This document provides information on intellectual and developmental disabilities (IDD). It defines a developmental disability as one that originates in childhood, is expected to continue indefinitely, and substantially limits major life activities. IDD can affect cognitive abilities, language, mobility, learning, self-care, and independent living. Examples of specific IDD include Down syndrome, fetal alcohol syndrome, autism, and intellectual disability. The document discusses causes, characteristics, and diagnostic criteria based on the DSM and ICD.

1. General guidelines for intellectual and
developmental disabilities

2. A developmental disability, according to the
Developmental Disabilities Assistance and Bill
of Rights Act, 2000; is defined as a severe,
chronic disability which:
*originated at birth or during childhood,
*is expected to continue indefinitely, and
*substantially restricts the individual's
functioning in several major life activities.
*and are likely to be lifelong

3. More specifically,
*mental or physical impairment or a combination of both
*is manifested before the person attains age 22
*results in substantial functional limitations in three or more
of the following areas of major life activity:
*self-care
*receptive and expressive language
*learning
*mobility
*self-direction
*capacity for independent living, and
*economic self-sufficiency;
*except that such term when applied to infants and young
children means individuals from birth to age five, inclusive,
who have substantial developmental delay or specific
congenital or acquired conditions with a high probability of
resulting in developmental disabilities if services are not
provided.

4. *
can occur before, during or after birth.
*before birth : genetic problems, poor prenatal care, or
exposure of the fetus to toxins including drugs and
alcohol.
*During birth :Difficulties during birth, restricted oxygen
supply to the infant or
*after birth :accidents after birth can also cause traumatic
brain injury resulting in developmental disabilities.
*Longer-term postnatal causes include malnutrition and
social deprivation.

5. *
Examples of developmental disabilities include:
* Behavior disorders
* Brain injury
* Cerebral palsy
* Down syndrome
* Fetal alcohol syndrome
* Intellectual disability
* Spina Bifida
* Physical defects /dysfunction or motor problems: poliomyelitis, cerebral palsy,
loss of limbs, motor neuron diseases, neuro muscular disorders, muscular
dystrophy
* Sensory deficits : partial or complete blindness, deafness
* Intelligence / cognitive deficits : mental retardation, slow learners
* Emotional disturbances
* Learning problems : dyslexia, dysgraphia, dyscalculia
* Speech and language disorders: articulation, voice pitch, loudness, rhythm
stuttering, expressing
* Pervasive developmental disorders :Autism, Asperger syndrome

6. *
Developmental Disabilities is an umbrella term that includes intellectual
disability but also includes other disabilities that are apparent during
childhood.
Intellectual disability encompasses the “cognitive” part of this definition,
that is, a disability that is broadly related to thought processes.
starts any time before a child turns 18 and is characterized by problems
with both:
>Intellectual functioning or intelligence: include the ability to learn,
reason, problem solve, and other skills; and
>Adaptive behavior: which includes everyday social and life skills.
"IDD" is the term often used to describe situations in which intellectual
disability and other disabilities are present.3
Because intellectual and other developmental disabilities often co-occur,
intellectual disability professionals often work with people who have both
types of disabilities.

7. *“An intellectual disability, formerly
referred to as “mental retardation”
*term used when a person has certain
limitations in mental functioning and skills
such as communicating, self care and social
skills.
*These limitations cause a child to learn and
develop more slowly than a typical child.
*Its severity is determined by the
discrepancy between the individual's
capabilities in learning and in and the
expectations of the social environment.
(Project IDEAL, 2008)
The Nature of Intellectual Disability

8. Severity of ID based on the levels
of intellectual functioning
• An intelligence quotient (IQ) is a total score derived from one
of several standardized tests designed to assess
human intelligence.
• Lewis M. Terman revised the Simon-Binet IQ Scale in 1916 and
published the Stanford Revision of the Binet-Simon Scale of
Intelligence (also known as the Stanford-Binet). The following
scale resulted for classifying IQ scores:
IQ Scale
Over 140 - Genius or almost genius
120 - 140 - Very superior intelligence
110 - 119 - Superior intelligence
90 - 109 - Average or normal intelligence
80 - 89 - Dullness
70 - 79 - Borderline deficiency in intelligence
Under 70 - Feeble-mindedness

