Intellectual disability

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Intellectual disability
Other namesIntellectual developmental disability (IDD), general learning disability[1]
A child runs through the finishing line
Children with intellectual disabilities and other developmental conditions competing in the Special Olympics World Games
SpecialtyPsychiatry, pediatrics
Differential diagnosisAutism, ADHD, down syndrome, Fragile X, Fetal alcohol spectrum disorder, learning disability
Frequency153 million (2015)[2]

Intellectual disability (ID), also known as general learning disability in the United Kingdom

adaptive functioning. It is defined by an IQ under 70, in addition to deficits in two or more adaptive behaviors that affect everyday, general living. Intellectual functions are defined under the DSM-5 as reasoning, problem‑solving, planning, abstract thinking, judgment, academic learning, and learning from instruction and experience, and practical understanding confirmed by both clinical assessment and standardized tests. Adaptive behavior is defined in terms of conceptual, social, and practical skills involving tasks performed by people in their everyday lives.[6]

Intellectual disability is subdivided into syndromic intellectual disability, in which intellectual deficits associated with other medical and behavioral signs and symptoms are present, and non-syndromic intellectual disability, in which intellectual deficits appear without other abnormalities.[7] Down syndrome and fragile X syndrome are examples of syndromic intellectual disabilities.

Intellectual disability affects about 2 to 3% of the general population.

idiopathic cases account for 30 to 50% of these cases.[8] About a quarter of cases are caused by a genetic disorder,[8] and about 5% of cases are inherited.[9] Cases of unknown cause affect about 95 million people as of 2013.[10]

Signs and symptoms

Intellectual disability (ID) becomes apparent during childhood and involves deficits in mental abilities, social skills, and core activities of daily living (ADLs) when compared to same-aged peers.[11] There often are no physical signs of mild forms of ID, although there may be characteristic physical traits when it is associated with a genetic disorder (e.g., Down syndrome).[12]

The level of impairment ranges in severity for each person. Some of the early signs can include:[12]

  • Delays in reaching, or failure to achieve milestones in motor skills development (sitting, crawling, walking)
  • Slowness learning to talk, or continued difficulties with speech and language skills after starting to talk
  • Difficulty with self-help and self-care skills (e.g., getting dressed, washing, and feeding themselves)
  • Poor planning or problem-solving abilities
  • Behavioral and social problems[13]
  • Failure to grow intellectually, or continued infant childlike behavior
  • Problems keeping up in school
  • Failure to adapt or adjust to new situations
  • Difficulty understanding and following social rules[11]

In early childhood, mild ID (IQ 50–69) may not be obvious or identified until children begin school.

specific learning disability or emotional/behavioral disorders. People with mild ID are capable of learning reading and mathematics skills to approximately the level of a typical child aged nine to twelve. They can learn self-care and practical skills, such as cooking or using the local mass transit system. As individuals with intellectual disabilities reach adulthood, many learn to live independently and maintain gainful employment.[8][15]
About 85% of persons with ID are likely to have mild ID.

Moderate ID (IQ 35–49) is nearly always apparent within the first years of life. Speech delays are particularly common signs of moderate ID. People with moderate intellectual disabilities need considerable support in school, at home, and in the community in order to fully participate. While their academic potential is limited, they can learn simple health and safety skills and to participate in simple activities. As adults, they may live with their parents, in a supportive group home, or even semi-independently with significant supportive services to help them, for example, manage their finances. As adults, they may work in a sheltered workshop.[8] About 10% of persons with ID are likely to have moderate ID.

People with Severe ID (IQ 20–34), accounting for 3.5% of persons with ID, or Profound ID (IQ 19 or below), accounting for 1.5% of persons with ID, need more intensive support and supervision for their entire lives. They may learn some ADLs, but an intellectual disability is considered severe or profound when individuals are unable to independently care for themselves without ongoing significant assistance from a caregiver throughout adulthood.[8] Individuals with profound ID are completely dependent on others for all ADLs and to maintain their physical health and safety. They may be able to learn to participate in some of these activities to a limited degree.[12]

