Caring for People with Intellectual Disability: What Every Clinician Needs to Know

Steph, Hannah, thank you very much for joining us on Aussie Med Ed.

I'd like to start off by asking Hannah first up.

For a medical student or an intern who has only encountered this diagnosis in passing, what do we actually mean by intellectual disability? How do you determine severity, and roughly how common is it?

Thanks, Gavin.

Those are really great questions.

I'd like to kind of first start by acknowledging that there are people with lived experience of intellectual disability who may be listening in on their podcast and want to acknowledge them as well as their families and carers, and also recognize the valuable contributions that that make to Australia and global society.

So intellectual disability is not taught extensively in the undergraduate medical curriculum, so we, we use the DSM, DSM-V specifically when we make a diagnosis of intellectual disability.

This is often made by a psychologist or a psychiatrist.

And really there are kind of three main parts of the diagnosis.

The first is that there is a deficit in intellectual functioning, and that might be in a, in a domain such as reasoning and problem-solving, in planning, in abstract thinking.

The second is that there is a deficit in adaptive functioning.

So in terms of adaptive functioning, it would be how somebody copes with their everyday skills and how much they meet the standard that is expected of their personal independence, of their specific age, of their socioeconomic background, and also of their cultural background as well.

And the way we see that can come out in different areas.

It may be conceptually, it may be in the social skills, and it may be in practical skills.

And these deficits impact on daily function and also occur in multiple settings.

And the third, and I feel this is the bit that most people don't really, you know, quite understand in their medical education, is that the emergence of the intellectual disability needs to be in the developmental period.

And so that's any time between birth to kind of somewhere between the age of eighteen to twenty-five.

So this is distinct from having an acquired bra-brain injury.

So if somebody were to be in a motor vehicle accident at the age of thirty and they sustained a brain injury from that, that we wouldn't consider that to be an intellectual disability.

But if it was, say, a five-year-old child who was involved in a motor vehicle accident and sustained a brain injury, then we would consider that to be an intellectual disability So I hope that kind of answers the first question about what we mean by intellectual disability.

The second part of your question was about how we determine severity, and I think Steph will have some reflections here as well because this is her area of practice.

But we determine the severity no longer by somebody's IQ.

So this is, you know, how we used to be able to kind of classify somebody, whether it was mild, moderate, severe, or profound, but we actually use somebody's level of adaptive functioning, so essentially how much support they need to determine whether or not they are a mild intellectual disability or if they are moderate, severe, or profound.

And so it's the spectrum of needing very minimal support in order to independently function to needing twenty-four-hour care at the profound end of things.

In terms of how common it is, about one in fifty people.