Chapter 50

Intellectual and Developmental Disabilities

Objectives

• Define the key terms and key abbreviations in this chapter.

• Identify the areas of function limited by intellectual and developmental disabilities.

• Explain how intellectual and developmental disabilities affect the person and family across the life-span.

• Explain when intellectual and developmental disabilities occur and their causes.

• Identify the types of support and services available to persons with intellectual and developmental disabilities.

• Describe the intellectual and developmental disabilities presented in this chapter.

• Explain how to promote PRIDE in the person, the family, and yourself.

Key Terms

birth defect A problem that develops during pregnancy, often during the first 3 months; it may involve a body structure or function

developmental disabilities A group of conditions caused by physical, learning, language, or behavior impairments

disability Any lost, absent, or impaired physical or mental function

inherited That which is passed down from parents to children

intellectual disability Involves severe limits in intellectual function and adaptive behavior occurring before age 18

spastic Uncontrolled contractions of skeletal muscles

Key Abbreviations

ADA	Americans With Disabilities Act of 1990
CP	Cerebral palsy
DS	Down syndrome
Fragile X	Fragile X syndrome
IDD	Intellectual and developmental disability
IQ	Intelligence quotient
SB	Spina bifida

A disability is any lost, absent, or impaired physical or mental function. Intellectual and developmental disabilities (IDDs) affect physical, intellectual, and emotional development. An IDD can be a physical or mental impairment or both.

• Developmental disabilities—a group of conditions caused by physical, learning, language, or behavior impairments.

• Intellectual disability—involves severe limits in intellectual function and adaptive behavior occurring before age 18.

Occurring during the developmental period (Chapter 11), IDDs begin before, during, or after birth or during childhood. They may affect day-to-day function and usually last throughout life. IDDs can be mild to severe. Causes are listed in Box 50-1.

Box 50-1

Intellectual and Developmental Disabilities—

Causes and Warning Signs

Causes

• Genetics

• Abnormal genes may be inherited from 1 or both parents. Inherited means to be passed down from parents to children. See “Fragile X Syndrome,” p. 789.

• Problems when genes combine during fertilization. See “Down Syndrome,” p. 788.

• The mother’s health or behaviors during pregnancy:

• Smoking.

• Substance abuse or addiction (alcohol, drugs).

• Infection with rubella (German measles).

• Untreated or uncontrolled diabetes.

• Contact with dangerous chemicals or toxins. Lead is an example.

• Poor nutrition.

• Head injury during or after birth

• Lack of oxygen to the brain

• Lack of oxygen to the brain

• Blood disease

• Problems after birth

• Infections—whooping cough, chicken pox, measles, Hib disease, meningitis, encephalitis

• Head injuries

• Near drowning

• Poisoning—lead, alcohol, ammonia, bleaches, detergent, household products, gasoline, kerosene, lighter fluid, drugs, lye, paint thinners and removers, pesticides, turpentine, weed killers, mercury, and so on

• Shaken baby syndrome

• Poor nutrition

• Dehydration

• Reye’s syndrome (a disease caused by drugs containing aspirin)

• Poor health care

Warning Signs

• Delays in sitting up, crawling, or walking

• Delays in talking or having difficulty speaking

• Trouble remembering things

• Trouble understanding the rules of social behavior

• Trouble “seeing” or “understanding” the outcomes of actions

• Trouble solving problems

“Causes” modified from The Arc of the United States: Causes and prevention of intellectual disabilities, Silver Springs, Md, revised March 1, 2011. “Warning Signs” modified from National Institute of Child Health and Human Development: What are the signs of IDDs? Bethesda, Md, updated November 30, 2012.

Some IDDs involve birth defects. A birth defect is a problem that develops during pregnancy, often during the first 3 months. It may involve a body structure or function. Spina bifida (p. 790) is an example of a structural defect. Down syndrome (p. 788) is a functional (developmental) defect. Birth defects may affect how a body looks, functions, or both.

Developmentally disabled children become adults. Independence to the extent possible is the goal for these persons. This includes having a job and living in the community. They need life-long help, support, and special services.

An IDD affects the family throughout life. The infant or child may become a teenager, young adult, middle-age adult, and older. Both the child and parents grow older. Often it is hard to provide care, handle, move, or financially support the disabled person. A parent may become ill, injured, or disabled or may die. Still the disabled person needs care.

See Focus on Long-Term Care and Home Care: Intellectual and Developmental Disabilities.

Focus on Long-Term Care and Home Care

Intellectual and Developmental Disabilities

Long-Term Care

Changes from aging (Chapter 12) may occur earlier when IDDs are severe. Some adults with IDDs need nursing center care. They are further protected by the Omnibus Budget Reconciliation Act of 1987 (OBRA). OBRA requires that centers provide age-appropriate activities. Staff must have special training to meet care needs.

Some severely disabled children live in centers for the developmentally disabled.

Intellectual Disabilities

Intellectual function relates to learning, thinking, reasoning, and solving problems. Adapt means to change or adjust. The person has low intellectual function. Adaptive behavior is impaired (Box 50-2). Adaptive behaviors are skills needed to function in everyday life—to live, work, and play.

Box 50-2

Adaptive Behaviors

• Communication

• Reading

• Writing

• Money concepts and managing money

• Social skills—interpersonal skills, responsibility, not being tricked by others, following rules, obeying laws

• Activities of daily living—eating, dressing, mobility, elimination, preparing meals, taking drugs, using the phone, using transportation, housekeeping, job skills, and maintaining a safe setting

The Arc of the United States is a national organization focusing on people with intellectual and related disabilities. The Arc describes an intellectual disability as:

• An IQ score between 70 and 75 or below. ( IQ means intelligence quotient.) The person learns at a slower rate than normal. Learning ability is less than normal.

• A significant limit in at least 1 adaptive behavior.

• Onset before age 18.

Brain development is impaired. According to the Arc, alcohol is the leading preventable cause of intellectual disabilities. See Box 50-1 for other causes.

Intellectual disabilities can be mild to severe. Persons mildly affected are slow to learn in school. As adults, they can function in society with some support. For example, they need help finding a job. Support is not needed every day. Others need much support every day at home and at work. Still others need constant support in all areas.

See Focus on Communication: Intellectual Disabilities.

Focus on Communication

Intellectual Disabilities

Mental retardation was a common term for intellectual disabilities. However, the term is offensive and out-dated. Intellectual disabilities is the preferred term.

In June 2003, the President’s Committee on Mental Retardation was changed to the “President’s Committee for People with Intellectual Disabilities.” The name was changed to:

• Update and improve the image of people with intellectual disabilities.

• Help reduce discrimination against such persons.

• Reduce confusion between “mental illness” and “mental retardation.”

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