Çocuk ve Ergenlerde Zihinsel Engellilik (INTELLECTUAL DISABILITY)
Özet
Zihinsel engellilik, IQ seviyesinin 70'in altında olması, uyumsal işlevlerde eksiklik ve 18 yaşından önce başlangıç ile karakterize bir bozukluktur. DSM-5 ve ICD-11'e göre bu durum, kavramsal, toplumsal ve uygulamalı alanlardaki kısıtlılıkları kapsayan "anlıksal yetersizlik" olarak tanımlanır. Dünya nüfusunun %1'ini etkileyen bu bozukluk, erkeklerde daha yaygın görülür. Hafif, orta, ağır ve çok ağır olmak üzere dört seviyeye ayrılan zihinsel engelliliğin etiyolojisi; Down, Frajil X ve Rett sendromu gibi genetik faktörlerin yanı sıra, fetal alkol sendromu ve enfeksiyonlar gibi çevresel etmenlere dayanır. Tanılama sürecinde klinik değerlendirmeler ve standart zeka testleri kullanılırken; tedavi yaklaşımı eğitim desteği, davranışsal müdahaleler, mesleki eğitim ve aile eğitimini kapsayan multidisipliner bir yapıyı gerektirir. Erken müdahale ve özel eğitim, bireyin bağımsız yaşam becerilerini ve yaşam kalitesini artırmada kritik rol oynar.
Intellectual disability is a disorder characterized by an IQ level below 70, deficits in adaptive functioning, and an onset before age 18. According to DSM-5 and ICD-11, this condition is defined as "intellectual disability," encompassing limitations in conceptual, social, and practical domains. Affecting 1% of the global population, it is more prevalent in males. Categorized into four levels—mild, moderate, severe, and profound—its etiology stems from genetic factors such as Down, Fragile X, and Rett syndromes, as well as environmental factors like fetal alcohol syndrome and infections. While clinical evaluations and standardized intelligence tests are used in diagnosis, the treatment approach requires a multidisciplinary structure including educational support, behavioral interventions, vocational training, and family education. Early intervention and special education play a critical role in enhancing an individual's independent living skills and quality of life.
Referanslar
Schalock, R. L., Borthwick-Duffy, S. A., Bradley, V. J., Buntinx, W. H., Coulter, D. L., Craig, E. M., ... & Yeager, M. H. (2010). Intellectual disability: Definition, classification, and systems of supports. American Association on Intellectual and Developmental Disabilities. 444 North Capitol Street NW Suite 846, Washington, DC 20001.
Birliği, A. P. (2013). Diagnostic and statistical manual of mental disorders. Baskı, Washington: American Psychiatric Association.
Harris, J. C. (2013). New terminology for mental retardation in DSM-5 and ICD-11. Current opinion in psychiatry, 26(3), 260-262.
Boat, T. F., Wu, J. T., & National Academies of Sciences, Engineering, and Medicine. (2015). Clinical characteristics of intellectual disabilities. In Mental disorders and disabilities among low-income children. National Academies Press (US).
Çetin, F. Ç., Pehlivantürk, B., Ünal, F., Uslu, R., İșeri, E., & Türkbay, T. (2008). Çocuk ve ergen psikiyatrisi temel kitabı. İşeri E. Cinsel istismar. 1inci Baskı, Ankara: Hekimler Yayın Birliği, 470-7.
Köroğlu, E., Güleç, C., & Şenol, S. (2007). Psikiyatri temel kitabı. Baskı. Ankara: HYB Basım Yayın, 273.
Lee, K., Cascella, M., & Marwaha, R. (2020). Intellectual disability. StatPearls. Treasure Island (FL): StatPearls Publishing.
Katz, G., & Lazcano-Ponce, E. (2008). Intellectual disability: definition, etiological factors, classification, diagnosis, treatment and prognosis. Salud pública de México, 50(S2), 132-141.
Blau, N. (2016). Genetics of phenylketonuria: then and now. Human mutation, 37(6), 508-515.
Harris, J. C. (2018). Lesch–Nyhan syndrome and its variants: examining the behavioral and neurocognitive phenotype. Current opinion in psychiatry, 31(2), 96-102.
Jacquemont, S., Berry-Kravis, E., Hagerman, R., Von Raison, F., Gasparini, F., Apostol, G., ... & Gomez-Mancilla, B. (2014). The challenges of clinical trials in fragile X syndrome. Psychopharmacology, 231(6), 1237-1250.
Plasschaert, E., Van Eylen, L., Descheemaeker, M. J., Noens, I., Legius, E., & Steyaert, J. (2016). Executive functioning deficits in children with neurofibromatosis type 1: The influence of intellectual and social functioning. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 171(3), 348-362.
Segawa, M. (2005). Early motor disturbances in Rett syndrome and its pathophysiological importance. Brain and Development, 27, S54-S58.
Cascella, M., & Muzio, M. R. (2015). Early onset intellectual disability in chromosome 22q11. 2 deletion syndrome. Revista chilena de pediatria, 86(4), 283-286.
Bell, L., Wittkowski, A., & Hare, D. J. (2019). Movement disorders and syndromic autism: a systematic review. Journal of autism and developmental disorders, 49(1), 54-67.
