Intellectual Disability And Association

Mental retardation (intellectual development issue) is now referred to as intellectual impairment. Individuals with intellectual disability are numerous. Intellectual disability is a multiphase condition. A family member may accompany the patient for a diagnosis in the early stages of development. Patients exhibit a range of comorbidities and aberrant behaviors in their second stage of life. Those who are in the later phases experience difficulty managing their everyday lives and themselves.

Intellectual Disability

Intellectual disability is defined by significant limitations on both intellectual functioning (reasoning, learning, and problem-solving) and adaptive behavior (conceptual and practical skills that emerge before the age of 18). Patients with intellectual disability have low intelligence combined with a deficit in adaptive functioning. The American Psychological Association adopted the definition from the American 

Association on Intellectual and Developmental Disability.

Intellectual ability

Low IQ refers to deficiencies in general mental abilities, which include reasoning, planning, problem-solving, abstract thought, judgment, learning from experience and instructions, and practical comprehension.
By watching the patients, it will be possible to associate any intellectual functioning problems with low IQs or decreased intelligence. Verbal comprehension is one of the key factors in intellectual disability.
Cognitive efficacy is low;  Perceptual reasoning is compromised; Abstract thought is impeded;  Working memory is compromised. 

Intellectual Functioning

Intelligence functioning is measured by standardised intelligence tests.
It is crucial to thoroughly examine the tests since they must be adjusted to account for the participant's age and social background. Knowledge of the standardized assessment exams should be present.

Intellectual disability score: The results are expressed as 2 SD < population mean or as 2 standard deviations. Scores for individuals with intellectual limitations are less than 2SD.  There is a margin of + 5 points. The SD is 15 if the test's mean is 100. By extension, 2SD equals 30 if 1 SD is 15. The mental retardation measurement yields a score of 70+/- 5. For this reason, an intellectual impairment is diagnosed when the score falls between 65 and 75. 

Factors That May Affect Test Scores

It's critical to comprehend intellectual disabilities. It is not the only reason for a low score to be an intellectual impairment. Low scores can be caused by a number of other circumstances. In addition to the scores, clinical diagnosis is a crucial component of patient assessment.

Every patient undergoing the test has some subjective components, thus accurate clinical judgment is essential to the diagnosis. 

Co-occurring disorders, such as sensory or motor function problems and language or communication impairments, are among the reasons.

Extreme hyperactivity,  Lowered frustration tolerance, which results in a low score when the patient is unable to comply for extended periods of time while sitting.  The Flynn effect holds significance. It is seen as an excessively high score because the current scenario uses outdated norms. As a result, updated versions of the tests that are standardized for the present population are repeated.

Adaptive Functioning

Low IQ is frequently linked to intellectual disability; nevertheless, adaptive functioning is also compromised. According to Edgar Doll's (1935) theory of adaptive functioning, behavior is necessary for social and personal sufficiency. It describes how well an individual complies with social obligations and communal standards.People with intellectual disabilities frequently fall short of the requirements for personal independence. They require a particular level of assistance in order to complete specific jobs.

Adaptive Reasoning Involves 3 Domains

Intellectual or scholarly. Memory, language, reading, writing, problem-solving, and judgment are all impaired. Some of the previously mentioned areas have an impact on competence. Social  Perception of the emotions and ideas of others. Social judgments;  Empathy; Interpersonal communication skills;  Friendship talents; 

Practical aspects include personal care, job responsibilities, money management, and recreational activities. Adaptive functioning is evaluated using standardized measurements and clinical examination.

Prevalence Of Intellectual Disability

Because modest difficulties are often not noticed until middle childhood, it can be challenging to determine the prevalence. The prevalence of SDM-5 is 1% in impoverished countries and 10-15/1000 in wealthy countries.  The prevalence of intellectual disability is 1.5 times higher in men than in women. 

Also Read: Communication Disorders In Child Psychiatry

Etiology Of Intellectual Disability

The length of exposure to the central nervous system or the timing of the trauma could have an impact on the severity. Only 50% of instances with modest intellectual disabilities have a cause that can be identified.

