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Intellectual disability is a neuro-developmental disorder characterized by impairment in the child's cognitive and intellectual functioning. The child usually has difficulty in learning and grasping as compared to children of his/her age. They also have difficulty in adaptive and social functioning in everyday life. The main difficulty with them lies in completing formal education. Due to their limited intelligence, they cannot attend a regular school. Due to this reason, they are put in a special school and taught basic concepts and activities of daily living. An IQ score below 70 indicates towards a diagnosis of Intellectual disability. Children with Down Syndrome or Fragile X syndrome also have Intellectual disability. A diagnosis of Global Developmental delay is given for children under the age of 5 years when the level of severity cannot be assessed in early childhood.
There are 4 levels of Intellectual disability based on the IQ score as well as their level of adaptive functioning: mild, moderate, severe and profound.
|Level of Intellectual disability||IQ range||Degree of functioning|
|Mild Intellectual disability||50 - 55 to 70||
|Moderate Intellectual disability||35 – 40 to 50 - 55||
|Severe Intellectual disability||20 -25 to 35-40||
|Profound Intellectual disability||Below 20 or 25||
In about one-third of the cases of Intellectual disability, the cause is unknown. However, there are certain known risk factors or reasons that can lead to Intellectual disability in the child.
The symptoms exhibited by children or patients with Intellectual disability differ according to the level of their disability – mild, moderate or severe.
A child with Mild Intellectual disability will have:
A child with Moderate Intellectual disability will have:
In order to plan a treatment for a child or adult with Intellectual disability, the first and foremost thing is to derive his/her IQ.
The IQ test mainly used is:
Based on the performance of the child on the above mentioned tests, the detailed clinical history and his/her interests, the child's strengths and weaknesses can be analyzed. This will help to plan his treatment ahead. His strengths can be utilized to develop his potential to the best of his ability and weaknesses can be worked upon. A supervised rehabilitation plan plays a big role in making such children independent and lead fulfilling lives. Some of the treatment options available are as follows:
Stem Cell therapy – This is a new form of treatment available for Neurodevelopmental disorders. Stem cell therapy helps in reducing the problem behaviors of the child in the first place. For ex: reducing hyperactivity, increasing his sitting tolerance, reducing aggressive and stubborn behavior which allows the child to cooperate. This in turn builds up his learning capacity and grasping power. His social interaction improves as well. He understands relationships better and develops a sense of self.
We have treated almost 300 patients of Intellectual disability (child cases as well as adults). After doing SCT, we have seen tremendous improvement in most of our cases of Intellectual disability. In case of Mild Intellectual disability, the child shows improved attention span and concentration, increased speed of processing, reduced hyperactivity and better sitting tolerance in school. He also shows interest in studies, can learn faster and remember better than before. His performance in school improves and making him study becomes more easy for the parent or the teacher. He becomes more active and responsible. If taught properly by a special teacher, the child can also learn basic mathematical calculations and the use of a calculator in daily life. He becomes more confident of his abilities and starts venturing out as well. His communication skills improve and he can make friends and socialize. In case of Moderate/Severe Intellectual disability, wherein the child or adult is dependent for his basic ADLs on the family, his level of independence also increases. He is able to take bath on his own, gets toilet trained or at least indicates to go to the washroom. This makes taking care of the child more easy and comfortable by the family.
What is Intellectual disability/ Mental Retardation exactly?
Intellectual disability is basically an impairment in general mental ability that impacts every day functioning in 3 major domains:
How can the diagnosis be made?
A diagnosis is made based on the clinical evaluation and a standardized intellectual testing. An IQ score of 70 or below is still considered to make a diagnosis of Intellectual Disability. The diagnosis can also be made based on the child's clinical picture and adaptive functioning if the IQ test cannot be done.
When is the diagnosis made?
The diagnosis is made after infancy, when the child just begins school.
How early can parents seek early intervention when their baby is found to be developmentally delayed?
As soon as it is recognized that the young child is developmentally delayed in cognition and intellectual functioning in comparison to other normal children or siblings, prompt treatment and intervention will help the child to reach his/her optimal level of development.
What is the life span of a child with Mental retardation?
Intellectual disability by itself does not reduce a child's normal life span. A lot depends on the cause, severity of disability, associated medical problems and the level of care given.
Will I have another child like this?
Depending on the cause, there may be the possibility of another child being affected. Therefore, parents are advised to go for genetic counseling prior to planning for another child.
Are there possibilities of other disabilities along with Intellectual disability/Mental Retardation?
Yes. The most common co morbid disabilities include autism, cerebral palsy, hyperactivity and epilepsy.
What is available in terms of treating or dealing with Mental Retardation/ Intellectual disability?
A child with Mental retardation or Intellectual Disability needs specialized training and one to one attention as well as specific therapists.
