March 26, 2018
ARTICLE:

Intellectual Disability (Or Intellectual Impairment)

By Dr Megan Yap - Paediatrician

So having blogged for the last few weeks on creepy-crawly, icky, infectious things you can catch, today for a change I thought I’d do a developmental topic.

I see a LOT of children who experience difficulties with their learning in various aspects of their schooling.  These difficulties present in a wide variety of ways.  They can be limited to reading and literacy based subjects, they could be limited to performance-based activities (like oral presentations, examinations) or they could be broader and affect the child’s entire learning curriculum.

When these difficulties are widespread, we often notice that the child’s general functioning can also be affected.  This can include social relationships, ability to follow instructions, routines and activities of daily living.  These kind of difficulties can make us suspect intellectual disability.

 

So what is “Intellectual disability” or “Intellectual impairment?”

An intellectual impairment is when a person has a reduced ability to think, reason, remember things and problem solve.  Someone who has an intellectual disability, might take longer to work through tasks and activities and need support to learn.

The degree or severity of intellectual disability can vary a lot between individuals.

From the Australian Bureau of Statistics, about 1.8% of the total population have intellectual disability with severe or profound core activity limitation.  Speech difficulties were the most common problem reported by people with an intellectual disability in 2003 (24%).

 

Causes Of Intellectual impairment

For many children who have an intellectual disability, even after extensive investigation, no cause is ever found.  For other children, it can be something that happened before a child was born, or it might have been something that occurred early in that child’s life.

Intellectual impairment can be caused by

  • An abnormality in the child’s chromosomes. This could be from a spontaneous change in that child’s chromosomes, or a change that they inherited from a parent
  • Damage to the brain caused by being born prematurely, a brain injury (eg from a stroke, or an event that may have deprived the brain of oxygen)
  • Severe malnourishment
  • Certain types of infections in early childhood
  • Drug or alcohol abuse by the child’s mother during pregnancy
  • Lead poisoning

How is it diagnosed?

The diagnosis of intellectual impairment or disability is made following formal testing of reasoning and problem solving abilities with a standardised test.  This is usually performed by a child (educational) psychologist.  In younger children, a play based assessment is sometimes done by one or several allied health professionals to gauge cognitive ability (that is, the ability to think, reason and problem solve).

Once it is diagnosed, what do you do?

Children with intellectual impairment still feel happiness and hurt, just like typically developing children.  This means that they are vulnerable to poor self esteem and poor confidence, and derive a great amount of benefit from experiencing success and encouragement as they learn at their own pace.  It is really important that they are kept part of the community and supported to participate in activities that make them feel good about themselves (eg extracurricular activities like sports, scouts/guides, dancing, craft etc).

Encourage independence by helping your child to learn every day skills like dressing, feeding him/herself, bathing/toileting and grooming. Give your child chores and break jobs down into smaller steps. Give your child frequent feedback and lots of praise when they do well.

Any child (whether with usual learning needs or one who has special learning needs) will only reach their full potential if the right level of support is given to them to meet their needs.  The best thing to do is to understand what your child’s needs are, then work with the school to support those requirements. A formal diagnosis of an intellectual disability will enable the school to access government funding making it easier to support your child’s learning.  Meet with the school to organise and learn about an “Individualised Education Plan” (or IEP) to tailor your child’s education to their needs. Find out what your child is learning at school – then practice and build on these skills!

Some children with a cognitive impairment benefit from attending a Special Education School where they receive a higher level of support.  Others do well in mainstream schools with extra assistance.  It is a parent’s choice as to what best suits their child’s needs, and it can be discussed with your paediatrician and/or school staff.

Edited to add:  A mum of a patient of mine reminded me (with a lovely comment) to acknowledge that for many parents of children diagnosed with intellectual disability (as with any child found to have life long or serious conditions), there is a process of grieving that sometimes needs to be worked through.  This is really important and you need to allow yourself this time.  Every parent has expectations of who they hope their little one will become, what they dream they will achieve and what this means for their (the parent, the child and the family’s) life.  It can be devastating when the reality is different to what we were wanting.  

Once the process of grief is worked through however, and the fog lifts, you realise that they are the same little person you always had, and although strategies might have to be developed to overcome the challenges, underneath it all – nothing really has changed.    

Be patient and be hopeful – children with intellectual disabilities are beautiful little people who just learn at a different pace to other kids.  Many children with mild intellectual disabilities, go on to lead independent lives.

Talk to parents of other children with intellectual disabilities.  Talk to your paediatrician.  Your therapists.  Find your tribe. Support each other, learn, grow and love with your little awesome person.

 

xx Dr Megs

For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at https://www.kids-health.guru/

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