Funcionamiento intelectual límite: guía de consenso y buenas prácticas

Borderline Intellectual Functioning: A Scoping Review

BACKGROUND

Borderline intellectual functioning (BIF) is a condition that involves limitations in cognitive skills that affect the daily functioning of people who present it. BIF has lost visibility in diagnostic manuals such as the DSM-5-TR and ICD-11, which relegate it to complementary categories of aspects requiring attention, rather than recognising it as a category of its own. This lack of recognition as well as unclear criteria for diagnosis underscores the need for a deeper understanding of BIF.

METHOD

The study conducted a scoping review to map the available evidence in the field of BIF. Following the PRISMA-ScR framework, ProQuest, WoS, SCOPUS and EBSCOhost databases were searched. Documents were selected based on inclusion criteria: date of publication (since 2012), study of BIF as a specific group and language (English or Spanish). A total of 138 documents were included, both academic and grey literature.

RESULTS

The review mapped the literature into key categories: intellectual functioning, adaptive functioning and additions for a comprehensive evaluation. Most research focused on comorbid psychiatric, emotional and behavioural disorders associated with BIF, as well as cognitive aspects. Very few addressed adaptive functioning explicitly, a crucial area for diagnosing and supporting individuals with BIF, though many covered its domains (conceptual, social and practical). Studies predominantly used quantitative methodologies, with only a few incorporating qualitative methods and directly involving people with BIF.

CONCLUSIONS

The review emphasises the need for a clearer definition of BIF. Future studies should incorporate the perspectives of individuals with BIF to fully understand their needs and challenges across various life domains.

Exploring the Clinical Characteristics and Comorbid Disorders of Borderline Intellectual Functioning

Borderline intellectual functioning (BIF) is characterized by cognitive impairment and deficits in adaptive functioning. Despite affecting a significant proportion of the population, BIF still remains underdiagnosed and poorly understood. In addition to cognitive impairments across a range of domains, individuals with BIF face a greater risk of academic failure and often require special educational support. They suffer from emotional problems, such as difficulties with emotional awareness, anxiety, depressed mood, and unhappiness. Individuals with BIF are more likely to have an impairment of social and adaptive functioning. Furthermore, individuals with BIF are at higher risk of physical and mental health problems, often receive inadequate treatment, and have a poorer prognosis. This review aims to enhance the understanding of clinicians, educators, and policymakers by providing an overview of the characteristics of BIF and its associated challenges, ultimately contributing to the improvement of support systems for individuals with BIF.

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.

Epidemiology and Diagnosis of Slow Learners (Borderline Intellectual Functioning)

The definitions of "slow learners" and "borderline intellectual functioning (BIF)" have not reached a consensus and have continually evolved in terminology. The criteria for diagnosing BIF include the Full-Scale Intelligence Quotient, adaptive functioning, and onset of symptoms from the developmental period; however, specific standards have not been provided. Until the Diagnostic and Statistical Manual of Mental Disorders-IV, a range for the Full-Scale Intelligence Quotient was provided, but due to its limitations in reflecting the actual functioning of individuals with BIF, this criterion was removed from the Diagnostic and Statistical Manual of Mental Disorders-5. The absence of specific diagnostic criteria complicates the identification of individuals with BIF, highlighting the need for a more precise classification and definition.

Challenges and Neuropsychological Functioning in Children and Adolescents with Borderline Intellectual Functioning

This retrospective chart review study sought to explore neuropsychological profiles, neuropsychiatric and psychiatric comorbidity, changes in diagnoses, support at daycare and school, medication use, psychiatric referrals, and progression into further education in a cohort of participants with borderline intellectual functioning (BIF). Additionally, developmental factors connected to BIF were studied. Delays in language and gross motor development were the initial reasons for the parents to seek health care. Comorbid neuropsychiatric and psychiatric diagnoses were frequent, a total of 41% of participants were referred to psychiatric services, and 45% used medication. Educational support was needed by 92% of the study participants. The majority of those graduating elementary school continued their studies at ordinary or special vocational schools. The risk of dropping out during secondary studies appeared to increase. The results in most of the neuropsychological subdomains declined over time, and 23% of the participants were later diagnosed with an intellectual disability (ID). The early developmental signs pointing towards BIF and the need for prompt support were a delay in language and motor development, difficulties in executive function, a delay in learning the activities of daily living among children under school age, and difficulties in reading and arithmetic skills and abstract reasoning at school age. It is important to follow up and support individuals with BIF as their risk for being left behind in the society is increased. Also, it would be important to repeat the neuropsychological testing of cognitive and adaptive functions before graduating elementary school as to capture those who meet the ID criteria.

