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An Overview

Intellectual Disability, previously called mental retardation, is characterized by below-average intelligence/mental ability and a lack of skills necessary for everyday living. Children with intellectual disabilities can and do learn new skills, but more slowly than others. There are varying degrees of intellectual disability, namely from mild to profound. The most easily identified ID is Down's Syndrome. Down syndrome is a condition in which a child has an extra chromosome. Chromosomes are small “packages” of genes in the body that determine how a baby’s body forms during pregnancy and how it functions as it grows in the womb and also after birth. A baby is born with 46 chromosomes normally. Those with Down syndrome have an extra copy of one of these chromosomes, namely chromosome 21. Medically, having an extra copy of a chromosome is called ‘trisomy.’ Down syndrome is also known as Trisomy 21. This extra copy of chromosome changes how the baby’s body and brain develop, which leads to both mental and physical issues for the baby. Even though children with Down syndrome may act and look similar, each one has different abilities. Children with Down syndrome may have an IQ (a measure of intelligence) in the mild-to-moderate low range and are generally slower to speak than other children.


Children with intellectual disability mainly have limitations in two areas. These are:

     Intellectual functioning (Also known as IQ) - It refers to a child’s ability to learn, reason, make decisions, solve problems etc.
     Adaptive behaviors - These are skills necessary for day-to-day life, such as communicating effectively, interacting with others, and taking care of oneself.

IQ (intelligence quotient) is measured by an IQ test. The average IQ of an individual is 100, with majority of people scoring between 85 and 115. A Child is considered intellectually disabled if he/she has an IQ less than 70 to 75.

To measure a child’s adaptive behaviors, a specialist will observe the child’s skills like feeding and dressing themselves, communicating with and understanding others and how the child interacts with family, friends, and other children of the same age. This is then compared with children of the same age.


Classification of intellectual disability -

ID is divided into four levels, based on your child’s IQ and degree of social adjustment.


Mild intellectual disability

Some of the symptoms include:

    having an IQ range of 50 to 69
    taking more time than other kids to learn to talk, but communicating well once they know how
    being fully independent in self-care as they get older
    having issues with reading and writing
    socially immature
    benefiting from specialized education plans


Moderate intellectual disability

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

    generally have an IQ range of 35 to 49
    are slow to understand and use language
    may have difficulties in communicating with others
    may learn basic reading, writing, and counting skills
    are generally dependent on others for life
    may manage on their own in familiar places
    may participate in various types of social activities


Severe intellectual disability

Symptoms of severe ID include:

    generally have an IQ in the range of 20 to 34
    more visible motor impairment
    damage to, or abnormal development of, the central nervous system


Profound intellectual disability

Symptoms of profound ID include:

    having an IQ of less than 20
    inability to understand or follow instructions
    possibly immobile
    urine/stool incontinence
    very basic nonverbal communication may be present
    inability to care for their own needs independently
    the need of regular help and supervision


Intellectual disability affects about 1% of the population. Of those affected, 85% have only mild issues. This means they are just a little slower than average to learn new skills. With the right support at the right time, most of them will be able to live independently as adults.

Anytime that interferes with normal brain development may cause intellectual disability. However, in only one-third of cases with intellectual disability a proper cause may be found.

The most common causes are:

  •  Genetic conditions - These include Down syndrome and fragile X syndrome.
  •  Problems during pregnancy - Things that can interfere with the child's brain development inside the womb include alcohol or drug use, malnutrition, certain infections, or preeclampsia (high BP).
  •  Problems during childbirth - if a baby is deprived of oxygen during birth or born extremely premature, it may lead to ID.
  •  Illness or injury - Infections like meningitis, whooping cough, or measles can lead to intellectual disability. Severe head injury, extreme malnutrition, exposure to toxic substances such as lead, and severe neglect or abuse can also cause it.
  •  None of the above - In two-thirds of all children who have intellectual disability, the cause may be unknown.

There are many different signs/symptoms of intellectual disability in children. Some signs may appear during infancy, or they may not be noticeable till the child attains school age. It often depends on the severity of the problem.

Some of the most common signs of intellectual disability are:

  • Delay in motor development - Rolling over, sitting up, crawling, or walking late
  • Delay in speech/language development - Talking late or having trouble with talking
  • Poor learning of ADLs (Activities of daily living) - Slow to master things like potty training, dressing, and feeding themselves
  • Poor memory/intellect - Difficulty remembering things
  • Poor cognitive skills - Inability to connect actions with consequences
  • Behavioural problems - such as explosive tantrums
  • Difficulty with problem-solving or logical thinking

In children with severe or profound intellectual disability, there may be other associated health problems as well.

These problems may include -

  •  Seizures (epilepsy)
  •  Mood disorders (anxiety)
  • Autism
  • Motor skills impairment
  • Vision problems
  • Hearing problems

Occupational therapists work with persons with ID/Down syndrome to help them master skills for independence through self-care like feeding and dressing, fine and gross motor skills, school performance, and play and leisure activities.
Occupational therapists guide individuals with ID/Down syndrome and their families to help them reach their potential throughout the life span. Occupational therapy intervention should begin as soon as a diagnosis is established.
During infancy
•    Occupational therapists can help children having feeding problems because of weak muscles in their cheeks, tongue, and lips.
During early childhood
•    Therapy can focus on developing motor skills for independence, focusing on low muscle tone, loose ligaments at the joints, and visual and auditory deficits.
•    Occupational therapists can suggest positioning or aids/adaptations that help the child become more independent.
School-aged children
•    Occupational therapists address self-care skills like zipping a jacket, and fine and gross motor skills like cutting with scissors or completing multistep classroom routines to improve participation in school activities.
•    Occupational therapists can also assist in the classroom by enhancing the child’s communication skills through printing, handwriting, and keyboarding.
•    Other issues addressed are adaptations to the classroom—such as the position of desks and chairs—for optimal performance, based on the child’s physical abilities.

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