INTELLECTUAL DISABILITY DISORDER

(IDD)
Summary of the case
The following case is of 10 years old girl who is the elder child of here family. She belongs to a middle
class family background. According to her mother she was the first child who got care, love and
pampered child. She was admitted in school in early childhood in Islamic University School with normal
children but she was week can’t give attention to academics and has no focus on things. She also had
speech issue as her speech was delayed and can’t express her feeling and thoughts through speech. She
has no attention span, focus, and learning. She has proper sitting and appearance was according to
school requirements.

Along with this she feel irritated in social gatherings and avoid them as she thinks cant adjust with
others as said by her mother or even when she goes with her family in gatherings, she try to come back
as early as possible. She has trouble in sleep sometimes but often has normal sleep. She has no
behavioral issues and has memory issues as she can’t memorize things and she feels trouble in learning,
problem solving. She can perform some task by her own like changing clothes, shoes, can eat
independently but has trouble in combing her hairs which her mother do. She is only comfortable with
her close family members and enjoy with them. She is closer to her mother and take care of her two
little sisters.

She learnt to talk later, trouble in speaking and explaining her thoughts and has no cognitive abilities,
perception. She has trouble in picking new things in her old school as her mother told that before
admitting her to Special Educational Academy, she faced a lot of trouble in old school as all students
there were normal and she was the one who can’t perform well in school. Later when she got to know
about her disability she admitted here in this school where she improved here speech. She follows
command and fulfills the task give to her

Furthermore, client was observed in different school sitting i.e. OT, music class, and sensory room. Her
behavior was observed in class room to see her attention, academic and interaction with other
children’s.

For assessment, client was assessed through formal and informal assessment. Formal assessment
includes CPM. Along with this informal assessment was down through Clinical Interview and MSE.
Identifying data
Name : AM

Age : 10

Birth order : 1st born

Siblings : 2 sisters

Socioeconomic status : Middle class

Gender : Female

Resident : Rawalpindi

Head of family : Father

Family structure : nuclear

Source and reason of referral

Client was referred by her class teacher and psychologist to do in-depth study on her. The reason to
referral was to get to know about her case to know about her symptoms observe her behavior in class
and therapy rooms to know about her how she perform on different places and does she has any grip on
things and has interest in any of them .To know the proper reasons of her disability due to which she
can’t focus on thing, give attention on academics and what are the difficulties she face in her daily life. In
short to focus on her and study her in-depth to get to know more about her and try to make her
independent in daily life activities.

Presenting complaints
Verbatim of client mother

She is a shy child and had problem in speech due to which she faces problem in communication. She
had delayed millstones. In early childhood is admitted to normal school were she faced trouble in
academic. Along with this she had faced difficulty interacting with peers as she had problem in speech
and was not able to speak like other children of her age fellow. She didn’t pay attention and can’t
 memorize things. Furthermore, client has problem in expressing her thoughts and feeling. Additionally
she avoids going in social gatherings.

History of present illness

The child is 10 years old. She belongs to middle class family system. She was born with
normal delivery. They were no complication in her mother’s delivery and at time of birth.
But she was unable to accomplish her developmental milestones as her all milestones were
delayed. She likes to be with her family and avoid social gathering as she get irritated and
hesitate in social gatherings.

Developmental Milestone

Developmental task Achieved age of milestones Age when achieve

First cry After After 2 minutes of

Neck birth 3 birth After 3 months
holding months 1 year
Sitting without support 8 After 2 years
months
Walking without support After 3 years
2 years
Monosyllables little After 5 years
1.5 years
speech Small/ full After 6 years
2.5 years
sentence Complete After 5
2.5
speech years Not
years
Bowl and bladder control yet
4
Taking bath without help
years
11
years
Personal History
Client is involved in different activities in school and home, As she told that she love to spend her time
with friend in school and in home she watches cartoon with her siblings and love to eat different thing
and her favorite is rice. She is comfortable with those who are close to her like family members,
teachers and her one friend in school. Client has issues in learning, speech as she can’t express her
feelings most of the time by words, she just smile while saying two to three word sentence.

