1. Nejednoznačnost terminologije i definicija intelektualnih teškoća

Početkom 21. stoljeća termin „intelektualne teškoće“ zamijenio je dotadašnji općeprihvaćeni termin „mentalna retardacija“ koji je imao vrlo negativne i etiketirajuće konotacije, a s vremenom su intelektualne teškoće postale internacionalno prihvaćen termin preferiran od većine asocijacija i organizacija koje se bave populacijom osoba s intelektualnim teškoćama (1, 2). Osim termina „mentalna retardacija“, korišteni su i termini „osobe s teškoćama u razvoju“ i „osobe s posebnim potrebama“, unatoč tome što, također, nisu najtočniji i najbolji terminološki izbori (1, 3).

Još uvijek je prisutna problematika nejednoznačnosti terminologije i definicija intelektualnih teškoća, koja potencijalno narušava dosljednost primjene zakona i mogućnost ostvarivanja pojedinih prava u područjima djelovanja koja su usmjerena na osobe s intelektualnim teškoćama, a što posljedično ima veliki utjecaj na njihov socijalni i pravni status, kao i na usluge i potrebnu podršku (1-3). U definiranju je intelektualne teškoće nužno promatrati kao rezultat novih saznanja o navedenom pojmu, a s ciljem očuvanja dostojanstva osoba s intelektualnim teškoćama (1, 2). Od izrazite je važnosti prihvaćanje univerzalne definicije intelektualnih teškoća radi sprječavanja različitosti u dijagnosticiranju, klasificiranju i epidemiološkim podacima (1, 2).

Zbog multidisciplinarnog pristupa, intelektualne teškoće definiraju se iz različitih aspekata, poput pedagoškog, psihološkog, socijalnog i medicinskog uz različite kriterije važne za pojedini aspekt (1, 2). Kriterij definicije iz medicinskog aspekta je uzrok, socijalnog aspekta stupanj socijalne adaptacije, a pedagoškog aspekta sposobnost za odgoj i obrazovanje (1-3).

Intelektualne teškoće nisu statičan poremećaj, specifično oboljenje ili bolest uzrokovana jednim uzrokom s preciznim kliničkim tijekom i prognozom, već razvojne teškoće koje se odnose na kognitivno i adaptivno funkcioniranje karakterizirane dinamičkim stanjem s varijabilnim kliničkim tijekom koji ovisi o uzroku i dostupnosti podrške (1, 2). Zbog heterogenosti stanja, poput genetičkih i metaboličkih poremećaja te funkcionalnih spoznajnih promjena, osobe s intelektualnim teškoćama potrebno je promatrati individualno prilikom planiranja intervencije i podrške (1, 2).

  1. Asocijacije i organizacije koje se bave intelektualnim teškoćama

Asocijacije i organizacije relevantne u području koji se bavi populacijom osoba s intelektualnim teškoćama imaju za cilj globalizirati dimenziju termina intelektualne teškoće i postići konzistentnost i dijalog između različitih stručnjaka u različitim zemaljama svijeta (1, 2). Neke od relevantnih asocijacija i organizacija su: Svjetska zdravstvena organizacija (SZO) (World Health Organization, WHO), Američka asocijacija za intelektualne i razvojne teškoće (American Association on Intellectual and Developmental Disabilities, AAIDD) i Američka psihijatrijska asocijacija (American Psychiatric Association, APA), a njihove definicije i klasifikacije intelektualnih teškoća slijede u nastavku (1, 2).

2.1 Definicija intelektualnih teškoća Svjetske zdravstvene organizacije

Međunarodna klasifikacija bolesti i srodnih zdravstvenih problema (MKB) (Intrenational Classification of Diseases and Related Health Problems, ICD) je dijagnostički priručnik koji objavljuje SZO  i smatra se zlatnim standardom u dijagnostici, a posljednje 11. izdanje MKB-11, izdano 2018. godine, intelektualne teškoće klasificira kao nespecifične poremećaje u intelektualnom razvoju (1, 2, 4). U MKB-11 intelektualne teškoće opisane su kao metasindrom koji se pojavljuje u razvojnom periodu života i uključuje oštećenje funkcije mozga (1, 2).

