Definition

Intellectual disability, previously called mental retardation, is a limitation of intellectual abilities, skills, and adaptive behavior for living daily life. Their cognitive abilities and intelligence were found to be below average. Someone with an intellectual disability can learn new knowledge or skills, but it takes longer than others. The degree of severity of intellectual disability is divided into mild, moderate, severe, and very severe.

A person with intellectual disabilities experiences obstacles in 2 areas, namely:

• Intellectual function, measured as intellectual quotient (IQ), which refers to a person's ability to learn, reason, make decisions, and solve problems
• Adaptive behavior is the ability to carry out daily activities, communicate effectively, interact with others, and care for oneself.

IQ is denoted by numbers and measured by IQ tests. The average human has an IQ of 100 (85-115). A person is said to have an intellectual disability if they have an IQ below 70–75.

Intellectual disability affects 1% of the population. About 85% of people with intellectual disabilities have mild disabilities, meaning they take longer than the normal population to learn new information or learn new skills. With the right support, children can still live independently.

Causes

The condition is associated with impaired brain development, but the exact cause of intellectual disability varies from person to person. Intellectual disability can be caused by prenatal (pregnancy), perinatal (during delivery), and postnatal (after birth) factors. The most common cause of intellectual disability is genetic factors, around 45% of all cases.

Prenatal 

• Genetic syndromes such as Down syndrome and Fragile X syndrome
• Inborn errors in metabolism
• Disorders of brain formation such as microcephaly (baby's head size is smaller than usual)
• Medical conditions suffered by the mother, for example, the mother being malnourished, often smoking, preeclampsia
• Environmental factors such as alcohol, drugs, toxins, and teratogens

Perinatal

• Complications during childbirth or anoxia (deficient body oxygen levels) at birth
• The baby's birth age is premature, so the lungs are not yet fully mature, and the baby lacks oxygen at birth.

Postnatal 

• Medical conditions that cause hypoxemia (decreased oxygen levels in the blood)
• Head trauma
• Infection
• Recurrent seizures
• Severe malnutrition
• Toxic substance intoxication (such as lead or mercury)

Risk factor

Some risk factors associated with intellectual disability include:

• Infections that occur before or after birth, such as CMV or rubella infection during pregnancy
• family history of chromosomal abnormalities such as Down syndrome
• Metabolic factors such as phenylketonuria, where the body cannot change one type of amino acid in protein
• Nutritional factors (malnutrition)
• Experiencing physical trauma before or after birth

The environment functions as a provider of children's basic needs for growth and development. What is meant by a child's environment in the context of growth and development is the atmosphere in which the child is located. Children's basic needs for growth and development are divided into three parts, namely:

1. Physical-biological needs (ASUH) such as food to fulfill nutrition, health care (immunization, breast milk, simple medication), cleanliness and sanitation, play, and physical activity
2. Affection and emotional needs (ASIH): children need love through a close and harmonious relationship with their mother; love will help optimal physical, mental, and psychosocial growth and development.
3. Stimulation needed (ASAH). To obtain optimal development, children must be 'honed' through early stimulation activities to develop sensory, motor, emotional-social, speech, cognitive abilities, etc.

Symptoms

Generally, the more severe the intellectual disability, the sooner symptoms can be observed. Some of the symptoms include:

• Prone, crawling, walking slower than peers his age (motor delays)
• Delay in speaking or having difficulty speaking (language delay)
• Slowly learn simple things such as dressing, cleaning, and eating
• Difficulty remembering information
• Difficulty adopting social rules
• Difficulty seeing the consequences of a behavior
• Difficult to solve problems
• Difficulty adapting to new environments
• Get involved in various conflicts with friends or family
• Not interested in new things

Children with severe mental retardation will usually be accompanied by other health problems such as seizures, mood disorders (anxiety and autism), motor disorders, vision problems, or hearing problems.