As a result, the cause is frequently unknown. About 3% of cases of severe intellectual disability have a known cause. Because the cause is easier to identify when the severity increases, the severity and cause are somewhat proportionate. 

In etiology, the reasons may include:
o Prenatal causes, in which a fetus is growing inside the mother.
o Prenatal causes occur during childbirth.
o Intellectual impairment can also result from postnatal factors.
o A sizable portion of individuals with intellectual disabilities have unknown causes. 

Causes during pregnancy:Between 4 and 28% of cases are genetic diseases. Incorporates Down syndrome and chromosomal abnormalities. The most frequent reason for intellectual disability is this.

Among the monogenic mutations are the most prevalent single gene cause of intellectual impairment is fragile X syndrome. It is the first known x-linked gene. Thus, the fragile X syndrome is the most prevalent genetic cause. There are many sporadic incidences of Down syndrome.

Phenylketonuria (PKV),  Additional metabolic conditions such lysosomal or glycogen storage disease, Lesch-Nyhan syndrome, etc.
Multiple sclerosis.  Some significant chromosomal abnormalities are present.  Some multifactorial genetic problems might exist. 

Mental retardation that runs in families, in which several family members may have the same condition. Making a family tree for pedigree analysis is hence crucial in this. Finding out if there are other members experiencing similar problems is helpful.

Microdeletion-related malformations, including Williams, Prader-Willi, and Angelman syndromes. Some hereditary variables might be involved here. The two most prevalent causes of intellectual disability are Down syndrome and fragile X syndrome. At the very least, individuals with the condition may exhibit a mild intellectual handicap.

In 7–17% of instances, congenital abnormalities are noted.  In this case, there is a CNS malformation that results in neural tube defects. This deformity can be brought on by a folate shortage or by certain medications, such as valproate, if used during pregnancy.
Prenatal factors are also linked to a few multiple malformation syndromes, including Cornelia de Lange Syndrome. 

5–13% of instances involve exposure during the prenatal stage.

Maternal infections, such as congenital rubella (German measles), are significant exposure factors. As the main factor contributing to congenital deformities and intellectual deficits brought on by maternal infection, it has supplanted syphilis. Syphilis, toxoplasmosis, HIV, cytomegalic inclusions (DS), and herpes simplex are other significant illnesses that affect mothers. 

Alcohol exposure is one of the more significant teratogens, making fetal alcohol syndrome one of the more significant contributors. It is one of the most prevalent causes of intellectual disability in the US and the West. Fetal alcohol syndrome can develop in pregnant mothers who use alcohol.  Intellectual disability can result from a variety of exposures, including radiation and trauma, as well as toxicemia or placental insufficiency, which includes preterm. 

Perinatal causes: the frequency is around 2 - 3%. 

In this case, conditions like meningitis and hypoxia are among the variables that may lead to intellectual incapacity.
Anemia hyperbilirubinous Low birth weight o Intracerebral hemorrhage
Thus, having a positive history is essential when dealing with developmental disorder concerns. Furthermore, there may be certain factors related to intellectual disability that are discovered during the perinatal and prenatal phases.

Postnatal causes: the frequency is around 3- 12%. 

Not just perinatal and prenatal variables can cause intellectual disability; acquired childhood diseases can also play a role. Post-delivery conditions can also have an impact.  Infections like meningitis and encephalitis; Toxins like lead poisoning are among the reasons. 

Brain tumors, trauma, and hypoxia in close proximity to drowning are additional postnatal reasons. Accidents in cars and homes might result in trauma. Abuse of children and shaken baby syndrome are frequently additional causes of trauma. For this reason, having a clean record is essential. 