Co-morbidity

Autism and intellectual disability

Intellectual disability and

autism spectrum disorder (ASD) share clinical characteristics which can result in confusion while diagnosing.[16] Overlapping these two disorders, while common, can be detrimental to a person's well-being. Those with ASD that hold symptoms of ID may be grouped into a co-diagnosis in which they are receiving treatment for a disorder they do not have. Likewise, those with ID that are mistaken to have ASD may be treated for symptoms of a disorder they do not have. Differentiating between these two disorders will allow clinicians to deliver or prescribe the appropriate treatments. Comorbidity between ID and ASD is very common; it was estimated that roughly 40% of those with ID also have ASD, and roughly 70% of those with ASD also have ID.[17] More recently, research has indicated a prevalence of roughly 30% for ID in individuals with ASD.[18][19][20][21] Both ASD and ID require shortfalls in communication and social awareness as defining criteria.[16]

Defining differences

In a study conducted in 2016 surveying 2816 cases, it was found that the top subsets that help differentiate between those with ID and ASD are, "impaired non-verbal social behavior and lack of social reciprocity, [...] restricted interests, strict adherence to routines, stereotyped and repetitive motor mannerisms, and preoccupation with parts of objects".[16] Those with ASD tend to show more deficits in non-verbal social behavior such as body language and understanding social cues. In a study done in 2008 of 336 individuals with varying levels of ID, it was found that those with ID display fewer instances of repetitive or ritualistic behaviors. It also recognized that those with ASD, when compared to those with ID, were more likely to isolate themselves and make less eye contact.[22] When it comes to classification ID and ASD have very different guidelines. ID has a standardized assessment called the Supports Intensity Scale (SIS); this measures severity on a system built around how much support an individual will need. While ASD also classifies severity by support needed, there is no standard assessment; clinicians are free to diagnose severity at their own judgment.[23]

Causes

An eight-year-old boy
Down syndrome is the most common genetic cause of intellectual disability.

Among children, the cause of intellectual disability is unknown for one-third to one-half of cases.[8] About 5% of cases are inherited.[9] Genetic defects that cause intellectual disability, but are not inherited, can be caused by accidents or mutations in genetic development. Examples of such accidents are development of an extra chromosome 18 (trisomy 18) and Down syndrome, which is the most common genetic cause.[9] DiGeorge syndrome and fetal alcohol spectrum disorders are the two next most common causes.[8] However, there are many other causes. The most common are:

  • XXXXY, or 49, XYYYY. 47, XYY is not associated with significantly lowered IQ though affected individuals may have slightly lower IQs than non-affected siblings on average.[28][29]
  • Problems during pregnancy. Intellectual disability can result when the fetus does not develop properly. For example, there may be a problem with the way the fetus's cells divide as it grows. A pregnant woman who drinks alcohol (see fetal alcohol spectrum disorder) or gets an infection like rubella during pregnancy may also have a baby with an intellectual disability.
  • Problems at birth. If a baby has problems during labor and birth, such as not getting enough oxygen, they may have a developmental disability due to brain damage.
  • The group of proteins known as histones have an essential part in gene regulation, and sometimes these proteins become modified and are prevented from working properly. When the genes responsible for the development of neurons are affected, it affects the brain and behavior in the individual.[30]
  • Exposure to certain types of
    toxins. Diseases like whooping cough, measles, or meningitis can cause intellectual disability if medical care is delayed or inadequate. Exposure to poisons like lead or mercury
    may also affect mental ability.
  • salt iodization programs. But, as of 2006, Russia had not.[31]
  • Malnutrition is a common cause of reduced intelligence in parts of the world affected by famine, such as Ethiopia and nations struggling with extended periods of warfare that disrupt agriculture production and distribution.[32]
  • Absence of the arcuate fasciculus.[33]

Diagnosis

According to both the

interpersonal skills, and more), and evidence that the limitations became apparent in childhood or adolescence. In general, people with intellectual disabilities have an IQ below 70, but clinical discretion may be necessary for individuals who have a somewhat higher IQ but severe impairment in adaptive functioning.[12]

It is formally diagnosed by an assessment of IQ and adaptive behavior. A third condition requiring onset during the developmental period is used to distinguish intellectual disability from other conditions, such as

).

Intelligence quotient

The first English-language IQ test, the Stanford–Binet Intelligence Scales, was adapted from a test battery designed for school placement by Alfred Binet in France. Lewis Terman adapted Binet's test and promoted it as a test measuring "general intelligence". Terman's test was the first widely used mental test to report scores in "intelligence quotient" form ("mental age" divided by chronological age, multiplied by 100). Current tests are scored in "deviation IQ" form, with a performance level by a test-taker two standard deviations below the median score for the test-takers age group defined as IQ 70. Until the most recent revision of diagnostic standards, an IQ of 70 or below was a primary factor for intellectual disability diagnosis, and IQ scores were used to categorize degrees of intellectual disability.

