Intellectual disability, or ID, affects learning, thinking, and everyday tasks like dressing and communicating. In children, it impacts self-care, play, communication, and movement. Each year, about 2% to 3% of children in the United States are diagnosed with ID.

While ID can vary and present at any age, developmental ID is diagnosed before the age of 22, and pediatric ID that is more severe is identified early. Early signs may include delays in rolling, sitting, standing, or walking. Many children with ID do learn to walk, but motor challenges can persist throughout life. These challenges can affect coordination (moving arms and legs together), balance, strength, and endurance. Parents may seek physical therapist services to help improve their child’s overall movement (motor) skills.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.

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On this page

• What Is Pediatric Intellectual Disability?
• Signs and Symptoms
• How Is It Diagnosed?
• How Can a Physical Therapist Help?
• Can This Injury or Condition Be Prevented?
• What Kind of Physical Therapist Do I Need?

What Is Pediatric Intellectual Disability?

Pediatric intellectual disability, or ID, is a condition that affects a child’s ability to learn, think, and perform everyday activities. A pediatric ID can be diagnosed at any time during development, which ends at 22 years old.

Intellectual disabilities are diagnosed by interdisciplinary teams (speech and language pathologists, psychologists, pediatricians, occupational therapists, special education teachers, and physical therapists) who use a variety of tests and measures, including:

IQ tests. While there is conflicting research on the use of IQ (intelligence quotient) to diagnose ID, IQ tests are still used as part of identifying severity. IQ tests check how well a child can think, plan, solve problems, and understand complex ideas. IQ scores below 70 suggest a disability.

Functional tests. These tests help determine how well the child does or handles everyday activities, including:

• Talking
• Walking
• Socializing
• Doing daily living tasks like eating and going to the bathroom
• Moving their body (motor skills)
• Following rules and solving problems

ID can be caused by genetic, environmental, nervous system, or metabolic problems before and/or after birth. The cause also can be unknown.

• Genetic causes. These can include:
• Errors in genes, such as Williams syndrome, Fragile X syndrome, and Rett syndrome.
• Chromosome differences, such as an extra or missing chromosome (e.g., Down syndrome).
• Environmental causes. These can include:
Exposure to toxins (such as alcohol or drugs) during development in the womb
• Infections before or just after birth
• Early childhood infections that impact the brain (such as meningitis)
• Traumatic brain injury (such as from a fall)
• Nervous system and metabolic causes. These can include:
• • Problems with brain development
  • Issues with how the body turns food into energy and uses energy
  • Lack of nutrition

  A diagnosis of ID is complex and made by considering the many tests and measures used by health care providers, and the context of the test results, as opposed to results on one test or measure. ID can be divided into four levels of severity (mild, moderate, severe, and profound) using general guidelines:

  Mild ID. Children with mild ID may:

  • Score around 50 to 70 on an IQ test.
  • Develop school skills up to a sixth-grade level, possibly needing extra time to do so.
  • Handle daily living and social interactions well.
  • Live independently and be employed with assistance.

  This person’s primary need is for guidance with decision-making.

  Moderate ID. Children with moderate ID may:

  • Score about 35 to 50 on an IQ test.
  • Learn functional skills, like reading and writing at a basic level, and manage some self-care needs with training.
  • Live in supported or semi-independent environments.

  This person may require consistent support for daily activities and work in supervised environments.

  Severe ID. Children with severe ID may:

  • Score about 20 to 35 on an IQ test.
  • Face significant challenges in communication and daily tasks.
  • Demonstrate challenges understanding gestures and subtle communications, such as sarcasm.
  • Form close relationships with family members and caregivers.

  This person is able to perform simple self-care tasks with supervision but needs extra support in most aspects of life.

  Profound ID. Children with severe ID may:

  • Score below 20 on an IQ test.
  • Be very limited with spoken or verbal communication.
  • Demonstrate physical challenges or other health issues.

  This person relies on caregivers for all daily living tasks and needs constant supervision.

Signs and Symptoms

Children with ID may:

• Learn skills later than other kids (like walking or talking).
• Have trouble solving problems or understanding rules.
• Have difficulty with memory.
• Have trouble with self-care.
• Have trouble communicating with others.
• Act younger than others in their age group.
• Need support at home, at school, or in the community.

Motor delays or problems often show up early in children with ID. For example, the child may:

• Not roll over or sit up at the usual age.
• Have low muscle tone (limbs and torso feel floppy).
• Have poor coordination or balance.
• Walk or move in an unusual way.

Signs of ID can vary by age. Below are some common challenges identified by age group:

Infant/Toddler

• Delayed spoken language skills.
• Inability to understand what others are saying when spoken to.
• Motor challenges (not rolling, crawling, or walking when their peers do).
• Frustration or behavioral challenges beyond what’s expected in a toddler.
• Problems with feeding or eating.

School-Age Child

• Challenges with learning school skills (reading, writing, math)
• Difficulty understanding and following socially accepted norms.
• Limited/lack of safety awareness.
• Need increased support for daily activities such as dressing and toileting.
• Frustration or behavioral challenges beyond what’s expected for the child’s age.
• Poor physical fitness.
• Trouble playing with friends and in recreation/leisure activities.

Teenagers

• Difficulty making decisions.
• Challenges with managing finances, planning, cleaning, cooking, etc.
• Dependence on support for decision-making.
• Difficulty learning academic skills.
• Difficulty understanding and following socially accepted norms.
• Limited/lack of safety awareness.
• Poor physical fitness.
• Trouble playing with friends and in recreation/leisure activities.