Psychotic disorders and poverty are examples of psychological issues.
Between 30 and 50 percent of postnatal causes of intellectual impairment are unknown. Important etiological factors that contribute to intellectual impairment include:
o Fragile X syndrome o Down syndrome
o Immaturity
o Alcohol syndrome in utero

Also Read: Emotion: Components, Emotional Process, Biology, Theories

Diagnostic

Diagnostic criteria as per the DSM-5.  Three requirements exist:
A: Cognitive abilities including learning, reasoning, planning, solving problems, and abstract thought are impaired. Both clinical evaluations and standardized IQ tests support it. The assessment heavily relies on clinical judgment.
B: There is a deficiency in adaptive functioning that prevents social responsibility and personal freedom from meeting developmental and sociocultural norms. People are unable to carry out daily tasks including social interaction, communication, and independent living at home, at work, and in the community as a result. The individual's activities are restricted by the shortfall.
C: The impairment first appears during the formative stage. 

Specify

There are four categories of intellectual disability: mild, moderate, severe, and profound. The severity levels are determined by adaptive functioning rather than IQ.  Adaptive functioning establishes the necessary degree of assistance. Severity is attached by analyzing the level of support. 

This is an area where both DSM-5 and ICD-11 agree: IQ tests are less reliable at the lower end of the IQ range. Because it is challenging to make a distinction solely on the basis of IQ, adaptive functioning plays a crucial role. 

Severity Of Intellectual Disability

The DSM-IV uses an IQ score to evaluate intellectual disabilities.

The conceptual, social, and practical areas of adaptive functioning are used in the DSM-V to evaluate intellectual disabilities. In addition, it might be categorized as profound, severe, moderate, or light. 

Also Read: Exploring Erik H. Erikson's Psychosocial Theory Of Development

Findings Discussion Based On The Classification

There are three domains within the conceptual domain: academic, social, and practical. When an intellectual handicap is minor, problem-solving techniques are more tangible and assistance is required.

Immaturity is evident in social situations. Compared to the average population, social bonds are not as strong. Assistance in certain areas can be necessary for a practical domain with a moderate intensity.

The conceptual domain of people with mild intellectual disabilities lags significantly behind that of their counterparts. In social marketplaces, one can observe distinctions amongst peers. The practical realm illustrates the need for both extended care and personal care. There is little extended support available for problem-solving in the social realm for those with significant intellectual disabilities. The here and now is the primary emphasis.

ADL needs to be supported in the practical domain. Support is also required for other jobs.  Rather than using symbolic processes, the talents related to profound intellectual disability involve the physical world. The use of items may also be restricted by motor or sensory disability.  The social domain demonstrates a restricted comprehension of speech, gesture, and symbolic communication. Maximum dependence is seen in the practical domain for all day care, medical care, safety, and health; • Adaptive functioning along with past medical history can aid in the classification of patients based on their degree of intellectual disability. 

 ICD-11

The term "mental retardation" is not used. A dysfunction of intellectual growth is the new word. It states that adaptive behavior and intellectual performance should be noticeably below average. similar to the DSM-5.
Moreover, two standard deviations or more below the mean. (about the second-third percentile) 

Severity Of Intellectual Disability

Prevalence

• The highest prevalence of 85% is mild intellectual disability.
• Moderate intellectual disability is existent in 10%.
• Severe intellectual disability comprises 3-4%.
• While profound intellectual disability makes up about 1-2%

IQ

• Normal IQ is 30-119
• The low average IQ is 80-89
• Borderline IQ is 90=89
• Based on the IQ, the severity are:
• In mild, it is 50-69
• In moderate, it is 35-49
• In severe it is 20-35
• In profound, it is less than 20

Academic skills

• Mild can study up to 6th grade or more.
• Moderate can study up to 2nd to 3rd grade
• Severe or profound may not have any formal education.

ICD -11 chart

• Mild intellectual development 2 - 3 standard deviation below the mean (0.1 - 2.3 percentile)
• moderate intellectual development 3 - 4 standard deviation below the mean (0.003 - 0.1 percentile)
• Severe intellectual development 4 or more standard deviation below the mean (< 0.003percentile)
• Profound intellectual development 24 or more standard deviation below the mean (<0.003 percentile)
• Thus, ICD-11 denotes that it is difficult to differentiate between severe and profound based on IQ.
• The differentiation is exclusively based on the behavior or adaptation functioning, as the existing IQ tests cannot differentiate. 