MKB-10 intelektualne teškoće definira kao stanje zaostalog ili nepotpunog razvoja uma, posebno karakterizirano oštećenjem sposobnosti koje se očituju za vrijeme razvoja, sposobnosti koje pridonose cjelokupnom stupnju razvoja inteligencije, poput mišljenja, govora, motorike te sposobnosti ostvarivanja društvenog kontakta, a dijele se na: laki, umjereni, teži i teški stupanj intelektualnih teškoća (1, 3, 5, 6). Proces dijagnosticiranja i vještačenja osoba s intelektualnim teškoćama u Hrvatskoj u skladu je s MKB-10 (1, 3).

Stupnjevi intelektualnih teškoća definirani su kvocijentom inteligencije (IQ). IQ između 50 i 70 karakterizira laki stupanj intelektualnih teškoća i odgovara uzrastu od 9 do 12 godina života prema mentalnoj dobi, uz pojavnost od 1% u općoj populaciji, dok IQ između 35 i 50 karakterizira umjereni stupanj intelektualnih teškoća i odgovara uzrastu od 6 do 9 godina života prema mentalnoj dobi, uz pojavnost od 0,3% u općoj populaciji (1, 5, 6). Teži stupanj intelektualnih teškoća karakterizira IQ između 20 i 35 i mentalna dob koja odgovara uzrastu od 3 do 6 godina živote te pojavnost od 1:10 000 stanovnika, a teški stupanj intelektualnih teškoća IQ ispod 20 i mentalna dob koja odgovara uzrastu ispod 3 godine života (1, 5, 6).

Osobama s lakim intelektualnim teškoćama tijekom školovanja je potrebna edukativna potpora i moguće ih je osposobiti za jednostavna zanimanja, one s umjerenim intelektualnim teškoćama su djelomično samostalne u samozbrinjavanju, učenju i komunikaciji uz potrebu za različite oblike potpore kroz život (5). Osobama s težim intelektualnim teškoćama potrebna je stalna potpora druge osobe u vještinama samozbrinjavanja, a one s teškim intelektualnim teškoćama imaju potrebu za stalnom pomoći druge osobe u svim aktivnostima jer su intelektualne teškoće često udružene s drugim teškoćama (5).

Porast mentalne dobi brži je što je stupanj teškoća manji i linearan je između 5. i 6. godine života, a kod osoba s lakim i umjerenim stupnjem intelektualnih teškoća može rasti do 40. godine života, za razliku od osoba s težim i teškim stupnjem intelektualnih teškoća kod kojih se prije doseže najviša razina mentalne dobi (1, 5). Mentalna dob pada nakon 60. godine života kod svih stupnjeva intelektualnih teškoća (1, 5).

2.2 Definicija intelektualnih teškoća Američke asocijacije za intelektualne i razvojne teškoće

2021. godine izdano je 12. izdanje priručnika AAIDD „Intelektualne teškoće: definicija, dijagnoza, klasifikacija i sustavi podrške“ koji kroz sustavni pristup dijagnostici, klasifikaciji podskupina i planiranju sustava podrške za osobe s intelektualnim teškoćama objedinjuje nalaze i razvoj tokom posljednjih 10 godina te prezentira promjenu kriterija završetka razvojne dobi s 18. na 22. godinu života (1, 7). Navedena promjena kriterija završetka razvojne dobi temelji se na rezultatima istraživanja koji navode kako se razvoj mozga nastavlja u 20-im godinama života (1, 8).

AAIDD definira intelektualne teškoće kao sniženu sposobnost s karakterističnim ograničenjima u intelektualnom funkcioniranju i adaptivnom ponašanju izraženima u konceptualnim, socijalnim i praktičnim vještinama (1, 3, 5, 8).

