CHAPTER 5: INTELLECTUAL DISABILITY (INTELLECTUAL

DEVELOPMENTAL DISORDER)
1) INTRODUCTION:
Intellectual Disability: characterized by significant limitations in mental
abilities (reasoning, planning and judgement) resulting in impairments in
adaptive functioning (conceptual, social and practical skills) needed to fulfil
everyday life aspects.
- we must take into account intellectual functioning within the context of what
is typical in their peers and culture, as well as communication, and
sensory/motor and behavioural factors when determining a deficit/disability).

2) INTELLIGENCE AND INTELLECTUAL DISABILITY:

3 categories of adaptive behaviour:

Adaptive skills are assessed through the Adaptive Behaviour Assessment

System or the Vineland Adaptive Behaviour Scale (both 3rd edition).

1.1) CLINICAL DESCRIPTION:

the DSM-5 summarizes diagnostic criteria for Intellectual Disability
DIAGNOSTIC CRITERIA FOR INTELLECTUAL DISABILITY:
1. 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).
 2. Deficits in adaptive functioning
- 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 (communication, social participation, and
independent living) across multiple environments (home, school, work, and
community).

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

Specify level of severity: mild, moderate, severe, profound.
1.2) SPECIFIERS (SEVERITY LEVELS):
The 4 levels of severity are defined on the basis of adaptive functioning in 3
primary domains:
- conceptual
- social
- practical

The DSM-5 has continued the tradition by specifying disability as:

- mild
- moderate
- severe
- profound

1. Children with mild intellectual disability:

- often show small delays in development during the preschool years but
typically are not identified until academic or behavior problems emerge
during the early elementary years.
- they typically develop social and communication skills during the preschool
years (ages 0–5 years) perhaps with modest delays in expressive language.
- They usually have minimal or no sensorimotor impairment and engage with
peers readily.

2. Persons with moderate intellectual disability:

- Are more intellectually and adaptively impaired than someone with mild
intellectual disability.
- They usually are identified during the preschool years; by the time they enter
school, these children may communicate through a combination of single
words and gestures, show self-care and motor skills like an average 2- to 3-
year-old.
- Most individuals with this level of intellectual disability acquire limited
communication skills during their early years, by age 12 they may be using
practical communication skills.
- They benefit from vocational training with moderate supervision, can attend
to their personal care, have training in social and occupational skills but they
are unlikely to progress beyond the second-grade level in academic subjects.
- Adolescents with moderate intellectual disability often have difficulty
recognizing social conventions, (appropriate dress or humor) which interferes
with peer relationships.
- By adulthood, persons with moderate intellectual disability typically adapt
well to living in the community and can perform unskilled or semiskilled work
under supervision.

3. People with severe intellectual disability:

- suffer from one or more organic causes of impairment (genetic defects) and
are identified at a very young age because they have substantial delays in
development and visible physical features or anomalies.
- they have trouble with milestones (standing, walking, toilet training, basic
self-care skills are usually acquired by about age 9).
- They may have problems with physical mobility, and other health-related
problems (respiratory, heart or physical complications)
- During early childhood they acquire little or no communicative speech by age
12 they may use some two-to three-word phrases (between 13 and 15 years
of age, their academic and adaptive abilities are like those of an average 4- 6
years old).
- They are limited in actions such as familiarity with the alphabet and simple
counting
- They can master skills (sight reading survival words such as “hot,” “danger,”
and “stop.”)

4. Persons with profound intellectual disability

- typically are identified in infancy because of marked delays in development
and biological anomalies such as asymmetrical facial features.
- During early childhood they show considerable impairments in sensorimotor
functioning by the age of 4 years their responsiveness is similar to that of a
typical 1-year-old.
- They can learn only the rudiments of communication skills and they require
intensive training to learn basics (eating, grooming, toileting, and dressing
behaviors).
- Require lifelong care and assistance and many have severe co-occurring
medical conditions (congenital heart defect or epilepsy) that sometimes lead
to death during childhood or early adulthood.
- Most of these individuals live in supervised group homes or small, specialized
facilities. Motor development as well as self-care and communication skills
may improve if appropriate training is provided.

The DSM-5 criteria for ID focuses on needed supports, which reflects the
consensus that determining the level of functioning of an individual with