9. *Low IQ & Mental Retardation
An IQ under 70 is considered as "mental retardation" or limited mental
ability. The severity of the mental retardation is commonly broken into 4
levels:
50-70 - Mild mental retardation (85%)
35-50 - Moderate mental retardation (10%)
20-35 - Severe mental retardation (4%)
IQ < 20 - Profound mental retardation (1%)
*High IQ & Genius IQ
Genius or near-genius IQ is considered to start around 140 to 145. Less
than 1/4 of 1 percent fall into this category. Here are some common
designations on the IQ scale:
115-124 - Above average
125-134 - Gifted
135-144 - Very gifted
145-164 - Genius
165-179 - High genius
180-200 - Highest genius

10. *“Significantly sub-average general intellectual
functioning, existing concurrently with deficits in
adaptive behavior and manifested during the
developmental period, that adversely affects a child’s
educational performance.”
IDEA (Individuals with Disabilities Education Act)
Definitions for Intellectual
Disability
*“Characterized by significant limitations both in
intellectual functioning and adaptive behavior,
which covers many everyday social and
practical skills. The disability originates before
the age of 18.”
AAIDD (American Association of Intellectual
and Developmental Disabilities, 2006)

11. Mental Retardation/ Intellectual
Disability in DSM – IV – TR is an Axis II
Disorder criteria that includes:
* Intelligence Test Scores
* Adaptive Functioning
* Age of Onset
(DSM-IV-TR, 2000)
The Nature of Intellectual Disability

12. Diagnostic and Statistical Manual of Mental
Disorders (DSM)
*published by American Psychiatric
Association (APA)
*offers a common language and standard criteria
for the classification of mental disorders
*relied upon, by clinicians,
researchers, psychiatric drug regulation
agencies, health insurance companies etc..
*The DSM is now in its fifth edition, DSM-5,
published on May 18, 2013.

13. *The International Statistical Classification of
Diseases and Related Health Problems(ICD),
produced by the (WHO) is the other commonly used
manual for mental disorders but distinguished from
the DSM in that it covers health as a whole
*While the DSM is the official diagnostic system for
mental disorders in the US, ICD is used more widely
in Europe and other parts of the world.
*All categories used in DSM -IV -TR are found in ICD
-10, but not all ICD-10 categories are in DSM-IV-TR

14. *
* Axis I Clinical disorders and other disorders
that may be a focus of clinical attention
*Axis II Personality disorders and mental
retardation
* Axis III General medical conditions
* Axis IV Psychosocial and environmental
problems
* Axis V Global Assessment of Functioning (GAF)
Scale

15. 15
*
Axis I

16. 16
*
Note Global Assessment for Axis V

17. Develop. dis
DSM IV: Disorders Usually First Diagnosed in
Infancy, Childhood or Adolescence
1. Mental Retardation (Coded on Axis II)
2. Learning Disorders
3. Motor Skills Disorder
4. Communication Disorders
5. Pervasive Developmental Disorders
6. Attention-Deficit and Disruptive Behavior Disorders
7. Feeding and Eating Disorders of Infancy or Early
Childhood
8. Tic Disorders
9. Elimination Disorders

18. 5. DSM IV Diagnostic Criteria for Pervasive
Developmental Disorders
childhood disintegrative disorder:
• Children with this rare condition begin their development
normally in all areas, physical and mental.
• At some point, usually between ages 2 and 10, a child
with this illness loses many of the skills he or she has
developed.
• In addition to the loss of social and language skills, a child
with disintegrative disorder may lose control of other
functions, including bowel and bladder control.

19. Rett syndrome :
• Children with this very rare disorder have the symptoms
associated with a PDD and also suffer problems with
physical development.
• generally suffer the loss of many motor or movement
skills -- such as walking and use of their hands -- and
develop poor coordination.
• This condition has been linked to a defect on the X
chromosome, so it almost always affects girls.
Pervasive development disorder, not otherwise specified
(PDD-NOS):
• referred to as a milder form of autism
• This category is used to refer to children who have
significant problems with communication and play, and
some difficulty interacting with others, but are too
social to be considered autistic.

