Borderline intellectual functioning

Prevalence and relevance of neurocognitive challenges in patients admitted to a secondary mental health outpatient clinic

BACKGROUND

Knowledge on factors affecting mental health is pivotal to offer the appropriate help for patients referred to mental health services. Neurocognitive challenges affect a person's capacity to cope in life. If underlying issues with cognitive functioning rather than psychiatric pathology cause suffering and failure to function, other measures than merely psychiatric treatment may be needed. However, there is a lack of knowledge on occurrence of neurocognitive challenges in the general psychiatric outpatient population.

MATERIAL AND METHOD

This study included 283 outpatients in a Community Mental Health Center. Information of previous neurocognitive testing as a proxy for cognitive challenges was registered by patient file exploration. Psychiatric symptoms as well as demographics were reported by patients and clinicians.

RESULTS

Of 283 participants, 45 (15.9%) had previously been tested for neurocognitive function, 217 (76.7%) had not been tested and for 21 (7.4%) information was lacking. Patients in the group tested were younger and had a lower level of education. They had higher use of psychotropic drugs, i.e. especially stimulants, and had a history of more psychiatric treatment and more school challenges. Clinicians reported higher cognitive challenges and lower social competence among this group.

DISCUSSION

A group of patients referred to specialized psychiatric treatment suffer from neurocognitive challenges that may affect their daily life function and symptoms more than merely psychiatric disorders. This indicates that neurocognitive difficulties should be assessed and adjusted for before further psychiatric treatment is initiated. Findings should be further explored.

Understanding Adaptive Skills in Borderline Intellectual Functioning: A Systematic Review

Borderline intellectual functioning (BIF) is characterized by an IQ typically ranging from 70 to 85, combined with deficits in adaptive functioning. Despite its prevalence, individuals with BIF are often excluded from diagnostic and support systems, which traditionally focus on strictly defined intellectual disabilities. This article presents a systematic review conducted across the ProQuest, WoS, SCOPUS, and EBSCOhost databases, aiming to develop a profile of the adaptive functioning in individuals with BIF. A total of 64 documents published from 2012 to the present were included, all of them addressing BIF and adaptive functioning skills, and quality was assessed using the SSAHS tool. The findings presented are synthesized according to conceptual, social, and practical domains and reveal that individuals with BIF experience widespread difficulties across the conceptual, social, and practical domains. Additionally, societal barriers, primarily limiting access to support services, persist. However, there are emerging resources aimed at supporting this population, such as legislative efforts to facilitate their integration into the labor market. The implications and limitations of the findings are discussed, highlighting the need to consider the adaptive functioning skills of individuals with BIF.

Family screening for neurodevelopmental problems and its associations with child cognitive function enable tailored treatment for childhood obesity

AIM

To identify neurodevelopmental disorders in children with obesity, and investigate associations to cognitive functions as well as parents' self-reported neurodevelopmental problems.

METHODS

Eighty children were included at two outpatient obesity clinics in Sweden 2018-2019. Of these, 50 children without previously diagnosed neurodevelopmental disorders were screened, and so were their parents. Children who screened positive for neurodevelopmental problems were referred to a specialised psychiatry unit for further diagnosis. Test results of cognitive functioning were compared with the norm and between study groups by neurodevelopmental diagnoses.

RESULTS

Of the screened families, 17/50 children were diagnosed by the psychiatric unit with attention deficit-hyperactivity disorder (ADHD) and 15/82 parents screened positive for neurodevelopmental problems. Having a mother who screened positive for neurodevelopmental problems was associated with child ADHD (p < 0.05). The children's full-scale intelligence quotient (92.86 ± 12.01, p < 0.001) and working memory index (90.62 ± 12.17, p < 0.001) were lower than the norm. Working memory index was lower in children with ADHD compared to without ADHD: 84.76 ± 9.58 versus 94.09 ± 12.29 (p ≤ 0.01). Executive constraints were associated with verbal deviances.

CONCLUSION

Increased awareness is needed about the overlap between neurodevelopmental problems and obesity in obesity clinics.

Etiology of Borderline Intellectual Functioning

Borderline intellectual functioning (BIF), characterized by intelligence quotient scores between 70 and 85, can lead to challenges in daily life. This review explored the multifaceted nature of BIF by examining the interplay between genetic predisposition, prenatal/perinatal factors, environmental influences, and underlying medical conditions.

Children born to parents with mild intellectual disability: Register-based follow-up of psychiatric and neurodevelopmental diagnoses and out-of-home placements

AIM

Study the outcomes in terms of registered neurodevelopmental diagnoses and out-of-home placements in children whose parents had been diagnosed with mild intellectual disability (ID) in childhood.

METHODS

The study groups consist of (1) a population-based sample of 78 individuals, born in 1979-1985, meeting criteria for mild ID during childhood, and (2) their 88 children. From national registers, data on outcomes were retrieved in 2020 regarding psychosocial and psychiatric outcomes for the adults, and neurodevelopmental diagnoses and out-of-home placements for the children.

RESULTS

Of the 78 adults with mild ID, 31 were parents of 88 children, aged 0-21 . The age-adjusted prevalence of neurodevelopmental disorders among the children was 67%. Of the 27 children aged between 13 and 21 years at follow-up, 16 had at least one registered neurodevelopmental diagnosis; 11 had ADHD and 7 had ID. Nine of these 27 children had experienced out of home placement.

CONCLUSION

Children of parents with mild ID are at high risk of neurodevelopmental disorders, in particular ADHD and ID, and out-of-home placements. Our findings indicate that individuals with mild ID who become parents routinely should be offered individually tailored parent support and their children offered assessment regard neurodevelopmental disorders.

