THE FACTS ABOUT INTELLECTUAL DISABILITY

What is cognitive impairment?

Cognitive impairment, also referred to as intellectual disability, describes the condition

of a child whose intellectual functioning level and adaptive skills are significantly below
the average for a child of his chronological age. It is the most common developmental
disorder, occurring in approximately 12 of every 1000 children. Varying levels of
developmental delays may be identified in a child’s social skills, emotional development,
communication capabilities, physical function, and academic skill sets.

The Center for Disease Control defines cognitive impairment among 8-year-old children
by a score of 70 or below on an test of intellectual capability, more commonly known as
an IQ test. Levels of cognitive impairment severity are defined by specific IQ ranges:

• Mild Cognitive Impairment – IQ of 50 to 70

• Moderate Cognitive Impairment – IQ of 35 to 55

• Severe Cognitive Impairment – IQ 20 to 40

• Profound Cognitive Impairment – Below 20

Cognitive impairment can be caused by a number of factors. Many instances of

cognitive impairment are the result of genetic or chromosomal disorders. Cognitive
impairment can also be attributed to injuries or illnesses that occur during pregnancy or
early infancy. Extreme malnutrition, inadequate medical care, and exposure to
environmental toxins can lead to cognitive impairments as well. With many possible
causes, it is often difficult to cite a specific single cause of a cognitive impairment in a
child.

Symptoms

Signs of cognitive impairment can be recognized as early as 2 years of age. These

symptoms will occur at varying levels depending on the severity of the disorder.

• Delays in reaching early childhood developmental milestones

• Difficulty retaining information and learning simple routines

• Confusion and behavior problems in new situations or places

• Short attention span

 • Lack of curiosity

• Difficulty understanding social rules

• Sustained infantile behavior into toddlerhood or preschool years

• Difficulty understanding consequences of actions

• Limited and/or inconsistent communication skills

• Lack of age-appropriate self-help and self-care skills

Supporting the Child’s Success

Children with a cognitive impairment can be successful in school and lead fulfilling lives.
They may just need individualized help in learning new skills. Extra time, repeated
instruction, and appropriate modeling will help them as they master important life skills,
such as appropriate hygiene, personal safety, and social manners. In order to promote
independence and developmental progress, parents and educators should be patient
and give children the time they need to learn new skills.

Breaking down tasks into smaller steps can be a helpful learning tool for children with
cognitive impairments. For instance, getting dressed can be broken down for the child
into very small simple steps: Shirt on, buttons, pants on, zipper, button, tuck in shirt,
belt, socks, etc. Walk the child through each part of the task, encouraging him to do it
independently and praising at success each step. This process, referred to as task
analysis, can be used to teach proper hygiene techniques, household chores, or any
other skills.

Parents can also support success by staying involved in their child’s academic learning.
Know the topics being taught in the classroom and find ways to integrate learning at
home. For instance, when the child is learning to tell time, periodically ask them for the
time. When he is learning about money, take him to grocery. Point out prices and let
him help with the checkout process. Social activities in the community can serve as a
valuable learning tool as well. Children with cognitive impairment can model the
behavior of their peers, improve social skills, experience new and different settings and
most importantly, have fun. To support the child’s success, family members and the
professionals providing services to the child should work together to understand his
strengths, weaknesses, and interests.

Next Steps

Finding out that a child has a cognitive impairment can be an emotional adjustment.
Parents may need time to work through feelings of grief, disappointment or anxiety.
Once they have had time to adjust, parents can reach out to connect with other families
of children with a cognitive impairment. They should talk to their own families and
friends to explain the child’s need and gain their support. They can also begin to gather
the information they will need to raise their child. Resources on specific topics such as
language development, positive behavior management, early intervention and family
dynamics may be especially useful. Quality educational programs, a stimulating home
environment, good health care, and positive support from family, friends and the
community enable people with a cognitive impairment to lead happy and fulfilling lives.
Cognitive impairment is one of the qualifying disabilities for special education and
related services under the Individuals with Disabilities Act (IDEA). For children three
years and older, the local educational system should be contacted for more information
on eligibility and special services.

Source: Siskin.org

Parents Guide to Developmental Milestones

Milestones at 1 Month

Movement Milestones

 Makes jerky, quivering arm thrusts

 Brings hands within range of eyes and mouth
 Moves head from side to side while lying on stomach
 Head flops backward if unsupported
 Keeps hands in tight fists
 Strong reflex movements

Visual and Hearing Milestones

 Focuses 8 to 12 inches (20.3 to 30.4 cm) away

 Eyes wander and occasionally cross
 Prefers black-and-white or high-contrast patterns
 Prefers the human face to all other patterns
 Hearing is fully mature
 Recognizes some sounds
 May turn toward familiar sounds and voices

Smell and Touch Milestones

 Prefers sweet smells

 Avoids bitter or acidic smells
  Recognizes the scent of his own mother’s breastmilk
 Prefers soft to coarse sensations
 Dislikes rough or abrupt handling

Developmental Health Watch

If, during the second, third, or fourth weeks of your baby’s life, she shows any of the
following signs of developmental delay, notify your pediatrician.

