This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders.
Intellectual Disabilities across the Lifespan by Andrea Chavez
Little Janie Doe is an eight-year old girl who has been refusing to go to school lately. Upon further investigation for possible causes, Janie’s mother discovered that Janie has been doing poorly in her schoolwork. Her teacher has noticed that Janie has difficulty completing her writing assignments and has become resistant to participate during reading time. She also struggles with her multiplication tables significantly more than her peers. Her teacher noticed that Janie does not interact with the other children. Janie says her classmates often manipulate her into doing things only to tease her afterwards.
Janie Doe is living with a mental condition called Intellectual Disability, along with approximately 1% of the general population. Formerly known as Mental Retardation, Intellectual Disabilities can affect people of all ages, cultures, races, and socioeconomic backgrounds. Mid childhood is an important period in development when children learn to form elaborate social connections, typically with parents and other children. Janie Doe has difficulty forming these connections and does not have very many social bonds outside of her family. Therefore, she does not have as many opportunities to practice conflict resolution and problem solving as do other children her age. She struggles to understand the perspective of others and to regulate her own emotions. As a result, she may experience difficulty in establishing social relationships in adolescence and adulthood. Throughout her childhood and into adolescence, Janie will be 3 times more likely to be sexually abused.
Conflict resolution is a crucial part of mid-childhood development. The successful acquisition of critical thinking and problem solving skills marks successful development. Children are expected to learn to follow directions, obey commands, and respect the authority of parents and other authority figures. Children with ID find difficulty in comprehending another person’s perspective, regulating their own emotions and, as a result, experience trouble with conflict management. In a recent study, researchers used the Parent-Child Problem-Solving Task, an activity in which children with ID and their parents had 5-10 minutes to create a solution to a problem they were facing with each other. Children with ID struggled more with this activity than children of typical development. During the same study, it was observed that parents tended to use more directiveness (giving orders that were inflexible to the child’s ability to make personal choices). This practice, which would be detrimental to the development of autonomy in a typically-developing child, seemed to result in the contrary in children with ID. Step-by-step commands were noted to increase the child’s social competence and make tasks easier to comprehend. Parents used directiveness merely to guide the conversation and help the child focus, not to impose ideas or feelings. Children with ID had similar levels of warmth and antagonism as the other children. Their mothers reciprocated that warmth and acknowledged their opinions and feelings. It is possible that parents had developed resilience and had learned a new style of parenting. They had adapted and now reacted similarly to parents of typically developing children.
As Janie enters adulthood, she will experience a higher risk for poor health, poverty, and limited social support systems. She may experience social exclusion or difficulty in finding and maintaining a job. As a result of her few social connections, it is probable that Janie will not have received adequate health and sexual education during her adolescence. She will have little information about effective contraceptives and a higher vulnerability to sexual abuse. Most women with ID who become mothers have a mild to moderate case of the disability. They will have difficulty with conflict resolution and higher rates of stress and depression. Mothers with ID struggle to maintain a job and are often unemployed, socially excluded, and at a socioeconomic disadvantage. The fathers of their children tend to also have psychosocial problems. Their children will suffer from poverty, limited resources, and an unstable access to adequate healthcare. Children born to mothers with ID have been observed to be at a higher risk to develop ID, conduct disorder, hyperactivity, or emotional disorders. Several surveys report that mothers with ID have a greater risk of having their children removed. In a 2005 survey of the UK, 48% mothers with ID had lost their children to child welfare services. Their children were 10 times more likely to die in infancy. Of the children surveyed, 57% had not lived with their mothers during childhood and adolescence, 16% had been exposed to sexual abuse, and 13% had experienced incarceration. These numbers are reduced significantly if the mother has a strong network of social support.
Middle Age and Beyond
As Janie ages someday, she will have even smaller social support networks and a more restricted access to personal resources, in large part due to her intellectual disability. It is likely that her primary caregivers will have been parents or close relatives. However, as her parents grow older and eventually die, Janie will be left alone to care for herself and may suffer from fewer resources and loneliness. She may experience a decline in her physical health and will be more prone to severe health problems such as osteoporosis, thyroid disorders, epilepsy, non-ischemic heart diseases, skin diseases, and signs of premature aging. Research predicts that when Janie reaches her 50th birthday, her overall health will be comparable to how it would be at age 65 if she did not have ID. She will have a propensity for hearing and vision impairments and an earlier onset of dementia than the general population.
However, there is a positive side that people with ID experience as they age. Older adults with ID have greater opportunities to obtain better housing conditions and access to forming bonds with other people who are living under similar circumstances. Although the elderly with ID typically do not live independently and have less autonomy, they report feeling a greater life satisfaction than ever before. This is especially true for those with better health. Researchers believe this is due to resilience obtained throughout the years or the formation of simpler expectations of the true meaning of happiness.
Having a diagnosis of Intellectual Disability does not mean that an individual cannot live a fulfilling and purposeful life. There are many options that people or their caregivers can explore in order to increase quality of life. Special education can help individuals acquire skills in academics, language, and independence from an early age. Vocational schools, case management, and job training sessions can assist in obtaining employment and finding the resources needed for sustainment. Treatment options such as ABA and CBT can decrease maladaptive behaviors and increase positive behaviors. People with ID can have satisfying relationships with family and friends and even form romantic relationships. Every person with ID is a unique individual that deserves the opportunity to be in an environment surrounded by positive companions that will facilitate their quest to fulfillment and life satisfaction.