Analysing trends of psychiatric disorders, treatment and service use across time in adults with borderline intellectual impairment: A cross-sectional study of private households

While there is evidence that mental health problems are more prevalent in people with borderline intellectual functioning (BIF) compared to the general population, it is not known to what extent this has varied or changed over time and whether there have been changes in access to services. This paper compares the prevalence rates of psychiatric disorders and monitors trends in treatment and services in this population compared to the general population. We conducted secondary analysis on the Adult Psychiatric Morbidity Surveys carried out in England in 2000, 2007 and 2014. The total sample analysed included 21,796 participants, with 12.8% of individuals identified with BIF (n = 2786). Regression models were used to examine trends in psychiatric disorders, treatment and service use across the three datasets. People with BIF had significantly higher odds of developing mood and anxiety disorders, psychosis, drug dependence and suicidal behaviour than the general population, increasing at each subsequent timepoint. They received significantly more pharmacological treatments than the general population but have had increasingly more access to general practitioners, community care and daycare services over time. This study shows increasing prevalence rates of several mental disorders in people with BIF. Access to day-care, community care and healthcare services has increased over time for this group but not formal psychiatric care. These changes over time underline some of the problems this population faces, emphasizing a need to recognize that this is a population often overlooked in research and clinical practice.

SNAP-25 Single Nucleotide Polymorphisms, Brain Morphology and Intelligence in Children With Borderline Intellectual Functioning: A Mediation Analysis

Borderline intellectual functioning (BIF) is a multifactorial condition in which both genetic and environmental factors are likely to contribute to the clinical outcome. Abnormal cortical development and lower IQ scores were shown to be correlated in BIF children, but the genetic components of this condition and their possible connection with intelligence and brain morphology have never been investigated in BIF. The synaptosomal-associated protein of 25 kD (SNAP-25) is involved in synaptic plasticity, neural maturation, and neurotransmission, affecting intellectual functioning. We investigated SNAP-25 polymorphisms in BIF and correlated such polymorphisms with intelligence and cortical thickness, using socioeconomic status and environmental stress as covariates as a good proxy of the variables that determine intellectual abilities. Thirty-three children with a diagnosis of BIF were enrolled in the study. SNAP-25 polymorphisms rs363050, rs363039, rs363043, rs3746544, and rs1051312 were analyzed by genotyping; cortical thickness was studied by MRI; intelligence was measured using the WISC-III/IV subscales; environmental stressors playing a role in neuropsychiatric development were considered as covariate factors. Results showed that BIF children carrying the rs363043(T) minor allele represented by (CT + TT) genotypes were characterized by lower performance Perceptual Reasoning Index and lower full-scale IQ scores (p = 0.04) compared to those carrying the (CC) genotype. This association was correlated with a reduced thickness of the left inferior parietal cortex (direct effect = 0.44) and of the left supramarginal gyrus (direct effect = 0.56). These results suggest a link between SNAP-25 polymorphism and intelligence with the mediation role of brain morphological features in children with BIF.

A New Perspective on the Role of Self-Confidence and Confidence in the Evaluation and Rehabilitation of Children With Adverse Life Experience and Borderline Intellectual Functioning: A Preliminary Study

The borderline intellectual functioning (BIF) is a neurodevelopmental condition characterized by a borderline intelligence quotient (range 70-85) with difficulties in cognitive and social domains. Children with BIF often live in adverse conditions and show academic and behavioral difficulties. Rehabilitation programs for these children focus mainly on cognitive aspects, sometimes with the aid of new technologies that are able to engage and motivate. In this framework, the affective development of children with BIF and its possible role both in the difficulties they manifest and in the rehabilitation is still poorly investigated. In this work, we investigate the characteristics of the internal working models of these children by applying the separation anxiety test, using both the classical and a new coding system to identify the specific features of the attachment representation. Results delineate a profile characterized by low self-confidence and high separation anxiety, with a tendency to somatization. In the light of these results, we suggest that this attachment profile has an impact on the therapeutic relationships and on the efficacy in the use of technological devices. We propose a new perspective in which the interpersonal relationship with the psychologist and the support of the self-confidence of children are crucial to treating cognitive and behavioral difficulties in children with BIF. Only in this case, the use of new technologies and tools may be effective in promoting the greatest possible benefit from therapeutic interventions.

A Short Version of the EFECO Online Questionnaire for the Assessment of Executive Functions in School-Age Children

Executive function (EF) is a group of processes that allow individuals to be goal-oriented and to have adaptive functioning, so that adequate performance is essential for success in activities of daily living, at school and in other activities. The present study aims to create a short version of the Executive Functioning Questionnaire (EFECO) since there is a gap in the Spanish literature due to the lack of behavioural observation questionnaires at school age. A total of 3926 participants completed the online questionnaire. Subsequently, the validity and reliability of the data are analysed. The results show that the short version of the questionnaire, the EFECO-S, has a structure with five dimensions (emotional self-control, initiation, working memory, inhibition, and spatial organisation), as well as a second-order factor (global executive skill) and high reliability (ordinal Alpha = 0.68-0.88). The EFECO is composed of 67 items, while the EFECO-S has 20 items, four per factor, which turns it into a quick and easy to apply test. Therefore, it becomes an interesting alternative to be applied in screening processes with children who may be experiencing executive difficulties.

Clinical phenotypes of infantile onset CACNA1A-related disorder

BACKGROUND

CACNA1A-related disorders present with persistent progressive and non-progressive cerebellar ataxia and paroxysmal events: epileptic seizures and non-epileptic attacks. These phenotypes overlap and co-exist in the majority of patients.