20. 7. DSM IV Diagnostic Criteria for Feeding and Eating
Disorders of Infancy or Early Childhood
A. Feeding disturbance as manifested by persistent
failure to eat adequately with significant failure to
gain weight or significant loss of weight over at
least 1 month
B. The disturbance is not due to an associated
gastrointestinal or other general medical condition
(e.g., esophageal reflux)
C. The disturbance is not better accounted for by
another mental disorder (e.g., Rumination Disorder) or
by lack of available food

21. D. The onset is before age 6 years
• Pica
• Rumination Disorder
• Feeding Disorder of Infancy or Early
childhood

22. 8. Tic Disorders
*Tics are sudden twitches, movements, or sounds
that people do repeatedly.
*Tics that involve movements are called
motor tics and those that are sounds are called
vocal tics.
*People who have tics cannot stop their body from
doing these things. For example, a person with
a motor tic might keep blinking over and over
again. Or, a person with a vocal tic might make a
grunting sound unwillingly.

23. *common in children and may last for less than one year
*most notable tic disorder is Tourette’s syndrome, in
which both physical (eyes blink) and verbal tics (grunting,
coughing, throat clearing, swallowing, blowing, or sucking
sounds.)occur in the same individual, often at the same time.
*Transient tic disorder also involves both types of tics, but
they often occur individually.
* In 2013, the Diagnostic and Statistical Manual, 5th Edition
(DSM-5) renamed this disorder as provisional tic disorder

24. DSM IV Diagnostic Criteria for Tic Disorders
Tourette's Disorder
A. Both multiple motor and one or more vocal tics have been
present at some time during the illness, although not
necessarily concurrently. (A tic is a sudden, rapid, recurrent,
nonrhythmic, stereotyped motor movement or vocalization.)
B. The tics occur many times a day (usually in bouts) nearly
every day or intermittently throughout a period of more than 1
year, and during this period there was never a tic-free period
of more than 3 consecutive months.
C. The onset is before age 18 years.
D. The disturbance is not due to the direct physiological
effects of a substance (e.g., stimulants) or a general medical
condition (e.g., Huntington's disease or postviral
encephalitis).

25. There are two types :
• Encopresis is the repeated passing of
feces into places other than the toilet,
such as in underwear or on the floor.
This behavior may or may not be done
on purpose.
• Enuresis is the repeated passing of
urine in places other than the toilet.
9. Elimination Disorders

26. DSM IV Diagnostic Criteria for Other Disorders of
Infancy, Childhood or Adolescence
Other Disorders of Infancy, Childhood, or
Adolescence:
•Selective Mutism
• Separation Anxiety Disorder
• Reactive Attachment Disorder of Infancy or Early
Childhood
• Stereotypic Movement Disorder
• Disorder of Infancy, Childhood, or Adolescence NOS

27. •WHO Definition
“a condition of arrested or incomplete development of the mind, which
is especially characterized by impairment of skills manifested during
the developmental period, which contribute to the overall level of
intelligence, i.e., cognitive, language, motor, and social abilities”
•Core symptoms
– Low intellectual functioning IQ <70 (i.e., 2 SD below mean)
AND
– Impaired adaptive behavior
•Types: Mild ID (IQ 50-69), Moderate (IQ 35-49)
Severe (IQ 20-34), Profound (IQ 0-20)
*Borderline Intellectual Functioning

28. *Speech
*Perception
*Cognition
*Concentration
*Memory
*Emotion
*Movement
*Behavior

29. •Heterogeneous
•Mild ID: no specific cause in 40% of cases
–Genetic causes, injury, infections, poor nutrition
•Marked ID: specific cause found more often
–Genetic: Trisomy 21, Fragile X, single gene
disorders
–Prenatal: fetal alcohol syndrome, maternal
infection like HIV
–Perinatal: placental dysfunction, birth trauma,
septicemia, jaundice
–Postnatal: brain infection, head injury

30. PRENATAL
CAUSES
PERINATAL
CAUSES
POSTNATAL
CAUSES
1. Chromosomal
Disorders
2. Inborn Errors of
Metabolism
3. Developmental
Disorders of
Brain
Formation
4. Environmental
Influences
1. Anoxia
(complete deprivation of
oxygen)
2. Low birth weight
(LBW)
3. Syphilis and
herpes simplex
1. Biological
2. Psychosocial
3. Child Abuse and
Neglect
Classifications of Intellectual Disability