Family history
Client belongs to a middle-class family background. She is the first born child and has two younger
sisters. She lives in nuclear family system of 6 family members. Client father is the only person who
works and is head of family .As she is the elder child she try to take care of her two younger sisters. She
has issues in family gatherings and she try to avoid them. She mentioned that she love her mother and is
attached to her and spend her most of time with her. She told that when she went to her aunty house
she enjoy a lot there as she is also one of favorite person of her. With whom she love to stay and in last
two sessions she always mentioned about her visit to Lahore where her aunt lives. Which shows that
client like to spend her time with her other family members too

Education history
Client has changed two schools as she was facing many problem like can’t concentrate, focus, pay
attention and also has trouble in learning and speech. Due to which teachers scold her and her
complains were coming as was not capable to perform good in academics. As in early childhood her
family admitted her in normal school (Islamic University, SLS). She told that her classmates were also not
nice as all of them make fun of mine which made me feel bad and uncomfortable and also all teachers
there scold me too. But in this school every one is nice and i have one friend here, my teachers are also
nice and i love to spend time here.

Medical history
She is not on any type of medication.

Social History
Since childhood client has problem in speech due to which she can’t express her feeling to others. Client
is comfortable with her family members and get irritable in social gathering. Furthermore client has no
friends as she says that everyone in her old school make funs of mine due to which she doesn’t like
friends. Adding to this she said my mother is my friend.

Behavioral Observation
The client was assessed through clinical interview. In start she was not comfortable but with time she
cooperated during interview as she answered all things except few.

Psychological assessment
In psychological assessment format and informal test were applied in client. Through initial observation
her behavior was observed and applied MSE and Clinical Interview and in formal did HFD and CPM.

I. Informal

MSE:
Psychological Assessment mental status examination MSE was used as a tool to describe appearance,
behavior, cognition, speech and mood of the client. It indicates client mental functioning and
orientation. It involves the following indicators.

1.Appearance
Client was 10 years old school going girl and looked according to her age. She has normal height which
children have at this age. The client was well dressed child according to school situation with suitable
weight according to her age. Overall her appearance was normal appropriate to weather and culture.
Her dress was neat and hairs were neatly tied.

2.Behavior
The client was not maintaining proper eye contact during sessions as she never answered with eye
contact. She doesn’t focus and pay attention to question asked in start but later she answered in few
words. She was constantly raping hairs on her hand.

3.Speech
Client has issue with speech as she can’t explain her feelings properly. Her speech was slow with low
volume. In start sessions faced difficulty while understanding her words and have distortion in speech.
4.Orientation
The client was not oriented as she did not responded accurately when about the person, season, date,
month, time and place.

5.Attention
The client had trouble in paying attention to questions in star but later she played attention and replied
honestly to all asked questions. But client faces trouble in maintaining eye contact and gaining attention
for longer period of time. Which show she face problem in attention.

6.Perception
No hallucination and delusions were found in the client.

7. Thought Content
Distorted thought content was observed through her speech. Her thought process was not logical and
relevant to the situation. As she associated her all things with one good or bad event happened in her
life.

8. Insight
She had no insight as she was not aware about her problem. She comes to sessions just because she can
have free time to play and enjoy with different games present in therapist room.

Clinical interview
The clinical interview was conducted with client to get detailed information about her
personal, family, educational, social history. The client seemed to be nervous before the
session and in star but after rappo building she was comfortable and answered all questions.
She doesn’t have insight of her problem and why she was coming for sessions. She faced
trouble while explaining her thoughts and she had speech issue. But she answered all
questions like she enjoy company of her family and like to watch cartoons and love to visit
her aunt which lives in Lahore. She was also told about her bad experience in her old
school were everyone makes fun of her and teachers scold due to which she doesn’t like
them but she was happy in her new school as teachers and students here are nice and
cooperative , help her in all things.
 I. Formal Assessment
 CPM

CPM (Colored progressive matrices)

CPM is a non-verbal test to measure abstract intelligence. For testing the client abstract
intelligence this test will be used.