Organic Causes

Few occurrences of mild intellectual disability are caused by organic factors. There are a lot of cases of moderate intellectual disability with organic reasons. Most cases of down syndrome are mild to moderate.

There is frequently one more organic factor when it comes to severe. Neurological and motor issues may also be present. Most have found organic causes when it comes to deep. 

Support Needed

o The level of support required is indicated by the degree of disability.
o Patients with mild intellectual disabilities may lead independent lives.
o Patients with moderate intellectual disabilities may flourish in a supportive community.
o For simple chores, a number of people with intellectual disabilities need constant supervision and help.
o Patients with severe intellectual disabilities need complete monitoring for food, personal hygiene, and other activities.

Also Read: Exploring Trailing Phenomena: Perception Beyond The Ordinary

Diagnostic Approach To Patient With Intellectual Disability

• Recording history is the first step.
  • The patient's medical history will include:
  o Exposure during pregnancy
  o Birth history (perinatal period is significant) o There have been cases of traumatic brain injury and CNS infection.
  o Regression toward development. This is intriguing since there are cases when development may be normal up to a specific point, at which point it may regress. The patient's history matters in this case.
  o There may also be medical problems, such as comorbid problems.
  o Hearing or vision impairment
  o The regression's past
  o Anomalous bodies
  o The kinds of schools and grades that are included are included in educational history. 

Speaking with the patient frequently facilitates the process of determining whether an intellectual disability has been diagnosed. Obtaining the patient's medical history aids in better understanding the individual.

Examination

Examining a patient is crucial for both intellectual disability and any psychological issues.Therefore, it's critical to perform a thorough assessment on a mental and physical level. 

Facial fractures and skin abnormalities are examples of significant and minor deformities that can develop in people with intellectual disabilities. Suspecting the condition can be aided by making basic observations of these anomalies. conditions like Down syndrome. It might also aid in making the diagnosis. 

Analyzing physical development and growth is crucial once more. One can see head circumference conditions like micro or macrocephaly.  In follow-up, the growth trajectory is significant. Because there may be both soft and conventional neurological signals, a neurological evaluation is crucial.  Pigmentation, which can arise in tuberous sclerosis, can be diagnosed with the aid of skin examination. 

Phenotypes of behavior. Observing the oral cavity, cleft palate, and irregular texture are critical for intellectual disability; therefore, history and examinations become very significant. specific aspects of the examination can help in suspecting specific causes, such as genetic factors. 

Family Pedigree (3 - Generations)

Frequently, the family members may exhibit the following:

o Issues with learning
o Unusual brain mapping
o A psychological condition
o Degenerative or neurological disorders; o Intellectual impairment.
In addition, a child born into a consanguinity marriage might provide information regarding consanguinity through family history.  Similarities with family 

Genetic Evaluation (When Indicated)

Not every situation calls for genetic evaluation. Only when it is deemed essential is it carried out.

• Fragile X testing; • Chromosome microassay; • DNA sequencing, either a single gene or a gene panel, based on the suspicions
• Methylation of DNA. If there is a possibility of Prader Willi or Angelman syndrome, it is treated.
Additional assessments include the following:
• Amniocentesis. A tiny sample of amniotic fluid is extracted at 15 weeks of gestation in order to identify any genetic abnormalities in the developing baby.
• Sampling of Chorionic Villi (CVS). It is performed for fetal chromosomal disorders between 8 and 10 weeks of gestation.Therefore, if there is a chance of chromosomal abnormalities, some of the tests are conducted during pregnancy. 

Laboratory Testing (When Indicated)

Muscle dystrophies could be treated with creatine kinase.  Metabolic investigations related to mitochondrial, lysosomal, and peroxisomal diseases, including galactosemia, phenylketonuria, and Lesch-Nyan syndrome.  You can use plasma amino acids or urine organic acids.

Testing for congenital glycosylation disorders may be conducted.
7-Smith, Lemli, and Opitz Syndrome can be tested for using dehydrocholesterol.) These are a few of the particular situations in which testing for intellectual disability may be performed.

