Understanding Intellectual Disability

• Intellectual Disability refers to a heterogenous group of childhood disorders.
• Impairments with Intellectual Disability result in difficulties across various life domains.
• There are a wide range of cognitive impairment levels with Intellectual Disability.
• Learning difficulties and comorbidities are often present in individuals with Intellectual Disability.
• "Intellectual Disability (ID)" or "Intellectual Developmental Disorder" has replaced "mental retardation."
• Two important domains for assessment are IQ and Adaptive Behavior.

Intellectual Disabilities (IDs)

• Signifies significantly subaverage general intellectual functioning, measured by a technically adequate and standardized IQ test.
• A score below 70-75 indicates subaverage intellectual functioning.
• IQ tests should be administered and interpreted by a competent and well-trained professional.
• Assessments must account for cultural, linguistic, and sensory-motor limitations that may affect performance.

Adaptive Functioning

• Adaptive Functioning is a collection of skills across multiple domains needed to function in daily life, such as dressing, social skills, and toileting.
• Standardized assessments must be used, like the Diagnostic Adaptive Behavior Scale.
• Adaptive Functioning must manifest during the developmental period, before age 18.
• A person must have significantly subaverage intellectual functioning and impairments in adaptive abilities with onset during the developmental period.
• Problems surrounding operationalizing this definition have arisen for both biological and philosophical reasons, including:
  • Psychometric properties of Assessment and Measurement Variance
  • Instability of IQ over time
  • High variability in trajectories across conditions
  • Concerns over predictive validity and cultural bias

Importance of Adaptive Behavior

• Adaptive behaviour includes one's participation and performance in daily life activities, like communication, social participation, function at school or work, or personal independence at home or in community settings.
• Adaptive Behavior ensures differential diagnosis among children who did not have educational opportunities and may underperform on measures of intellectual functioning due to linguistic, cultural, or other systemic factors.
• The American Association on Intellectual and Developmental Disabilities (AAIDD) divides adaptive functioning into three domains:
  • Conceptual Skills: language, literacy, money, time, number concepts, and self-direction.
  • Practical Skills: Includes ADL, occupational skills, health care, travel/transportation, schedules/routines, safety, use of money, use of communication devices.
  • Socialization Skills: interpersonal skills, social responsibility, self-esteem, naivete, social problem solving, and the ability to follow rules and obey laws.
• DSM-5 emphasizes that ID should be classified by adaptive behaviour.
• Adaptive Behavior provides a more complete view of everyday functioning across domains than classification by degree of intellectual impairment.
• Adaptive Behavior is more clinically useful for adults.
• Adaptive Behavior is less useful for children who often display discordance in the domains of adaptive behavior.
• Adaptive Behavior must be measured using individualized, standardized, and culturally appropriate tests and scales.

Etiology of IDs

• There is no clear etiology in approximately 30-40% of cases.
• Hereditary disorders (e.g., Tay-Sachs disease) affect 5% of cases.
• Early Alterations of Embryonic Development affects 30% of cases, including chromosomal changes or prenatal damage due to environmental toxins.
• Later Pregnancy and Perinatal Problems affect 10% of cases, including fetal malnutrition, placental insufficiency, prematurity, viruses/infection.
• Medical Conditions acquired during childhood and accidents affect 5% of cases (e.g., meningitis or lead poisoning).
• Other mental disorders/environmental variables account for 15-20% of cases.

Prevalence

• Intellectual disability occurs in ~7.2 per 1000 individuals
• Numbers are similar across the world.
• Boys are more likely to be diagnosed with an ID than girls.
• Mild impairments are identified later than severe.
• Recurrence risks for families with one child with severe intellectual disability