Analysis
The client was of 10 years and her total score in CPM was 13 which fall in 5th percentile. The score of
client indicates intellectual detective and presence of intellectual disability.

Age Time Total score Discrepancy percentile

10 years 30 minutes 13 2 2 3 5

Tentative Diagnosis
Intellectual Development Disorder 318.0(F 71)

Intellectual Development Disorder 318.0(F 71)

The following criteria is fulfilled according to client’s symptoms from DSM-5

Diagnostic Criteria
Intellectual disability (intellectual developmental disorder) is a disorder with onset during the
developmental period that includes both intellectual and adaptive functioning deficits in conceptual,
social, and practical domains. The following three criteria must be met:

A. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract

Thinking, judgment, academic learning, and learning from experience, confirmed by both clinical
assessment and individualized, standardized intelligence testing.

B. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural.
Standards for personal independence and social responsibility. Without ongoing support, the adaptive
deficits limit functioning in one or more activities of daily life, Such as communication, social
participation, and independent living, across multiple environments, such as home, school, work, and
community.

C. Onset of intellectual and adaptive deficits during the developmental period.

Note: The client has mild level disability because she can perform her daily life task without any help but
has learning issues, speech problem, and trouble social interaction

Case formulation
Biological factor

This research was conducted by ( Noureen omar et al) in which it is stated that Mothers of most of the
cases and controls belonged to the 14-24 years age group at the time of marriage while one-fourth were
categorized within the range of 31-50 years at the time of birth of the participant. Concurrent with the
results of a study, mothers of more than half of the cases had the age above 30 years,22 thus leading to
the conclusion that although early marriage has no significant relationship, advanced maternal age can
be considered an influencing factor in the development of ID

Management Plan
Intervention plan for the child's behavioral and academic problems was based on:

I. Individualized Education Plan (IEP): Collaborate with educators to develop

an IEP that addresses the individual's specific learning needs and goals. This plan can include
accommodations, modifications, and specialized instruction to support their academic
progress

II. Behavioral Interventions: Implement behavior management strategies to address

challenging behaviors and promote positive behaviors. This may involve using positive
reinforcement, visual schedules, social stories, and structured routines to enhance
predictability and reduce anxiety.

III. Social Skills Training: Help individuals with IDD develop social skills by providing
opportunities for social interaction, teaching appropriate social behaviors, and promoting
empathy and understanding. Group therapy or social skills groups can be beneficial in this
regard.
IV. Cognitive-Behavioral Therapy (CBT): CBT can be effective in addressing
anxiety, depression, and other mental health concerns that may co-occur with IDD. It focuses
on identifying and challenging negative thoughts and developing healthier coping strategies.

V. Family Support and Education: Involve family members in the therapeutic

process by providing education, support, and guidance. This can help create a supportive
environment and enhance the individual's overall well-being.

VI. Occupational Therapy: Occupational therapists can assist individuals with IDD in
developing skills for daily living, such as self-care, fine motor skills, and sensory integration.
They can also help identify and address sensory sensitivities or challenges.

VII. Speech and Language Therapy: For individuals with communication

difficulties, speech and language therapy can be beneficial. This therapy focuses on
improving communication skills, including speech production, receptive and expressive
language, and social communication
REFERENCE
Omar, Naureen & Kokab, Farkhanda. (2019). Intellectual disability among special children and its
associated factors: A case control study, Lahore Pakistan. Journal of the Pakistan Medical Association.
69. 684-689.

Iqbal, Zafar & Bokhoven, Hans. (2014). Identifying Genes Responsible for Intellectual Disability in
Consanguineous Families. Human heredity. 77. 150-60. 10.1159/000360539.