OBJECTIVE

To describe phenotypes in infantile onset CACNA1A-related disorder and to explore intra-familial variations and genotype-phenotype correlations.

MATERIAL AND METHODS

This study was a multicenter international collaboration. A retrospective chart review of CACNA1A patients was performed. Clinical, radiological, and genetic data were collected and analyzed in 47 patients with infantile-onset disorder.

RESULTS

Paroxysmal non-epileptic events (PNEE) were observed in 68% of infants, with paroxysmal tonic upward gaze (PTU) noticed in 47% of infants. Congenital cerebellar ataxia (CCA) was diagnosed in 51% of patients including four patients with developmental delay and only one neurological sign. PNEEs were found in 63% of patients at follow-up, with episodic ataxia (EA) in 40% of the sample. Cerebellar ataxia was found in 58% of the patients at follow-up. Four patients had epilepsy in infancy and nine in childhood. Seven infants had febrile convulsions, three of which developed epilepsy later; all three patients had CCA. Cognitive difficulties were demonstrated in 70% of the children. Cerebellar atrophy was found in only one infant but was depicted in 64% of MRIs after age two.

CONCLUSIONS

Nearly all of the infants had CCA, PNEE or both. Cognitive difficulties were frequent and appeared to be associated with CCA. Epilepsy was more frequent after age two. Febrile convulsions in association with CCA may indicate risk of epilepsy in later childhood. Brain MRI was normal in infancy. There were no genotype-phenotype correlations found.

Prevalence and Characteristics of Borderline Intellectual Functioning in a Cohort of Patients With Polysubstance Use Disorder

Objective: To determine the prevalence and associated demographic and clinical features of borderline intellectual functioning (BIF) among individuals with polysubstance use disorder (pSUD). Methods: We applied a cross-sectional analytical design to data from the Norwegian STAYER study (n = 162), a cohort study of patients with a pSUD from the Stavanger University hospital catchment area. We used Wechsler Abbreviated Scale of Intelligence Full Scale IQ (FSIQ) to define BIF (FSIQ = 70-85) and non-BIF (FSIQ = >85) and collected demographic and clinical data using semi-structured interviews and self-reports on the Symptom Checklist 90-Revised (SCL-90-R) and the Satisfaction With Life Scale (SWLS). Results: The prevalence of BIF was 18% in the present study. The presence of BIF was associated with higher SCL-90-R GSI scores than in the non-BIF group. There were no significant differences between the BIF and non-BIF groups regarding age, gender, participation in meaningful daily activity, years of work experience, years of education, satisfaction with life, level of care, treatment attempts, age at substance-use onset, years of substance use, history of injecting drugs, or age of onset of injecting drugs. Conclusion: The present study confirmed a higher prevalence of BIF among patients with pSUD than expected from the distribution of IQ scores in a general population. Elevated SCL-90-R GSI scores suggested that BIF is associated with increased psychological distress in patients receiving treatment for pSUD. Further studies on this association, and its effect on treatment procedure and outcomes are strongly warranted.

Oral health and oral health behaviour of adolescents with mild or borderline intellectual disabilities compared with a national representative sample of 17-year-olds in the Netherlands

BACKGROUND

People with intellectual disabilities have worse health outcomes compared to their peers without. However, regarding oral health parameters, recent systematic reviews reported conflicting evidence. The aim was to assess whether adolescents with MBID differ from their peers in oral health and oral health behaviour.

METHODS

Ninety seven adolescents with MBID participated in this comparative study. Outcomes were compared to data of 17-year-old Dutch adolescents (n = 581) from a national epidemiological study on oral health and oral health behaviour.

RESULTS

Adolescents with MBID showed worse oral health outcomes and poorer oral hygiene than their peers from the general population. Furthermore, they visit the dentist less regularly, brush less frequently, eat main-dishes less frequently and have higher levels of dental anxiety.

CONCLUSION

Adolescents with MBID have poorer oral health and show worse oral health-promoting behaviours than their peers in the general population. Targeted interventions to reach this vulnerable group are necessary.

Economic burden of slow learners: A prevalence-based cost of illness study of its direct, indirect, and intangible costs

Aims:

The primary objective of this study was to evaluate the economic burden of slow learners (students with “borderline intellectual functioning”) by estimating its direct, indirect, and intangible costs. The secondary objective was to assess the impact of variables on the economic burden.

Settings and Design:

Cross-sectional, single-arm descriptive study.

Setting:

Learning disability clinic in a public medical college in Mumbai.

Materials and Methods:

The study cases (age ≥5 - 18 years) were recruited by nonprobability sampling. A structured questionnaire was used to interview the parent to collect data related to direct and indirect costs. Intangible costs data were collected by documenting the willingness-to-pay value using the contingent valuation technique.

Statistical Analysis Used:

A quantile regression model was used to assess the impact of predictor variables on the costs.

