Cognitive Disabilities: Types, Diagnosis, and Support

Before we start discussing cognitive disability, it is important to understand what cognition and cognitive ability are.

Cognition refers to the way in which a person understands their surroundings and the world in general, and behaves. Cognitive abilities are a group of mental processes or abilities that are a part of almost everything we do consciously. They are brain-based skills required for a human to execute tasks – from simple chores like washing dishes to solving complex math problems. It is about how individuals learn, focus, remember, and solve problems, and not how much knowledge one has.

Let us take a simple example: an individual is asked to buy some groceries from a supermarket. It involves perception – hearing the request/order, decision making – how to get to the supermarket, once there, which brands to buy, motor skills – putting the chosen products in the shopping cart, language skills – talking to the store employees, and social skills – being able to converse confidently with other human beings. Yes, something that we take for granted, involves so many brain functions!

There are specific neuronal networks in our brains that make these abilities possible. Areas in the temporal and frontal lobes are responsible for memory skills. People with traumatic brain injuries are likely to lose some cognitive ability, as they may have neuronal networks and regions which got damaged or compromised during the injury.

Now that we have a fair understanding of cognition and cognitive ability, let’s proceed.

Cognitive Disabilities – Definition

Cognitive disabilities hamper the behavior as well as intellectual development of a person. We use this term when a person has some specific limitations in their mental capabilities like learning, social skills, communication, focusing, self-help, and so on.

For students to be diagnosed as having cognitive disabilities, it is necessary that they have some impairment in adaptive behavior as well as intellectual functioning, with the symptoms being present before the child turns 18. Intellectual functioning is about the individual’s ability to plan, reason, and understand, and it can be assessed using various methods. Adaptive behavior is all about how a person applies social and practical skills in their daily life. The way they dress, eat, handle money, follow rules, interact with other people, and care for themselves, are all examples of adaptive behavior.

Broadly speaking, a cognitive disability is a set of medical conditions that hamper cognitive ability, and it includes several cognitive or intellectual deficits. These include intellectual disability, mild deficits that don’t qualify as intellectual disability, and specific conditions or learning disabilities that are usually present in children. Issues that crop up in later life due to injuries to the brain or degenerative diseases like dementia, are also considered cognitive disabilities.

Types of Cognitive Disabilities

Cognitive disabilities are first categorized according to the severity of the deficiency. Some cognitive disability examples include:

Mild Cognitive Disability

This is the most common type of cognitive disability, and 85% of cognitive disabilities fall into this category. Usually, children in this category score between 55 and 70 on IQ tests, and they are part of the normal classroom. Mild disability characteristics like a short span of attention, adapting to new situations, inability to remember concepts learned earlier, inability to predict, weak short-term memory are seen in these children.

Moderate Cognitive Disability

Children who score between 30 and 55 on IQ tests are considered to have a moderate cognitive disability, which accounts for roughly 10% of children with cognitive disability. They may exhibit problems like social awkwardness, inability to communicate well, delays in reaching milestones of language, comprehension and more.

Severe Cognitive Disability

Children with severe cognitive disability are unable to score over 30 in IQ tests, and are likely to have extremely poor communication skills; they are also likely to need direct supervision. Around 3 to 4% of children with cognitive disabilities fall in this category.

The third type of cognitive disability is a severe cognitive disability. Kids with severe cognitive disabilities who have IQ scores that fall under 30 will have few communication skills and will need direct supervision. Of all cognitive disabilities, only about 3-4% of children have a severe cognitive disability.

Dementia

Dementia is a severe loss of cognitive ability in individuals who were previously unimpaired – beyond the normal impairment that happens due to advanced age. Neurologists diagnose dementia when an individual has an IQ that is two standard deviations below the median. If the low IQ is a lifelong condition, it is defined as an intellectual disability, and if it is something acquired later in life, it is termed dementia.

