Care for children with intellectual disability

Intellectual disability is a condition, in which there is delay or deficiency in all aspects of development. This is the commonest form of developmental disability which manifests at early childhood, usually before the age of 18 years and it is a life long condition.
It is usually ascertained by Intelligence Quotient (IQ) assessment and assessment of adaptive functioning and behaviour in respect of areas such as, communication, self care, home living, social or interpersonal skills, use of community resources, self direction, functional academic skills, work, leisure, health and safety.
Intellectual disability is a condition of mutlifactorial origin. Combination of genetic and environmental factors like specific genetic syndromes, lower socio-economic class, malnutrition, poor living conditions are important risk factors. Besides, birth complications like birth injury, hypothyroidism (lack of thyroid hormone), infection, trauma and toxicity are the factors which are very relevant to the socio-cultural context in Bangladesh.
Children with intellectual disability usually face a lot of familial and social discrimination, negligence and humiliation. Surprisingly, the problem starts from his/her family. The parents and family members are ashamed of them and try to hide them from social gatherings. Very often they are placed in an inhuman condition, lack proper nutrition and fail to meet the basic demands of life.
The discriminations towards them are immense, especially to the female children. Occasionally, female children are sexually abused by their relatives and outsiders. Sometimes, criminals provoke and use them in different sorts of delinquent and subversive activities like stealing, arson and other destructive activities.
Early detection and interventions are vital to prevent intellectual disability among children and to enhance maximum functional outcome. It is established from national and international studies that birth complications are important risk factors for developing intellectual disabilities. So, healthcare services to detect and prevent this should be incorporated in the reproductive healthcare package, maternal and child healthcare (MCH) and emergency obstetric care (EOC) services.
The basic life skill training from the family level is to be applied so that they can achieve the skill such as eating, dressing, bathing toilet training and other personal care gradually. All the family members should share the responsibilities rather than over burden a single individual, especially the mother. It will promote a congenial environment for the children within the family and enhances family bondage.
The concerted efforts of person concerned such as psychiatrists, psychologists, paediatricians, occupational therapists, social workers, speech therapist, physiotherapists counsellor, volunteers, policymakers and other persons working in government and NGO level are needed for the best interest of the children with intellectual disability.
We have to work together to build up a better future for the children with intellectual disability so that they could lead socially and economically productive life with dignity and justice in the society.
The writer is a Mental Health Physician, Department of Psychiatry, DMCH. E-mail: [email protected]