Za procjenu intelektualnog funkcioniranja u dijagnostičkom konceptu koriste se standardizirani IQ testovi, ali u primijenjenom kontekstu, intelektualno funkcioniranje ima šire značenje (9). Intelektualno funkcioniranje podrazumijeva mentalnu sposobnost rasuđivanja, mišljenja, zaključivanja, planiranja, rješavanja problema, apstraktnog mišljenja, razumijevanja kompleksnih ideja, brzog učenja i učenja kroz iskustvo, generalnim pojmom definiranu kao inteligenciju čija se ograničenja mjere IQ testovima (1, 5, 6, 9). Zatim, podrazumijeva i sposobnosti mjerene IQ testovima, poput jezičnih vještina, matematičkih sposobnosti, pamćenja i prostorne vizualizacije te shvaćanje da je intelektualno funkcioniranje pod utjecajem drugih oblika ljudskog funkcioniranja i sustava podrške (9).

Stoga, u širem kontekstu intelektualno funkcioniranje razmatra trenutno funkcioniranje osobe: u zajednici, u odnosu na kulturne, jezične, osjetilne, motoričke ili bihevioralne čimbenike, uz koegzistirajuća ograničenja i snage te uz preciznu identifikaciju ograničenja s ciljem pružanja potrebne podrške kako bi se poboljšalo životno funkcioniranje (9).

Adaptivno ponašanje predstavlja skup konceptualnih, društvenih i praktičnih vještina naučenih u svrhu svakodnevnog funkcioniranja koja uključuju:

  • Konceptualne vještine: jezik i pismenost, samousmjeravanje, koncepti brojeva, novca i vremena
  • Društvene vještine: međuljudske vještine, društvena odgovornost, samopoštovanje, lakovjernost, naivnost (tj. oprez), rješavanje društvenih problema, sposobnost poštivanja pravila, zakona i izbjegavanja viktimizacije
  • Praktične vještine: aktivnosti svakodnevnog života (osobna njega), profesionalne vještine, korištenje novca, sigurnost, zdravstvena njega, putovanja/prijevoz, rasporedi/rutine i korištenje telefona (1, 5, 6, 10, 11).

Ograničenja u adaptivnom ponašanju mogu se odrediti standardiziranim testovima (10). Adaptivno ponašanje je drugačiji koncept od intelektualnog funkcioniranja, s obzirom da je ono naučeno kroz niz usvojenih vještina te odražava društvenu i praktičnu sposobnost zadovoljavanja zahtjeva svakodnevnog života svake osobe (11). S promjenom zahtjeva svakodnevnog života, potrebno je usvajati nove vještine kako bi se mogli zadovoljiti novi zahtjevi (11).

Za primjenu i shvaćanje definicije intelektualnih teškoća prema AAIDD, važno je ljudsko funkcioniranje promatrati kroz multidimenzionalni pristup koji se sastoji od pet dimenzija i uloge podrške ljudskom funkcioniranju (1-3). Spomenute dimenzije odnose se na: intelektualne sposobnosti, adaptivno ponašanje, zdravlje, sudjelovanje-uključivanje i kontekst (1-3). Važno je napomenuti kako su ljudsko funkcioniranje i potreba za podrškom u međusobnom recipročnom odnosu (1-3). Pri procjeni intelektualnog invaliditeta u obzir se moraju uzeti i dodatni čimbenici, poput okruženja u zajednici tipičnog za vršnjake i kulturu pojedinca te jezične i kulturološke različitosti, ali potrebno je i predvidjeti kako ograničenja često postoje zajedno s jakim stranama osobe (10). Zbog toga bi se razina životnog funkcioniranja trebala poboljšati ako se osobi s intelektualnim teškoćama pruža individualizirana i prikladna podrška tijekom dužeg razdoblja (10).