31. PRENATAL
CAUSES
1.

32. *affects many parts of the body and
range from relatively mild to severe.
*slow growth before and after birth
leading to:
• short stature
• intellectual disability (moderate
to severe)
• abnormalities of bones in the
arms, hands, and fingers.
• excessive body hair
(hypertrichosis)
• problems with the digestive tract Cornelia de
Lange
Syndrome

33. *distinctive facial features, including arched
eyebrows that often meet in the middle
(synophrys), long eyelashes, low-set ears,
small and widely spaced teeth, and a small
and upturned nose
*Some people with this condition are born
with an opening in the roof of the mouth
called a cleft palate.
*small head (microcephaly)
*behavior problems
*Involves heart defects
*hearing loss
*Manifest self-injurious behavior

34. *A piece of chromosome 5 is missing.
* Infants with this condition often have a
high-pitched cry that sounds like that of
a cat.
*delayed development, microcephaly, low
birth weight, and weak muscle tone
(hypotonia) in infancy.
*distinctive facial features, including
widely set eyes (hypertelorism), low-set
ears, a small jaw, and a rounded face.
*Some are born with a heart defect.
*Difficulty swallowing and sucking
*Hyperactive, aggressive, and repetitive
movements Cri-du-Chat
Syndrome

35. *Also referred to as Trisomy 21
*Usually not an inherited condition
*most common type of chromosomal
disorder
*Developmental: short stature, delayed
development, learning disability, or
speech delay in a child
*Cognitive: intellectual disability or
difficulty thinking and understanding
*Mouth: abnormally large tongue or
displacement of the tongue,
small mouth Down’s Syndrome

36. • Eyes: lazy eye or spots
• Distinctive facial features, such as a flat
face, small ears
• A short neck and short arms and legs.
• Low muscle tone and loose joints.
Muscle tone usually improves by late
childhood

38. *A genetic condition in which
a male is born with an extra
copy of the X chromosome
:XXY
* result of a random genetic
error after conception.
*Sterility in men
*Decreased IQ
*Poor coordination
*Skeletal abnormalities
*Poor coordinationa
Klinefelter’s
Syndrome

39. • have low testosterone and reduced muscle
mass, facial hair and body hair.
• attention deficit hyperactivity disorder
predominantly inattentive
• breast enlargement, delayed puberty, flaccid
muscles, low-set ears, osteoporosis, reduced
sex drive, or small penis

40. *caused especially by the
absence of certain genes
normally present on the copy of
chromosome 15 inherited from
the father
*learning difficulties
*growth abnormalities
*obsessive eating
*weak muscle tone (hypotonia)
Prader-Willi
Syndrome

41. *Beginning in childhood, affected individuals develop an
insatiable appetite, which leads to chronic overeating
(hyperphagia) and obesity.
*Sometimes obese also develop type 2 diabetes mellitus
*The leading genetic cause of obesity.
*At risk of developing a variety of other health problems: heart
defects, kidney problems, scoliosis, etc.
*Both affected males and females have underdeveloped genitals.
* Puberty is delayed or incomplete, and most affected individuals
are unable to have children (infertile).

42. * narrow forehead
*almond-shaped eyes,
*triangular mouth;
*short stature;
*small hands and feet.
*Some people with Prader-Willi syndrome have
unusually fair skin and light-colored hair.
*Significant externalizing behaviors (tantrums/
aggression/ passive aggression, etc

43. • genetic disorder associated with 3 major clinical
elements: overproduction of uric acid, neurologic
disability, and behavioral problems.
• occurs almost exclusively in males
• overproduction of uric acid :gouty arthritis (arthritis
caused by an accumulation of uric acid in the joints),
kidney and bladder stones.
• The neurologic disability include abnormal involuntary
muscle movements, such as tensing of various muscles
(dystonia), jerking movements (chorea), and flailing
of the limbs (ballismus).
Lesch-Nyhan Disease

44. • behavioral problems include intellectual
disability (mental retardation) and aggressive
and impulsive behaviors.
• usually cannot walk, require assistance sitting,
and generally use a wheelchair.
• Self-injury (including biting and head banging) is
the most common and distinctive behavioral
problem in individuals with Lesch-Nyhan
syndrome.

