With HIE, there can be a wide range of outcomes when it comes to the level of cognitive or intellectual impairment that a child might experience, depending on numerous factors. The terminology surrounding cognitive and intellectual disabilities can be somewhat confusing, so here is a brief explanation of the differences between these categories.
Intellectual disability: intellectual disability is a broad category of persistent disorders that reduce an individual’s cognitive capacity. It is accompanied by trouble in carrying out the activities of daily living and adaptive behaviors like managing money, schedules, and social interactions. By definition, intellectual disabilities arise before a child is 18 years old. Typically, individuals with intellectual disabilities require supportive programs throughout their adulthood. - Developmental delay: A developmental delay occurs when a child misses developmental milestones at a particular age. Sometimes these go away when a child continues to grow. If they persist, the child is then said to have a developmental disability.
- Developmental disabilities: Developmental disabilities are severe long-term disabilities that can impact either cognitive or physical abilities or both. These appear before a child is 22 years old; it is likely to be lifelong and is not expected to improve.
Testing for Intellectual and Developmental Disabilities
The most well-known test of cognitive ability is the IQ test. The level of impairment that a child may experience can vary quite widely. Outcomes can vary from mild to very severe. Cognitive disabilities can impact both intellectual function (IQ scores of 70-75 or lower) and adaptive behaviors (the ability to apply social and practical skills in everyday life):
- Mild cognitive disability: IQ 55-70; usually included in mainstream classrooms.
- Moderate cognitive disability: IQ 30-55.
- Severe cognitive disability: IQ under 30; often have few communication skills and need direct supervision.
While a child with HIE may not always necessarily have a cognitive impairment, a significant portion do. The more severe the oxygen-depriving episode, the more likely a child may have a cognitive disability.
Conditions Associated with Intellectual and Developmental Disabilities
Cognition covers a very broad range of the brain’s processes, so a cognitive disability might impact numerous different functional areas of the brain, including comprehension, planning, reasoning, decision-making, emotional processing, reading, learning, attention, computation, memory, problem-solving, recognition, speech/language and executive function. Because HIE is fundamentally a brain injury, and because brain injuries can impact numerous areas of the brain, cognitive impairments can be associated with other conditions (co-morbidities):
- Anxiety disorders
- ADHD
- Behavioral difficulties
- Mood disorders (such as depression)
- Fatigue
- Psychological disorders
- Sleep difficulties
- Autism spectrum disorders
Individuals with cognitive or intellectual impairments can benefit from supportive services, as well as specialized education plans (IEPs) to maximize their functional abilities. These educational plans include input from a number of professionals, including occupational therapists, physical therapists, doctors, psychologists, special education teachers and speech/language pathologist. The Americans with Disabilities (ADA) Act set forth ground rules for providing services to individuals with disabilities; more information about special education law can be found at Wright’s Law, a legal resource specifically devoted to helping navigate special education.
Early Detection of Intellectual and Developmental Disabilities
Cognitive disabilities can be difficult to detect while a child is very young; typically, parents bring up concerns with their pediatrician when their child does not meet developmental milestones. However, even from a young age, children respond to their environment. The best way to determine if a child has a cognitive disability is to observe them at home and to see whether the child responds to environmental stimuli. If the child doesn’t respond or doesn’t seem interested in what’s going on around them, this may potentially be a cause for concern. In an infant, a lack of response to a parent’s touch or the sound of their voice is cause to go to a doctor immediately.
Other signs of cognitive impairments can potentially include:
- A child disliking being touched
- Delays in language
- Trouble with concentration, attention or learning
- Trouble with processing information
- Outbursts and poor temper
- Poor memory
- Trouble with social interactions
- Trouble speaking or responding to other people