The Global Impact of Intellectual Disability and Other Mental Disorders in Children

Abstract

Intellectual disabilities and other mental disorders in children are serious health problems and occur in all countries. They result in profound challenges for learning and adaptive behavior and generally require professional services and treatment. Outcomes depend upon access to highly trained professionals and often costly medications. Interactions with the culture of disability in the community and nation are very important for independence and self-fulfillment. Normative and legal barriers can push children with these disabilities to the margins of society and waste their potential. Case examples are given from low-, middle-and high-income countries. Recommendations are made based upon recent World Health Organization Action Plans on Disability.

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Features
The Global Impact of
Intellectual Disability and
Other Mental Disorders in Children
by James G. Linn, PhD, Jorge Chuaqui, PhD, Debra R. Wilson, PhD, and Emanuel Arredondo, MA
Abstract: Intellectual disabilities and
other mental disorders in children are
serious health problems and occur in all
countries. They result in profound chal-
lenges for learning and adaptive behavior
and generally require professional services
and treatment. Outcomes depend upon
access to highly trained professionals and
often costly medications. Interactions with
the culture of disability in the community
and nation are very important for inde-
pendence and self-fulfillment. Normative
and legal barriers can push children with
these disabilities to the margins of society
and waste their potential. Case examples
are given from low-, middle- and high-
income countries. Recommendations are
made based upon recent World Health
Organization Action Plans on Disability.
Keywords: Intellectual Disability and Mental Disorder
Introduction
The World Health Organization (WHO, 2014) uses the
word disability as a general term, which includes impair-
ments, activity constraints, and limitations on participation.
An impairment is defined as a problem in physical or mental
function; activity limitations are difficulties encountered by a
person when doing a task or action; while limits in participa-
tion are restrictions experienced by an individual when they
are involved in a life situation. Disability is more complex
than a health problem. As a phenomenon, it reflects a per-
son’s body and/or mind and aspects of the country in which
they live. Resolving the problems confronted by persons with
disabilities requires interventions and innovations to elimi-
nate social and environmental barriers. Therefore, disability
is more than a social problem. Globally it is also a human
rights problem.
Currently, there are greater than one billion people with
disabilities; that includes about 15 percent of the world’s
population or approximately one in seven people. An esti-
mated 93 million children, or about one in twenty of those
below 15 years of age, live with moderate or severe disability.
An estimated 80 percent of persons with disabilities live in
developing countries (WHO, 2018).
Intellectual Disability
According to the Centers for Disease Control (2015),
intellectual disability refers to a condition when there are
limits to a person’s capacity to learn at an expected level and
function in daily living. Degrees of intellectual disability vary
greatly in children – from a very slight difficulty to a very
severe difficulty. Children with intellectual disability often
have communication problems. They have a difficult time with
self-care and with informing others of their needs. Intellectual
disability may cause a child to develop at a slower rate than
peers of the same age. It may take more time for a child with
intellectual disability to learn to eat, speak, walk, or dress with-
out assistance. Further, learning in school may be a problem.
Intellectual disability may be caused by a problem that
begins any time before the child completes their 18th year
– even before they are born (Patel, Minas, Cohen, & Prince,
2014). It may result from a problem in the brain, injury, or
disease. However, for many children the etiology of intellec-
tual disability is never known. Many of the most commonly
known causes occur before birth. They are birth defects,

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The Global Impact of Intellectual Disability
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infections, Down syndrome, fetal alcohol syndrome, fragile X
syndrome, and genetic conditions. Other causes of intel-
lectual disability are events that occur while a child is being
born or immediately after birth. Further, other problems as-
sociated with intellectual disability such as certain infections,
stroke, or serious trauma to the head do not happen until a
child is older.
In severe cases of intellectual disability, the signs of the
disorder appear early in the child’s life (Committee to Evalu-
ate the Supplemental Security Income Disability Program for
Children with Mental Disorders, 2015). In these situations,
children may:
• sit, crawl, or stand and walk after other children,
• have difficulty speaking and learn to talk later,
• have a poor memory,
• may not comprehend social rules,
• have difficulty understanding the consequences of their
actions,
• have difficulty with problem solving.
Estimates of the prevalence of intellectual disabilities
include both children and adults. The prevalence of intel-
lectual disability in the United States has been reported to
be between two and three percent of the general population
(Daily et al., 2000). For northern Europe, it is slightly less at
1.5 percent (Bertelli & Kishore, 2014). However, for low- and
middle-income developing countries, it is estimated to be
higher at 4 to 6 percent due to many preventable causes
such as poor diet (Durkin, 2002).
