APPROACH TO INTELLECTUAL DISABILITY

Definitions:

• ADAPTIVE FUNCTIONING TESTS: Psychological assessments that measure social, communication, daily living, and community functioning skills. A collat­eral source who knows the patient well is required to answer questions needed to complete the assessment. Some of these skills can be measured with the Vineland Social Maturity Scale, a commonly used test.

• DOWN SYNDROME: Trisomy 21, which is associated with hypotonia, language and motor developmental delay, and typical facial features. It is the most common cause of moderate to severe intellectual disability in the United States.

• FRAGILE X SYNDROME: The second most common cause of intellectual dis­ability in the United States, resulting from a mutation at the Xq27.3 locus. Males generally have moderate to severe intellectual disability, while female carriers are less severely affected.

• INTELLIGENCE TESTS: Psychological assessments that measure intellectual capacity. The results of these tests vary based on educational attainment. The most commonly used tests include the Wechsler scales (the Wechsler Preschool and Pri­mary Scale of Intelligence, the Wechsler Intelligence Scale for Children, and the Wechsler Adult Intelligence Scale) and the Stanford-Binet Scale.

Pathophysiology:
Intellectual Disability results from diverse etiologies, including genetic disorders (e.g., Down Syndrome, Fragile X), prenatal factors (e.g., fetal alcohol exposure), perinatal complications (e.g., prematurity, birth asphyxia), and environmental influences (e.g., lead exposure, early neglect). Neurodevelopmental delays affect cognitive processing, problem-solving, and adaptive behavior.

Treatment:

• Early intervention: Speech, occupational, and educational therapy.
• Educational support: Individualized Education Plan (IEP) with specialized instruction.
• Behavioral therapy: Reinforces social skills, emotional regulation, and daily living tasks.
• Medication: Used for comorbid conditions like ADHD or anxiety if present.
• Parental support and training: Helps caregivers provide structured support at home.

Comorbidities:
Commonly associated with ADHD, autism spectrum disorder, anxiety, and mood disorders. Regular screening is essential for managing coexisting conditions.

CASE CORRELATION

• Autism Spectrum Disorder (similar adaptive and social challenges)
•  Major Neurocognitive Disorder (differential diagnosis in adults)