Intellectual Disabilities: the Type of Disability - Essay Example

This paper examines intellectual disabilities in order to provide an overview of this type of disability. It also looks at specific aspects of the disability with an educational perspective. Firstly the development of the definition of intellectual disabilities is presented and some of the more common ways of defining intellectual disabilities. Some data is presented to give a general idea of the prevalence of intellectual disabilities. Then an attempt is made to show how intellectual disabilities are assessed and classified in children. The causes of intellectual disabilities are discussed including the association between poverty and incidence of intellectual disabilities. Difficulties with assessment and classification are discussed. Finally the education of children particularly with mild to moderate disabilities is discussed. Several programs and strategies that have been developed to teach children with intellectual disabilities are reported on. Intellectual Disabilities In order to examine and understand the about Intellectual Disabilities it is first helpful to define the term. However even before coming to a definitive definition we need to know something of the history of this term and how the thinking about intellectual disabilities has changed over the years. Specifically we need to know the connection between mental retardation, learning disabilities and intellectual disabilities. In the early 1800s J.Langdon Hayden Down proposed a classification of intellectual disabilities based on ethnic classification in an attempt to absolve parents from blame that it was their fault that their child was intellectually disabled. This was not accepted and was abandoned by Hayden who later proposed three major groups of classification. One was congenital where intellectual disability was caused by brain defects or epilepsy. The second was developmental classification due to stress occurring during a developmental crisis. And the third was accidental as a result of an injury or illness in early childhood. This was later developed into the brain pathology theory of the 1880s and led to the 19th century theories that realized that intellectual disability had multiple causes and various levels of disability (Harris, 2005). Over the years there have been several terms used to describe intellectually disabilities including words such as idiocy, imbecility, feeble-mindedness and mental deficiency. As Meservy (2008) explains because the name mental retardation has been associated with such negative connotation efforts have been made to move away from using the term. Recently the movement has been more towards Intellectual Disabilities. It is thought that the use of the word disability is more related to social and culture constructs and therefore demands more respect and dignity. Intellectual Disabilities are more considered “the dynamic interaction between the person and the environment” (Meservey 2008, p.7) and so is not so much a trait of the person. In 2007 the American Association on Intellectual and Developmental Disabilities (AAIDD- formerly the American Association of Mental Retardation) officially adopted the term Intellectual Disabilities. According to Salvador-Carulla and Bertelli (1997) the terms mental retardation and learning disabilities are outdated and intellectual disabilities is getting increasing acceptance and that since 2005 two international organizations adopted the name. Despite the adoption of the new term, some are still using the terms mental retardation and learning disabilities almost interchangeably and including intellectual disabilities when talking about people with cognitive disorders. Pollaway et al (1997) examined these terms carefully. They first define mental retardation as follows-“Mental retardation refers to substantial limitations in present functioning. It is characterized by significantly sub-average intellectual functioning, existing concurrently with related limitations in two or more of the following applicable adaptive skill areas: communication, self-care, home-living , social skills, community use, self-direction, health and safety, functional academics, leisure and work” (p.298). Learning disability is a more general term encompassing a group of disorders more specifically related to academic or cognitive skills such as reading writing and mathematics. They suggest that these two –mental retardation and learning disorders may co-exist but that there is some confusion in the relationship between the two. The term intellectual disability replaces mental retardation, however in the academic world the term learning disability forms part of the intellectual disability spectrum and sometimes emphasis can be placed only on the learning disabilities, forgetting that there are other skills to be addressed. The prevalence of intellectual disabilities has been reported to be between 1.5% of children in Western countries to 4% deprived world regions. (Salvador-Carulla and Bertelli, 1997). In the poor countries the excess rate is though to be related to conditions that are generally associated with low income including poor environments and diet and maternal care. Hou et al (1998) reported similar figures of between 1 and 3 %, but they suggest that the variation in the figure could depend on how the data was collected, the sample size used and what definition was used. According to these authors about 85% of the children have mild intellectual disabilities and 15% have severe intellectual disabilities. The classification of intellectual disabilities is not simple either. Salvador-Carulla and Bertelli (1997) report three criteria used for classification. These are having an IQ below 70, displaying impairment of adaptive skills and the age of onset must be before 18 years. But this is not without issues. One of these issues is that there has been no internationally accepted