 Sucks poorly and feeds slowly

 Doesn’t blink when shown a bright light
 Doesn’t focus and follow a nearby object moving side to side
 Rarely moves arms and legs; seems stiff
 Seems excessively loose in the limbs, or floppy
 Lower jaw trembles constantly, even when not crying or excited
 Doesn’t respond to loud sounds

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Milestones at 3 Months

Movement Milestones

 Raises head and chest when lying on stomach

 Supports upper body with arms when lying on stomach
 Stretches legs out and kicks when lying on stomach or back
 Opens and shuts hands
 Pushes down on legs when feet are placed on a firm surface
 Brings hand to mouth
 Takes swipes at dangling objects with hands
 Grasps and shakes hand toys

Visual and Hearing Milestones

 Watches faces intently

 Follows moving objects
 Recognizes familiar objects and people at a distance
 Starts using hands and eyes in coordination
 Smiles at the sound of your voice
 Begins to babble
 Begins to imitate some sounds
 Turns head toward direction of sound
Social and Emotional Milestones

 Begins to develop a social smile

 Enjoys playing with other people and may cry when playing stops
 Becomes more communicative and expressive with face and body
 Imitates some movements and facial expressions

Developmental Health Watch

Although each baby develops in her own individual way and at her own rate, failure to
reach certain milestones may signal medical or developmental problems requiring
special attention. If you notice any of the following warning signs in your infant at this
age, discuss them with your pediatrician.

 Doesn’t seem to respond to loud sounds

 Doesn’t notice her hands by two months
 Doesn’t smile at the sound of your voice by two months
 Doesn’t follow moving objects with her eyes by two to three months
 Doesn’t grasp and hold objects by three months
 Doesn’t smile at people by three months
 Cannot support her head well at three months
 Doesn’t reach for and grasp toys by three to four months
 Doesn’t babble by three to four months
 Doesn’t bring objects to her mouth by four months
 Begins babbling, but doesn’t try to imitate any of your sounds by four months
 Doesn’t push down with her legs when her feet are placed on a firm surface by
four months
 Has trouble moving one or both eyes in all directions
 Crosses her eyes most of the time (Occasional crossing of the eyes is normal in
these first months.)
 Doesn’t pay attention to new faces, or seems very frightened by new faces or
surroundings
 Still has the tonic neck reflex at four to five months

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Milestones at 7 Months

Movement Milestones

 Rolls both ways (front to back, back to front)

 Sits with, and then without, support of her hands
 Supports her whole weight on her legs
 Reaches with one hand
 Transfers object from hand to hand
  Uses raking grasp (not pincer)

Visual Milestones

 Develops full color vision

 Distance vision matures
 Ability to track moving objects improves

Language Milestones

 Responds to own name

 Begins to respond to “no”
 Distinguishes emotions by tone of voice
 Responds to sound by making sounds
 Uses voice to express joy and displeasure
 Babbles chains of consonants

Cognitive Milestones

 Finds partially hidden object

 Explores with hands and mouth
 Struggles to get objects that are out of reach

Social and Emotional Milestones

 Enjoys social play

 Interested in mirror images
 Responds to other people’s expressions of emotion and appears joyful often

Developmental Health Watch

Because each baby develops in his own particular manner, it’s impossible to tell exactly
when or how your child will perfect a given skill. The developmental milestones listed in
this book will give you a general idea of the changes you can expect, but don’t be
alarmed if your own baby’s development takes a slightly different course. Alert your
pediatrician, however, if your baby displays any of the following signs of possible
developmental delay for this age range.

