More about intellectual disabilities

Information about Intellectual Disabilities

The following information has been provided with the help of Dr. Anna Eliatamby from The Disability Foundation in Colombo.

· Intellectual Disability

· Cerebral Palsy

· Down’s Syndrome

· Autism

· Attention Deficit Disorder and Attention Deficit Hyperactive Disorder

Intellectual Disability

What is Intellectual Disability (ID)?

Intellectual Disability refers to people who have difficulties understanding and learning new information and skills. A person with an ID has intelligence which, when assessed using standardised tools, is significantly below that of an average person of the same age. They will also have significant difficulties with day-to-day living, for example managing finances, communicating their needs, getting washed and dressed or using public transport independently. To be diagnosed with an ID these problems should be present before adulthood and have a lasting effect on development. The degree of ID ranges from mild to profound. People with mild ID often manage well and may be able to live independently with some extra support.  People with profound ID may need assistance with many aspects of daily living but with the correct assistance and support from society, they can live full lives.

What causes ID?

There are many reasons why a child might be born with an ID or acquire one before the age of 18 years. Occasionally, something can go wrong with the development of the baby before it is born or there can be a problem during birth which can result in ID. There are some syndromes associated with ID which result from genetic or chromosomal abnormalities. This means that there is something different about the make-up of the cells, which are the building blocks of the developing baby. Examples of such syndromes are Down syndrome, Fragile X syndrome, Angelman syndrome and Prader-Willi syndrome. In other cases a baby’s development can be affected by maternal illness. There are some illnesses which are particularly dangerous for pregnant women, namely rubella, hepatitis or HIV. Pregnant women should also not be exposed to environmental toxins such as lead or radiation for the same reasons.

Sometimes an otherwise healthy baby can be born and brought up in very difficult social circumstances, for example if the parents abuse drugs or alcohol, the family does not have enough to eat, or the baby is neglected or raised in an institution. These kinds of experiences early in life are also associated with ID.

Other issues associated with ID

Children with a general ID can also have other specific developmental issues, such as an autistic spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD). Epilepsy is also common

amongst people with ID, but can usually be controlled with appropriate medication. People with ID can also be more vulnerable to mental health problems, such as anxiety and depression.

What do children with ID and their families need?

A child with ID, like any child, needs to be loved, accepted and given a stimulating environment. Children with ID need their parents, family members and school teachers to understand their difficulties and appreciate their strengths. Given the right kind of support, a child with an ID can grow up to be a happy and fulfilled person. But raising and educating a child with ID will present additional challenges. Families and teachers may benefit from some extra support from professionals who have experience working with children with disabilities. It is important to get accurate information for your family about your child’s learning problems and also to get practical advice about the management of challenging behaviours and how to provide emotional support and counselling.


Cerebral Palsy


Cerebral palsy is a group of impairments caused by permanent damage to the brain during the following stages of a child’s development:


· Before birth - Damage may be caused due to abnormal development of the brain.  

· At birth - Damage may occur as a result of birth injuries, lack of oxygen, etc.

· During early infancy - Conditions of Meningitis, Encephalitis, Jaundice, head injuries, etc. can cause permanent damage to the brain.


Symptoms of a Child with Cerebral Palsy

- Delay in acquiring various physical skills such as rolling, crawling, sitting, standing, walking, etc.

- Tensed or floppy muscles and lack of postural control against gravity.

- Persistence of infantile behaviours.

- Presence of associated disabilities in addition to physical disabilities. (i.e. defects of vision and hearing, difficulties in communication, speech and language, defects in perception, mental subnormality, learning disorders, behavioural problems, epilepsy)



1. Objectives:

· To develop some form of locomotion.

· To develop some means of communication.

· To give the child independence.

2. Early intervention

Early treatment of Cerebral Palsy is very important as it minimizes secondary problems, such as abnormal postures, movements patterns and deformities. Therefore, as soon as a delay in achieving specific skills (delay in holding the head erect, sitting, walking etc.) is noticed, necessary advice should be sought from a professional regarding diagnosis, treatment and management.

Parents too play a vital role in the management of these children. The treatment of children with cerebral palsy is a continuous process to be carried out throughout the day. Hence, in addition to exercise sessions, correct methods of carrying, feeding, etc. by parents play a vital role in the child’s progress. Acceptance of the cerebral palsied child within the family, regular visit to the treatment centers accompanied by both parents, carrying out home management programmes given by the professional in a continuous and consistent manner, are also some ways in which parents can help these children to overcome their difficulties.


Down’s Syndrome

What is Down syndrome?