Consider Inborn Errors Of Metabolism (IEMS)

Inborn errors of metabolism (IEMS) can be diagnosed in patients with intellectual disabilities thanks to certain results.  Visual hallucinations; seizures; encephalopathy; catatonia; manic episodes.  Organic elements are frequently at play.  Make symptoms worse by causing psychological stress

Imaging

Though it can be done in the following situations:  Micro/Macrocephaly  Abnormal head circumference  Seizures,  Focused neurological symptoms and indicators · Deteriorating cognitive and motor abilities
The aforementioned features' occurrences point to the need for imaging. 

There are various kinds of imaging, including:  Structural MRI Brain
It is feasible. Here, nonspecific results are present in 50% of instances. Just 5% of instances involving non-specific intellectual disabilities benefit from it.

Among the non-specific findings are: Ventricular enlargement Corpus callosum dysplasia ♣ Minor abnormalities: Cerebellar vermis, White matter signal, or cortical gyration.  The majority of uses for functional brain imaging, such DTI or FMRI, are in research. Functional brain imaging is not performed for intellectual disability in clinical day-to-day analysis.

Other Studies

Muscle biopsy for mitochondrial illness and dystrophy;  EEG polygraphic study (waking/sleep video);  Seizures history.  Severe linguistic impairments and/or particular genetic disorders, such as Angelman Syndrome

Adjunct Diagnosis

Ophthalmology and hearing need to be evaluated. These are frequently seen and may be signs of intellectual impairment. Psychometric testing evaluates intellectual and adaptive performance. Standardized tests should be used for assessment. 

Assessment

Instruments and methods for evaluating cognitive and adaptive abilities.  It's critical to comprehend these established measurements. To gain a fundamental grasp of the measures, it is necessary to have sufficient exposure to these examinations. Indian versions of the tests are available for use while administering them. 

Tests Used To Assess Intellectual Functioning:

An intelligence quotient is indicated by IQ. It is quantified historically using the following metrics: Age mental/temporal times 100

Fifty would be the maximum chronological age.The Raw Score, which is converted into a normal distribution with a mean of 100 and a standard deviation of 15, is how IQ is measured in contemporary tests. Anything less than 70 validates intellectual impairment, since two standard deviations equal thirty.

Depending on the patient's age, a variety of Wechsler tests are available. The first is the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI - IV) 2012.

The scale's age ranges from 2.6 months to 7–3 months.  Full-scale IQ is tested along with verbal and performance IQ. In this, specific tasks are completed by individuals in the performance tests, and specific questions are asked in the verbal examinations.

In addition to full-scale IQ, verbal and performance IQ are also determined based on the tests. 

The Wechsler Intelligence Tests for Children, Fifth Edition (WISC-V) 2014, is the second exam. The scale spans six years to sixteen years and eleven months in age. Once more, it provides full-scale, verbal, and performance IQ. Wechsler Intelligence Scale, Fourth Edition (WISC- IV) 2008 is the third exam. The scale's age range is 16 to 90 years old. It is therefore mostly intended for adults. Once more, it provides full-scale, verbal, and performance IQ.

Also Read: Human Aggression: A Comprehensive Approach 

Components Of Each Of The Tests

Among the components of verbal tests are DIVSAC (mnemonics).
Digit span, Details  Terminology Similarities, Arithmetic, Understanding.

Block design : BPPOD (mnemonics) are components of performance tests. The individual must repeat the sequence displayed in this.
Picture completion involves asking the subject to fill in the blank and complete the picture. Picture arrangement is a monicker in which a specific arrangement of the photographs is required. Assembly of objects.  Digital sign • In order to obtain the performance score, the patients must complete the aforementioned tasks. 

Stanford Binet Intelligence Scale 5the ed. (ROID, 2003)

Ages 2 to 85+ are eligible.  Verbal, quantitative, abstract/visual, short-term memory, and composite score are the domains that are evaluated.

Progressive Matrices (RAVEN, 2003). It has two sets of tests.

• Adults aged 11 to up use the STANDARD exam.
  o Make analogies and use analytical thinking
  o Colored tests are administered to the elderly for five years.
  o Group assessments, reasoning figures.