 Seems very stiff, with tight muscles

 Seems very floppy, like a rag doll
 Head still flops back when body is pulled up to a sitting position
 Reaches with one hand only
 Refuses to cuddle
 Shows no affection for the person who cares for him
  Doesn’t seem to enjoy being around people
 One or both eyes consistently turn in or out
 Persistent tearing, eye drainage, or sensitivity to light
 Does not respond to sounds around him
 Has difficulty getting objects to his mouth
 Does not turn his head to locate sounds by four months
 Doesn’t roll over in either direction (front to back or back to front) by five months
 Seems inconsolable at night after five months
 Doesn’t smile spontaneously by five months
 Cannot sit with help by six months
 Does not laugh or make squealing sounds by six months
 Does not actively reach for objects by six to seven months
 Doesn’t follow objects with both eyes at near (1 foot) [30 cm] and far (6 feet) [180
cm] ranges by seven months
 Does not bear some weight on legs by seven months
 Does not try to attract attention through actions by seven months
 Does not babble by eight months

 Shows no interest in games of peekaboo by eight months

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Milestones at 1 Year

Movement Milestones

 Gets to sitting position without assistance

 Crawls forward on belly by pulling with arms and pushing with legs
 Assumes hands-and-knees position
 Creeps on hands and knees supporting trunk on hands and knees
 Gets from sitting to crawling or prone (lying on stomach) position
 Pulls self up to stand
 Walks holding on to furniture
 Stands momentarily without support
 May walk two or three steps without support

Milestones In Hand and Finger Skills

 Uses pincer grasp

 Bangs two cubes together
 Puts objects into container
 Takes objects out of container
 Lets objects go voluntarily
 Pokes with index finger
  Tries to imitate scribbling

Language Milestones

 Pays increasing attention to speech

 Responds to simple verbal requests
 Responds to “no”
 Uses simple gestures, such as shaking head for “no”
 Babbles with inflection
 Says “dada” and “mama”
 Uses exclamations, such as “oh-oh!”
 Tries to imitate words

Cognitive Milestones

 Explores objects in many different ways (shaking, banging, throwing, dropping)

 Finds hidden objects easily
 Looks at correct picture when the image is named
 Imitates gestures
 Begins to use objects correctly (drinking from cup, brushing hair, dialing phone,
listening to receiver)

Social and Emotional Milestones

 Shy or anxious with strangers

 Cries when mother or father leaves
 Enjoys imitating people in play
 Shows specific preferences for certain people and toys
 Tests parental responses to his actions during feedings (What do you do when
he refuses a food?)
 Tests parental responses to his behavior (What do you do if he cries after you
leave the room?)
 May be fearful in some situations
 Prefers mother and/or regular caregiver over all others
 Repeats sounds or gestures for attention
 Finger-feeds himself
 Extends arm or leg to help when being dressed

Developmental Health Watch

Each baby develops in his own manner, so it’s impossible to tell exactly when your child
will perfect a given skill. Although the developmental milestones listed in this book will
give you a general idea of the changes you can expect as your child gets older, don’t be
alarmed if his development takes a slightly different course. Alert your pediatrician if
your baby displays any of the following signs of possible developmental delay in the
eight-to twelve-month age range.

 Does not crawl

 Drags one side of body while crawling (for over one month)
 Cannot stand when supported
 Does not search for objects that are hidden while he watches
 Says no single words (“mama” or “dada”)
 Does not learn to use gestures, such as waving or shaking head
 Does not point to objects or pictures

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Milestones at 2 Years

Movement milestones

 Walks alone
 Pulls toys behind her while walking
 Carries large toy or several toys while walking
 Begins to run
 Stands on tiptoe
 Kicks a ball
 Climbs onto and down from furniture unassisted
 Walks up and down stairs holding on to support
 Milestones in hand and finger skills
 Scribbles spontaneously
 Turns over container to pour out contents
 Builds tower of four blocks or more
 Might use one hand more frequently than the other

Language milestones

 Points to object or picture when it’s named for him

 Recognizes names of familiar people, objects, and body parts
 Says several single words (by fifteen to eighteen months)
 Uses simple phrases (by eighteen to twenty-four months)
 Uses two- to four-word sentences
 Follows simple instructions
 Repeats words overheard in conversation

Cognitive milestones

 Finds objects even when hidden under two or three covers

  Begins to sort by shapes and colors
 Begins make-believe play

Social and emotional milestones

 Imitates behavior of others, especially adults and older children

 Increasingly aware of herself as separate from others
 Increasingly enthusiastic about company of other children
 Demonstrates increasing independence
 Begins to show defiant behavior
 Increasing episodes of separation anxiety toward midyear, then they fade

Developmental health watch

Because each child develops at his own particular pace, it’s impossible to tell exactly
when yours will perfect a given skill. The developmental milestones will give you a
general idea of the changes you can expect as your child gets older, but don’t be
alarmed if he takes a slightly different course. Alert your pediatrician, however, if he
displays any of the following signs of possible developmental delay for this age range.