Results:

The direct, indirect, and intangible costs of slow learners were INR 6,065,915, 10,298,613, and 145,172,800, respectively. Indirect costs comprised 62.9% of the total costs. Expenditure on tuitions, medications, and remedial education comprised 57.38%, 16.18%, and 10.30% of the direct costs, respectively. The average annual total costs of slow learners were INR 3,544,880. The average annual learning disability clinic costs were INR 2,250,194. The average annual total costs per student were INR 57,951. Longer duration of poor school performance was predictive of higher direct and total costs.

Conclusion:

The economic burden of slow learners is enormous (intangible > indirect > direct costs). Tuitions are the most costly component of direct costs. Parental loss of earnings is the most costly component of indirect costs.

Intervening on the Developmental Course of Children With Borderline Intellectual Functioning With a Multimodal Intervention: Results From a Randomized Controlled Trial

An adverse social environment is a major risk factor for borderline intellectual functioning (BIF), a condition characterized by an intelligence quotient (IQ) within the low range of normality (70-85) with difficulties in the academic achievements and adaptive behavior. Children with BIF show impairments in planning, language, movement, emotion regulation, and social abilities. Moreover, the BIF condition exposes children to an increased risk of school failures and the development of mental health problems, and poverty in adulthood. Thus, an early and effective intervention capable of improving the neurodevelopmental trajectory of children with BIF is of great relevance.

AIM

The present work aims to report the results of a randomized controlled trial (RCT) in which an intensive, integrated and innovative intervention, the movement cognition and narration of the emotions (MCNT) was compared to standard speech therapy (SST) for the treatment of children with BIF.

METHODS

This was a multicenter, interventional, single blind RCT with two groups of children with BIF: the experimental treatment (MCNT) and the treatment as usual (SST). A mixed factorial ANOVA was carried out to assess differences in the effectiveness between treatments. Primary outcome measures were: WISC III, Child Behavior Checklist (CBCL), Vineland II, and Movement ABC.

RESULTS

MCNT proved to be more effective than SST in the increment of full-scale IQ (p = 0.0220), performance IQ (p < 0.0150), socialization abilities (p = 0.0220), and behavior (p = 0.0016). No improvement was observed in motor abilities. Both treatments were linked to improvements in verbal memory, selective attention, planning, and language comprehension. Finally, children in the SST group showed a significant worsening in their behavior.

CONCLUSION

Our data show that an intensive and multimodal treatment is more effective than a single domain treatment for improving intellectual, adaptive and behavioral functioning in children with BIF. These improvements are relevant as they might represent protective factors against the risk of school failure, poverty and psychopathology to which children with BIF are exposed in the adult age. Limitations of the study are represented by the small number of subjects and the lack of a no-treatment group.

CLINICAL TRIAL REGISTRATION

ISRCTN Registry (isrctn.com), identifier ISRCTN81710297.

Is there an association between full IQ score and mental health problems in young adults? A study with a convenience sample

Background

Intelligence is the aggregate or global capacity of the individual to act purposefully, to think rationally and to deal effectively with the environment. Previous studies have shown that individuals with intellectual disability, IQ < 70, have increased risk of being diagnosed with one or more mental disorders. We wanted to investigate if this also applies to individuals with IQ between 70 and 85.

Methods

In this study, data was abstracted from a longitudinal follow-up study of individuals with low birth weight and a control group. In the present study, mental health of participants with borderline IQ, defined as a full IQ score 70–84, were compared with mental health of a reference group with full IQ scores ≥85. Mental health at age 19 was assessed using the Schedule for Affective Disorder and Schizophrenia for School-age Children Present and Lifetime (K-SADS P/L) whereby scores meeting the diagnostic criteria for a mental disorder were defined as having mental health problems. In addition the participants completed the ADHD-rating scale and the Autism Spectrum Quotient form (AQ). Logistic regression analyses were used to calculate odds ratio (OR) with 95% confidence intervals (CI) for high scores on the K-SADS.

Results

Thirty participants with borderline IQ and 146 controls were included. Sixteen (53%) of the participants with borderline IQ met the diagnostic criteria on the K-SADS for any diagnosis compared with 18 (12%) in the reference group (OR: 6.2; CI: 2.6–14.9). In particular the participants with borderline IQ had excess risk of ADHD and anxiety. These associations were slightly attenuated when adjusted for birth weight and parents’ socioeconomic status.

Conclusions

53% of the participants with borderline IQ had increased risk for a research assessed psychiatric diagnosis compared to about one in ten in the reference group. The group with borderline IQ also had higher total scores and higher scores on some sub-scores included in the Autism Spectrum Quotient form. Our results points towards an increased vulnerability for mental illness in individuals with borderline low IQ.

Trial registration

The main study is recorded by the Regional Committee for Health Research Ethics in Mid-Norway (as project number 4.2005.2605).