Mental Health and Common Mental Disorders
in Children
Children who are mentally healthy typically have at-
tained several emotional and developmental markers. They
manifest expected social skills for their age and demonstrate
effective coping skills. Further, they have high personal well-
being because they function well at home, in school, and
in their community (Perou, 2013). Mental disorders among
children are described as serious deviations from expected
social and emotional development (U.S. Department of
Health and Human Services, 1999). They are considered
a significant public health issue in the United States and
elsewhere because of their frequency, early onset, and impact
on the child, family, and community. Approximately 13
to 20 percent of children in the United States in a given
year experience a mental disorder, and this is believed to
be increasing. Epidemiological data on mental disorders of
children in low- and middle-income developing countries
is largely nonexistent (Okpaku, 2014), although based on
clinical evidence and small sample studies in Brazil (Anselmi
et al., 2004), rates of these disorders are at least as high as
those found in the United States and Europe.
While globally there are very few large sample studies
of the epidemiology of specific mental disorders in children,
the United States has tracked prevalence rates on several
commonly occurring mental disorders since the mid-2000s
(USDHHS, 2013). The most prevalent parent-reported
current diagnosis is attention deficit/hyperactivity disorder
which was reported for about 7 percent of U.S. children ages
3-17. This was followed by conduct or behavior problems
(3.5%), anxiety (3.0%), depression (2.1%) and autism spec-
trum disorder (1.1%).
As with intellectual disabilities, the causes of mental
disorders in children can be attributed to genetic, prenatal,
and environmental factors. Keiling and Associates (2011)
specified several life-long risks. They included: genetic
background, problems in physical and mental health of the
child or family, deficiencies in psychosocial or educational
environment, exposure to harmful substances or toxins, and
exposure to violence, abuse, or neglect. Rutter’s Child and
Adolescent Psychiatry (Thapar, et al., 2006) follows the cur-
rent strategy in the search for the cause of mental disorders.
Their work focuses on the interaction between documented
and measured genetic and environmental factors such as
maltreatment or stressful events.
When parents suspect that their child has a mental
disorder, as with intellectual disabilities, they should, as soon
as possible, seek the assistance of a mental health profes-
sional (if available) or other healthcare professional who has
received training to diagnose and treat mental disorders.
Also, if a diagnosis of a mental disorder has been made by a
certified professional, the parent should seek the assistance
(if the child is age 3 or under) of an early intervention center
or (if over 3), their public school. Unfortunately, these ser-
vices are usually only available in higher income industrial-
ized countries. As Dua, et al. (2011) observed, the treatment
gap for mental disorders in many low- and middle-income
developing countries is greater than 75 percent. To address
this situation, the World Health Organization has made
evidence-based guidelines for various substance abuse,
neurological, and mental disorders including child and
adolescent mental health problems (Kieling et al., 2014). The
proposal is organized into 13 areas which include parenting
interventions such as treatment of maternal mood issues,
behavioral and development disorders, detection of child
abuse, cooperating with school-based programs, and cogni-
tive, behavioral and pharmacological treatments for various
disorders such as anxiety, ADHD, and depression.
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Barriers to the Social Inclusion of Children
with Intellectual Disabilities and Other Mental
Disorders
Although there is accurate measurement of the global
impact of intellectual disabilities and other mental disorders,
and effective strategies have been devised for their preven-
tion and treatment in children and adolescents, only a small
group of nations can adequately meet their own needs. The
deficiencies in services and formal training were documented
in large multi-country studies completed by the WHO in
2004 – 192 nations – and in 2011 – 42 nations (Belfer &
Saxen, 2006; Morris and Belfer, 2011). The low- and middle-
income developing countries were least likely to have well
organized and resourced systems of mental health services
and medical, nursing, and psychological training institutions
(Belter & Child, 2008).
As public policy has increasingly emphasized the
importance of upholding human rights of persons with
disability, including children with intellectual disabilities
and other mental disorders (WHO, 2014), researchers have
made us aware of the relationship of poverty with stigma
and discrimination and threats toward those with disabilities.
The negative implications of these regional differences in
poverty for access to effective healthcare and education and
the programs that address stigma toward children and others
with intellectual disabilities and other mental disorders are
substantial.
