PE27.9 | Intellectual Disability — Summary & Reflection

KEY TAKEAWAYS

Intellectual disability is a neurodevelopmental disorder defined by the DSM-5 as significant deficits in BOTH intellectual functions AND adaptive behaviour, with onset in the developmental period (before 18 years). Severity is classified by adaptive functioning — not IQ alone — into mild, moderate, severe, and profound categories. Aetiology is heterogeneous: genetic/chromosomal (Down syndrome, Fragile X, metabolic disorders such as PKU and hypothyroidism), prenatal environmental (TORCH, alcohol, iodine deficiency), perinatal (birth asphyxia, prematurity, kernicterus), and postnatal (meningitis, lead, severe deprivation). Assessment requires a detailed developmental history, standardised assessment (DASII, Vineland Adaptive Behaviour Scales, BKT), directed investigations, and formal psychometric testing. Management is multidisciplinary: treat the underlying cause where possible (thyroxine for hypothyroidism, dietary restriction for PKU), initiate early intervention before age 5 (physiotherapy, OT, SLT, special education), manage comorbidities (epilepsy, psychiatric disorders, sensory impairments), and provide family counselling including genetic guidance and legal entitlement information under the RPWD Act 2016.

REFLECT

Think about a child you have encountered (or imagine one from today's case vignette) with intellectual disability. Reflect on the following: How did the family initially respond to the diagnosis? What barriers — financial, social, geographic — might have delayed diagnosis or access to intervention in the Indian context? What role can the primary care physician play in early identification and referral, even without access to a tertiary centre? How would your communication with the family change knowing that early intervention before age 5 is the single most impactful window? Write a brief note on what you would do differently in a resource-limited rural setting versus an urban tertiary centre.