile X syndrome. A major environmental contributor to ID is foetal alcohol syndrome.

Prenatal

• Genetic syndromes (e.g., Down syndrome and Fragile X syndrome)
• Inborn errors of metabolism
• Brain malformation (e.g., microcephaly)
• Maternal disease (e.g., placental disease)
• Environmental influences (e.g., alcohol, other drugs, toxins, teratogens)

Perinatal

• Labour and delivery–related events (leading to neonatal encephalopathy)
• Anoxia at birth

Postnatal

• Hypoxic-ischemic injury
• Traumatic brain injury
• Infections
• Demyelinating disorders
• Seizure disorders (e.g., infantile spasms)
• Severe and chronic social deprivation
• Toxic metabolic syndromes and intoxications (e.g., lead, mercury)

Some people's ideas regarding what causes ID may be influenced by their cultural background (Allison & Strydom, 2009; Scior, 2011).

How is intellectual disability diagnosed?

To be given an ID diagnosis, your child will need to be significantly below average in intelligence and adaptability. The physician caring for your kid will do a three-part examination, which will include:

• interviews with you
• observations of your child
• standard tests

The Stanford-Binet Intelligence Scale and other widely used tests will be used to evaluate your child's mental capacity. Your child's IQ can be calculated with this information by the doctor.

Additional tests, such as the Vineland Adaptive Behavior Scales, may be given by the doctor. Your child's social and daily-living skills will be evaluated in comparison to other children of the same age using this test.

It is worth keeping in mind that kids from diverse backgrounds and socioeconomic levels may have varying levels of success on these types of assessments. The doctor will look at the test results, talk to you and your child, and use their clinical judgement to come up with a diagnosis.

Your child's evaluation process may include visits to specialists such as:

• psychologist
• speech pathologist
• social worker
• pediatric neurologist
• developmental pediatrician
• physical therapist

Tests in the lab and on scans might be done as well. Your child's doctor may use them to spot metabolic and genetic diseases, as well as structural issues in the brain.

Delays in development can also be caused by illnesses like hearing loss, learning issues, neurological disorders, and emotional problems. Before diagnosing your child with ID, your child's doctor should investigate these possibilities.

Results from these assessments will be used by your child's doctor, school, and you to create a plan for your child's care and education.

What are the treatment options for intellectual disability?

Each person with ID has a distinct profile that takes into account not just their language capabilities but also their hearing, cognitive level, speech production abilities, and emotional state. In order to provide the most effective care possible, interventions must take into account the person's unique set of circumstances, including their strengths and areas of growth.

The availability of a communicative intervention for people with ID is supported by research. According to AAIDD (2013), providing an individual with the right kind of individualised support over time can help them perform better in their daily lives. The purpose of treatment is to lessen the severity of the condition and its associated difficulties for the patient and their loved ones, while increasing the probability of a positive result.

Treatment Principles

Interventions in communication for people with ID are designed with the people they encounter in their everyday lives in mind. Communication specialists make sure their patients have plenty of practise with a wide range of language functions (such as greeting, commenting, and requesting), partners, forms and modalities (such as speech and augmentative and alternative communication [AAC]), and settings (including the home, school, community, and workplace). Treatment plans often incorporate a wide range of methods (Goldstein, 2006).

SLPs aid in ensuring that communication partners acknowledge and respond to attempts at communication and expand on the interests, initiations, and requests of individuals with ID. SLPs help others understand the role language will play in their development and success by involving them in intervention activities.

Treatment Targets and Contexts

Interventions in communication take into account linguistic and cultural differences while also addressing the three main categories of the International Classification of Functioning, Disability, and Health (ICF) (WHO, 2001) framework: body structures/functions, activities/participation, and context (personal and environmental).

Intervention for people with ID can focus on a variety of domains, including but not limited to the following:

• Early communication skills (for example, pointing, taking turns, and sharing attention);
• social interaction and play;
• pragmatic (spoken and nonspoken) conventions for communicating appropriately in a variety of situations
• speech production;
• spoken and written language for social, educational, and vocational functions, with a focus on participation in activities identified as problematic for the individual;
• literacy;
• increased spoken and written language complexity for more effective communication
• factors influencing an individual's relative success or difficulty in those activities;
• compensatory communication strategies and techniques, such as the use of AAC or other assistive technology;
• Feeding and swallowing.

When designing a treatment plan, SLPs take into account each patient's unique goals and needs, giving priority to those therapy targets with the most potential to boost patients' ability to communicate.

