Author: Ushna Nawaz
It is highly present is children and
adolescent (Maulik, Mascarenhas, Mathers, Dua, & Saxena, 2011). The
main causes of intellectual disability are as follows:
- Mutation in genetic conditions
- Complications during pregnancy
- Problems during childbirth
- Serious illness or injury especially in the brain region
In some cases, the
cause of intellectual disability is unknown. In 2011 Glover demonstrated that
maternal stress during pregnancy increases the possibility for the child to
have a neurodevelopmental disorder. It was also explained that high-risk
pregnancy or complications during pregnancy have a significant correlation with
developmental delay in children (Amir Ali Akbari, Torabi, Soleimani & Alavi
Majd, 2011). The case discussed below will help us to understand the causes of
intellectual disability and how it affects the individual.
Case History
Present Illness
The client was
diagnosed with global developmental delay as his developmental milestones were
delayed. He came to the hospital with behavioural, speech, cognitive, and
walking problem.
Personal History
The client was 3.5
years old boy. The client’s mother had C-section, along with some
complications. Client’s mother had stress during pregnancy and at the time of
delivery. During the pregnancy of the client’s mother, the doctor told her that
the fetus had a cyst in one of his brain part and feet problems. The first cry
of the client was not delayed. The client was having a history of anoxia, pneumonia,
chest problem and its colour turned to blue. The doctor admitted him in the
nursery, and there he had treatment without using an incubator. His milestones
were delayed. At the age of 4-5 months, he started neck holding and started
sitting the age of 7-8 months. He started crawling at the age of 13-14 months.
He started standing with support at the age of 16-17 months. At the age of 2
years, he started walking with support. He was having a speech problem and
showing a delayed response. The client was taking medication from the 1st day
of his birth (mainly medication of calcium and vitamin D). On the 3rd day of
the client’s birth, he was having feet treatment (foot plaster and shoes). At
the age of 6-7 days, he was admitted in the hospital for ten days, for the
treatment of chest problem. When he was of 15-20 days, he was admitted in the
hospital for 10-12 days, for the treatment of jaundice. At the age of 6-7
months, the client was having mild fits, for which he was admitted in the
hospital for one week. When the client was getting treatment from the hospital,
his fits became severe.
Then his parents took
him to another hospital, where he didn’t get admitted. After that, at the age
of 9 months, he was admitted in the hospital for 15-20 days for treatment of
fits. At the age of 15 months, the client’s fits became mild. Client's parent
consulted a neuro-physician; there, he had a CT scan and EEG of the brain. It
was reported that the cyst was of small size and didn’t enlarge. He didn’t like
loud sounds and got terrified of the noise. He became rude when something
happened against his will. The client liked to watch T.V, bike riding, poems,
roads, and playing with water.
Family History
The client belonged to
a middle-class family and had a joint family system. Client's father was 36
years old and worked as a general officer at the national bank. Due to his job,
he was living out of the station and visited family on weekends. Client's
father was strict, moody, and aggressive and rarely showed jolly behaviour.
Client's mother was 36 years old. She was a house wife, and by nature, she was
loving, caring and rarely showed aggressive behaviour. Client's mother was
taking care of his daily activities. He had 1 brother with whom he had a loving
relationship. The client was not attached to his father but with his mother.
Client’s father was more attached to his younger brother. The client’s
grandparents loved him.
History of the Physical
Problem
The client was having
congenital feet problem. It was also observed by the therapist that the client
was having eye problems.
Premorbid Personality
The client’s problem
started before his birth. Therefore, no significant premorbid personality can
be reported.
Assessment
Both PGEE (portage
guideline to early education) and informal assessment was used to assess the
client.
Clinical Interview
The clinical interview
was used to assess the behavioural, emotional, and intellectual state of the
client. The therapist took a detailed history of the client that helped the
therapist to identify the client’s problem. Moreover, the therapist was gaining
a detailed description of the client’s background, duration, and nature of the
problem and all other aspects of precipitating, predisposing and maintaining
factors. The detailed history was enough to examine the client’s problematic
behaviours. It also helped the therapist in devising the management plan of the
client.
Mental Status Examination
The client was wearing
clean clothes according to the environment and weather. He had no eye contact
with the therapist. He was not in a good mood. He cried during the session.
However, he produced a pleasant sound along with clapping on hearing poems. He
was not well aware of his surroundings. He was not listening to the guidelines
of the therapist. He showed reluctant and non-cooperative behaviour towards the
client. He was tapping his face with his hand repeatedly and lying down on the
floor.
Portage Guideline to Early Education
According to portage
guideline to early education, the client’s mental age was one year old;
however, chronologically he was four years old.
Preventions
Intellectual
disability can be prevented by providing early measure during pregnancy and
comprehensive parental care. The proper diet plan should be followed especially
during pregnancy period such as in the taking of folic acid reduces the risk of
intellectual disability of the child, by regularly updating immunization,
intake of multiple vitamins, genetic counselling and stopping the use of
abusive drugs. This can also be achieved by removing stress and tensions from
the environment to reduce the stress level of the mother. This can also be
prevented after pregnancy, by protecting children from injury or illness,
through childhood immunizations, by protecting them from poisoned or harmful
things and by newborn screening (Luckasson, Ford, McMillan, Misilo, &
Nygren, 2017).
Interventions
Following techniques
can be used to deal with individuals having intellectual disability (Ali,
Blickwedel, & Hassiotis, 2014):
Psychological Interventions
Psychological
interventions can be used for the treatment of intellectual disability; it will
help to modify the problematic behaviour and emotions.
Applied Behaviour Analysis
Applied behaviour
analysis can be used to modify the behaviour of the individual in a systematic
manner by applying psychological principles of learning theory and
motivation.
Positive Behaviour Support
Positive behaviour
support is a management system which will help to understand which factors are
involved in maintaining an individual’s problematic behaviour, based on the
results of the functional assessment.
Social Interventions
Support from others is
a very active way that can be used to treat people with intellectual
disability. Government and organizations are also involved in providing better
facilities to the people suffering from an intellectual disability.
Pharmacological Interventions
Pharmacological
interventions will be helpful for the treatment of intellectually disabled
individuals. Antipsychotics, as well as mood stabilizers, will be regularly
prescribed to the intellectually disabled individuals.