Treatment, Education, and Prognosis of Slow Learners (Borderline Intelligence)

Objectives

Borderline intelligence has been excluded from formal diagnostic systems and not included in disability diagnoses, leaving gaps in treatment, education, and social welfare despite various functional impairments. Therefore, we aimed to shed light on ways to enhance the intelligence and functioning of individuals with borderline intelligence by reviewing research on its progression, education, and treatment.

Methods

Ten studies that met the inclusion and exclusion criteria were included in the final literature review and analyzed according to detailed topics (participant characteristics, design, and results).

Results

Borderline intelligence is associated with various comorbid conditions, such as anxiety, depression, attention deficit/hyperactivity disorder, and addictive disorders, which negatively impact its course and prognosis. Individuals with borderline intelligence often face challenges in academics, employment, interpersonal relationships, and health owing to lifelong cognitive impairments. The treatment of borderline intelligence necessitates addressing environmental factors, such as neglect and abuse, as well as treating comorbid mental disorders, which are crucial for prognosis. Tailoring treatment programs for cognitive profile characteristics have been proposed, and studies have reported the effectiveness of pharmacotherapy, working memory training, and intensive rehabilitation training. Therefore, early intervention during childhood brain development is necessary. Risk factors, such as lack of parental education, and their impact on treatment outcomes have also been reported.

Conclusion

Extensive research is needed on education, treatment, and prognosis related to borderline intelligence. Active intervention for children with borderline intelligence is essential to improve their functioning and quality of life.

Case Report: Intellectual disability and borderline intellectual functioning in two sisters with a 12p11.22 loss

Multiple genome sequencing studies have identified genetic abnormalities as major causes of severe intellectual disability (ID). However, many children affected by mild ID and borderline intellectual functioning (BIF) lack a genetic diagnosis because known causative ID genetic mutations have not been identified or the role of genetic variants in mild cases is less understood. Genetic variant testing in mild cases is necessary to provide information on prognosis and risk of occurrence. In this study, we report two sibling patients who were 5 years 9 months old and 3 years 3 months old and presented to the hospital due to developmental delay. Clinical assessment and chromosomal microarray analysis were performed. The patients were diagnosed with mild intellectual disability (ID) and borderline intellectual functioning (BIF). Genetic analysis identified a loss of 12p11.22, including the OVCH1-AS1, OVCH1, and TMTC1 genes, which was the only variant that occurred in both sisters. Identical variants were found in their father with probable BIF. Neither patient presented any brain structural abnormalities or dysmorphism, and no exogenous factors or parenting problems were reported. Thus, loss of 12p11.22 may be associated with our patients' cognitive impairment. The OVCH1, OVCH1-AS1 and TMTC1 variants identified in this study are the most likely disease-causing genes in the sisters. Our findings may expand as yet limited knowledge on mild ID and BIF causative variants, which would further support the diagnosis even if the severity is mild.

Hippocampal ΔFosB expression is associated with cognitive impairment in a subgroup of patients with childhood epilepsies

Epilepsy is a chronic neurological disorder characterized by recurrent seizures, and is often comorbid with other neurological and neurodegenerative diseases, such as Alzheimer's disease (AD). Patients with recurrent seizures often present with cognitive impairment. However, it is unclear how seizures, even when infrequent, produce long-lasting deficits in cognition. One mechanism may be seizure-induced expression of ΔFosB, a long-lived transcription factor that persistently regulates expression of plasticity-related genes and drives cognitive dysfunction. We previously found that, compared with cognitively-intact subjects, the activity-dependent expression of ΔFosB in the hippocampal dentate gyrus (DG) was increased in individuals with mild cognitive impairment (MCI) and in individuals with AD. In MCI patients, higher ΔFosB expression corresponded to lower Mini-Mental State Examination scores. Surgically resected DG tissue from patients with temporal lobe epilepsy also showed robust ΔFosB expression; however, it is unclear whether ΔFosB expression also corresponds to cognitive dysfunction in non-AD-related epilepsy. To test whether DG ΔFosB expression is indicative of cognitive impairment in epilepsies with different etiologies, we assessed ΔFosB expression in surgically-resected hippocampal tissue from 33 patients with childhood epilepsies who had undergone Wechsler Intelligence Scale for Children (WISC) testing prior to surgery. We found that ΔFosB expression is inversely correlated with Full-Scale Intelligence Quotient (FSIQ) in patients with mild to severe intellectual disability (FSIQ < 85). Our data indicate that ΔFosB expression corresponds to cognitive impairment in epilepsies with different etiologies, supporting the hypothesis that ΔFosB may epigenetically regulate gene expression and impair cognition across a wide range of epilepsy syndromes.

Intellectual development of patients with biliary atresia who underwent living donor liver transplantation in infancy

BACKGROUND

The impact of pediatric liver transplantation on intellectual development has yet to be determined. We investigated the intellectual outcomes of school-aged patients after living donor liver transplantation for biliary atresia in infancy.

METHODS

The Wechsler Intelligence Scale for Children-fourth edition test was administered to 20 patients who survived [Formula: see text] 5 years after living donor liver transplantation. Borderline full scale intelligence quotient was defined as ≤ 85. Pre-, peri-, and postoperative data were compared between patients with > 85 and ≤ 85 to identify predictive factors of borderline performance.

RESULTS

The one-sample t test demonstrated that the mean full scale intelligence quotient of patients after transplantation for biliary atresia was significantly lower than that of the general population (91.8 vs. 100.0, p = 0.026) and 7 (35%) were classified as intellectual borderline functioning. Multivariable logistic regression models were unable to identify any factors predictive of full scale intelligence quotients of ≤ 85.

CONCLUSION

This is the first study to indicate that the mean full scale intelligence quotient among school-aged patients who underwent living donor liver transplantation for biliary atresia in infancy is significantly lower than that of the general population.