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ความบกพร่องทางสติปัญญา Intellectual Disability
Cognitive impairment
"Intellectual impairment" is a term used to replace the term "mental retardation" because the original word has been used quite negatively. Making negative feelings And is not accepted in the social sector Therefore changing to a new name This word matches the diagnosis of a child psychiatric disorder named "Intellectual Disability" or "Intellectual Developmental Disorder" (according to the DSM-5 criteria of the American Psychiatric Association) or "Mental Retardation" (according to the World Health Organization's ICD-10 criteria F70-79). Have similar definitions Can be used interchangeably. In the future, the ICD-11 criteria will stop using the term "Mental Retardation" as well. "Intellectual Developmental Disorder"
In Thailand, cognitive impairment Being the type 5 disabled person "Intellectual Disability" according to the announcement of the Ministry of Social Development and Human Security on the types and criteria for disability (Issue 2) B.E. 2555, which was issued under the Act to promote and develop the quality of life of the disabled. 2007 means "People have limitations in their daily activities or participation in social activities. Which is a result of slower than normal development Or have lower intelligence levels than general people With the abnormality shown first And developmental disabilities At a severe and chronic level "but depending on voluntary registration of persons with disabilities To request the use of various rights or not, not compulsory
In addition, it is classified as a disabled type. "Intellectual Disability" in accordance with the notification of the Ministry of Education on the determination of categories and rules of education for the disabled in 2552 B.E. Educational Management for People with Disabilities 2008
Children with intellectual disabilities Often have problems in almost every area of ​​daily life And study problems Because children have limitations or ceilings in learning Causing not being able to do many things as a friend of the same age Is a condition in which the brain ceases to develop or develops completely Causing defects in various skills In development And affect intelligence levels in all aspects
Characteristic
Cognitive impairment According to the DSM-5 diagnosis criteria of the American Psychiatric Association, which is clearly below the standard. Together with a deficiency in adaptive skills With symptoms seen during childhood or adolescence Resulting in many aspects of daily life, both at home, school, work and community, with details as follows
Cognitive skills 
such as reasoning, problem solving, planning, abstract thinking, academic learning decisions And learning from experience Confirmed by clinical evaluation And intelligence testing Intelligence test Also known as IQ measurement Should be done by standardized tests to be reliable Average 90-109 if 70-89 is called a slow learning group But if less than 70 will meet the criteria of intellectual disability
Adaptation skills
Is a factor indicating ability in daily life has 3 aspects as follows
  • Conceptual domain means language skills, reading, writing, calculating, reasoning and memory.
  • Social (social domain) means understanding other people. Decision making in various social situations Interpersonal communication And relationships
  • The practical domain is to take care of oneself, such as personal hygiene. Responsibility for study and work And managing their own finances
Severity
Intellectual disability is severely divided into 4 levels according to intelligence level. And the ability level that can be measured
Low level
Have an IQ level between 50-69, may not show symptoms until school age (But if observed in detail Will find that these children are clearly below the ability since preschool age) often do not have any physical, personality or behavioral symptoms in particular That indicates intellectual impairment Except for the characteristic characteristic syndrome, which can be diagnosed at birth Or in infancy
Children in this group can develop social skills. And communicate like a normal child But often have sensory impairments And movement Can be learned (educable). Academic skills are often a major problem encountered in school age. But is able to study until the end of primary school Can practice social and professional skills Enough to support oneself Is a labor that does not require skilled skills Or semi-skilled But may need advice And some help when experiencing stress
Moderate
Have an IQ level between 35-49 during the first year Tend to develop normal movement But the development of language and speaking will be delayed Which can be clearly seen during toddlers Education after elementary school Rarely develop Able to train (trainable) in self-help skills, learn to travel on their own in familiar locations And can practice some careers Able to work without skill But should be under close supervision
Severe
Have an IQ level in the range of 20-34, tend to find slow movement skills clearly Slightly developed language Interpretation skills, little or no Enough to practice care skills Some basic self but little Live in a society under full control. Working requires a program in the community. Or special assistance
 