definition of intelligence and consequently variation in methods of measuring this IQ. Some have attempted to define a single factor of intelligence, but this has been made difficult by Howard Gardner’s proposed multiple intelligences. There has been some settlement on an IQ measured by standardized tests for the sake of classifying and identifying intellectual disabilities. There is still confusion surrounding the use of IQ test for identifying intellectual disabilities according to Colmar et al (2006). For one thing, they believe that a child with a known intellectual disability will score low on an IQ test because that is how the tests are designed. Despite these issues the DSM-IV-TR of the American Psychological Association suggest the following classification for the different levels of intellectual disabilities. The mildly intellectually disabled fall in the IQ range of 55-70. For the moderately intellectually disabled the range is 40-55. Severely intellectually disabled fall within an IQ of 25-40. Below 25 is considered profoundly intellectually disabled (p.180). Some of the limitations of using these IQ ranges are that the IQ tests are norm referenced for ‘intellectually able’ children only. Also since one of the major characteristics of intellectual disabilities is limitations in reading and comprehension skills, intellectually disabled children are already at a disadvantage reading and understanding what is being asked in the IQ tests. Since IQ tests vary so much in context and assessment it has been suggested that instead of using a single number for measurement of IQ that two standard deviations below the mean and an allowance of a 5-point measurement error be included in the IQ score. Since there are so many issues and difficulties associated with assessment of IQ and therefore classification of intellectual disabilities, Colmar et al (2006) therefore suggest that the diagnosis should be made “should be made only after taking into account the environment in which the child is living, family structure, cultural and ethnic background, socioeconomic status, and ruling out any other reasons for the child’s current level of functioning (p.186). Before official assessments can be carried out, the National Dissemination Center for Children with Disabilities suggest some signs to look for in a child if intellectual disability is suspected. These signs include delays in sitting, crawling and talking; trouble remembering things, understanding social rules and the consequences of their own behavior and thinking logically and solving problems. (National Dissemination Center for Children with Disabilities, n.d) In educational situations the terms educable mentally retarded and trainable mentally retarded may be used. The Georgia State Department of Education in their 1981 Resource Manual for exceptional children states that a trainable mentally retarded child “will usually have an intellectual ability of approximately one third to one half that of the average child of a comparable chronological age” (p.9). Educators must hold out that the trainable mentally retarded individual can benefit from special programs that are specifically designed to further their socio-economic usefulness and that he or she can lead a productive life under supervision. Harris (2005) explains that classification of intellectual disability varies according to the function of the classification. There are four systems that are used depending on whether it is according to medical, functional or the intensity of support needed. The AAMR is mostly used in educational contexts since it is multidimensional and includes measures of IQ but also takes into account adaptive behavior and the amount of support that the child needs. Identifying the causes of intellectual disabilities is equally problematic. The factors so far identified can be classified as hereditary, environmental, biological or unknown. The hereditary disorders are associated with chromosomal accidents such as Down’s Syndrome and Fragile X Syndrome. Pregnancy and birth related causes account for a large number of cases. At every stage of the pregnancy and birth there are risks for factors that could cause intellectual disabilities. Prenatal conditions that can cause intellectual disabilities include chromosomal aberrations, single-gene disorders, complex malformation syndromes, exposure to toxins or drugs and congenital infections. Perinatally there can be complications of prematurity, hypoxic-ischemic insults and infections. Postnatally the child is at risk of infections, toxins such as lead, metabolic disorders, trauma and severe deprivation. Other biological causes are childhood diseases. Toxins in the environment have also been known to cause intellectual disabilities. In addition to all these factors there are some cases for which the cause is unknown. The causes may be obvious, for example the genetic diseases and these are usually in the severe intellectual disability; or they may be more obscure and this occurs more commonly in mild intellectual disabilities. The above mentioned factors especially those associated with pregnancy and birth and the environment are usually related to deprived environments. Emerson (2007) examined the connection between poverty and incidence of intellectual disabilities. According to him, “epidemiological research undertaken in the world’s richer countries has consistently reported an association between poverty and the prevalence of less severe intellectual disability” (p.108). Further he reports that similar studies undertaken in the poorer nations for example, Pakistan, India and Bangladesh, have also reported such links between poverty and prevalence of intellectual disabilities. Emerson presents data to show that in Australia families that were socio-economically disadvantaged there was more than five times the risk of mild and moderate intellectual disability and in Britain there was a four times