Since the current diagnosis of intellectual disability is not based on IQ scores alone, but must also take into consideration a person's adaptive functioning, the diagnosis is not made rigidly. It encompasses intellectual scores, adaptive functioning scores from an adaptive behavior rating scale based on descriptions of known abilities provided by someone familiar with the person, and also the observations of the assessment examiner, who is able to find out directly from the person what they can understand, communicate, and such like. IQ assessment must be based on a current test. This enables a diagnosis to avoid the pitfall of the Flynn effect, which is a consequence of changes in population IQ test performance changing IQ test norms over time.

Distinction from other disabilities

congenital medical conditions that have no mental or intellectual components, although it, too, is sometimes used as a euphemism for intellectual disability.[36]

Limitations in more than one area

Adaptive behavior, or adaptive functioning, refers to the skills needed to live independently (or at the minimally acceptable level for age). To assess adaptive behavior, professionals compare the functional abilities of a child to those of other children of similar age. To measure adaptive behavior, professionals use structured interviews, with which they systematically elicit information about persons' functioning in the community from people who know them well. There are many adaptive behavior scales, and accurate assessment of the quality of someone's adaptive behavior requires clinical judgment as well. Certain skills are important to adaptive behavior, such as:

Other specific skills can be critical to an individual's inclusion in the community and to develop appropriate social behaviors, as for example being aware of the different social expectations linked to the principal lifespan stages (i.e., childhood, adulthood, old age). The results of a Swiss study suggest that the performance of adults with ID in recognizing different lifespan stages is related to specific cognitive abilities and to the type of material used to test this performance.[37]

Management

By most definitions, intellectual disability is more accurately considered a disability rather than a disease. Intellectual disability can be distinguished in many ways from

depression. Currently, there is no "cure" for an established disability, though with appropriate support and teaching, most individuals can learn to do many things. Causes, such as congenital hypothyroidism, if detected early may be treated to prevent the development of an intellectual disability.[38]

There are thousands of agencies around the world that provide assistance for people with developmental disabilities. They include state-run, for-profit, and non-profit, privately run agencies. Within one agency there could be departments that include fully staffed residential homes, day rehabilitation programs that approximate schools, workshops wherein people with disabilities can obtain jobs, programs that assist people with developmental disabilities in obtaining jobs in the community, programs that provide support for people with developmental disabilities who have their own apartments, programs that assist them with raising their children, and many more. There are also many agencies and programs for parents of children with developmental disabilities.

Beyond that, there are specific programs that people with developmental disabilities can take part in wherein they learn basic life skills. These "goals" may take a much longer amount of time for them to accomplish, but the ultimate goal is independence. This may be anything from independence in tooth brushing to an independent residence. People with developmental disabilities learn throughout their lives and can obtain many new skills even late in life with the help of their families, caregivers, clinicians and the people who coordinate the efforts of all of these people.

There are four broad areas of intervention that allow for active participation from caregivers, community members, clinicians, and of course, the individual(s) with an intellectual disability. These include psychosocial treatments, behavioral treatments, cognitive-behavioral treatments, and family-oriented strategies.[39] Psychosocial treatments are intended primarily for children before and during the preschool years as this is the optimum time for intervention.[40] This early intervention should include encouragement of exploration, mentoring in basic skills, celebration of developmental advances, guided rehearsal and extension of newly acquired skills, protection from harmful displays of disapproval, teasing, or punishment, and exposure to a rich and responsive language environment.[41] A great example of a successful intervention is the Carolina Abecedarian Project that was conducted with over 100 children from low socioeconomic status families beginning in infancy through pre-school years. Results indicated that by age 2, the children provided the intervention had higher test scores than control group children, and they remained approximately 5 points higher 10 years after the end of the program. By young adulthood, children from the intervention group had better educational attainment, employment opportunities, and fewer behavioral problems than their control-group counterparts.[42]

Core components of behavioral treatments include language and social skills acquisition. Typically, one-to-one training is offered in which a therapist uses a shaping procedure in combination with positive reinforcements to help the child pronounce syllables until words are completed. Sometimes involving pictures and visual aids, therapists aim at improving speech capacity so that short sentences about important daily tasks (e.g. bathroom use, eating, etc.) can be effectively communicated by the child.