Sanguine Form Board Test

One more exam of performance. It consists of a board with different forms on it that objects or blocks of different shapes must fit into to form comparable shapes. It is a brief test of general intelligence that focuses more on a person's visual motor speed. The test is valid for children aged three to eleven. For those with intellectual disabilities of all ages, thought is valid. The drawing exam by Gessel .

It spans from 15 months to 8 years of age. It's an additional exam on performance. People are required to replicate certain photos. It's a mental development screening test. Because the image needs to be replicated, the exam is invalid for people who have never attended school or who have never used a pencil.

Indian Population Measure

Scales utilized for the Indian population: o Malin (1973) modified the original WISE scale; o Malin's intelligence scale for Indian children (MISIC).  The age range for it is six to sixteen years old. It includes tests for verbal and performance IQ. A person's formal education also affects the results of several verbal examinations. The exam also measures performance and verbal IQ. 

The following are the key elements of MISIC:
The verbal components of the MISIC test comprise the following: DIVSAC (mnemonics); Digit span; Information; Vocabulary; Similarities; Arithmetic; and Comprehension.

The performance test components of MISIC consist of Block design and BPPOCM (mnemonics). There are different blocks in this, and the user can choose from different patterns. The individual must use the blocks to finish the pattern. Picture completion involves asking the subject to fill in the blank and complete the picture. Picture arrangement is a monicker in which a specific arrangement of the photographs is required. Assembly of objects  Coding Mazes, in which a person must begin and finish.

The Indian populace is the target audience for the MISIC toolbox. The components are used to carry out the tests listed above. It also includes instructions on how to score and a guide to help with the process.

The India edition of the Wechsler Intelligence Scale, Fourth Edition (WISC- IV) has been revised. It is designed to evaluate students between the ages of 6 and 16 and 11 years old. It includes a verbal and performance IQ component. The exams are lengthy, taking between 60 and 90 minutes to complete. 

The Binet-Kamat test was developed in 1967 by Kamat, who modified the 1916 version of the Binet-Simon test for intelligence. Ventatesan reevaluated it in 2002. o It is utilized by people ranging in age from three to adulthood. The test's dependence on formal education is one of its limitations. That means certain sections of the test will be impossible for someone without a formal education to complete. Raven's progressive matrices from 2003. Deshpande et al. (2002) provided the Indian norm for STANDARD components.

The battery of intelligence performance tests developed by Bhatia (1955). This performance test is intended for individuals 11 years of age and beyond. It is not specifically designed for people with intellectual disabilities because it typically tests IQs greater than 70.

Gessel's drawing exam is a performance test that is used as a screening tool for mental development. It was adapted for use with children between the ages of 15 months and 8 years. Verma et al. (1972) validated it again in 2002.

The Sepin Form Board Exam.  It is a performance exam; • Bharat Raj created the Indian adaption in 1971; Goel and Sen followed in 1984; and Venkatesan revalidated it in 1998. The test is applicable for all ages and intelligence disabilities, and it is dependable for 3 to 11 years. Some significant indicators of intellectual functioning are the tests mentioned above. 

Adaptive Functioning

• Important tools used for adaptive functioning

• Vineland Adaptive Behavior Scale, 2nd ed. (VABS)
• o It encompasses the ages of 18 to 11 years old.
  o Was modified in 2005 by Sparrow et al.
  o Vital areas that can be evaluated include: o Communication: This area evaluates writing, receptiveness, and expression.
  o Daily living skills: This includes an evaluation of social, household, and personal abilities.
  o Socialization: Play, leisure, and interpersonal interactions; copying abilities are evaluated.
  o Motor skills: Both gross and fine motor skills are evaluated here.
  o An Indian adaptation was also made in 1968 by Malin and expanded upon in 1992 by Bharat Raj.
  o The scale's age range is 0 to 15 years.
  o The exams' skill sets need to be revised to reflect the changing times, as the idea of behavior modification also changes with time

ABAS-11: Second Edition of the Adaptive Behavior Assessment System
The system is designed for a broad age range, 0 to 89 years; • SIB-R improved the independent behavior scales  The method is intended for a broad age range, from 0 to over 80. 
Diagnostic and Adaptive Behavior Scale (DABS). Over the critical ranges needed to carry out adaptive functioning. As will be covered later, there are additional scales as well.