 Cannot walk by eighteen months

 Fails to develop a mature heel-toe walking pattern after several months of
walking, or walks exclusively on his toes
 Does not speak at least fifteen words by eighteen months
 Does not use two-word sentences by age two
 Does not seem to know the function of common household objects (brush,
telephone, bell, fork, spoon) by fifteen months
 Does not imitate actions or words by the end of this period
 Does not follow simple instructions by age two
 Cannot push a wheeled toy by age two

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Milestones at 4 Years

Movement milestones

 Hops and stands on one foot up to five seconds

 Goes upstairs and downstairs without support
 Kicks ball forward
 Throws ball overhand
 Catches bounced ball most of the time
 Moves forward and backward with agility
Milestones in hand and finger skills

 Copies square shapes

 Draws a person with two to four body parts
 Uses scissors
 Draws circles and squares
 Begins to copy some capital letters

Language milestones

 Understands the concepts of “same” and “different”

 Has mastered some basic rules of grammar
 Speaks in sentences of five to six words
 Speaks clearly enough for strangers to understand
 Tells stories

Cognitive milestones

 Correctly names some colors

 Understands the concept of counting and may know a few numbers
 Approaches problems from a single point of view
 Begins to have a clearer sense of time
 Follows three-part commands
 Recalls parts of a story
 Understands the concept of same/different
 Engages in fantasy play

Social and emotional milestones

 Interested in new experiences

 Cooperates with other children
 Plays “Mom” or “Dad”
 Increasingly inventive in fantasy play
 Dresses and undresses
 Negotiates solutions to conflicts
 More independent
 Imagines that many unfamiliar images may be “monsters”
 Views self as a whole person involving body, mind, and feelings
 Often cannot distinguish between fantasy and reality

Developmental health watch

Because each child develops in his own particular manner, it’s impossible to tell exactly
when or how he’ll perfect a given skill. The developmental milestones listed here will
give you a general idea of the changes you can expect as your child gets older, but
don’t be alarmed if his development takes a slightly different course. Alert your
pediatrician, however, if your child displays any of the following signs of possible
developmental delay for this age range.

 Cannot throw a ball overhand

 Cannot jump in place
 Cannot ride a tricycle
 Cannot grasp a crayon between thumb and fingers
 Has difficulty scribbling
 Cannot stack four blocks
 Still clings or cries whenever his parents leave him
 Shows no interest in interactive games
 Ignores other children
 Doesn’t respond to people outside the family
 Doesn’t engage in fantasy play
 Resists dressing, sleeping, using the toilet
 Lashes out without any self-control when angry or upset
 Cannot copy a circle
 Doesn’t use sentences of more than three words
 Doesn’t use “me” and “you” appropriately

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Milestones at 5 Years

Movement milestones

 Stands on one foot for ten seconds or longer

 Hops, somersaults
 Swings, climbs
 May be able to skip

Milestones in hand and finger skills

 Copies triangle and other geometric patterns

 Draws person with body
 Prints some letters
 Dresses and undresses without assistance
 Uses fork, spoon, and (sometimes) a table knife
 Usually cares for own toilet needs
Language milestones

 Recalls part of a story

 Speaks sentences of more than five words
 Uses future tense
 Tells longer stories
 Says name and address

Cognitive milestones

 Can count ten or more objects

 Correctly names at least four colors
 Better understands the concept of time
 Knows about things used every day in the home (money, food, appliances)

Social and emotional milestones

 Wants to please friends

 Wants to be like her friends
 More likely to agree to rules
 Likes to sing, dance, and act
 Shows more independence and may even visit a next-door neighbor by herself
 Aware of sexuality
 Able to distinguish fantasy from reality
 Sometimes demanding, sometimes eagerly cooperative

Developmental health watch

Because each child develops in her own particular manner, it’s impossible to predict
exactly when or how your own preschooler will perfect a given skill. The developmental
milestones listed here will give you a general idea of the changes you can expect as
your child gets older, but don’t be alarmed if her development takes a slightly different
course. Alert your pediatrician, however, if your child displays any of the following signs
of possible developmental delay for this age range.

 Exhibits extremely fearful or timid behavior

 Exhibits extremely aggressive behavior
 Is unable to separate from parents without major protest
 Is easily distracted and unable to concentrate on any single activity for more than
five minutes
 Shows little interest in playing with other children
 Refuses to respond to people in general, or responds only superficially
 Rarely uses fantasy or imitation in play
 Seems unhappy or sad much of the time
  Doesn’t engage in a variety of activities
 Avoids or seems aloof with other children and adults
 Doesn’t express a wide range of emotions
 Has trouble eating, sleeping, or using the toilet
 Can’t differentiate between fantasy and reality
 Seems unusually passive
 Cannot understand two-part commands using prepositions (“Put the cup on the
table”; “Get the ball under the couch.”)
 Can’t correctly give her first and last name
 Doesn’t use plurals or past tense properly when speaking
 Doesn’t talk about her daily activities and experiences
 Cannot build a tower of six to eight blocks
 Seems uncomfortable holding a crayon
 Has trouble taking off her clothing
 Cannot brush her teeth efficiently
 Cannot wash and dry her hands

Source: childmind . org

What is Autism Spectrum Disorder?