phonological awareness, word reading, decoding, expressive and receptive language skills, and reading fluency were noted when these elements were part of the teaching intervention.[49]

Although there is no specific medication for intellectual disability, many people with developmental disabilities have further medical complications and may be prescribed several medications. For example, autistic children with developmental delay may be prescribed

benzodiazepines in people with intellectual disability requires monitoring and vigilance as side effects occur commonly and are often misdiagnosed as behavioral and psychiatric problems.[50]

Epidemiology

Intellectual disability affects about 2–3% of the general population. 75–90% of the affected people have mild intellectual disability. Non-syndromic or

idiopathic ID accounts for 30–50% of cases. About a quarter of cases are caused by a genetic disorder.[8] Cases of unknown cause affect about 95 million people as of 2013.[10] It is more common in males and in low to middle income countries.[38]

History

Intellectual disability has been documented under a variety of names throughout history. Throughout much of human history, society was unkind to those with any type of disability, and people with intellectual disability were commonly viewed as burdens on their families.

four humors in the brain. In ancient Rome people with intellectual disabilities had limited rights and were generally looked down upon.[51] They were considered property and could be kept slaves by their father.[52] These people could also not marry, hold office, or raise children. Many of them were killed early in the childhood, and then dumped into the Tiber in order to avoid them burdening society.[53] However, they were exempt from their crimes under Roman law,[54][55] and they were also used to perform menial labor.[56][57]

Caliph Al-Walid (r. 705–715) built one of the first care homes for individuals with intellectual disabilities and built the first hospital which accommodated intellectually disabled individuals as part of its services. In addition, Al-Walid assigned each intellectually disabled individual a caregiver.[58]

Until the Enlightenment in Europe, care and asylum was provided by families and the church (in monasteries and other religious communities), focusing on the provision of basic physical needs such as food, shelter, and clothing. Negative stereotypes were prominent in social attitudes of the time.

In the 13th century, England declared people with intellectual disabilities to be incapable of making decisions or managing their affairs.

Guardianships
were created to take over their financial affairs.

In the 17th century, Thomas Willis provided the first description of intellectual disability as a disease.[56] He believed that it was caused by structural problems in the brain. According to Willis, the anatomical problems could be either an inborn condition or acquired later in life.

In the 18th and 19th centuries, housing and care moved away from families and towards an

Cape Town, South Africa shows the distribution between different facilities. Out of 2046 persons surveyed, 1,281 were in private dwellings, 120 in jails, and 645 in asylums, with men representing nearly two-thirds of the number surveyed. In situations of scarcity of accommodation, preference was given to white men and Black men (whose insanity threatened white society by disrupting employment relations and the taboo sexual contact with white women).[59]

In the late 19th century, in response to Charles Darwin's

Holocaust
. Eugenics was later abandoned as an violation of human rights, and the practice of forced sterilization and prohibition from marriage was discontinued by most of the developed world by the mid-20th century.

In 1905, Alfred Binet produced the first standardized test for measuring intelligence in children.[56]

Although ancient Roman law had declared people with intellectual disability to be incapable of the deliberate intent to harm that was necessary for a person to commit a crime, during the 1920s, Western society believed they were morally degenerate.[56]

Ignoring the prevailing attitude,

deviant
, sub-human and burdens of charity, resulting in the adoption of that "deviant" role. Wolfensberger argued that this dehumanization, and the segregated institutions that result from it, ignored the potential productive contributions that all people can make to society. He pushed for a shift in policy and practice that recognized the human needs of those with intellectual disability and provided the same basic human rights as for the rest of the population.

The publication of this book may be regarded as the first move towards the widespread adoption of the social model of disability in regard to these types of disabilities, and was the impetus for the development of government strategies for desegregation. Successful lawsuits against governments and increasing awareness of human rights and self-advocacy also contributed to this process, resulting in the passing in the U.S. of the Civil Rights of Institutionalized Persons Act in 1980.