Communication partners are often trained as part of a treatment plan so that they may better assist patients with their language needs. Communication strategies, cueing methods, and assistive technologies may all be part of a person's training.

Communication is another area that may benefit from interprofessional collaboration. Speech-language pathologists (SLPs) and exercise physiologists (EPs) often collaborate to improve respiratory support, which in turn benefits speech production and comprehension.

Treatment Modes/Modalities

Modalities and modes of therapy refer to the technologies and other forms of assistance utilised in conjunction with or for the delivery of specific treatment methods. In peer-mediated interventions, for instance, video-based training can be utilised to teach social skills and other desired behaviours.

Supplementing or replacing natural speech and/or writing with aided e.g., image communication symbols, line drawings, Blissymbols, and tangible items and/or unaided e.g., manual signals, gestures, and fingerspelling symbols is known as augmentation and alternative communication (AAC). To transmit assisted symbols, a transmission equipment is needed, but to make unaided signals, only the body is needed. Devices that generate speech are examples of aided AAC.

Activity schedules/visual supports are items, images, drawings, or written words used as cues or prompts to aid in the completion of a sequence of tasks/activities, attendance at tasks, a transition from one task to another, or acceptable behaviour in a variety of circumstances. Scripts are the verbal and/or nonverbal cues used to start or continue a conversation. Although scripts are most commonly associated with encouraging social connection, they can also be utilised effectively in the classroom to support academic discussions and boost student engagement.

Instructional methods that rely on the use of electronic devices, such as the iPad, and/or computer-based software to educate students in interpersonal and communicative competence.

Video-based instruction, also known as video modelling, is an observational method of teaching that employs video recordings to serve as a model of the desired behaviour or ability. In this method, the person watches video recordings of desirable behaviours and then attempts to model their own actions after them. The students' attempts at self-modeling can be recorded and analysed at a later time.

Treatment Options

Modalities and modes of therapy refer to the technologies and other forms of assistance utilised in conjunction with or for the delivery of specific treatment methods. In peer-mediated interventions, for instance, video-based training can be utilised to teach social skills and other desired behaviours.

Supplementing or replacing natural speech and/or writing with aided e.g., image communication symbols, line drawings, Blissymbols, and tangible items and/or unaided e.g., manual signals, gestures, and fingerspelling symbols is known as augmentation and alternative communication (AAC). To transmit assisted symbols, a transmission equipment is needed, but to make unaided signals, only the body is needed. Devices that generate speech are examples of aided AAC.

Activity schedules/visual supports are items, images, drawings, or written words used as cues or prompts to aid in the completion of a sequence of tasks/activities, attendance at tasks, a transition from one task to another, or acceptable behaviour in a variety of circumstances. Scripts are the verbal and/or nonverbal cues used to start or continue a conversation. Although scripts are most commonly associated with encouraging social connection, they can also be utilised effectively in the classroom to support academic discussions and boost student engagement.

Instructional methods that rely on the use of electronic devices, such as the iPad, and/or computer-based software to educate students in interpersonal and communicative competence.

Video-based instruction, also known as video modelling, is an observational method of teaching that employs video recordings to serve as a model of the desired behaviour or ability. In this method, the person watches video recordings of desirable behaviours and then attempts to model their own actions after them. The students' attempts at self-modeling can be recorded and analysed at a later time.

Applied behaviour analysis (ABA)—treatment based on the principles of learning theory, which aim to induce long-lasting, beneficial changes in patient behaviour. Techniques from the field of applied behaviour analysis (ABA) have been utilised to develop and generalise abilities like communication, social interaction, and self-regulation. The methods are adaptable for usage in formal (e.g., classroom) and informal (e.g., family dinnertime) contexts, and for one-on-one or small-group tutoring. Individuals with ID, and especially those who also have ASD, have benefited from ABA.

Interventions are tailored to each person's unique set of circumstances, including their needs, interests, and family dynamics. In intensive, early intervention programmes that begin before the age of 4, ABA approaches are commonly employed to address a wide range of life skills. Intensive courses often last between one and three years and consist of anywhere from 25 to 40 weekly hours. If you're interested in delivering ABA therapy, but aren't sure if you meet the necessary qualifications in your state, you should definitely look into that.

Environmental arrangement—one method of facilitating conversation using spatial manipulation. The goal is to pique people's curiosity about the setting and provide a natural opening for conversation. By using techniques such as making interesting materials visible but out of reach, sabotaging the situation by missing elements or providing inadequate portions, and setting up decision-making, unexpected, or silly situations, the SLP can capitalise on the individuals' desire to request and comment on aspects of the environment.