Više o intelektualnim teškoćama možete saznati na linku:  https://www.aaidd.org/intellectual-disability/intersectionality

2.3 Definicija intelektualnih teškoća Američke psihijatrijske asocijacije

Peto izdanje „Dijagnostičkog i statističkog priručnika mentalnih poremećaja“ (DSM-5) definira intelektualne teškoće kao intelektualne razvojne poremećaje s početka razvojnog perioda do 18. godine života koji uključuju deficite u intelektualnom i adaptivnom funkcioniranju u konceptualnim, socijalnim i praktičnim vještinama, prihvaćajući kriterije adaptivnog ponašanja predložene od AAIDD (1-3, 5). Deficit u intelektualnom funkcioniranju odnosi se na IQ od približno 70 ili niži, a što se adaptivnog ponašanja tiče, deficiti moraju biti prisutni u barem dva od navedenih područja: komunikacija, briga o sebi, obiteljski život, socijalne i interpersonalne vještine, uporaba zajedničkih sredstava, rad, slobodno vrijeme i sigurnost (1, 5). Trenutno je aktualno revidirano izdanje priručnika DSM-5 iz 2022. pod nazivom DSM-5-TR (1, 12).

  1. Opće prihvaćanje definicije intelektualnih teškoća

Zbog nepostojanja konsenzusa navedenih vodećih organizacija, ni jedna definicija intelektualnih teškoća nije univerzalno prihvaćena, ali se općenito prihvaća kako su intelektualne teškoće skup stanja proizašlih iz genetskih, neuroloških, prehrambenih, društvenih, traumatskih i drugih čimbenika koji se pojavljuju u razvojnom periodu, prije rođenja, tokom poroda ili tokom djetinjstva do dobi zrelosti mozga, odnosno 18. godine života i utječu na intelektualni razvoj (1, 13). Sve navedeno rezultira nižim prosječnim životnim vijekom, nižom sposobnosti samostalnog funkcioniranja, samoodređenja te osobnog, društvenog i profesionalnog funkcioniranja, a nerijetko se pojavljuju s različitim stupnjevima tjelesnog, osjetilnog i psihičkog oštećenja (1, 13).

  1. Suvremena klasifikacija i temelji suvremenih pristupa osobama s intelektualnim teškoćama

Sposobnosti osoba s intelektualnim teškoćama odnose se na pamćenje, percepciju, pažnju, govor, socijalne vještine, motorički, emocionalni razvoj i spolnost (5). One ovise o stupnju intelektualnih teškoća te im napredak može varirati zbog utjecaja odgoja i okoline (5).

Suvremeni modeli skrbi za osobe s intelektualnim teškoćama podrazumijevaju normalizaciju životnih uvjeta i individualiziranu podršku u užoj i široj društvenoj zajednici koja za cilj ima usmjeravanje na jake i slabe strane pojedinca, uzimajući u obzir zahtjeve te očekivanja društva i obitelji (5). Sukladno navedenom određuje se kategorija i intenzitet podrške (3).

Kategorije potrebnih razina podrške:

  1. Povremena podrška: kratkotrajna, u situacijama promijenjenih životnih okolnosti (stanje akutne bolesti, gubitak posla)
  2. Ograničena podrška: uključuje vremensko ograničenje, ali ne i sporadičnu pomoć
  3. Opsežna podrška: konzistentna, ali nije vremenski ograničena (prijelaz iz školske u odraslu dob), uključuje manje osoblja, iziskuje manja financijska sredstva od dugotrajnog oblika
  4. Trajna podrška: redovita, dugotrajna, intenzivna, opsežna i kontinuirana, potrebna u svim situacijama tijekom života, uključuje više osoblja od ostalih oblika pomoći (3, 5).