Clinical Diagnosis of Cognitive Disability

Traumatic brain injury, autism, dementia and Down Syndrome are some of the clinically diagnosed cognitive disabilities; ADHD, dyslexia, dyscalculia, and other learning disabilities are some other cognitive conditions, and these are considered less severe than the earlier set of disabilities.

Clinical diagnosis of cognitive disability can include Down syndrome, Traumatic Brain Injury (TBI), Autism, or Dementia. Clinical diagnoses are important from the medical viewpoint as it helps in deciding the treatment plan including therapy and medication.

Functional Diagnosis of Cognitive Disability

A clinical diagnosis may not always give us the right perspective, and hence it is important to view cognitive disability from a functional viewpoint. This method does not consider medical or behavioral reasons for cognitive disability, but instead, looks at the challenges an individual with a cognitive disability has to overcome in daily life. Functional cognitive disabilities include difficulties in paying attention, solving problems, math and/or visual comprehension, memorizing, reading, and so on.

Types of Cognitive Disabilities (Functional)

Dyslexia

This is the most commonly found disability based on language, and it is thought that about 15 to 20% of people have some type of learning disability based on language. Dyslexia is basically about reading, and evidence points to it being hereditary. It can occur in any gender or race. Dyslexic people may not have any other developmental or sensory issues; it can therefore be very perplexing to others when they compare the said individual’s other academic and intellectual capabilities. Phonological processing, reading single words in isolation, are all difficult for dyslexics, and they may sometimes have problems with spelling and writing too.

Attention Deficit Hyperactivity Disorder (ADHD)

Is ADHD a learning disability? Yes. ADHD is a medical condition that affects an individual’s ability to focus, control impulses, and sit still for long. They often are unable to focus on subjects and tasks, and find it difficult to multi-task; their lack of impulse control, like not waiting for their chance, blurting out things suddenly, and anger management issues, can get them in trouble quickly. ADHD starts in early childhood, but sometimes diagnosis may happen in adolescence or later. People with ADHD tend to forget tasks they are supposed to do – like homework, lose or break things, and often have impaired fine motor skills. Forgetting homework, being unable to follow instructions, especially if multiple instructions are given at one go, making careless mistakes, not paying attention to details, being disorganized, fidgeting, talking nonstop, social awkwardness, restlessness – are all symptoms of this condition.

Brain Injury

Brain injury can be of several types – stroke, traumatic brain injury, meningitis, tumor, illness, etc. All of these are unique in their own ways, and it is extremely difficult to predict how they will affect a person’s brain. A person with brain injury has to undergo numerous neurological and psychological tests to identify which areas of the brain have been impacted. With some injuries the damages and resultant behavioral changes may be negligible; however, in others, the damage, and the effects could be extensive. The extent of the brain injury determines how much cognitive ability they still have.

Genetic Disability

Dementia, autism, and Down Syndrome, are genetic disabilities, and each person may exhibit different levels of deficiencies – some may be able to hold jobs and live independently, while others may need constant supervision and assistance. The more severe the cognitive disability, the more difficult it is for the person to comprehend and function normally.

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Signs of Cognitive and Intellectual Disabilities

While each individual with cognitive disability may exhibit different symptoms, there are some symptoms that commonly manifest, like:

Inadequate understanding of social construct and etiquette, and social awkwardness
Delayed motor skills like talking and walking
Impaired fine motor skills
Poor problems solving skill
Problems with speech
Lack of impulse control and remorse
Inability to understand consequences of actions
Poor memory
Lack of focus

Lack of cognitive abilities can negatively affect the daily life of those individuals; it can affect their education, career, and personal or family life. Of course, everything depends on the severity of the disability.

Diagnosis of Cognitive & Intellectual Disability

Psychiatrists and neurologists conduct extensive examinations of the affected person to determine if they have cognitive and/or intellectual deficiencies or disabilities. They will take comprehensive notes about the child’s health issues, early life (even as a baby, how well they slept, and so on), behavioural history, and study minute aspects of their behaviour while interacting with the child in the course of the evaluation.