From the 1960s to the present, most states have moved towards the elimination of segregated institutions.

state institutions created public outrage that led to change to a more community-based method of providing services.[63]

By the mid-1970s, most governments had committed to de-institutionalization and had started preparing for the wholesale movement of people into the general community, in line with the principles of normalization. In most countries, this was essentially complete by the late 1990s, although the debate over whether or not to close institutions persists in some states, including Massachusetts.[64]

In the past,

maternal age, which is associated with several syndromic forms of intellectual disability.[citation needed
]

Along with the changes in terminology, and the downward drift in acceptability of the old terms, institutions of all kinds have had to repeatedly change their names. This affects the names of schools, hospitals, societies, government departments, and academic journals. For example, the Midlands Institute of Mental Sub-normality became the British Institute of Mental Handicap and is now the British Institute of Learning Disability. This phenomenon is shared with mental health and motor disabilities, and seen to a lesser degree in sensory disabilities.[citation needed]

Terminology

Over the past two decades, the term intellectual disability has become preferred by most advocates and researchers in most English-speaking countries.[5][12] In a 2012 survey of 101 Canadian healthcare professionals, 78% said they would use the term developmental delay with parents over intellectual disability (8%).[65] Expressions like developmentally disabled,[66] special, special needs, or challenged are sometimes used, but have been criticized for "reinforc[ing] the idea that people cannot deal honestly with their disabilities".[67][68]

The term mental retardation, which stemmed from the understanding that such conditions arose as a result of delays or retardation of a child's natural development,

DSM-IV (1994) and in the World Health Organization's ICD-10 (codes F70–F79). In the next revision, ICD-11, it was replaced by the term "disorders of intellectual development" (codes 6A00–6A04; 6A00.Z for the "unspecified" diagnosis code).[70][71] The term "intellectual disability (intellectual developmental disorder)" is used in the DSM-5 (2013).[12] The term "mental retardation" is still used in some professional settings such as governmental aid programs or health insurance paperwork, where "mental retardation" is specifically covered but "intellectual disability" is not.[72]

euphemism treadmill.[67][65] The terms mental retardation and mentally retarded became popular in the middle of the 20th century to replace the previous set of terms, which included "imbecile",[73][74] "idiot", "feeble-minded", and "moron",[75] among others, and are now considered offensive. By the end of the 20th century, retardation and retard become widely seen as disparaging, politically incorrect, and in need of replacement.[76]

Usage has changed over the years and differed from country to country. For example, mental retardation in some contexts covers the whole field, but it previously applied to people with milder impairments. Feeble-minded used to mean mild impairments in the UK, and once applied in the US to the whole field. "Borderline intellectual functioning" is not currently defined, but the term may be used to apply to people with IQs in the 70s. People with IQs of 70 to 85 used to be eligible for special consideration in the US public education system on grounds of intellectual disability.[citation needed]

United States

Special Olympics USA team in July 2019
  • In North America, intellectual disability is subsumed into the broader term developmental disability, which also includes epilepsy, autism, cerebral palsy, and other disorders that develop during the developmental period (birth to age 18). Because service provision is tied to the designation "developmental disability", it is used by many parents, direct support professionals, and physicians. In the United States, however, in school-based settings, the more specific term mental retardation or, more recently (and preferably), intellectual disability, is still typically used, and is one of 13 categories of disability under which children may be identified for special education services under Public Law 108–446.
  • The phrase intellectual disability is increasingly being used as a synonym for people with significantly below-average cognitive ability. These terms are sometimes used as a means of separating general intellectual limitations from specific, limited deficits as well as indicating that it is not an emotional or psychological disability. It is not specific to congenital disorders such as Down syndrome.

The American Association on Mental Retardation changed its name to the American Association on Intellectual and Developmental Disabilities (AAIDD) in 2007, and soon thereafter changed the names of its scholarly journals[77] to reflect the term "intellectual disability". In 2010, the AAIDD released its 11th edition of its terminology and classification manual, which also used the term intellectual disability.[78][79]

United Kingdom

In the UK, mental handicap had become the common medical term, replacing mental subnormality in Scotland and mental deficiency in England and Wales, until

Secretary of State for Health for the United Kingdom from 1995 to 1997, changed the NHS's designation to learning disability.[80] The new term is not yet widely understood, and is often taken to refer to problems affecting schoolwork (the American usage), which are known in the UK as "learning difficulties". British social workers may use "learning difficulty" to refer to both people with intellectual disability and those with conditions such as dyslexia.[81] In education, "learning difficulties" is applied to a wide range of conditions: "specific learning difficulty" may refer to dyslexia, dyscalculia or developmental coordination disorder, while "moderate learning difficulties", "severe learning difficulties" and "profound learning difficulties" refer to more significant impairments.[82][83] The term "Profound and Multiple Learning Disability/ies" (PMLD) is used: the NHS describes PMLD as "when a person has a severe learning disability and other disabilities that significantly affect their ability to communicate and be independent".[84][85]