Temelji suvremenih pristupa u pružanju podrške osobama s intelektualnim teškoćama odnose se na naglašavanje promicanja pune uključenosti u zajednicu, jačanje samousmjeravanja i smanjivanje razlike u ishodima zdravstvene skrbi (14). Od usluga i podrške očekuje se poštivanje želja i interesa osoba s intelektualnim teškoćama i njihovih obitelji, kao i podržavanje standarda visoke kvalitete života koje žele svi članovi društva (14).

English version

1 Ambiguity of terminology and definition of intellectual disabilities

At the beginning of the 21st century, the term “intellectual disabilities” replaced the previously generally accepted term “mental retardation”, which had very negative and labeling connotations, and over time intellectual disabilities became an internationally accepted term preferred by most associations and organizations dealing with the population of people with intellectual disabilities (1, 2). In addition to the term “mental retardation”, the terms “persons with developmental disabilities” and “persons with special needs” are also used, despite the fact that they aren’t the most accurate and best terminological choices (1, 3).

There is still the problem of the ambiguity of terminology and definitions of intellectual disabilities, which potentially impairs the consistency of the application of the law and the possibility of realizing certain rights in the areas of activity aimed at people with intellectual disabilities, which consequently has a great impact on their social and legal status, as well as to services and necessary support (1-3). In defining intellectual disabilities, it is necessary to observe them as a result of new knowledge about the mentioned term, with the aim of preserving the dignity of a person with intellectual disabilities (1, 2). It is important to accept a universal definition of intellectual disabilities in order to prevent differences in diagnosis, classification and epidemiological data (1, 2).

Due to the multidisciplinary approach, intellectual disabilities are defined from different aspects, such as pedagogical, psychological, social and medical, with different criteria important for each aspect (1, 2). The definition criteria from the medical aspect is the cause, from the social aspect is degree of social adaptation, and from the pedagogical aspect the ability for upbringing and education (1-3).

Intellectual disabilities are not a static disorder, specific illness or disease caused by a single cause with a precise clinical course and prognosis, but developmental difficulties related to cognitive and adaptive functioning characterized by a dynamic state with a variable clinical course that depends on the cause and the availability of support (1, 2) . Due to the heterogeneity of conditions, such as genetic and metabolic disorders and functional cognitive changes, people with intellectual disabilities need to be observed individually when planning intervention and support (1, 2).

2 Associations and organizations dealing with intellectual disabilities

Associations and organizations relevant in the field dealing with the population of people with intellectual disabilities aim to globalize the dimension of the term intellectual disability and achieve consistency and dialogue between different experts in different countries of the world (1, 2). Some of the relevant associations and organizations are: World Health Organization (WHO), American Association on Intellectual and Developmental Disabilities (AAIDD) and American Psychiatric Association (APA), and here are their definitions and classifications of intellectual disabilities (1, 2).

2.1 World Health Organization’s definition of intellectual disabilities

The International Classification of Diseases and Related Health Problems (ICD) is a diagnostic manual published by the WHO and is considered the gold standard in diagnostics (1, 2, 4). The latest 11th edition of the ICD-11, issued in 2018, classifies intellectual disabilities as non-specific disorders in intellectual development (1, 2, 4). In the ICD-11, intellectual disabilities are described as a metasyndrome that appears in the developmental period of life and includes impaired brain function (1, 2).

ICD-10 defines intellectual disabilities as a state of incomplete development of the mind, especially characterized by impaired abilities that manifest themselves during development, abilities that contribute to the overall level of intelligence development, such as thinking, speech, motor skills and the ability to achieve social contact (1, 3, 5, 6). They are divided into: mild, moderate, severe and profound intellectual disabilities (1, 3, 5, 6). Diagnostic process and examining persons with intellectual disabilities in Croatia is in accordance with ICD-10 (1, 3).