How Is It Diagnosed?

Health care providers diagnose intellectual disability with testing. They do this by measuring their intellectual quotient, or IQ, and assessing how they achieve everyday tasks. The diagnostic process typically involves several evaluations from a team of health care providers. Physical therapists play a crucial role in evaluating physical abilities and motor development (movement skills) as they relate to a child becoming more independent managing life.

Diagnosis of an intellectual disability occurs when a child meets the following three criteria:

1. IQ scores below 70. This may indicate challenges with reasoning, problem-solving, planning, thinking, and learning.
2. Deficits in self-help/adaptive skills that impact the child’s ability to participate in daily activities (brushing teeth, eating, toileting, bathing). Self-help/adaptive skills can also include playing, making friends, learning, cooking, and understanding directions.
3. These challenges occur before 22 years of age.

Physical Therapy Evaluation

Your child’s physical therapist will perform a complete evaluation that begins by gathering information about their health history. This will include learning about their medical history, family and social background, and current medications. They also will evaluate how well your child moves. This will include large motor skills (like walking or jumping) and small motor skills (like grasping). They also will check for any communication challenges and look for any health concerns that might need more attention.7 They may ask you questions, such as:

• Does your child have any known genetic or medical conditions?
• Does your child have any long-term health issues?
• When did your child start to sit, crawl, or walk?
• Has your child recently lost skills they once had, like movement abilities or the ability to learn skills at home or school?
• Do you have concerns about your child’s balance, strength, or coordination?
• What challenges does your child experience with their movement?

Your child’s physical therapist will conduct a thorough physical exam with functional tests. These tests will help them to:

• Assess your child’s gross motor skills and how well they can do certain motor activities.
• Identify any areas where they may need help participating with peers.
• Evaluate your child’s individual strengths.

Based on their evaluation and findings, the physical therapist will develop a plan to address your child’s specific needs to support their movement and independence. Physical therapists can help your child participate more in recreation and leisure activities and engage more within movement aspects of family participation.

How Can a Physical Therapist Help?

After a detailed assessment of your child’s needs, your child’s physical therapist may gather additional input from other caregivers, teachers, and your child. They also will use standardized tools to assess your child’s abilities. They will plan activities and exercises that are personalized to your child’s needs to help them improve their functional abilities.

Physical therapists help children with ID move better by creating a personalized plan with fun and safe ways to build skills for:

• Balance
• Strength
• Coordination
• Walking, running, jumping
• Playing on the playground
• Climbing stairs
• Using a walker or wheelchair, if needed
• Participating in leisure activities with family and friends
• Physical fitness and an active lifestyle

Physical therapists also teach parents and classroom teachers how to support the child’s movement at home or school. Family involvement is crucial to meeting your child’s goals. Your child’s physical therapist can work with you and other family members so everyone understands all the ways they can help. Physical therapists also can recommend ways for children to be included in physical activities and sports within school and outside of school. They do this by working with families, coaches, and physical education teachers.

Physical therapy programs and the settings where your child receives services will evolve and look different based on your child’s age and stage of life.

• Infants and toddlers: Early treatment and early intervention programs help young children learn big movement skills like sitting, crawling, and walking.
• Infants and toddlers:</strong School-age children: School-based physical therapist services support the child’s access to their school and their participation in activities. These can include moving through the hallways, climbing stairs, playing in gym class or with friends, and managing school routines. Clinic-based services can focus on daily tasks for home and community participation, such as riding bikes and achieving higher-level balance skills.
• Infants and toddlers:</strong Adolescents and teenagers: As teens prepare to move from pediatric to adult care (usually between ages 16 and 21), physical therapists work with them and their families to plan for a smooth transition. Early, transition-focused planning helps ensure that this change is successful and productive. This can include helping the child participate in sport and recreation opportunities and vocational opportunities.

Can This Injury or Condition Be Prevented?

Genetic and environmental causes of pediatric ID are often beyond our control. However, many related health challenges related to ID — like poor physical fitness, low activity lifestyles, heart disease, obesity, and falls — can be improved or prevented with the right support and treatment. Physical therapists can help families continually promote improvements to overall quality of life for children with ID.

What Kind of Physical Therapist Do I Need?

All physical therapists are trained through education and experience to evaluate, manage, and treat various symptoms and conditions. You may want to consider seeing a physical therapist:

• Experienced in treating children with mobility needs, intellectual disability, and other pediatric neurodevelopmental or developmental conditions.
• Board-certified clinical specialist in pediatrics or neurological physical therapy, or who has completed a residency or fellowship in pediatrics or neurology. This physical therapist has advanced knowledge, experience, and skills that may apply to treating children with ID.
• Focused on addressing functional needs or areas of limitation faced by the individual.
• If your child’s physical and/or motor abilities limit them from participating in or benefiting from their education in school, they may benefit from a school-based physical therapist. Unlike clinical or outpatient physical therapy, which focuses on broader health and physical development, school-based physical therapy specifically addresses the child’s ability to access and engage in the school environment and curriculum.

You can find physical therapists in your area with these credentials and clinical expertise through Find a PT, a tool built by the American Physical Therapy Association.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, or other health care providers.
• Ask about the physical therapist's experience with treating pediatric intellectual disability before you make an appointment.
• Be prepared to describe your child’s symptoms in as much detail as possible. Make a note of what makes those symptoms worse or better.

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