Edgar Arnold Doll developed the Vineland Social Maturity Scale (VSMS), a tool for evaluating social competency.  It evaluates adaptability and social skills.  The performer receives a social score (SQ) from the evaluation. VSMS comprises eight significant subscales.
Among these are: self-direction; self-help in dressing and eating; general self-help capacity; locomotion abilities; occupation skills; and socialization skills. 

The scale used to evaluate intellectual disability has an Indian version. The skills test requires a caregiver and only takes a few minutes to complete; the social score is generated accordingly.

Genetic Intellectual Disability And Behavior Phenotypes

Dykens provided the definition. These are essentially syndromes where there is a higher likelihood than expected of a certain behavior or a constellation of behaviors being expressed. Certain hereditary causes of intellectual disability are linked to specific predicted and predictable behaviors. For this reason, a genetic basis may be present if a case of intellectual disability exhibits any or all behavioral characteristics. 

For instance, a patient with intellectual disability may exhibit specific behaviors more frequently in cases with Fragile X syndrome than in cases where the patient does not have an intellectual handicap. Intellectual disability may vary among patients; notably, it is less severe in women.  The patients' verbal IQ is higher than their performance IQ.
Inattentiveness and hyperactivity are also noted. It is observed in over two thirds of the cases. Social avoidance; Stereotypes; Irritability; For instance, in Down syndrome; The syndrome's moderate range of severity; The person is socially adept and strong in social development; Childhood hyperactivity; Verbal IQ superior to auditory processing; Depression and Alzheimer-type dementia are middle-aged risks.

Comorbidities

Comorbidities are frequently the cause of individuals presenting with intellectual disabilities.About two thirds of the cases in this have coexisting mental health conditions. As a result, it is typical to have concomitant intellectual disability. It and severity have a correlation. But there's no relationship between gender or age. Comorbidities frequently get worse with severity.

Disruptive conduct is noted in mild intellectual impairment comorbidity. Severity risk of specific comorbidity.  Patients may have little tolerance for frustration, low self-worth, or a negative self-image. Additionally, conduct disorder is more common than the other severities. 

Severe intellectual disability indicates a higher prevalence of symptoms associated with autism spectrum disorders, such as self-injurious behavior or self-stimulation.It's interesting to note that the risk of co-occurring psychiatric disorders is lower among people with severe intellectual disabilities. It can be challenging to diagnose concomitant psychiatric disorders. 

50% satisfy the criteria for a mood disorder; 2–3% meet the criteria for schizophrenia; and there are comorbidities in intellectual disability.Thus, mental issues frequently accompany intellectual deficiency.

Psychopathology In Intellectual Disability

A few of the comorbidity prevalence-related factors. It might be a factor in those with intellectual disabilities being more susceptible to mental illnesses.  A few of the crucial elements include the risk of various comorbidities can also be raised by neuropathoogical processes associated with intellectual disability. 

A communication deficit might frequently raise the likelihood of emotional issues. Inadequate coping mechanisms also raise the possibility of coexisting psychological disorders.
o A higher risk of abuse, separation, and loss.
o Another factor contributing to comorbidities is higher familial risks.
o Patients with intellectual disabilities may be more susceptible to comorbidities if their chances for leisure and employment are reduced.
o The detrimental effects of intellectual disability on self-worth may also lead to a rise in comorbidity among people. 

Comorbidities In Intellectual Disability

ADHD: about 9 - 18 individuals with intellectual disability have ADHD. Observing symptoms that are excessive for the person's mental age is part of the diagnosing process for ADHD. The signs of an intellectually disabled person must be observed in relation to their mental age.

An impulse control disorder diagnosis should be made if the patient simply exhibits impulsivity. 

Impulse control and stereotypic movement disorder may also lead to self-harm along with aggression.  When cognitive impairment worsens or becomes more severe, self-harming behavior frequently becomes more prevalent.  Self-harming conduct frequently develops into a chronic or recurring pattern.  Due to pre-existing comorbidities, patients of various age groups may appear with intellectual incapacity. 