Early Life Adversities and Borderline Intellectual Functioning Negatively Impact Limbic System Connectivity in Childhood: A Connectomics-Based Study

Early life adversity (ELA) in childhood is a major risk factor for borderline intellectual functioning (BIF). BIF affects both adaptive and intellectual abilities, commonly leading to school failure and to an increased risk to develop mental and social problems in the adulthood. This study aimed to investigate the neurobiological underpinnings of ELA associated with BIF in terms of global topological organization and structural connectivity and their relation with intellectual functioning. BIF (N=32) and age-matched typical development (TD, N=14) children were evaluated for intelligence quotient (IQ), behavioral competencies, and ELA. Children underwent an anatomical and diffusion-weighted MR imaging (DWI) protocol. Global brain topological organization was assessed measuring segregation and integration indexes. Moreover, structural matrices, measuring normalized number of fibers (NFn), were compared between the 2 groups using network-based statistics. Finally, a linear regression model was used to explore the relationship between network parameters and clinical measures. Results showed increased behavioral difficulties and ELA, together with decreased network integration in BIF children. Moreover, significantly lower NFn was observed in the BIF group (p=.039) in a sub-network comprising anterior and posterior cingulate, the pericallosal sulcus, the orbital frontal areas, amygdala, basal ganglia, the accumbens nucleus, and the hippocampus. Linear regression showed that NFn significantly predicted IQ (p<.0001). This study demonstrated that ELA in children with BIF is associated with a decreased information integration at the global level, and with an altered structural connectivity within the limbic system strictly related to the intellectual functioning.

Rehabilitation and Disability Spectrum From Adverse Childhood Experience: The Impact of the Movement Cognition and Narration of Emotions Treatment (MCNT) Version 2.0

Adverse Childhood Experiences (ACE) are associated with an increased risk of cerebral, behavioral, and cognitive outcomes, and vulnerability to develop a Borderline Intellectual Functioning (BIF). BIF is characterized by an intelligence quotient (IQ) in the range 70-85, poor executive functioning, difficulties in emotion processing, and motor competencies. All these difficulties can lead to mental and/or neurodevelopmental disorders that require long-term care. Accordingly, we developed an intensive and multidomain rehabilitation program for children with ACE and BIF, termed the Movement Cognition and Narration of emotions Treatment (MCNT1.0). The efficacy of MCNT1.0 on cognitive and social functioning was demonstrated with a previously reported randomized controlled trial (RCT). To extend the impact of the treatment also to the motor domain a new version, called MCNT2.0, was implemented. The present study aims to verify the feasibility of MCNT2.0 and its effects on the motor domain. A quasi-experimental approach was used in which a group of 18 children with ACE and BIF were consecutively recruited and participated in the MCNT 2.0 program. Participants were compared with the MCNT1.0 group as an active comparator, using the dataset of the RCT. The two groups received a full evaluation comprising: the Wechsler Intelligent Scale for Children-IV (WISC-IV), the Movement-ABC (M-ABC), the Test of Gross Motor Development (TGMD), the Social Skills from Vineland Adaptive Behavioral Scale-II (VABS-II) and the Child Behavior Check List 6-18 (CBCL). An ANCOVA was carried out on changes in the scale scores from baseline with age and baseline score as covariates. Results showed a mean adherence to treatment of 0.85 (sd = 0.07), with no differences between groups in IQ, and Social Skills changes, while greater improvements for motor abilities were shown in the MCNT 2.0 group: M-ABC (p = 0.002), and TGMD (p = 0.002). Finally, greater improvement in the CBCL scale was observed in the MCNT 1.0 group (p = 0.002). Results indicate that due to its positive effects on cognitive, social participation and motor domains, MCNT2.0 may represent a protective factor against maladaptive outcomes of children with ACE and BIF.

Association of Borderline Intellectual Functioning and Adverse Childhood Experience with adult psychiatric morbidity. Findings from a British birth cohort

BACKGROUND

To examine whether Borderline Intellectual Functioning (BIF) and Adverse Childhood Experiences independently predict adult psychiatric morbidity.

METHODS

We performed a secondary analysis of longitudinal data derived from the 1970 British Birth Cohort Study to examine whether BIF and Adverse Childhood Experiences independently predict adult mental distress as measured by the Malaise Inventory. Factor analysis was used to derive a proxy measure of IQ from cognitive testing at age 10 or 5. Variables that could be indicators of exposure to Adverse Childhood Experiences were identified and grouped into health related and socio-economic related adversity.

RESULTS

Children with BIF were significantly more likely than their peers to have been exposed to Adverse Childhood Experiences (BIF mean 5.90, non-BIF mean 3.19; Mann-Whitney z = 31.74, p < 0.001). As adults, participants with BIF were significantly more likely to score above the cut-off on the Malaise Inventory. We found statistically significant relationships between the number of socio-economic Adverse Childhood Experiences and poorer adult psychiatric morbidity (r range 0.104-0.141, all p < 001). At all ages the indirect mediating effects of Adverse Childhood Experiences were significantly related to adult psychiatric morbidity.

CONCLUSIONS

The relationship between BIF and adult psychiatric morbidity appears to be partially mediated by exposure to Adverse Childhood Experiences. Where possible, targeting Adverse Childhood Experiences through early detection, prevention and interventions may improve psychiatric morbidity in this population group.