greater risk. Poverty however is an indirect cause and its effect is mediated through the association between poverty and exposure to a number of environmental and psychosocial hazards as poverty is associated with increased risk of exposure to environmental toxins, accidents, infections, less than optimum parenting, and poor schooling. (Emerson, 2007). Because of the factors that can cause intellectual disability-genetics, biological accidents, etc. it is very challenging to prevent intellectual disabilities and can raise ethical issues. Emerson suggests that the least challenging might be to avoid exposure to environmental and social risk factors. Environmental toxins and infections might be easier to avoid than poverty and under-nutrition. He quotes figures that show that reducing the amount of children living in poverty in the US can decrease the prevalence of intellectual disability by almost 10 %. Reducing poverty will also have a positive impact on families who have children with intellectual disabilities who might have a better chance of developing social and cognitive skills with increased resources. This will generally lead to better overall health of the child. Additional strategies that will help to alleviate the effect of poverty on the prevalence of intellectual disabilities include effective early interventions and child development programs, such as Head Start, and parent training programs. These will help to break the cycle of disadvantage. Assessing and classifying children with intellectual disabilities is complex. The American Association of Mental Retardation diagnostic manual lists a series of adaptive behavior skills to be used in identification based on achievement. These skills are listed in three domains-social, conceptual and practical- to be assessed and coded. However sometimes other conditions such as schizophrenia or brain damage from an injury can cause cognitive impairment before the age of eighteen and so may be confused for developmental intellectual disability. Meservy (2008) presents five dimensions for classification and assessment of individuals with intellectual disability which cover several areas of functioning. The first is IQ or intellectual ability as discussed previously. Adaptive behavior, such as social and practical skills such as eating and dressing, is the second component. The third is participation and interaction in social situations. Health is an important component. This includes not just physical health, but also mental health. And finally the context in which the child is functioning, i.e. the environment and culture, must be considered in the assessment. Assessing and classifying a child for intellectual disabilities must include both IQ tests and adaptive behavior scales. It is important that IQ levels not be used rigidly. Harris (2005) recommends that IQ be determined using a standardized test that is individually administered and that the local cultural context for the child must be included. The adaptive Behavior Scale must be completed by a parent or a care-giver who knows the child’s ability level to perform daily activities that will allow them to function with a suitable level of social and personal sufficiency. The AAMR has an Adaptive Behavior Scale that is recommended. Another appropriate scale is the Vineland Adaptive Behavior Scale. It is very difficult to disconnect cognitive functioning from social behavior in children with intellectual disabilities. The exact cause and effect may not be clear-whether limited intellectual functioning affects the child’s ability to learn social and develop social skills or whether the difficulty in controlling behavior affects the child’s concentration and therefore learning ability in the classroom. Kostikj-Ivanaviky (2009) examined the social, emotional and behavioral characteristics of children with intellectual disabilities. She reports research results that show that 30-30% of persons with intellectual disabilities have some behavioral problem (p.51). The behavior problems are sometimes because of the difficulties that parents face in bringing up children with intellectual disabilities and the resultant inappropriate upbringing. But it is important to detect and intervene early to eliminate these behavior problems in order to prevent secondary behavior problems from developing and so that the child can successfully enter the social world. A number of research studies have been reported by this author. Some have said that the majority of behavior problems with intellectual disability are in the form of physical or verbal aggression and self-injury. Another research study on 279 institutionalized persons with intellectual disabilities found that the maladaptive behavior was dependent on the age of the person and the type of disability, but was more frequent in persons with lower mental abilities. And yet another study on 110 pre-schoolers with intellectual disability showed that the level of social development depends on the level of intellectual disability in the child and the age of the child. Kostikj-Ivanoviky carried out her research with a sample of one hundred children between the ages of 7-18, 74 with mild intellectual disabilities and 26 with moderate disabilities. The instrument used was the AAMD Adaptive Behavior Scale. Approximately three-quarters of the sample were found to have some behavior disorder including psychiatric disorders, resistance towards authorities and antisocial behavior. Educating the intellectual disabled involves special consideration paid not only to teaching the basics of reading and writing, but also to the development of the social, emotional and behavioral domains. As Morse and Schuster (2000) state, “a curriculum for students with moderate intellectual disabilities should emphasize skills that are both functional and longitudinally relevant” (p.273). Students with moderate intellectual disabilities need greater support and