Down syndrome (DS) is the most common cause of ID, accounting for approximately 15-2O% of the intellectually disabled population. DS occurs when there is an extra chromosome in the cells of the body.  Instead of the usual 46, there is 47. It is not known why this occurs in some babies, although there is an association with older mothers. There is nothing that can be done in pregnancy to prevent DS. DS can affect any family, irrespective of race, religion, social class or culture.

How is it diagnosed?

DS is usually diagnosed shortly after birth, indicated by the distinctive physical characteristics of babies born with this condition, e.g. a short stature, a ‘flat’ face with folds at the inner corners of the eyes, one crease across the palm (single palmar crease). Prenatal testing for DS is available but there can be risks involved.

Cognitive and behavioural features

All people wit DS with have some degree of ID but there is great variability.  Children with DS are usually able to walk and acquire some language but they will usually reach these milestones later than children without DS.


Medical issues

There is a higher rate of some medical conditions amongst people with DS; namely heart problems, hearing and sight difficulties, thyroid disorder, respiratory difficulties and problems with the gastrointestinal tract. Over the age of 40 years, people with DS have a higher risk of developing dementia. However, some people with DS never experience any of these health problems which also occur in the general population.



What is autism?

Autism is a lifelong developmental disorder. The term Autistic Spectrum Disorder (ASD) is often used to convey the huge variability in the way in which and the degree to which the condition affects the everyday life of people with autism. Some people are able to live independently and have a job; others need full-time support with the most basic aspects of daily living. However, to be diagnosed with an ASD, a person needs to show difficulties in 3 main areas:


1. Social and emotional understanding

People with ASD find it very difficult to understand other peoples’ feelings and to express their own, making social situations hard for them; for example, they may talk about inappropriate topics, or laugh when someone is telling them about a problem or some bad news.

2. Communication

People with ASD have difficulties with many aspects of communication. Children with ASD are often delayed acquiring language, and those who are more seriously affected will never use spoken language or just use a few single words.  Those with good language skills can find it difficult to use language in the same way as people without an ASD. Many have an over literal understanding, meaning they always think that people mean exactly what they say. People with ASD also find it difficult to ‘read’ non-verbal communication, such as facial expressions, gestures or intonation and struggle to judge the timing and give-and-take of social conversation.

3. Flexibi1iy in thinking and behaviour

People with ASD have difficulties thinking and behaving in a flexible way. This means that they often become reliant on fixed routines and can become anxious and confused when these routines are disrupted and they are forced to respond to an unfamiliar situation.

How is autism diagnosed?

There is no medical test for ASD. The diagnosis is made by skilled clinicians through careful observation of the child’s behaviour and interviews with parents and teachers. A diagnosis of autism is not made before 3 years of age.

What causes autism?

There has been a lot of research, but no simple answer. Autism is probably the result of a complex interaction between a range of genetic and environmental factors. A minority of cases can be attributed to various identifiable genetic mutations. Autism is NOT a punishment from god and there is nothing that anyone can do to prevent their child being born with autism. Autism can happen in family, irrespective of race, social. class or religion.

Attention Deficit Disorder and Attention Deficit Hyperactive Disorder

What is ADHD & ADD?

These are terms used to describe a syndrome characterised by persistent overactivity, impulsivity and difficulties sustaining attention. For the purposes of this brief description, we will limit ourselves to ADHD as this is the most widely used term. Children with ADHD often have some learning and attainment problems (see below). Children with ADHD have difficulties in five main areas, summarised below:

1. Thinking: e.g. short attention span, distractibility, poor planning, language delay, delayed internalization of speech.

2. Affect: e.g. poor self regulation, poor impulse control, excitability, low frustration tolerance, anger, low mood

3. Behaviour: e.g. high rate of activity, delay in motor development, risk taking, underdeveloped adaptive behavior

4. Physical Condition: e.g. Immature physical size and growth, allergies, increased respiratory infections and a high rate of injury

5. Interpersonal adjustment: e.g. problematic relationships with parents, teachers and peers.


What causes ADHD?

There is no straightforward answer to this question. Lots of different explanations have been proposed but none fully explain the occurrence of ADHD. Some people think that ADHD is inherited from parents, or is a result of structural problem in the brain or imbalance in brain chemicals. Other biological theories suggest that children with ADHD are less responsive to stimulation and therefore require a lot of stimulation to stay focused on one task for any length of time. Psychological theories propose that marital conflict, parental psychological and social problems contribute to the development of ADHD.

How is ADHD diagnosed?

ADHD is diagnosed through detailed observation of the child’s behaviour across different settings.  For example, in school and at home.

How is ADHD treated?

Some children respond well to medication. However, this should be monitored closely by a skilled practitioner and combined with family and school interventions.

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