Gross motor proficiency and intellectual functioning: A comparison among children with Down syndrome, children with borderline intellectual functioning, and typically developing children

This cross-sectional study examines differences in gross motor proficiency as a function of different intellectual functioning profiles. Two motor areas have been investigated as being equally essential to gross motor functions in every-day life: locomotion and object control.It aims to compare gross motor skills endorsed by children with Down syndrome (DS), children with borderline intellectual functioning (BIF), and typically developing children (TDC).Group 1 was composed of 18 children with DS (chronological age = 8.22), group 2 was composed of 18 children with BIF (chronological age = 9.32), and group 3 was composed of 18 children with typical development (TD) (chronological age = 9.28).Gross motor skills were measured through the test of gross motor development (TGMD-Test) composed of locomotion and object control tasks.Children with DS showed worse gross motor skills compared with children with BIF and typically developing children by underscoring both on all locomotion (e.g., walking, running, hopping, galloping, jumping, sliding, and leaping) and all object control tasks (e.g., throwing, catching, striking, bouncing, kicking, pulling, and pushing).In DS group strengths were found on run and slide skills, in BIF group strengths were on run, long jump and slide skills and in TDC group strengths were on run and slide skills. For all of the 3 groups the locomotor worst performed task was jump forward with arm swing.Findings suggest implications for further practice to develop evidence-based exercise programs aimed to rehabilitate gross motor skills through the regular participation in structured exercise activities.

The association between employment status and health among British adults with and without intellectual impairments: cross-sectional analyses of a cohort study

Background

There exists a well established link between employment status and health, with unemployment being associated with poorer health. Much less is known about the association between economic inactivity and health, especially among people with disabilities. Our aim is to determine whether the association between employment status and health is similar for adults with and adults without intellectual impairment.

Methods

Using nationally representative data from the 1970 British Cohort Study, we undertook a series of cross sectional analyses of the association between employment status and health (self-reported general health, mental health) among British adults with and without intellectual impairments at ages 26, 30, 34, 38 and 42.

Results

People with intellectual disability and borderline intellectual functioning had markedly lower employment rates and poorer health than other participants at all waves of data collection. When compared with participants in full-time employment the prevalence of poorer self rated health and mental health was higher among participants with and without intellectual impairment who were in either part-time employment or were economically inactive at all ages. When compared with participants in employment the prevalence of poorer self rated health and mental health was higher among participants with and without intellectual impairment who were in the economically inactive categories of unemployment, education/training and ill/disabled at all ages. Intellectual disability status appeared to moderate the strength of the relationship between economic activity and self-rated health and, to a much lesser extent, the relationship between economic activity and mental health. In all instances the moderation indicated a stronger association among participants without intellectual impairment.

Conclusions

The results provide substantive evidence to suggest that the nature of the well-established association between employment and better health is similar for British adults with and without intellectual impairments. The results do, however, indicate that the magnitude of the effect involved differed. Further research is needed to identify mechanisms that may underlie this difference.

The association between non-standard employment, job insecurity and health among British adults with and without intellectual impairments: Cohort study

We sought to investigate the association between employment conditions and health among working age British adults with and without intellectual impairments. Using data from the 1970 British Cohort Study, we undertook a series of cross sectional analyses of the association between employment conditions and health (self-reported general health, mental health) among British adults with and without intellectual impairments at ages 30, 34 and 42. Our results indicated that: (1) British adults with intellectual impairments were more likely than their peers to be exposed to non-standard employment conditions and experience job insecurity; (2) in both groups exposure was typically associated with poorer health; (3) British adults with intellectual impairments in non-standard employment conditions were more likely than their peers to transition to economic inactivity; (4) among both groups, transitioning into employment was associated with positive health status and transitioning out of employment was associated with poorer health status. British adults with intellectual impairments are significantly more likely than their peers to be exposed to non-standard and more precarious working conditions. The association between employment conditions and health was similar for British adults with and without intellectual impairments. As such, the study found no evidence to suggest that research on causal pathways between employment and health derived from studies of the general population should not generalize to the population of people with intellectual impairments.

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Little is known about the association between employment conditions and health among adults with intellectual impairments.

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Adults with intellectual impairments were more likely than their peers to be exposed to non-standard employment conditions and experience job insecurity.

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Exposure was associated with poorer health.

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Adults with intellectual impairments in non-standard employment were more likely than their peers to transition to economic inactivity.

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Transitioning into employment was associated with positive health status and transitioning out of employment was associated with poorer health status.

