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Behavioral problems with intellectual disability
Causes, symptoms, diagnostics
The World Health Organization (WHO) defines intellectual disability as a developmental, halted or incomplete development of mental abilities with a particular impairment of skills that contribute to the level of intelligence, such as cognition, language, motor and social skills. It can be inherited or acquired early in development through external factors - including prenatal or through problems during childbirth. Depending on the recording and definition criteria for intellectual disability, the overall prevalence (prevalence: frequency of occurrence of a disease in the population at a certain point in time or in a certain period of time) in Germany is around 1% (source: S2-k guideline 028/042 : Intellectual disability). Men are more at risk than women due to specific inheritance patterns (x-linked) and more frequent brain damage during childbirth.
In the case of intellectual disabilities, mild to severe manifestations can be observed; depending on this, there are disturbances in communication, social abilities and skills as well as in the possibility of independent care.
Caused by the intellectual disability, behavioral problems and disorders can occur that require treatment. Whether an outpatient, partial inpatient or inpatient treatment is carried out depends on the type and extent. Cooperation with the social environment of those affected is particularly important, as this is sometimes the only way to obtain reliable anamnestic (medical history) information, which is an indispensable basis for planning and carrying out therapy. It goes without saying that we involve our patients as intensively as possible in the diagnostic and therapeutic process. In the case of behavioral disorders based on intellectual disability, personal (that is, those relating to the characteristics of the patient) and situational (encompassing the environment, integration and dealing with the patient) factors are found as triggering and symptom-sustaining. If the behavior poses a hazard for the person concerned or for other people, inpatient treatment is required.
The following diagnostic steps are necessary:
- Suspected diagnosis based on deficits in cognition, language, motor skills and social skills - diagnosis confirmation through an intelligence test
- Family history, if necessary with access to the family register
- Pre-, peri- and postnatal anamnesis (influences before, during and after the birth)
- Neurological examination and search for dysmorphological (deviating from the normal body shape) abnormalities (matching defined chromosomal anomalies)
- EEG (electroencephalography: recording of the course of brain activity currents)
- Imaging of the head (cranial computed tomogram or magnetic resonance tomogram of the head)
- in rare cases genetic tests (usually already available in adulthood)
The diagnosis of intellectual disability is often known in advance when the patients present themselves to our clinic. We then secure this diagnosis again with regard to the severity and, if necessary, with regard to the causes. The underlying intellectual disability cannot be significantly influenced; a behavioral disorder almost always leads to the treatment itself.
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