BORDERLINE INTELLECTUAL

FUNCTIONING: A complex picture of deficits and problems in no-man´s land

1. Villablanca Serveis Assistencials, Reus, Spain.

2. Fundació Villablanca, Reus, Spain; IISPV, URV, CIBERSAM.

3.University of Sydney, Sydney, Australia.

A. Torres 1, M. Fernández 1, M.J. Cortés2, A. Folch2, L. Salvador-Carulla3, R. Martínez-Leal 2

DEFINITION

� It’s not a medical condition, neither a disease, there is no code for diagnosis in any classification (DSM or ICD-10).

� It could be considered a health metacondition (like pregnancy) where special attention is required at certain times.

� There are concerns in health services about where and � There are concerns in health services about where and how these people must be attended.

� There are not enough data about the complications that occur in Borderline Intellectual Functning (BIF), and the prevalence of added disorders and other problems is not well-known

� Salvador-Carulla L, Ruiz Gutierrez-Colosía M, Nadal M, Grupo CONFIL. Documento de Consenso sobre el funcionamiento intelectual límite. Madrid: Obra Social Caja Madrid; 2010

PREVALENCE

� Prevalence and justification of those not being classificated in an important part of society:13-18% (Hassiotis, A. Et al, 2001; Seltzzer, MM. 2005)

� Gallén (2005) speech about 41000 people in Spain, data from INE, although she cites could be up to 1 to 1.5 per cent of Spanish populationcent of Spanish population(Gallén C., 2005, Las Fronteras de la normalidad, Una aproximación en clave social a las personas con inteligencia limite o Borderline))

IQ

Mounting evidence suggest...

� Mental health problems in people with BIF are not well addressed bygeneral psychiatry (Wieland, J. Et al, 2014)

� A reduced sleep duration, an increased rate of stage shifts and awakenings. (Esposito, M. 2014, 2010)

� Emotional and behavioural problems as well as a lack of social competencein youngers (Nestler, J. & Goldbeck, L., 2011)

� Increased rates of suicidal behaviour in young people with BIF and social � Increased rates of suicidal behaviour in young people with BIF and social disadvantages (Hassiotis, A. 2011)

� Problems with motor skill performance and higher-order executivefunctions (Hartman, E. Et al; 2010; Vuijk P et al, 2010)

� More emotional, substance use, personality, adaptation and social problemsin adults (Hassiotis, A, 1999)

� Higher rates of mental health problems in children (Emerson, E., 2010)

� Worse prognosis of mental health problems in BIF population (Chaplin, R; 2006)

Background

� Data about BIF are very scarce.

� Are there real differences among BIF and mild ID regardingfunctioning and adaptive behaviour?

� Is functioning taken into account for the differential diagnosis?

OBJECTIVESOBJECTIVES

-To compare the level of impairments presented by BIF and ID.

-To present information about mental health conditions in BIF.

Methodology: NATIONAL SURVEY

(EDAD 2008)

� Specific for disability

� Interviewed more than 33000 people with disability

� 2840 had intellectual disability –including BIF-

� Geographical representation, taking into account residencesand private homes in the community.

The interview included a modified version of the International � The interview included a modified version of the International Classification of Functioning (WHO).

� Variables:

-Sex -ID/BIF

-Age -ICF areas of functioning

-Living arrangements

Instituto Nacional de Estadística, 2010. Encuesta de Discapacidad, Autonomia Personal y Dependencia EDAD-2008.

Sample Representation

122

431

Sample 2192

Borderline Intellectual Functioning: BIF

Mild Intellectual

1639

Mild Intellectual Disability: Mild ID

Several Mental Disorder: SMD

BIFn:122

Mild IDn:431

SMDn:1639

Male 56.1% 54.9% 51.3%

Age x:41.40(21) x:43.03(17.62) x:57.26(17.51)**

Family home 35.3% 63.9% 45.8%

Single 91% 92.8% 48%**

**Significant differences in age among SMD and the other

groups being the SMD group older, there are not difference

between BIF and Mild ID

Single 91% 92.8% 48%**

Disability certificate 65.6% 83.1% 57.8%

RESULTS

Persons with BIF have similar problems to those with mildID in important areas such as:� VISION and HEARING

� COMMUNICATION

� TASK PERFORMANCE and LEARNING

� SOCIAL INTERACTIONS

Persons with BIF are more independent in areas such as:� AUTONOMY and SELF CARE

� DOMESTIC SKILLS

More than 60% of persons with BIF living in thecommunity presented some type of Mental Disorder.