Are there different types or levels of Mental retardation?
Yes. There are different levels of Mental retardation which fall into mild, moderate, severe and profound.
Is it important to send the child to school?
Yes, of course. It is extremely important that the child be sent to school, either normal or special school depending on the severity of his intellectual disability. It is important that he be given exposure to a learning environment, peers of his age and capabilities from a young age itself. Special schools provide individualized education, addressing specific needs. Student to teacher ratios are kept low, depending upon the needs of the children. Special schools provide modifications to make learning simpler.
How does stem cell therapy work?
The biological task of stem cells is to repair and regenerate damaged cells. Stem cell therapy exploits this function by administering these cells in high concentrations directly in and around the damaged tissue, where they advance its self-healing and repair.
In children with mental retardation, generally, certain areas of the brain like the frontal cortex and temporal lobe are damaged or functioning less, which can be seen on the PET CT Scan brain. Stem cells home on to these sites of damage and help improve functioning of these areas.
Are there ethical concerns surrounding adult stem cell research and therapy?
Bone marrow transplantation has been used successfully for genetic disorders of blood, such as sickle cell anemia, thalassemia, as well as cancers such as leukemia. Since our therapy uses these very cell, which are harvested from the patient's own body (autologous cells), there are no major ethical concerns. Ethical concerns are primarily on the use of embryonic stem cells (which we do not use).
Does the treatment have any side effects?
Stem cell therapy is minimally invasive and reasonably safe. None of our patients have shown any neurological deterioration so far about the stem cell therapy itself. Some side effects, such as headache (spinal headache) lasting 3-4 days which is generally self-limiting, neck/back pain, vomiting, some mild rash or pain at the site of bone marrow aspiration/stem cell injection may occur. However, like any other medical or surgical treatment unexpected complications are always a possibility. These complications may be related to the medicines given, the stem cell procedure, the anesthesia, and the rehabilitation or to any of the preexisting medical or neurological conditions.
In case of children with seizures, or previous history of seizures or an abnormal EEG, a small possibility of triggering seizures can be there. However, proper antiepileptic cover/drugs, could circumvent this problem.
How long will it take me to know that I have benefitted from the treatment?
Maximal improvements are seen around 3-6 months after the treatment. However, in many patients there are slow progressive improvements that continue for several months/years later. Most patients do show some immediate improvements also i.e. before the discharge, in some of their symptoms.
Is the transplantation of the stem cells done once or more than once?
The decision to do the therapy a second time is taken after seeing the progress/improvements after the first therapy. If the patients show some encouraging improvement, then the case is reviewed by the entire medical and rehabilitation team. Certain special imaging tests, such as PET CT Scan of the brain, would be repeated and then a second treatment may be recommended. This may be done anytime between 3-6 months of the first therapy.
Can other treatments be taken at the same time?
We will review what other medications the patient is already on. In most cases, we do not discontinue any already going on treatment. However, this is decided on a case by case basis. Please inform us about any medications you are taking beforehand.
Will my child improve after stem cell therapy?
In NeuroGen Brain and Spine Institute, we have treated over 25 patients with mental retardation. They were administered with autologous stem cells, intrathecally. On follow up, majority of the patients improved in various domains of symptoms such as cognition – attention, concentration, learning, speed of processing and grasping, social interaction, communication, toilette training, hyperactivity, sitting tolerance, self-care, etc.This consequently, relieves the pressure of the caretaker and the family. Overall mental development is improved which is recorded as improvement in IQ as well.
Case Report 1
An 18 year old case of Intellectual disability underwent Stem Cell therapy at NeuroGen twice. At the time of first Stem cell therapy, she had the following chief complaints as reported by the parents:
However, after doing stem cell therapy and following a regular rehabilitation program at home, there has been a drastic change and improvement in her condition. The parents report the following improvements after SCT when they came in for a second time:
Learning and Academics:
Language, Speech and Communication:
Activities of daily living:
Case Report 2
Bensen Benny is a 13 year old male child and a known case of Intellectual Disability. He was a Full-term, C-section delivery and weighed 3.7 kgs at the time of birth. His birth cry was immediate. No neonatal complications were reported. However, he had febrile convulsions at the age of 4 months. He was diagnosed with ID at the age of 5 years due to delayed milestones and speech. He had been going to a mainstream school but had minimal learning in the school.
He came to the hospital with the following chief complaints:
His SQ at the time of admission was assessed to be 50 suggestive of Moderate Intellectual Disability.
He underwent Stem Cell treatment post which he followed a rigorous regime of rehabilitation at home where he underwent Occupational Therapy and Speech Therapy everyday under a registered practitioner.
Post 8 months, they reported a deluge of improvements in the patient in various aspects like:
His Social Quotient (SQ) increased from 50 to 55.