 
Very severe
Have an IQ of less than 20, with a clear development delay in all areas, often with developmental movements And can practice self-help There are many limitations in understanding and using language. Need help Closely monitor all the time
Epidemiology
The prevalence of cognitive impairment in the general population is approximately 1 percent, which varies with age. Found highest during the age of 10-14 years and then gradually decreased, found a significant decrease in adulthood. The most common level of violence is low, 85%, and the prevalence rate is 5.4-10.6 per 1,000 population. Found in males more than females. Found in the ratio of 2: 1 in mild severity and 1.5: 1 in the extreme level. According to the Isle of Wight study, which surveyed children aged 9-11 years, intellectual disabilities were found at about 2.5 percent if using only the intelligence level. But if the criteria for adjustment ability consists of The prevalence rate is reduced by half, which is 1.35 percent.
Cause
Most of the causes are unable to identify the obvious cause (30-50 percent), often due to many causes being a common factor. Both biological factors And psychosocial factors, biological factors It can be caused during pregnancy, during childbirth and after birth, often with other disorders. The causes include
• genetic diseases
• Infection
• Exposure to toxins
• Lack of oxygen
• Malnutrition
• Various accidents
Psychosocial factors such as lack of proper care, neglect, broken family, poor status, in unfavorable environments for learning. Lack of enthusiasm Lack of good motivation.
 
Maintenance guidelines
1) Promoting family potential
Strong family Is the power of success Families should have the knowledge, skills and good attitudes for care. Saw the importance of continuously training various skills Family counseling to reduce family stress Provide information and various options To make decisions And encouraging
2) Early Intervention
Should arrange the skills training program that is necessary to learn Promoting development in all aspects Do it systematically and continuously. In order to lead to the appropriate development according to age in all aspects Children that have been trained since childhood Will be able to learn better than practice when grown up
3) medical rehabilitation
Often have different needs according to the problem condition And the needs of each child are different With specific guidance In all 4 developmental aspects as follows
• Physical Therapy focuses on the development of large muscles Movement, correct walking and reduce muscle contraction
• Occupational Therapy focuses on the development of small muscles, concentration, and perception.
• Speech Therapy, focusing on language and communication development
• Activity of Daily Living Training focuses on social development. And taking care of oneself in daily life
4) Educational rehabilitation
Promote the learning management as much as possible By making an IEP - Individualized Educational Program. It is necessary to design instruction to suit the strengths, weaknesses and interests of each child. For easy learning, not confusing Aims at allowing children to use the skills they have gained from their classes in real life outside of the classroom. It is important that children have the opportunity to do various activities Share with normal children
5) Social rehabilitation
Is to encourage children to live life in society And communities as normal By giving children the opportunity to act equally To reduce feelings of alienation from society Can live a normal life in society Higher self-esteem And is determined to continue developing other skills
6) Occupational rehabilitation
Career preparation, including training on basic professional skills And practice appropriate work habits such as punctuality Recognize orders Able to treat oneself appropriately And understand social etiquette
7) Drug use
Drug use is not intended to cause cognitive impairment. Or helps the brain improve But used to alleviate the severity of the problem Or symptoms associated with, such as epilepsy, violent behavior Emotional problems Problems with concentration, etc.
 
 
Protection
Various factors should be avoided Screening for high risk groups And the initial care Will help reduce the severity of problems, complications, and the consequences that follow
The guidelines for the prevention of intellectual disabilities are as follows.
  1. Spouses should have family planning in advance.
  2. Always take care of healthy Health check before pregnancy
  3. During pregnancy Should have an antenatal care regularly Take care of your health and avoid risk factors such as non-smoking, non-drinking, not buying your own medication.
  4. At-risk groups should undergo additional examinations, such as mothers aged 35 and older
  5. After childbirth, should follow up to assess development according to age If there is a delay in development Should be examined More assess And promoting development at the outset in question
  6. Take care of children appropriately Keep the children healthy, both physically and mentally. Have the opportunity to learn appropriately according to age
โพสเมื่อ : 17 มี.ค. 2563,18:17   อ่าน 1779 ครั้ง
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