Intellectual Disability

Question 1

Definition of ID

Answer 1

• A significant impairment of cognitive and adaptive functions, with age of onset before 18 years

OR DSMV:

• IQ≤70 [2SD below mean]on WISC
AND significant impairment in adaptive functioning in at least two areas: communication, self-care, home-living, social skills, self-direction, academic skills, work, leisure, health, safety

Question 2

Gives some examples of the aetiology of ID, and divide these examples into 3 main umbrellas.

Answer 2

Prenatal

- Chromosomal 
	• DS, fragile X, Klinefelter's, Trisomy 13
- Genetic metabolic
	• Turner's, PKU, hypothyroidism
- Genetic neurologic
	• Neurofibromatosis
- Congenital infections (TORCH; esp in 1st trim)
	• Toxoplasmosis, rubella, CMV, HIV
- Drug and toxins
	• EtOH, valproate, chemo, mercury, Pb
- Maternal malnutrition

Perinatal

• CNS bleeding
• Hypoxia
• Trauma
• Placental abruption
• Twin/twin syndrome

Postnatal

• Trauma
• Environmental deprivation
• Infections
• Alcohol, heavy metals, chroming
• Malnutrition

Question 3

Risk factors for ID

Answer 3

• Male
• Consanguineous parents
• FHx
• Older maternal age

Question 4

What is the main objective of Mx of ID, and give examples of Mx points for ID.

Answer 4

• Main objective is to enhance adaptive functioning level
• Multi-disciplinary team approach with strong case co-ordination
• Emphasise community-based treatment with early intervention
• Individual/family therapy, behaviour management services, therapy services (e.g. OT, SLP), medications for associated conditions
• Education: life skills, vocational training, communication skills, family education
• Psychosocial support for individual and family, respite care