What is an intellectual disability?
An intellectual disability means that the mental capabilities of those affected have not been fully formed or delayed. These are in particular the skills that shape human intelligence: Language, motor skills (= movement functions), social skills and cognition, i.e. all processes that affect thinking and perception.
Intellectual disability can occur in many different forms. Depending on their form, those affected can lead their lives alone and participate in social and professional life. In serious cases, this is not possible and people are completely dependent on assistance.
Intellectual disability can arise, for example, from genetic mutations, problems during pregnancy or childbirth, or as a result of a specific disease pattern. Usually, the impairments are already apparent in early childhood when children are delayed in or have incomplete developmental steps.
As part of the ICD-10 revision (ICD-11), the name of the intellectual disability will be replaced in the next few years.
What forms of intellectual disability are there?
A distinction is made between four severity levels of intelligence degradation:
Slight loss of intelligence
Those affected can lead their lives independently, take care of themselves and participate in professional and social life. They often have difficulties in school and are more likely to take up practical activities. They experience limitations, for example, in speaking and understanding, which is learned with a delay. Their intelligence quotient (IQ) is 50 to 69, which is the age of a nine- to twelve-year-old child.
Moderate loss of intelligence
There are significant developmental delays during childhood. Most people affected achieve a sufficient level of language skills and independence. However, they usually need help at times when living and working. Their intelligence quotient (IQ) is 35-49, which is the age of a six- to nine-year-old child.
Severe loss of intelligence
Language and motor skills are not sufficiently developed to lead an independent life. Those affected need ongoing and lifelong support. Their intelligence quotient (IQ) is 20-34, which is the age of a three- to six-year-old child.
Most severe loss of intelligence
Those affected are physically and linguistically limited to the maximum and hardly acquire any competence of their own. Since they are unable to identify their basic needs, they cannot provide themselves and are dependent on care. Their intelligence quotient is under 20, which is the age of a three-year-old or younger child.
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Intellectual disability occurs in mild to severe forms. The symptoms increase in their strength depending upon the degree of severity. Speech and understanding impairments are key symptoms. Furthermore, all areas of cognition are affected. That includes the abilities of the brain, such as orienting, planning, learning, remembering and imagining. This reduces the ability of those affected to act and makes it difficult for them to adapt to the demands of everyday life. The fact that they cannot cope with simple tasks can hinder their social development. Affected persons also often show passivity and a low tolerance for frustration.
The reduction of intelligence can lead to behavioural abnormalities and disorders that require treatment. Impaired impulse control, self-injury and aggressiveness are further symptoms.
How does a doctor know if there is a loss of intelligence?
The diagnosis is typically made in childhood. Deficits in cognition, language, motor skills and social skills are directly or less directly apparent depending on the severity of the loss of intelligence. The diagnosis is always confirmed by a so-called intelligence test, which determines the intelligence quotient (IQ). In addition to this instrument, doctors include the family and their medical history. A focus is therefore concentrated on influences before, during and after the birth of the person concerned.
Neurological studies are also performed, such as measuring brain activity using electroencephalography (EEG). Physical examinations are also performed. It is important that the loss of intelligence is differentiated from other mental illnesses or dementias.
In addition, psychotherapy has been regarded as a very valuable treatment option in recent years and is becoming more and more relevant for those affected.
Intellectual disabilities accompany those affected throughout their lives. Depending on their severity and characteristics, there are therapeutic measures that can improve their quality of life:
- Occupational therapy with regard to individual performance levels
- Sports and exercise therapy
- Physiotherapy exercises
- Social-therapeutic care, including the social environment
- Cognitive training depending on the extent of the loss of intelligence
- Supporting psychological conversations, provided that cognitive performance and communication skills are sufficient for this
- Stress tests in the current or new environment, including work tests in a workshop for disabled people
- Psychopharmacotherapy for pronounced behavioural abnormalities or accompanying mental disorders such as depressive syndromes
Most of the people affected depend on the support of their family in their daily lives as part of a reduction in their intelligence. This is a big, lifelong task for family members and often a full-time job. In order to have the necessary patience, perseverance and care, it is essential that family members pay attention to their limitations and do not take over. It is essential to make use of early offers of help that relieve family life and support relatives in the challenges they face. Visiting self-help groups helps many.
In the case of a loss of intelligence, the disorders of the brain are irreparable, so that it cannot be cured. Targeted training and training tailored to the individual needs of those affected can help to improve cognitive performance. These lead to an increase in the general mental abilities as well as stability of the acquired knowledge. Normal intelligence cannot be achieved despite these efforts.
The aim of therapy is to improve the existing skills as much as possible so that daily tasks can be partially or almost completely taken over by the person concerned.
The terms "intellectual disability" and "loss of intelligence" are often used interchangeably and refer to the same phenomenon. However, those affected no longer use the term "mental disability", because it is perceived as degrading and is not clearly defined.
An intellectual disability is often caused by genetic defects and mutations. In addition, problems before, during and after birth can lead to this, including from premature births or birth traumas. The use of drugs, medicines or alcohol during pregnancy is also a possible trigger. Other causes include brain defects in development and infections. In many cases, however, the exact cause is not known.
Unlike previously suspected, genetic defects that trigger intelligence reduction are rarely inherited by children from their parents. Rather, the mutations occur spontaneously in a large proportion of patients. New mutations arise after fertilization of the egg and are not anchored in the genome of the mother or father. In many cases, parents of a child with reduced intelligence do not have a significantly increased risk that their next child will be born with a corresponding impairment.
Intelligence is the brain's ability to learn and remember things, to adapt easily to new situations and to think abstractly. The intelligence of a person can be measured with special tests. The so-called intelligence quotient (IQ) is determined as a meaningful value.
An IQ of 85 to 115 is considered "normal intelligence". IQ in the range of 70 to 85 is below average; in this case, it is referred to as a learning disability. If the measured value is less than 70, it is an intellectual disability. This is divided into the four severity levels slightly (IQ from 69 to 50), moderately (IQ from 35 to 49), severely (IQ from 20 to 34) and most severe loss of intelligence (IQ under 20).