Medical and Psychological Testing

• Testing should be based on medical history and physical examination.
• Some children with subtle physical or neurological findings also may have determinable biological origins of intellectual disability.
• Factors to consider: the degree of intellectual disability, if there a specific diagnostic path to follow, if the parents are planning to have more children, and what are the parents' wishes
• Standardized Cognitive Assessments (IQ tests)
• Assessments of Adaptive Behavior
• Early Learning Abilities/Academics
• Restrictive behavior (Functional Behavior Assessment)
• Skills Training (Individual and Family goals)
• Habituation, Goal Setting, and Choice
• The focus is on identifying environmental supports to enhance a person's functioning across domains and what people can do rather than their deficits. STRENGTHS!
• Variety of tests are used to evaluate individual intelligence and adaptive skills.
• Poor predictive validity until about 10 years old.
• Tests can differentiate young children with severe intellectual disability, but not with mild.
• Wechsler scales are accurate in predicting adult IQ in school-age children.
• Often, there is a correlation between scores on intelligence and adaptive scales.
• Consider non-verbal tests of intelligence.
• Consider academic assessment/skills assessment.

Comorbidity

• High rates of comorbidity with medical and psychological disorders.
• Common associated impairments: Cerebral palsy, seizure disorders, communication disorders, sensory impairments, psychological/behavioral disorders.
• Essential to identify comorbid conditions for intervention and treatment.
• Associated impairments make it difficult to distinguish intellectual disability from other developmental disabilities.
• Repeated assessments may be necessary.

Support & Intervention

• Environmental Interventions and Enrichment Programs
• Active learning/Engagement
• Specialized and effective instruction methods
• Ensuring communication needs are met
• Behavioral Interventions/Applied Behavior Analysis:
  • Teach skills that allow access to meaningful environments and less restriction.
  • Reduce dangerous behavior/self-harm with accessing less restrictive environments.
  • Community Living/Transition Goals
  • Ensuring skills and goals selected are meaningful
• It is important to reinforce Choice and Supported Decision Making.
• Least Restrictive Environment and Right to Education.

IDEA

• IDEA (Individuals with Disabilities Education Improvement Act) explicitly states that children with disabilities should be educated with children who do not have disabilities "to the maximum extent appropriate."
• Special education services must be provided in the Least Restrictive Environment (LRE).

Studies of “Self-Contained” Classrooms

• Self-contained classrooms are segregated within a school from the regular classroom environment; a special education teacher is responsible for instruction of all academic subjects
• Students often work in isolation without effort to create a supportive learning community.
• Significant portions of the day were spent in non-academic activities.
• A significant number of interruptions and distractions occur during the day (e.g., adults in the room conversing and leaving and entering the room).
• Poorer social and academic outcomes for children with ID

Special Education Laws in Ontario

• Ontario's Special Education Act sets out rules around access and eligibility for special education.
• There is no specific language around LRE; however, “rationale/reasons” must be provided by the Identification, Placement, and Review Committee (IPRC) if is placed in a special education classroom
• There are no suspension limitations other than its “not mandatory” for children with disabilities.
• “Temporary withdrawal” must be only one school day unless consent from the parent is obtained.
• Sight word instruction with safety and functional words has limitations in maintenance and generalization
• Reviews the Edmark Reading Program for sight words using direct instruction/programmed instruction.
• A limitation of ERP is it does not include phonics instruction .
• Reviewed programs with effective instruction components/modifications for individuals with ID.

The Right to Eat Too Many Donuts and Take a Nap

• Habilitation is teaching the skills needed to live as Independently as possible
• Rights and liberties are compromised to achieve habilitation goals
  • Client input around treatment goals
  • Lack of consideration around client preference and choice due to other competing interests
  • Choice making is often not taught

Research on Choice

• Individuals prefer activities with choice embedded
• Individuals participate more in activities when choices are embedded
• Availability of choice has been shown to improve performance
• Availability of choice reduces problem behavior

Supported Decision Making

• A tool that allows people with disabilities to retain the decision-making capacity through supporters.
• Supporters agree to help the person understand, consider, and communicate decisions, giving the person with a disability the tools to make informed decisions.
• This looks different for everyone and must be tailored to the individual:
  • Plain language materials or audio-visual information
  • Provision of extra time to discuss choices
  • Role playing
  • Bringing supporters to appointments to take notes and help remember options

Explore the characteristics, diagnostic criteria, and assessment of Intellectual Disability (ID). Learn about IQ testing, adaptive behavior, and the challenges faced by individuals with ID. Discover the range of cognitive impairment levels and common comorbidities associated with ID.