Intellectual Disability (Early childhood–17 years) • Intellectual Disability/Intellectual Developmental Disorder • Global Developmental Delay (prior to age five) • Older terminology: Mental retardation, Static encephalopathy • Severity: Mild, Moderate, Severe, Profound CLINICAL PEARLS • Intellectual disability (ID) requires an individual to have deficits in both intellectual and adaptive functioning (conceptual, social, and practical domains) prior to age 18.3 • Behavioral issues such as aggression, property destruction, self- injurious behavior, or verbal outbursts can occur in individuals with ID. These behaviors are often the primary reason children with ID present for behavioral health treatment. • Challenging behaviors can be driven by medical problems, behavioral health disorders, and/ or response to the environment. As such, these behavioral problems warrant interdisciplinary assessment and treatment. • Nearly all behavioral health disorders can be observed in children and adolescents with ID, with stability of diagnoses through adulthood. Diagnosis can be challenging due to limitations in ability to self-report internal experiences. Disorders often go undiagnosed and untreated. • Assessment often relies on behavioral observation with inferences about underlying meaning. Using information about change from baseline behavior can be an effective approach.13 Standardized rating scales used to assess and monitor behavioral conditions in children without ID (e.g. ADHD, anxiety, depression) can be helpful tools, although they often have not been validated in children with ID and warrant careful interpretation. ASSESSMENT AND TREATMENT OF CORE SYMPTOMS IN INDIVIDUALS WITH INTELLECTUAL DISABILITY Step 1: Confirm and classify diagnosis of ID with neuropsychological testing to assess intelligence (IQ), adaptive functioning, and system of supports for the individual.4 Step 2: Obtain a medical evaluation including assessment for potential causes of ID (genetics, metabolic disorders, prenatal exposures) and associated medical illnesses. Genetic testing can identify congenital syndromes with specific “neurobehavioral phenotypes” and associated medical conditions to monitor for throughout the child’s development.11 Step 3: Early interventions should be in place including appropriate educational placement and supports (Individualized Education Program), family support, and ancillary therapies (speech, occupational, and physical therapy).
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