Diagnosis

Based on the Guidelines for Classification and Diagnosis of Mental Disorders III (PPDGJ III), intellectual disabilities are diagnosed based on the level of intelligence (intelligence), clinical findings, adaptive behavior, and psychometric results. Based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), this diagnosis must be established before the child is 18. A definite diagnosis of intellectual disability must cover all abilities (global abilities) so that it creates obstacles in skills.

PPDGJ III also determines the extent of impairment experienced by children with mental retardation and classifies intellectual disabilities based on IQ tests, namely:

Mild mental retardation

Children experience language problems in this condition but can still master them for daily speaking. Generally, they can also care for themselves independently (eating, washing, wearing clothes, and controlling the digestive tract and bladder). However, their level of development could be faster than normal people. The main difficulty in mild mental retardation is in academic school work, and many have problems in reading and writing. Children's IQ ranges from 50–69 (85% of cases).

Moderate mental retardation

Children experience developmental delays in understanding and using language. The ability to care for themselves and their motor skills also experience delays; some require lifelong supervision. Children's IQ ranges from 35–49 (10% of cases).

Severe mental retardation

In severe mental retardation, children experience significant motor development disorders and neurological deficits (decreased nerve function). Children's IQs ranged from 20–34 (4% of cases).

 Very severe mental retardation.

Children have limited abilities to understand and obey requests and instructions/commands. Their mobility is generally minimal, and their IQ is less than 20 (1% of cases).

Tests to diagnose intellectual disability require additional tests to exclude other organic or structural causes. These examinations include chromosome analysis, urine examination, blood examination, and head imaging (neuroimaging). Chromosome analysis is usually performed during pregnancy. Urine and blood examinations function to evaluate enzyme activity and detect inborn errors of metabolism such as PKU, galactosemia, etc. Meanwhile, a CT scan or MRI examination serves to see the presence of microcephaly and cerebral palsy.

Management

Treatment for intellectual disability must begin as early as possible after the diagnosis is established to prevent worsening and control the symptoms of disability that arise.

Tips for Parents

• Looking for help and accurate information regarding your child's disability
• Join a community of parents of children with intellectual disabilities
• Be patient when teaching children new information or skills because children need a little more time to learn new things
• Continue to apply independence and responsibility to children
• Do group activities with other children, such as art classes, to teach social skills

Complications

The outcome of intellectual disability depends on the severity of the disability, other medical conditions, and compliance with therapy. Children with intellectual disabilities can remain productive and live independently. Parental support and therapy compliance greatly influence this.

Educational support. Health workers will meet with families and schools to make academic plans according to the child's condition. With a personalized plan, children can continue to learn at their own pace. These skills emphasize communication, vocational, social, self-care, and adaptive behavior abilities.

Behavioral intervention. Behavioral intervention functions to teach children about good habits and leave bad habits.

Vocational training can help young people with intellectual disabilities develop the skills to find work. Children will be supervised by a multidisciplinary team of social workers, therapists, teachers, counselors, and psychologists for vocational training.

Psychopharmacology. Medication is not the main component in the treatment of intellectual disability, but it can help treat comorbid conditions. Aggressive behavior often appears in children with intellectual disabilities, so medications such as antipsychotics can help control this behavior.

Treatment for other medical conditions such as attention deficit disorder and depression.

Prevention

Some causes of intellectual disability can be prevented, such as fetal alcohol syndrome, namely, not consuming alcohol during pregnancy. Routine and good pregnancy checks, taking prenatal vitamins, and getting vaccines for certain infections can reduce the risk of a child being born with intellectual disabilities.

If you have a family history of intellectual disability, you may want to seek genetic counseling before having children.

Intellectual disability issues can be detected through specific tests, including ultrasounds and amniocentesis, during pregnancy. Unfortunately, some of these causes cannot be resolved independently.

When to see a doctor?

If you suspect your child has an intellectual disability, observed developmental delays, or another medical condition, the first step you can take is to talk to a professional. A psychiatrist will carry out a thorough examination to diagnose this condition. Early detection and treatment can help prevent the progression of the condition. With that, you can help your child reach his potential.