Functional communication training (FCT)—a behavioural intervention plan that uses ABA techniques to teach appropriate replacement behaviours after first assessing the social significance of problematic ones. Extinction can be used to get rid of problematic behaviours and replace them with more suitable ways of expressing needs and wants. FCT can be utilised with people of varying ages, cognitive abilities, and expressive language skills (E. G. Carr & Durand, 1985).

Incidental teaching—a method of instruction that makes use of behavioural techniques to instruct complex linguistics; learning opportunities arise organically and are tailored to each student. As individuals are followed, attempts at communication that are closer to the ideal communication behaviour are reinforced (McGee, Morrier, & Daly, 1999). The learner must take the first step in the incidental learning process in order for it to begin. If the other person doesn't start talking right away, an expectant glance and a little bit of time could be all it takes to get them to open up. The doctor may ask, "What do you want?" to serve as a prompt or may demonstrate how to make a request (e.g., Say: I need paint.).

Milieu therapy—integration of a variety of techniques, such as incidental education, time delay, and mand-model procedures, into a child's everyday life. Not limited to the confines of a therapy session, this form of training takes place in real-world settings and naturally occurs throughout daily activities. The goal of Milieu Language Teaching and similar procedures is to provide children with a systematic way to encourage them to employ a wider variety of communication functions and higher-order linguistic abilities (Kaiser, Yoder, & Keetz, 1992; Kasari et al., 2014).

Time delay—a pedagogical approach that gradually eliminates the need for teachers to rely on prompts as they instruct. For instance, when the learner improves, the time lapse between the initial lesson and subsequent reminders or instructions is lengthened. No matter a person's intelligence or capacity for verbal expression, time delay can be useful (e.g., Liber, Frea, & Symon, 2008).

Peer-mediated/implemented treatment— methods use peers as communication partners for kids with disabilities to help them overcome social isolation, serve as positive examples, and improve their communication skills. Interventions are often carried out in inclusive environments where play with typically developing peers occurs organically, and typically developing peers are given methods to facilitate play and social interactions (e.g., preschool setting). Children with ID may utilise the following illustrations according to their specific language requirements.

Learning Experiences and Alternative Program (LEAP)— a comprehensive intervention for parents of preschoolers with autism spectrum disorder (Hoyson, Jamieson, & Strain, 1984; Strain & Hoyson, 2000). Applied Behavior Analysis (ABA), peer-mediated instruction, self-management instruction, prompting, and parent training are only some of the approaches and practises used in LEAP. In order to encourage children with ASD to engage in child-initiated play, LEAP is used in classrooms with both children with and without the disorder.

Circle of Friends—a method of treatment that forms a friendship circle among a student's peers in an effort to increase that student's social acceptance in the classroom. Developing habits that are appreciated in natural contexts is emphasised. As often as feasible, circumstances that call for the application of acquired skills are woven into the fabric of the learning process, allowing for the most organic reinforcement possible (Whitaker, Barratt, Joy, Potter, & Thomas, 1998).

Integrated play groups—a therapeutic approach that helps kids of all ages and skill levels who have autism spectrum disorder engage in play with typically developing kids. The children are split up into smaller groups and are supervised by an adult while they play. It's all about encouraging the kid's natural curiosity and enthusiasm for making friends (Wolfberg & Schuler, 1993).

Treatment Considerations

Target Behaviors for Specific Populations

Increased understanding of the specific communication difficulties associated with various diagnoses has aided the selection of target behaviours for individuals with ID, particularly the most researched populations, those with Down syndrome and autism spectrum disorder. Many options exist, and choosing one depends on the person and their specific circumstances.

Distinguishing between intellectual disability and another label, "global developmental delay," is crucial. Mental abilities and adaptive functioning life skills must be significantly below average before an intellectual impairment diagnosis is made. A kid is said to have a "developmental delay" if they are behind schedule in reaching certain developmental milestones. Delays in these areas can affect a person's ability to communicate verbally, socially, physically, or cognitively. The full requirements for intellectual disability go beyond mild developmental delays. A child may be too young for a thorough evaluation in some cases. On other occasions, the kid might just not have what it takes to finish such tests. This can be the case because of testing constraints. As an example, a child who has trouble communicating may not be able to answer interview questions. Although developmental delays are common among children with intellectual disabilities, this does not mean that all people with such delays have such a disability.