IMPAIRTMENTS IN VISION

8

10

12

BIF

BIF

Mild ID

SMD

0

2

4

6

8 BIF

Mild ID

SMD

BLIND DIFFICULTY

READ

NEWSPAPER

AT LEAST 1

DIFFICULTY

AT VISION

DIFFICULTY

SEE FACES

AT DISTANCE

IMPAIRTMENTS IN HEARING

8

10

12

BIF

BIF

Mild ID

SMD

0

2

4

6

8

5,7**

BIF

Mild ID

SMD

DEAF DIFFICULTY

LOUD

SOUNDS

AT LEAST 1

DIFFICULTY

AT HEARING

DIFFICULTY

CONVERSATIONS

IMPORTANT IMPAIRTMENTS IN

COMMUNICATION

40

50

60

70

BIF

BIF

SMD

0

10

20

30

40

6,6*

BIF

Mild ID

SMD

DIFFICULTIES TO

PRODUCE

UNDERSTANDABLE

AND MEANINFULL

TALKING

UNDERSTANDING

OTHERS GESTURES,

DRAWS AND

SYMBOLS

MANTEIN A

CONVERSATION

OR INTERCHANGE

IDEAS USING ANY

KIND OF

LANGUAGE

USING THE

TELEPHONE

WRITTEN

LANGUAGE

AT LEAST 1

COMMUNICATION

PROBLEM

IMPORTANT IMPAIRTMENTS IN TASK

PERFORMANCE AND LEARNING

40

50

60

BIF

BIF

Mild ID

SMD

0

10

20

30

BIF

Mild ID

SMD

DIFFICULTIES

AT TASK

PERFORMANCE

DIFFICULTIES

LEARNING TO

READ, COUNT,

WRITTING, USING

TOOLS, ETC

DIFFICULTIES

WITH COMPLEX

TASKS

AT LEAST 1

DIFFICULTY WITH

TASKS

PERFORMANCE

DIFFICULTIES

WITH EASY TASKS

IMPORTANT IMPAIRTMENTS IN MOBILITY

40

50

60

70

BIF

BIF

SMD0

10

20

30

40

18,9**23**

36,1**

BIF

Mild ID

SMD

POSTURAL

CHANGE

MAINTAIN

BODY

POSITION

WALK

OUTSIDE

PUBLIC

TRANSPORTSDRIVING

MANIPULATES

AND MOVES

OBJECTS

LIFT AND

CARRY OBJECTS MANIPULATES

SMALL

OBJECTS

WALK

AT

HOME

IMPORTANT IMPAIRMENTS IN AUTONOMY

ANS SELF-CARE

50

60

70

80

50,8* BIF

BIF

SMD0

10

20

30

40

50

19,7* 19,7**

2,5*

10,7*

39,3**

21,3**

BIF

Mild ID

SMD

WASHING/

DRYING

BASIC

BODY

SELF-CARE DEFECATIONDRESS/

UNDRESSEATING/

DRINKINGGENERAL

SAFETY

TAKING

MEDICATION

URINATION

AT LEAST 1

IMPORTANT

IMPAIRMENT IN

AUTONOMY

IMPORTANT IMPAIRMENTS IN SOCIAL

INTERACTIONS

50

60

70

80

BIF

BIF

Mild IDSMD

0

10

20

30

40

50

26,2**

42,5**

BIF

Mild ID

SMD

EXPRESSING

AFFECTION,

RESPECT,

EMOTIONS

FRIENDS,

NEIGHBOURS,

MATES

FAMILY

RELATIONSHIPSLOVE,

SEXUAL

PARTNERS

RELATIONS

AT WORK,

SERVICES AT LEAST 1

IMPAIRMENT IN

SOCIAL

INTERACTIONS

IMPORTANT IMPAIRMENTS IN DOMESTIC

LIFE

50

60

70

80

48,4** BIF

BIF

Mild ID

SMD

0

10

20

30

40

5038,5** 41**

32,8**

BIF

Mild ID

SMD

SHOPING AND

CARRYINGPREPARING

MEALSHOUSE KEEPING

AT LEAST 1

IMPAIRMENT IN

DOMESTIC LIFE

MENTAL DISORDERS IN PERSONS LIVING

AT HOME n=230

60

80

100

68,4

BIF

BIF

Mild IDSMD

0

20

40

60 BIF

Mild ID

SMD

SCHIZOPHRENIA DEPRESSIONBIPOLAR

DISORDEROTHER MENTAL

ILLNESSES

CHRONIC ANXIETY

AT LEAST 1

MENTAL ILLNESS

CONCLUSIONS

� There is a large number of persons classified as havingBIF that present limitations in important areas of functioning at the same level as persons with mild ID

� A high proportion of people with BIF living in thecommunity present some type of Mental Disorder

� Controversy about the delimitation of the entities of BIF and ID and the relative importance of theintelligence coefficient is supported by these results.

� Further research and better proffesional training are needed in order to dillucidate whether and when more intensive services or care should be available for persons with BIF.

THANK YOU