Autism spectrum disorder (ASD) is a developmental disability  that can cause significant
social, communication and behavioral challenges. There is often nothing about how
people with ASD look that sets them apart from other people, but people with ASD may
communicate, interact, behave, and learn in ways that are different from most other
people. The learning, thinking, and problem-solving abilities of people with ASD can
range from gifted to severely challenged. Some people with ASD need a lot of help in
their daily lives; others need less.

A diagnosis of ASD now includes several conditions that used to be diagnosed

separately: autistic disorder, pervasive developmental disorder not otherwise specified
(PDD-NOS), and Asperger syndrome. These conditions are now all called autism
spectrum disorder.

Signs and Symptoms

People with ASD often have problems with social, emotional, and communication skills.
They might repeat certain behaviors and might not want change in their daily activities.
Many people with ASD also have different ways of learning, paying attention, or reacting
to things. Signs of ASD begin during early childhood and typically last throughout a
person’s life.

Children or adults with ASD might:

 not point at objects to show interest (for example, not point at an airplane flying
over)
 not look at objects when another person points at them
 have trouble relating to others or not have an interest in other people at all
 avoid eye contact and want to be alone
  have trouble understanding other people’s feelings or talking about their own
feelings
 prefer not to be held or cuddled, or might cuddle only when they want to
 appear to be unaware when people talk to them, but respond to other sounds
 be very interested in people, but not know how to talk, play, or relate to them
 repeat or echo words or phrases said to them, or repeat words or phrases in
place of normal language
 have trouble expressing their needs using typical words or motions
 not play “pretend” games (for example, not pretend to “feed” a doll)
 repeat actions over and over again
 have trouble adapting when a routine changes
 have unusual reactions to the way things smell, taste, look, feel, or sound
 lose skills they once had (for example, stop saying words they were using)

Diagnosis
Diagnosing ASD can be difficult since there is no medical test, like a blood test, to
diagnose the disorders. Doctors look at the child’s behavior and development to make a
diagnosis.

ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an

experienced professional can be considered very reliable. 1 However, many children do
not receive a final diagnosis until much older. This delay means that children with ASD
might not get the early help they need.

Treatment
There is currently no cure for ASD. However, research shows that early intervention
treatment services can improve a child’s development. 2, 3 Early intervention services
help children from birth to 3 years old (36 months) learn important skills. Services can
include therapy to help the child talk, walk, and interact with others. Therefore, it is
important to talk to your child’s doctor as soon as possible if you think your child has
ASD or other developmental problem.

Even if your child has not been diagnosed with an ASD, he or she may be eligible for
early intervention treatment services. The Individuals with Disabilities Education Act
(IDEA)external icon says that children under the age of 3 years (36 months) who are at
risk of having developmental delays may be eligible for services. These services are
provided through an early intervention system in your state. Through this system, you
can ask for an evaluation.
In addition, treatment for particular symptoms, such as speech therapy for language
delays, often does not need to wait for a formal ASD diagnosis.
Causes and Risk Factors
We do not know all of the causes of ASD. However, we have learned that there are
likely many causes for multiple types of ASD. There may be many different factors that
make a child more likely to have an ASD, including environmental, biologic and genetic
factors.

 Most scientists agree that genes are one of the risk factors that can make a
person more likely to develop ASD.
 Children who have a sibling with ASD are at a higher risk of also having ASD. 
 Individuals with certain genetic or chromosomal conditions, such as fragile X
syndrome or tuberous sclerosis, can have a greater chance of having ASD. 
 When taken during pregnancy, the prescription drugs valproic acid and
thalidomide have been linked with a higher risk of ASD.
 There is some evidence that the critical period for developing ASD occurs before,
during, and immediately after birth. 17
 Children born to older parents are at greater risk for having ASD. 

ASD continues to be an important public health concern. Like the many families living
with ASD, CDC wants to find out what causes the disorder. Understanding the factors
that make a person more likely to develop ASD will help us learn more about the
causes. We are currently working on one of the largest U.S. studies to date,
called Study to Explore Early Development (SEED). SEED is looking at many possible
risk factors for ASD, including genetic, environmental, pregnancy, and behavioral
factors.