45. *
*an inherited condition Associated with X
chromosome in the 23rd pair of chromosomes
that is abnormally susceptible to damage,
especially by folic acid deficiency.
*Usually, males are more severely affected
*causes a range of developmental problems
including learning disabilities and cognitive
impairment.
*Children affected have anxiety and hyperactive
behavior such as fidgeting or impulsive actions,
attention deficit disorder (ADD)

46. *About one-third of individuals
with fragile X syndrome have
features of autism spectrum
disorders that affect
communication and social
interaction
*prominent jaws
*macro-orchidism (large testes)
*long and thin faces
*long and soft ears and hands
*enlarged heads

47. *Results from the absence of one of
the X chromosomes (XO) in females
*Usually results in learning disability
– not mental retardation
*Common problems are in spatial
relations, mathematics, memory,
attention, and social competence
*Physical development includes lack
of secondary sex characteristics,
sterility, and short stature
*webbing of the neck, puffiness or
swelling of the hands and feet
*Associated with heart defects and
kidney problems
Turner’s
Syndrome

48. *Caused by the absence of
material on the seventh pair of
chromosome.
*“elfin” facial features.
*Their unusual sensitivity to
sound makes them competent in
music and language despite of
their low IQ level.
*Identified medical concerns
including cardiac, digestive, and
feeding difficulties
William’s
Syndrome

49. *Wide range of IQ, but most have Mild Mental Retardation to
Borderline Intellectual Functioning
*Overly friendly in their interactions
*Highly anxious
*Well-developed vocabulary but difficulty with reciprocal
conversation
*An ability to learn to read over time and with strength in phonics-
based spelling
*Limited visual-spatial development and poor visual-motor skills
(e.g., handwriting problems)
*Limited mathematical and numerical knowledge

50. PRENATAL
CAUSES
2.

51. *Galactosemia - inability of
the body to use simple
sugar galactose
*Hunter Syndrome –
defective breakdown of
chemical
mucopolysaccharide.
*Phenylketonuria (PKU) –
inability of the body to
convert phenylalanine to
tyrosine
*Tay-Sachs Disease –
absence of Hex-A enzyme.
Can be prevented through an early
detection (e.g. newborn screening)
and can be treated by providing a
special diet program.

52. PRENATAL CAUSES
3.

53. *microcephaly usually is the
result of the brain
developing abnormally in
the womb or not growing as
it should after birth.
*The intellectual disability
usually ranges from severe
to profound.
*There is no specific
treatment and life
expectancy is low.
Microcephalus

54. *
*Craniosynostosis. The premature fusing of the joints (sutures)
between the bony plates that form an infant's skull keeps the
brain from growing..
*Chromosomal abnormalities. Down syndrome
*Decreased oxygen to the fetal brain (cerebral anoxia).
* Infections of the fetus during pregnancy. German measles
(rubella), chickenpox (varicella) etc
*Exposure to drugs, alcohol or certain toxic chemicals in the
womb.
*Severe malnutrition
*Uncontrolled phenylketonuria (fen-ul-kee-toe-NU-ree-uh),
also known as PKU, in the mother. PKU is a birth defect that
hampers the body's ability to break down the amino acid
phenylalanine.

55. *Results from an
accumulation of
cerebrospinal fluid
inside or outside the
brain.
*water on the brain.
*The degree of
intellectual disability
depends on how early
the condition is
diagnosed and
treated. Hydrocephalus
(Hallahan & Kauffman,2003)

56. Causes:
• blockage develops that prevents CSF from
flowing normally
• there is a decrease in the ability of blood
vessels to absorb it
• brain produces an excess amount of it
• Too much of this fluid puts your brain under
too much pressure causing brain swelling,
which can damage your brain tis

57. Underlying Causes
starts before a baby is born. This can result from:
• a birth defect in which the spinal column doesn’t close
a genetic abnormality
• certain infections that occur during pregnancy, such as
rubella
This condition can also occur in infants, toddlers, and
older children due to:
• central nervous system infections such as meningitis,
especially in babies
• bleeding in the brain during or shortly after delivery,
especially in babies born prematurely
• injuries that occur before, during, or after delivery
• head trauma
• central nervous system tumors

