Intellectual disability: When a child struggles to learn?

Folake is a 10-year-old girl who has already repeated every class she has attended so far. She is currently in primary two. Her class teacher complains that she finds it very difficult to understand basic concepts such as the alphabets.

The mother brought her to the child psychiatry clinic and explains that she is worried about Folake, and she fears something might be wrong with her.

Folake’s mother: She is growing up normally and she looks alright physically. She is also very nice and friendly but she just seems to be not as intelligent as other children of her age. I have tried my best to encourage her, and I am just frustrated now.

Psychiatrist: Thank you for coming and for sharing your worries with me. I would like to ask a few more questions to clarify some aspects. Firstly, when you were pregnant with Folake, were you ill at any time? Were there any complications during the pregnancy? Did you attend antenatal care?

Folake’s mother: No, I was not ill – other than the malaria I had once or twice. I also went for antenatal and everything was going smoothly until I did a scan at eight months and they told me the baby was not coming down with the head but was horizontal in my womb – I think they called it ‘breech’.

The doctors then told me that when the pregnancy got to term (at nine months), they were going to do a caesarian section (CS) operation to bring out the baby as it would be almost impossible for me to deliver normally. I was alarmed and discussed with my mother.

We then agreed that when it was time to deliver, I should go to a prayer house for the man of God to pray for me. With God, everything is possible and our prayer was for me to deliver normally without operation. Everyone in my family had always delivered normally. Why should mine be different?

Psychiatrist: Hmmm. Okay. So how did that work out?

Folake’s mother: Well, I waited until I started having labour pains and I then went to the prayer house. Prayers went on all through the night and all of the following day. The labour pains continued but I could not deliver the baby.

By the following evening, I was completely exhausted and I was just crying. The man of God then advised that we should go to the hospital, while they continue to support with prayers. So we finally got to the hospital and I was immediately prepared for surgery and delivered Folake through a CS within four hours.

Psychiatrist: Okay. And how was Folake growing up in her early years? Was she seriously ill in her first few years of life? Did she start sitting, walking and talking at the normally expected times?

Folake’s mother: No she was not a sickly child. She was very pleasant, quiet and always smiling. The only problem we noticed was that she did not start walking until after two years. And she only started talking when she was almost three years.

But I reassured myself that some children are usually slow developers. She looked fine. It was when she went to school that we realised her performance was very poor and she was struggling….even in nursery class.

Psychiatrist: But outside of school, can you send her on errands around the house? Does she understand instructions? Does she appreciate the value of money and would she know how to calculate the right change if she went to buy something?

Folake’s mother: Nooo, you can’t send Folake on an errand to buy something. She will get confused and she would not know how much change to collect. Even in the house, she can only obey very simple instructions.

Psychiatrist: I see. Well, now it is my turn to share some information with you. Based on what you have told me about Folake thus far, it would appear as if the period of delayed labour before you came to the hospital may have had an effect on her brain.

A baby until it is born, depends entirely on its mother for sustenance through the umbilical cord…which is very soft and can be easily compressed. When labour is unnecessarily delayed, the cord may be compressed for a very long time and the baby is starved of glucose and oxygen.

This may affect the brain of the baby. These effects will only become clear over the years when the child starts having delayed growth and speech, or difficulties with learning in school. We call this ‘intellectual disability’. The old name for the condition is ‘mental retardation’.

So, in this situation, the way forward is to perform an IQ assessment and explore how best to support Folake and help her maximize her potential. It is a spectrum, and Folake may be gifted in certain areas, even if her school work is poor.