Parents are sometimes asked to fill out surveys, and if deemed necessary, the doctor may ask you to bring the child to the doctor’s office again for more exams including language and psychological tests, a physical examination, or even scans. Psychological evaluations are conducted in the form of games or other activities that enable the doctors to identify any telltale signs of cognitive or intellectual disability to make a precise diagnosis.

Once the assessment is over, the parents are usually given a report of the situation, along with information on community and online resources which may help your child. The reports help parents understand how to deal with their child’s disability, what kind of support the child needs, and how to provide it. It is extremely important that the intervention is begun as early as possible, and it is also important for the parent to be educated thoroughly about their child’s condition.

To learn more about cognitive and intellectual disabilities and their diagnosis, contact us.

Causes of Cognitive Disabilities

In most cases, there is no apparent cause of cognitive disability – the reason remains unknown. However, doctors are of the opinion that premature birth, low birth weight, complications in pregnancy, inadequate oxygen at birth, etc., may cause cognitive disabilities in some children. Certain disabilities may have their own causes – like Down Syndrome is caused by trisomy 21 – three copies of the chromosome 21, instead of two. Some are brought on by brain injuries; some may be caused because of toxins ingested or inhaled by the mother during pregnancy. Sometimes, there are some problems in the chemicals, such as a shortage of dopamine in the brain, or the structure of the brain itself being damaged or weak since birth; some cognitive disabilities may even be inherited.

What Is the Difference Between Cognitive Disability and Intellectual Disability?

Cognitive disability is essentially a learning disorder, wherein people with such disabilities find it difficult to comprehend, identify, perceive, select, remember, and so on. The academic progress of students with a cognitive disability is often hindered, as they find it difficult to solve math problems, or are unable to imagine situations and scenarios, imagine possible solutions and so on.

Intellectual disability, on the other hand, is a specific cognitive disability that is indicated by low scores in IQ tests, and difficulty for those children to adapt to new surroundings, especially living and working environments – a change of school, for instance. Formerly, such individuals were often referred to as mentally challenged or mentally retarded.

Intellectual disability is a particular cognitive impairment that can lead to low IQ scores and significant issues in adapting students to new environments, such as living and working environments. This disability is more difficult to understand and apply the newly gained information. A person (like Mary) with an intellectual disability was formerly referred to as “mentally challenged” or “mentally retarded”. There are various supports offered by the NDIS for such impairments which can be read here.

Treatments

There are a number of aids today that are used in the treatment of children with cognitive disabilities.

Psychiatrists and neurologists are more likely to prescribe medicines and in some cases some therapy, while psychologists will recommend only therapy. Of course, psychologists, not being medical doctors, cannot prescribe medicines.

One of the most important things you need to do is accept that there is a problem, that your child has some sort of disability, and you need to have the willingness to do what it takes to help your child live as normal and functional a life as a neurotypical child. The earlier you start, the better chances your child has at overcoming their disabilities and shortcomings. Of course, we cannot say that you can cure something like ADHD, but with the right tools, attitude, therapy and medicine, you can equip your child to manage and control their emotions, be socially confident, and live independently eventually. Some specific treatment methods may be:

Speech therapy
Role playing
Medication
Time-outs
Positive reinforcement
Taking away privileges for unacceptable behavior
Fidget toys
Physical exercise – plenty of it
Occupational therapy
Special education programs at school
Transition care

Of course, this list is by no means comprehensive; at Legacy Care, we will do our best to provide the services needed to help your child thrive and lead a fulfilling life. We can also guide you to community resources, and provide support from our dedicated staff whenever you need it. As a registered NDIS provider in Sydney, we deliver services that are tailored to the most pressing needs of affected persons and their families. We are your voice, and we are here to help you meet your goals effectively and with the least stress

Cognitive Disability – A Complete Guide!