Memory and linguistic/executive functions of children with borderline intellectual functioning

Children with Borderline Intellectual Functioning (BIF) have received a minimal amount of research attention and have been studied in conjunction with Intellectual and Developmental Disabilities. The present study intends to broaden the knowledge of BIF, by analyzing domains such as verbal memory and visual memory, as well as tasks that rely simultaneously on memory, executive functions, and language. A cross-sectional, comparison study was carried out between a group of 40 children with BIF (mean age = 10.03; 24 male and 16 female), and a control group of 40 normal children of the same age, gender, and socioeconomic level as the BIF group. The WISC-III Full Scale IQs of the BIF group ranged from 71 to 84. The following instruments were used: Word List, Narrative Memory, Rey Complex Figure, Face Memory, Rapid Naming (both RAN and RAS tests), and Verbal Fluency. The results showed deficits in children with BIF in verbal short-term memory, rapid naming, phonemic verbal fluency, and visual short-term memory, specifically in a visual recognition task, when compared with the control group. Long-term verbal memory was impaired only in older children with BIF and long-term visual memory showed no deficit. Verbal short-term memory stands out as a limitation and visual long-term memory as a strength. Correlations between the WISC-III and neuropsychological tests scores were predominantly low. The study expands the neuropsychological characterization of children with BIF and the implications of the deficits and strengths are stressed.

Movement cognition and narration of the emotions treatment versus standard speech therapy in the treatment of children with borderline intellectual functioning: a randomized controlled trial

BACKGROUND

Borderline intellectual functioning (BIF) is defined as a "health meta-condition… characterized by various cognitive dysfunctions associated with an intellectual quotient (IQ) between 71 and 85 which determines a deficit in the individual's functioning both in the restriction of activities and in the limitation of social participation". It can be caused by many factors, including a disadvantaged background and prematurity. BIF affects 7-12% of primary school children that show academic difficulties due to poor executive functioning. In many children with BIF, language, movement and social abilities are also affected, making it difficult to take part in daily activities. Dropping out of school and psychological afflictions such as anxiety and depression are common in children with BIF. This study investigates whether an intensive rehabilitation program that involves all of the areas affected in children with BIF (Movement, Cognition and Narration of emotions, MCNT) is more effective than Standard Speech Therapy (SST).

METHODS

This is a multicenter interventional single blind randomized controlled study. Children aged between 6 to 11 years who attend a mainstream primary school and have multiple learning difficulties, behavioral problems and an IQ ranging between 85 to 70 have been enrolled. Participants are randomly allocated to one of three groups. The first group receives individual treatment with SST for 45 min, twice a week for 9 months. The second group receives the experimental treatment MCNT for 3 h per day, 5 days/ week for 9 months and children work in small groups. The third group consists of children on a waiting list for the SST for nine months.

DISCUSSION

BIF is a very frequent condition with no ad hoc treatment. Over the long term, there is a high risk to develop psychiatric disorders in adulthood. Due to its high social impact, we consider it very important to intervene during childhood so as to intercept the remarkable plasticity of the developing brain.

TRIAL REGISTRATION

"Study Let them grow: A new intensive and multimodal Treatment for children with borderline intellectual functioning based on Movement, Cognition and Narration of emotions", retrospectively registered in ISRCTN Register with ISRCTN81710297 at 2017-01-09.

Social Competence in Children with Borderline Intellectual Functioning: Delayed Development of Theory of Mind Across All Complexity Levels

Borderline intellectual functioning (BIF) is characterized by heterogeneous cognitive difficulties, with an intelligence quotient (IQ) between 70 and 85 points, and a failure to meet the developmental and sociocultural standards for personal independence and social responsibility required in daily life. The fact that this population still remain a marginal clinical category, with no ad hoc diagnostic and therapeutic approaches, has stimulated the present research. Our goal was to study children with BIF investigating the development of Theory of Mind (ToM) as a pillar of social competence. Children with BIF (N = 28, 16 male/12 female, and mean age 9.46 ± 1.26 years) and children with typical development (TD; N = 31, 17 male/14 female; mean age 8.94 years ± 0.99) underwent a neurocognitive assessment and a ToM assessment. Children with BIF showed a significant lower performance across all the levels of ToM development investigated compared to the control group, and a correlation between executive functions and the advanced levels of ToM reasoning. These results constitute a first step in the direction of defining the clinical profile of children with BIF concerning ToM development, opening the way to future interventions in order to support the developmental evolution of this population in an adaptive direction.

Australian indigenous children with low cognitive ability: Family and cultural participation

Family and cultural inclusion are essential for the healthy development of young Australian Indigenous peoples with low cognitive ability. To date, this issue has received limited research attention. A secondary analysis of data collected in Wave 4 of Footprints in Time, Australia's Longitudinal Study of Indigenous Children, was conducted to help address this research gap. The study results indicated that in some areas, Indigenous children with low cognitive ability are at a higher risk of social exclusion than their peers. We discuss the policy implications of these findings with regards to addressing Indigenous disadvantage.

The Mental Health of British Adults with Intellectual Impairments Living in General Households

BACKGROUND

People with intellectual disability or borderline intellectual functioning may have poorer mental health than their peers. The present authors sought to (i) estimate the risk of poorer mental health among British adults with and without intellectual impairments and (ii) estimate the extent to which any between-group differences in mental health may reflect between-group differences in rates of exposure to common social determinants of poorer health.

MATERIALS AND METHODS

The present authors undertook secondary analysis of confidentialized unit records collected in Wave 3 of Understanding Society.