Chile, which in the last two decades has become a
leader in the defense of the human rights of persons with
disabilities, has recently (2016) passed an educational reform
that prohibits discrimination against children with intel-
lectual disabilities and other mental disorders who apply for
admission to the most selective and competitive schools in
the country (Arredondo, 2018). Jorge Chuaqui (2017) has
led a comprehensive attack against cultural and institutional
barriers to the social inclusion of children and adults with
intellectual disabilities and other mental disorders by specify-
ing objective and subjective criteria of full inclusion. The
objective criteria of full inclusion are:
• Have a well-paying personally fulfilling full-time job;
• Form a committed relationship or family with a spouse or
partner;
• Live in your own apartment or house.
The objective standards are complemented by several
subjective criteria:
• Individual psychosocial development is guided by
personal values;
• Job, or work role, reflects vocational commitment and
mental and physical capabilities;
• Occupational, relational, and residential inclusion
produces increased autonomy and empowerment.
Despite these regional advances, recent data from the
U.N. Educational, Scientific, and Cultural Organization con-
cluded that we must make education for disabled children
more inclusive. An estimated 50 percent of children with dis-
abilities do not go to school as a result of prejudice, stigma,
or the absence of accessible learning. Further, it was reported
that of those disabled children who attend school, almost
one-half do not receive a quality education because of insuf-
ficient numbers of trained teachers, accessible facilities, or
specialized learning technology (Arroyo & Thampoe, 2018).
This statement describes the global situation of most chil-
dren with intellectual disabilities and other mental disorders.
Conclusions
Intellectual disabilities and other mental disorders in
children are significant public health issues in the United
States and elsewhere because of their frequency, early onset,
and impact on the child, family, and community. The causes
of intellectual disabilities and other mental disorders in
children can be attributed to genetic, prenatal, and envi-
ronmental factors. When parents suspect that their child
has one or more of these problems, they should, as soon as
possible, seek the assistance of a mental health professional
(if available) or other healthcare professional who is trained
to make a diagnosis and treat mental disorders. However,
only a small group of nations can meet their populations’
mental health treatment needs. The treatment gap in many
low- and middle-income developing countries is greater than
75 percent. Despite the fact that disability issues are now
human rights issues that demand full social inclusion, there
remain formidable institutional and normative challenges to
their resolution and a better quality of life for children and
adults who have disabilities.
Recommendations
1. Nurses, Physician Assistants, and Medical Doctors
involved in prenatal care should educate their patients
with regard to the genetic, prenatal, and environmental
risk factors that are associated with intellectual disability
and other mental disorders in children.
2. Parents of young children who are concerned about
their child’s development and/or behavior should
be encouraged to seek early diagnosis and potential
treatment from qualified healthcare specialists and
designated community intervention agencies.
The Global Impact of Intellectual Disability
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The Global Impact of Intellectual Disability
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3. Parents of children with disabilities who are stigmatized
and/or bullied in their school and community should be
placed in contact with disability advocacy groups and
government agencies that can support them.
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James G. Linn, PhD has done funded health and mental health
research in the United States, Latin America, and Africa for over
30 years. Many of his studies have looked at the impact of HIV
disability on the quality of life in low, middle, and high-income
countries. He served on the Manuscript Review Board of the inter-
national journal “Review of Disability Studies” and has published
his work in the same journal. He is Co-Coordinator of the Chronic
Disease and Disability Section of the Western Social Science Asso-
ciation and has been President (2002-2007) of the Mental Health
and Illness section of the International Sociological Association.
Jorge Chuaqui, PhD is a Professor in the Institute of Sociology of
the University of Valparaiso, Chile where he also directs the pro-
gram on health of the Center of Sociological Investigations. UNI-
CEF recently recognized his scholarly and policy work in disability.
He is a member of the Executive Committee of RC-49---Research
Committee on Mental Health and Illness of the International
Sociological Association. He is a pioneer in the study of disability
and mental health in Latin America.
Debra R. Wilson, PhD and MSN is at the School of Nursing of
Austin Peay State University. She is internationally recognized
for her work in childbirth education and has collaborated with
nursing faculty at the University of Botswana on professional and
scholarly projects. Currently, she is co-coordinator of the Chronic
Disease and Disability Section of the Western Social Science Asso-
ciation and was the American Holistic Nurse of the Year last year.
Emanuel Arredondo, MA is an Instructor in the Institute of
Sociology of the University of Valparaiso, Chile. He is a member
of the Interdisciplinary Research Committee on Mental Health,
Social Inclusion and Art Therapy of the University of Valparaiso.
Currently, he is conducting research on the new inclusion law
covering persons with intellectual disabilities who are students in
the Chilean educational system.