Degrees of intellectual disabilities are defined by the intelligence quotient (IQ). An IQ between 50 and 70 characterizes a mild intellectual disability and corresponds to the age of 9 to 12 years of life according to mental age, with an incidence of 1% in the general population, while an IQ between 35 and 50 characterizes a moderate intellectual disability and corresponds to the age of 6 to 9 years of life according to mental age, with an incidence of 0.3% in the general population (1, 5, 6). Severe intellectual disability is characterized by an IQ between 20 and 35 and a mental age corresponding to the age of 3 to 6 years of life and an incidence of 1 per 10,000 in the population, while profound intellectual disability is characterized by an IQ below 20 and a mental age corresponding to an age of less than 3 years of life (1, 5, 6).

People with mild intellectual disabilities need educational support during school education and can be trained for simple occupations, those with moderate intellectual disabilities are partially independent in self-care, learning and communication with the need for various forms of support throughout life (5). People with severe intellectual disabilities need the constant support of another person in self-care skills, and those with profound intellectual disabilities need the constant help of another person in all activities because intellectual disabilities are often associated with other disabilities (5).

The increase in mental age is faster as the degree of difficulty is lower and is linear between the ages of 5 and 6 (1, 5). In persons with mild and moderate intellectual disabilities it can develop to the age of 40, in contrast to persons with severe and profound intellectual disabilities in which the highest level of mental age is reached earlier (1, 5). Mental age decreases after the age of 60 in all degrees of intellectual disability (1, 5).

2.2 Definition of intellectual disability by the American Association on Intellectual and Developmental Disabilities

The 12th edition of the AAIDD manual “Intellectual Disabilities: Definition, Diagnosis, Classification and Support Systems” was published in 2021 (1, 7). With a systematic approach to diagnosis, classification of subgroups and planning of support systems for people with intellectual disabilities manual consolidates findings and development over the past 10 years and presents change in criteria for the end of developmental age from 18 to 22 years (1, 7). This change in criteria for the end of developmental age is based on research results that state that brain development continues in the 20s (1, 8).

AAIDD defines intellectual disability as a reduced ability with characteristic limitations in intellectual functioning and adaptive behavior expressed in conceptual, social and practical skills (1, 3, 5, 8).

Standardized IQ tests are used to assess intellectual functioning in the diagnostic concept, but in the applied context, intellectual functioning has a broader meaning (9). Intellectual functioning implies the mental ability to reason, think, conclude, plan, solve problems, abstract thinking, understand complex ideas, learn quickly and learn through experience, generally defined as intelligence whose limits are measured by IQ tests (1, 5, 6, 9) . Then, it also includes abilities measured by IQ tests, such as language skills, mathematical abilities, memory and spatial visualization, and the understanding that intellectual functioning is influenced by other forms of human functioning and support systems (9).

Therefore, in a broader context, intellectual functioning considers a person’s current functioning: in the community, in relation to cultural, linguistic, sensory, motor or behavioral factors, with coexisting limitations and strengths, and with the precise identification of limitations with the aim of providing the necessary support to improve life functioning (9).

Adaptive behavior is a set of conceptual, social and practical skills learned for everyday functioning that include:

  • Conceptual skills: language and literacy, self-directioning, concepts of numbers, money and time
  • Social skills: interpersonal skills, social responsibility, self-esteem, gullibility, naivety (i.e. caution), social problem solving, ability to follow rules, laws and avoid victimization
  • Practical skills: activities of daily living (personal care), professional skills, use of money, safety, health care, travel/transportation, schedules/routines and telephone use (1, 5, 6, 10, 11).

Limitations in adaptive behavior can be determined by standardized tests (10). Adaptive behavior is a different concept from intellectual functioning, given that it is learned through a series of adopted skills and reflects the social and practical ability to meet the demands of everyday life of each person (11). With the changes in the demands of everyday life, it is necessary to acquire new skills in order to be able to meet the new demands (11).