58. PRENATAL
CAUSES
4.

59. *Maternal Malnutrition and
Infection
*Fetal Alcohol Syndrome
(FAS)
*Lead exposure
*Illicit drug exposure
*Exposure to Radiation
*Rubella (German measles)
(Hallahan & Kauffman,2003) (Piearangelo & Giuliani, 2007)

60. PERINATAL
CAUSES

61. *Anoxia (deprivation
of oxygen)
*Low birth weight
(LBW)
*Syphilis and herpes
simplex
PERINATAL CAUSES
(Hallahan & Kauffman,2003)

62. POSTNATAL CAUSES
1.Environmental
and Psychosocial
Problems

63. *Nutritional Problems
*Adverse living conditions
*Inadequate health care
*Lack of early cognitive
stimulation
*Child abuse and neglect
*Traumatic Brain Injury
*Meningitis or Encephalitis
*Lead Poisoning

64. *
I. Persons with developmental disabilities have a right to appropriate treatment,
services and habilitation for such disabilities.
II. The Federal Government and the States both have an obligation to assure that public
funds are not provided to any institutional or other residential programs for persons with
developmental disabilities that—
A. Does not provide treatment services, and habilitation which is appropriate
to the needs to such persons or
B. Does not meet the following minimum standards:
1. Provision of a nourishing, well-balanced daily diet to the persons with developmental
disabilities served by the program
2. Provision to such persons of appropriate and sufficient medical and dental services
3. Prohibition of the use of physical restraint on such persons unless absolutely
necessary and prohibition of the use of such restraint a punishment or a s a
substitute for a habilitation program
4. Prohibition on the excessive use of chemical restraints on such persons and the use of
such restraints as punishment or as a substitute for a habilitation program or in
quantities that interfere with services, treatment, or habilitation for such persons.
5.Permission for close relatives of such persons to visit them at reasonable hours without
prior notice
6. Compliance with adequate fire and safety standards as may be promulgated by the
Secretary of Health, Education, & Welfare.

65. *
Purposes:
I. to provide a clear and comprehensive national mandate for the elimination of discrimination
against individuals with disabilities;
II to provide clear, strong, consistent enforceable standards addressing
discrimination against individuals with disabilities;
III. to ensure that the Federal Government plays a central role in enforcing the
standards established in this Act on behalf of individuals with disabilities;
IV. to invoke the sweep of congressional authority, including the power to
enforce the Fourteenth Amendment and to regulate commerce, in order to
address the major areas of discrimination faced day to day by people with
disabilities

66. *
Acceptance of ideas has little to do with their intrinsic value. Community-oriented reforms did not
succeed in the past for the following reasons:
1. A shortage of manpower to implement programs, which in part
reflects inadequate training facilities.
2. A shortage of resources associated with the low priority accorded
the mentally ill by the public and their legislators.
3. Theories concerning the etiology and treatment of mental disorder favored
exciting new ideas and fads. At the turn of the century, the intellectual and
scientific community was buzzing with new ideas in neuropathology and
psychoanalysis. Optimistic treatment modalities linking patients back to their
home communities were considered unrealistic and "old-fashioned.“
4. The naivete and lack of understanding of psychiatrists about problems of
community dynamics that complicated the implementation of their programs.
Theories of psychic functioning cannot be formulated in a vacuum. Factors in
the social, political, economic, and scientific milieu affect the manner in
which theories are developed as well as the success of their implementation.

67. *
Acceptance of ideas has little to do with their intrinsic value. Community-oriented reforms did not
succeed in the past for the following reasons:
5. The tendency of psychiatrists to embrace panaceas and to hail each
change as the solution to all difficulties. The system was oversold to
the public and to fellow professionals. When shortcomings were
revealed, there was a pendulum swing in the opposite direction with
the entire system being jettisoned.
6. When public complaints about the failure of optimistic promises
started to surface, psychiatrists tended to deal with such outside
pressure by evasion rather than by direct confrontation. Psychiatrists
retreated into their professional guild and lost touch with the realities
of community life.
7. Faddish theories were entirely untested. By the time the
shortcomings of expensive plans had been realized, so much
propaganda and money had been spent that it was difficult to abandon