In England and Wales between 1983 and 2008, the Mental Health Act 1983 defined "mental impairment" and "severe mental impairment" as "a state of arrested or incomplete development of mind which includes significant/severe impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned."[86] As behavior was involved, these were not necessarily permanent conditions: they were defined for the purpose of authorizing detention in hospital or guardianship. The term mental impairment was removed from the Act in November 2008, but the grounds for detention remained. However, English statute law uses mental impairment elsewhere in a less well-defined manner—e.g. to allow exemption from taxes—implying that intellectual disability without any behavioral problems is what is meant.

A 2008

Celebrity Big Brother live used the phrase "walking like a retard", despite complaints from the public and the charity Mencap, the communications regulator Ofcom did not uphold the complaint saying "it was not used in an offensive context [...] and had been used light-heartedly". It was, however, noted that two previous similar complaints from other shows were upheld.[88]

Australia

In the past, Australia has used British and American terms interchangeably, including "mental retardation" and "mental handicap". Today, "intellectual disability" is the preferred and more commonly used descriptor.[89]

Society and culture

Severely disabled girl in Bhutan

People with intellectual disabilities are often not seen as full citizens of society. Person-centered planning and approaches are seen as methods of addressing the continued labeling and exclusion of socially devalued people, such as people with disabilities, encouraging a focus on the person as someone with capacities and gifts as well as support needs. The

self-direction
by people with intellectual disabilities, which means allowing them to make decisions about their own lives.

Until the middle of the 20th century, people with intellectual disabilities were routinely excluded from public education, or educated away from other typically developing children. Compared to peers who were segregated in

special schools, students who are mainstreamed or included in regular classrooms report similar levels of stigma and social self-conception, but more ambitious plans for employment.[90] As adults, they may live independently, with family members, or in different types of institutions organized to support people with disabilities. About 8% currently live in an institution or a group home.[91]

In the United States, the average lifetime cost of a person with an intellectual disability amounts to $223,000 per person, in 2003 US dollars, for direct costs such as medical and educational expenses.

hearing impairments.[91] Of the costs, about 14% is due to increased medical expenses (not including what is normally incurred by the typical person), and 10% is due to direct non-medical expenses, such as the excess cost of special education compared to standard schooling.[91] The largest amount, 76%, is indirect costs accounting for reduced productivity and shortened lifespans.[91] Some expenses, such as ongoing costs to family caregivers or the extra costs associated with living in a group home, were excluded from this calculation.[91]

Human rights and legal status

The law treats person with intellectual disabilities differently than those without intellectual disabilities. Their human rights and freedoms, including the right to vote, the right to conduct business, enter into a contract, enter into marriage, right to education, are often limited. The courts have upheld some of these limitations and found discrimination in others. The UN Convention on the Rights of Persons with Disabilities, which sets minimum standards for the rights of persons with disabilities, has been ratified by more than 180 countries. In several U.S. states, and several European Union states, persons with intellectual disabilities are disenfranchised.[92][93] The European Court of Human Rights ruled in Alajos Kiss v. Hungary (2010) that Hungary cannot restrict voting rights only on the basis of guardianship due to a psychosocial disability.[94]

Health disparities

People with intellectual disabilities are usually at a higher risk of living with complex health conditions such as

gastrointestinal disorders, and behavioral and psychiatric problems compared to people without disabilities.[95] Adults also have a higher prevalence of poor social determinants of health, behavioral risk factors, depression, diabetes
, and poor or fair health status than adults without intellectual disability.

In the United Kingdom people with intellectual disability live on average 16 years less than the general population. Some of the barriers that exist for people with ID accessing quality healthcare include: communication challenges, service eligibility, lack of training for healthcare providers, diagnostic overshadowing, and absence of targeted health promotion services.[96][97] Key recommendations from the CDC for improving the health status for people with intellectual disabilities include: improve access to health care, improve data collection, strengthen the workforce, include people with ID in public health programs, and prepare for emergencies with people with disabilities in mind.[98]

See also

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Further reading

External links