Intellectual disability is sub-average intellectual functioning with impaired adaptive functioning. The limitations in their adaptive skill hampers the ability to cope with stressful life events. There are many issues which require attention while dealing with them like parental level, peer groups, schools, presence of comorbid conditions, etc. Interventions at right stage under efficient supervision can lead to healthy and smooth functioning of cases with ID and with good outcomes. Difficulties like lack of human resources, quality training of clinical psychologists in India, scarcity of effective clinical guidelines, conflicts among the team approach, acceptance in the family and society requires attention in current scenario. There are many things that can be offered but what we need is their acceptance in our society and awareness towards Intervention. This chapter aims at acknowledging these issues to create awareness amongst the responsible caregivers. Timely recognition of treatable causes of intellectual disability can be very rewarding and prevent a lifelong disability.
TopIntroduction
In the prehistoric period, individuals with intellectual disability (then known as ‘feeble mindedness’), was posed by an advocate W.E. Fernald as ‘a section who lived happily in institutions and got segregated from mainstream society; hence, what else they look or want’. This perspective further took various folds in terms of being sensitive and providing much deserved helping approach to this section. The World Health Organization defines Disability as “an umbrella term, covering impairments, activity limitations, and participation restrictions.” Impairment is a problem in body function or structure; activity limitation is a difficulty encountered by an individual in executing a task or action; participation restriction is a problem experienced by an individual in involvement in life situations. Thus disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which she or he lives. Intellectual disability (ID) means disability in the cognitive capacity of an individual. Although there is a great variability in development, there are earlier and a later limit to what is considered ‘normal/ typical’ development. Statistically, children with intellectual disability are those who develop at a rate significantly below average-the lowest 3% on the normal, bell-shaped curve distribution- indicating why ID is called a “developmental disability”. In simple terms, whatever a mentally normal child can do within a particular frame of time the mentally sub-normal child is either unable to do or will take longer period of time to complete. The learning of particular skill will also depend upon the complexity of the task or on the rate of learning. The delay of learning also depends upon the severity of intellectual disability. It is very obvious and natural that the parents of developmentally disabled child will wonder what will be the future of their child. Will she / he be normal? Will she / he be able to get job? Will the child be able to live independently? Will the child be accepted in the society and family? These are the few questions which will haunt the society in general and the caregivers in particular and thus awareness towards intervention is required for better outcome.
Intellectual disability can be defined as impairments of general mental abilities that impact adaptive functioning in three domains, or areas. These domains determine how well an individual copes with everyday tasks:
- •
The conceptual domain includes skills in language, reading, writing, math, reasoning, knowledge, and memory.
- •
The social domain refers to empathy, social judgment, interpersonal communication skills, the ability to make and retain friendships, and similar capacities.
- •
The practical domain centres on self-management in areas such as personal care, job responsibilities, money management, recreation, and organizing school and work tasks.
These mental abilities are measured by Intelligence Quotient (IQ) tests. A score of two standard deviations below average represents significant cognitive deficit and would occur in about 2.5% of total population signifying that 97.5% of people of the same age and culture would score higher. The test used to measure IQ must be standardised and culturally acceptable. Intelletual Disability is defined at an IQ score of 70 or below. (DSM-5, APA, 2013).
It has been estimated that individuals with intellectual disability comprise from 1 percent – 3 percent of populations around the world. (WHO, 2001). The total number of disabled people in India are 26 million out of which 1.5 million have intellectual disability (Indian Census, 2011). A census reported by American bureau in the year 2015 that prevalence of receipt of special education services for ID in United States has declined from 2004 to 2012 after which they aggressively started to plan and execute schemes for this population (U.S.census bureau, 2015). IDs can be mild or more severe. Children with more severe forms typically require more support–particularly in school. Children with milder IDs can gain some independent skills, especially in communities with good teaching and support. Since, this disability demarcates such people from the normal individuals of the society they face various problems throughout their life due to stigma and discrimination. They don’t get proper education, they require supervision, they cannot do job; they are isolated by the peer groups society.