To apply and understand the definition of intellectual disabilities according to AAIDD, it is important to observe human functioning through a multidimensional approach consisting of five dimensions and the role of supporting human functioning (1-3). The mentioned dimensions refer to: intellectual abilities, adaptive behavior, health, participation-inclusion and context (1-3). It is important to note that human functioning and the need for support are mutually reciprocal (1-3). When assessing intellectual disability, additional factors must be taken into account, such as the community environment typical of the individual’s peers and culture, as well as linguistic and cultural diversity, but it is also necessary to anticipate that limitations often exist together with a person’s strengths (10). Because of that the level of life functioning should improve if the person with intellectual disabilities is provided with individualized and appropriate support over a longer period (10).

More about intellectual disabilities find at the link: https://www.aaidd.org/intellectual-disability/intersectionality

2.3 American Psychiatric Association’s definition of intellectual disabilities

The fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders“ (DSM-5) defines intellectual disabilities as intellectual developmental disorders from the beginning of the developmental period until the age of 18 that include deficits in intellectual and adaptive functioning in conceptual, social and practical skills, accepting the criteria of adaptive behavior proposed by the AAIDD (1-3, 5). A deficit in intellectual functioning refers to an IQ of approximately 70 or lower, and as far as adaptive behavior is concerned, deficits must be present in at least two of the following areas: communication, self-care, family life, social and interpersonal skills, use of shared resources, work, free time and security (1, 5). The revised edition of the DSM-5 Manual, called DSM-5-TR, is current from 2022 (1, 12).

3 General acceptance of the definition of intellectual disabilities

Due to the lack of consensus of the mentioned leading organizations, no single definition of intellectual disabilities is universally accepted, but it is generally accepted that intellectual disabilities are a set of conditions resulting from genetic, neurological, nutritional, social, traumatic and other factors that appear in the developmental period, before birth, during birth or during childhood until the age of brain maturity (18 years), and affect intellectual development (1, 13). All of that results in a lower average life expectancy, a lower ability to function independently, a lower capacity for self-determination and personal, social and professional functioning, and they often appear with different degrees of physical, sensory and psychological impairment (1, 13).

4 Modern classification and foundations of modern approaches to people with intellectual disabilities

The abilities of people with intellectual disabilities refer to memory, perception, attention, speech, social skills, development of motor skills, emotional development and sexuality (5). They depend on the degree of intellectual disabilities, and their progress may vary due to the influence of upbringing and social environment (5).

Modern models of care for people with intellectual disabilities imply the normalization of living conditions and individualized support in the immediate and wider social community, which focuses on the strengths and weaknesses of the individual, taking into account the demands and expectations of society and family (5). In accordance with the above, the category and intensity of support is determined (3).

Categories of required support levels:

1 Intermittent support: short-term, in situations of changed life circumstances (state of acute illness, job loss)

2 Limited support: Includes time limit but not sporadic assistance

3 Extensive support: consistent, but not time-limited (transition from school to adulthood), involves less staff, requires less financial resources than a long-term form

4 Pervasive support: regular, long-term, intensive, comprehensive and continuous, needed in all situations during life, involves more personnel than other forms of assistance (3, 5).

The foundations of modern approaches in providing support to people with intellectual disabilities relate to emphasize promoting full inclusion in the community, enhancing self-direction and reducing the difference in health care outcomes (14). Services and support are expected to respect the desires and interests of people with intellectual disabilities and their families, as well as support the high quality of life standards desired by all members of society (14).

Literatura (Literature)