RESULTS

British adults with intellectual impairments living in general households are at significantly increased risk of potential mental health problems than their non-disabled peers (e.g. GHQ Caseness OR = 1.77, 95% CI (1.25-2.52), P < 0.001). Adjusting for between-group differences in age, gender and indicators of socio-economic position eliminated this increased risk [GHQ Caseness adjusted OR = 1.06, 95% CI (0.73-1.52), n.s].

CONCLUSIONS

Our analyses are consistent with the hypothesis that the increased risk of poor mental health among people with intellectual impairments may be attributable to their poorer living conditions rather than their intellectual impairments per se. Greater attention should be given to understanding and addressing the impact of exposure to common social determinants of mental health among marginalized or vulnerable groups.

The prevalence of personality disorders in psychiatric outpatients with borderline intellectual functioning: Comparison with outpatients from regular mental health care and outpatients with mild intellectual disabilities

BACKGROUND

There is little research on the subject of personality disorder (PD) in individuals with borderline intellectual functioning (BIF). Unlike in most countries, in the Netherlands, patients with BIF are eligible for specialized mental health care. This offers the unique possibility of examining the rates of PDs in patients, who in other countries are treated relatively invisibly in regular mental health care.

AIM

To compare, in a naturalistic setting, the frequency of PD diagnoses in outpatients with BIF with outpatients from regular mental health care and outpatients with mild ID.

METHODS

We compared the rates of all DSM-IV-TR axis II PDs in outpatients with BIF (BIF group; n = 235) with rates of the same disorders in outpatients from regular mental health care (RMHC group; n = 1026) and outpatients with mild intellectual disability (ID) (mild ID group; n = 152) in a naturalistic cross-sectional anonymized medical chart review.

RESULTS

Over half of the patients with BIF (52.8%) were diagnosed with a PD, compared with one in five in the RMHC group (19.3%) and one in three of the mild ID group (33.6%). All PD diagnoses, except for cluster A PDs and histrionic PDs, were most frequently diagnosed in the BIF group. PD NOS and borderline PD were the most frequently diagnosed PDs in BIF. The majority of PD patients had one or more comorbid axis I disorder.

CONCLUSION

There is a high frequency of PD diagnoses in BIF outpatients in daily clinical practice. In anticipation of further scientific research, results suggest that PDs should not be overlooked in patients with BIF.

Borderline intellectual functioning is associated with poor social functioning, increased rates of psychiatric diagnosis and drug use--a cross sectional population based study

Borderline intellectual functioning is defined by the DSM IV as an IQ range that is between one to two standard deviations below the mean (71<IQ<84), and a considerable percentage of the population is included in this definition (approximately 13.5%). The few studies performed on this group indicate that borderline intellectual functioning is associated with various mental disorders, problems in everyday functioning, social disability and poor academic or occupational achievement. Using data from the Israeli military, we retrieved the social and clinical characteristics of 76,962 adolescents with borderline intellectual functioning and compared their social functioning, psychiatric diagnoses and drug abuse with those of 96,580 adolescents with average IQ (± 0.25 SD from population mean). The results demonstrated that the borderline intellectual functioning group had higher rates of poor social functioning compared to the control group (OR=1.9, 95% CI=1.85-1.94). Individuals with borderline intellectual functioning were 2.37 times more likely to have a psychiatric diagnosis (95% CI=2.30-2.45) and 1.2 times more likely to use drugs (95% CI=1.07-0.35) than those with average IQ. These results suggest that adolescents with borderline intellectual functioning are more likely to suffer from psychiatric disorders, poor social functioning and drug abuse than those with average intelligence, and that borderline intellectual functioning is a marker of vulnerability to these poor outcomes.

Abnormal development of sensory-motor, visual temporal and parahippocampal cortex in children with learning disabilities and borderline intellectual functioning

Borderline intellectual functioning (BIF) is a condition characterized by an intelligence quotient (IQ) between 70 and 85. BIF children present with cognitive, motor, social, and adaptive limitations that result in learning disabilities and are more likely to develop psychiatric disorders later in life. The aim of this study was to investigate brain morphometry and its relation to IQ level in BIF children. Thirteen children with BIF and 14 age- and sex-matched typically developing (TD) children were enrolled. All children underwent a full IQ assessment (WISC-III scale) and a magnetic resonance (MR) examination including conventional sequences to assess brain structural abnormalities and high resolution 3D images for voxel-based morphometry analysis. To investigate to what extent the group influenced gray matter (GM) volumes, both univariate and multivariate generalized linear model analysis of variance were used, and the varimax factor analysis was used to explore variable correlations and clusters among subjects. Results showed that BIF children, compared to controls have increased regional GM volume in bilateral sensorimotor and right posterior temporal cortices and decreased GM volume in the right parahippocampal gyrus. GM volumes were highly correlated with IQ indices. The present work is a case study of a group of BIF children showing that BIF is associated with abnormal cortical development in brain areas that have a pivotal role in motor, learning, and behavioral processes. Our findings, although allowing for little generalization to the general population, contribute to the very limited knowledge in this field. Future longitudinal MR studies will be useful in verifying whether cortical features can be modified over time even in association with rehabilitative intervention.