Genetic syndrome:Lesch-Nyhan syndrome may exhibit self-biting

Smith Magni's syndrome, fingernail pulling is observed. DSM-5: They have added a specifier to the diagnosis of stereotypic movement disorder. 

Oppositional defiant disorder or conduct disorder: The DSM-5 diagnostic necessitates comparison with individuals of a comparable mental age.  Both diagnoses necessitate a certain level of intentionality from the patient. Disobedience, for instance, is driven by resentment.
But in cases of intellectual disability, this is frequently hard to diagnose.

Anxiety disorder: It could range from 1 to 25%.  There is a broad range because the patient must independently report the symptoms, which they frequently do not. Consequently, it can occasionally be challenging to diagnose anxiety disorders.  Panic disorder, PTSD, OCD, and specific phobias are among the anxiety disorders that have been noted.
Patients with panic disorders may not be able to communicate their fears, such as a fear of dying. The disorder shows up as panic attacks accompanied by sobbing, yelling, etc. 

Diagnosing OCD is important since individuals may exhibit stereotyped movements. Sound judgment is required in this matter.  Individualized phobias are more prevalent in some developmental disorders. Thus, it's critical to watch the patient's conduct in order to comprehend the problems. 

Comorbid Neurological Disorder

Disorder of seizures. Patients with intellectual disabilities experience a higher frequency..  As the intensity increases, so does the frequency.

0.07% of the general population may have an intellectual handicap, epilepsy, and autistic spectrum condition together. The trio may manifest concurrently in specific scenarios.  Comorbidity is prevalent in intellectual disability, and diagnosing it can be challenging. 

When every attempt is made to arrive at a working diagnosis and create a treatment plan, a provisional diagnosis is frequently used. More data availability may allow for modifications to the diagnosis and treatment approach. Further subjective input from the patient and family members may help to fine-tune the diagnosis and appropriate treatment approach. 

In comorbidity, an acute medical or psychiatric etiology may be the cause if the behavior is recent in beginning.  A lot depends on the situation. It is less likely to be a mental disease or mood disorder if the symptoms are brought on by the pressure of the task requirements.
There is awareness if the patient exercises self-control to refrain from particular activities, which is essentially an ego-dystonia trait. 

For instance, the patient with OCD is aware that the thoughts are absurd. As a result, the patient's behavior provides information regarding the ego-dystonia aspect of their symptoms. Making better clinical decisions can be facilitated by using this information to distinguish between the comorbidities.

Diagnostic And Behavioral Rating Scales

• ABC - Aberrant behavior checklist.
• DBC - Developmental behavior checklist.
• BPI - Behavior problem inventory
• DASH - Diagnostic assessment of severely handicapped
• REISS scale for children’s dual diagnosis
• The above are important rating scales used in intellectual disability patients with comorbidities. 

Isability Of Assessment

• The Rights of Persons with Disability Act of 2016 is in effect.
  • Kids older than one and up to five years
  • Global developmental delay (GDD) is the diagnosis on the certificate; if necessary, the diagnosis must be modified. A temporary certificate calls for reevaluation.
  • People older than five years
  • A certificate indicating an intellectual disability diagnosis was given.
  • The certificate ought to specify the date of renewal. For instance, it is offered for life at the ages of five, ten, and eighteen.
  • Gaining knowledge about assessments and certifications is essential for improving the management of intellectual disabilities.  The tool for adaptive functioning is VSMS. For determining IQ, use MISIC or BKT.

Disability Calculations

• Based on the VSMS Score, understanding of Disability can be developed.
• • VSMS Score 0 - 20,  Disability profound 100%
  • VSMS Score 20 - 35 Disability severe 90%
  • VSMS Score 36 - 54 Disability moderate 75%%
  • VSMS Score  55 - 69 Disability mild 50%
  • VSMS Score  70- 84 Disability borderline 25%

Hope you found this blog helpful for your Psychiatric Theory and Specialities Preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.