  1. Puškar Wirnsberger K. Utjecaj tjelesne aktivnosti i sporta na tjelesnu sposobnost odraslih osoba s intelektualnim teškoćama [diplomski rad]. [Rijeka]: Fakultet zdravstvenih studija Sveučilišta u Rijeci; 2023. 67 p.
  2. Nikolić M, Vantić-Tanjić M. Definiranje intelektualnih teškoća u 21. stoljeću. Defektologija [Internet]. Jul 2015 [cited 2024 Jun 19]; 21(2):105-110. Available from: https://www.researchgate.net/publication/342889627_DEFINIRANJE_INTELEKTUALNIH_TESKOCA_U_21_STOLJECU
  3. Not T. Mentalna retardacija: definicija, klasifikacija i suvremena podrška osobama s intelektualnim teškoćama. Nova prisutnost VI/3 [Internet]. Nov 2008 [cited 2024 Jun 19]; 339-351. Available from: https://hrcak.srce.hr/file/54773
  4. World Health Organization. ICD-11 for Mortality and Morbidity Statistics [Internet]. Geneva: World Health Organization; 2023 [cited 2024 Jun 19]. Available from: https://icd.who.int/browse11/l-m/en#/http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1516623224
  5. Grbavica T. Zdravstvena njega osoba s intelektualnim teškoćama [završni rad]. [Internet] [Split]: Sveučilišni odjel zdravstvenih studija Sveučilišta u Splitu; 2018 [cited 2024 Jun 19]. 31 p. Available from: https://repo.ozs.unist.hr/islandora/object/ozs:381/datastream/PDF/view
  6. Ljubičić M. Zdravstvena njega osoba s invaliditetom. Zadar: Sveučilište u Zadru; 2014. Chapter 6, Intelektualna teškoća i zdravstvena njega osoba s intelektualnim teškoćama; p. 132-151.
  7. American Association on Intellectual and Developmental Disabilities. AAIDD Announces the Publication of the 12th Edition of its Manual [Internet]. Silver Spring: American Association on Intellectual and Developmental Disabilities; 2021 [cited 2024 Jun 20].  Available from: https://www.aaidd.org/news-policy/news/2021/01/15/aaidd-announces-the-publication-of-the-12th-edition-of-its-manual
  8. Schalock RL, Luckasson R, and Tassé MJ. Twenty questions and answers regarding the 12th edition of the AAIDD manual: Intellectual disability: definition, diagnosis, classification, and systems of supports. American Association on Intellectual and Developmental Disabilities. [Internet]. Mar 2021 [cited 2024 Jun 20]. Available from: https://www.researchgate.net/publication/349409269_Schalock_R_L_Luckasson_R_Tasse_M_J_2021_Intellectual
  9. American Association on Intellectual and Developmental Disabilities. Intellectual Functioning [Internet]. Silver Spring: American Association on Intellectual and Developmental Disabilities; 2024 [cited 2024 Jun 20].  Available from: https://www.aaidd.org/intellectual-disability/definition/intellectual-functioning
  10. American Association on Intellectual and Developmental Disabilities. Defining Criteria for Intellectual Disability [Internet]. Silver Spring: American Association on Intellectual and Developmental Disabilities; 2024 [cited 2024 Jun 20].  Available from: https://www.aaidd.org/intellectual-disability/definition
  11. American Association on Intellectual and Developmental Disabilities. Adaptive Behavior [Internet]. Silver Spring: American Association on Intellectual and Developmental Disabilities; 2024 [cited 2024 Jun 20].  Available from: https://www.aaidd.org/intellectual-disability/definition/adaptive-behavior
  12. American Psychiatric Association. APA Releases Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) [Internet]. Washington DC: American Psychiatric Association; 2022 [cited 2024 Jun 20]. Available from: https://www.psychiatry.org/News-room/News-Releases/APA-Releases-Diagnostic-and-Statistical-Manual-of
  13. World Health Organization. Ageing and intellectual disabilities – improving longevity and promoting healthy ageing: summative report [Internet]. Geneva: World Health Organization; 2000 [cited 2024 Jun 20]. Available from: https://apps.who.int/iris/bitstream/handle/10665/66367/WHO_MSD_HPS_MDP_00.3_eng.pdf
  14. American Association on Intellectual and Developmental Disabilities. FAQs on Intellectual Disability [Internet]. Silver Spring: American Association on Intellectual and Developmental Disabilities; 2024 [cited 2024 Jun 20].  Available from: https://www.aaidd.org/intellectual-disability/faqs-on-intellectual-disability