teaching to ensure that they are able to function and interact with the community in which they will have to live after school. Schools therefore that include intellectually disabled children have to develop curricula and special programs to include these skills, in addition to special instructional strategies for teaching the basic academic subjects. Teachers of intellectually disabled children must be trained to be able to decide what skills are to be taught and to understand the levels at which each intellectually disabled child will develop that skill or learn that particular subject. Special Education educators and Education Ministries all over the world have been working to develop suitable and effective programs for children with all special needs including intellectual disabilities and to train special education teachers. In some systems having separate classes or even schools for special education students is the practice but moving towards total inclusion of these students into ‘regular’ schools is the emerging practice in several countries. The focus of curricula for elementary students with intellectual disabilities should be on teaching basic competencies and scaffolding advance skills onto these. Poloway et al (1997). They support approaches that rely on teacher-directed learning activities- such as “direct instruction, mastery learning and precision teaching” (p.303). Emphasis is shifting from the behavioral orientation in the 1970s and 1980s to more cognitively oriented instructional methods for students with mild disabilities. Research has been done in the use of mnemonics as one effective strategy for these students. One successful way of helping children with cognitive impairments to master concepts is a system reported by Rao and Barkley (2009) called adapted/created/enhanced stories- ACE. As these authors explain, most of the material used for instruction in general classrooms is either traditional text books or other text-based material. However most of this material is too difficult for the intellectually disabled child to read. In the ACE strategy stories are personalized for the child and prepared with child’s level and interest in mind. Adapted stories borrow a theme, setting or story line from an existing story and the language is then increased or decreased to the child’s level. Or, stories are created with a particular subject, topic or content to meet the student’s needs. The interest, age, ability and likes and dislikes are taken into consideration. Stories can be created to teach about classroom situations, family situations and problems that they encounter. These stories have been found to be useful to teach intellectually disabled students any skills including how to function in certain social situations, math, science, social studies, and day-by-day living. After the term ‘learning disability’ was included as a category of exceptionality in the Education for All Handicapped Children Act (PL-94-142) in 1977, there was an increase in the percentage of students with learning disabilities to an estimated seven percent of the school-age population. (Gersten et al, 2001). One significant finding was that the vast majority, 80%, of these students had serious reading problems. Some of the characteristics displayed by students with intellectual disabilities when learning to read are that they have more difficulty comprehending what they read, they have greater difficulty distinguishing between narrative text (stories) and expository text ( for information and explanation), and they also have difficulty with the vocabulary in academic writing. A particular characteristic that hinders their reading comprehension is that they do not seem able to persist at a task. These authors therefore reviewed the literature on methods used to teach reading. Some of the suggestions found in the literature for improving reading in students with intellectual difficulties included that teachers should incorporate careful modeling and provide extensive feedback to these students. It is also important for teachers to encourage and support students to read across a variety of materials. Some suggestions to increase their persistence at a task include using reinforcements to increase their extrinsic motivation, increasing their intrinsic motivation (wanting to learn to read for their own sake) and the use of peer-instruction where there is more interaction with peers during instruction and reading practice. The Georgia State Department of Education (1981) emphasizes the importance of remembering that trainably mentally retarded students function at different levels of development in each learning domain. They have suggested a list of the domains that should be included in the curriculum and the specific skills in each domain. Some examples of domains and their specific skills are communication skills as a domain and verbal and non verbal skills and reading and writing as specific skills; cognitive skills as a domain with specific skills including matching, sorting, identifying, memory and constructing; gross and fine motor skills include body awareness, manipulation and dexterity. It is always important to teach social skills to children with intellectual disabilities, since it cannot be assumed that they will automatically pick up these skills from the others around them or the environment as other children. It is particularly important to teach the child appropriate interaction and communicating skills. One skill that was identified as important is shopping. (Morse and Schuster, 2000). Teaching shopping extends to teaching a wide variety of skills for intellectually disabled students including social skills, math skills and fine and gross motor skills. Research reported by these authors show a long list of skills developed by such a curriculum, including how to make a grocery list, how to locate and purchase items, how to select lower-priced items, calculator skills. This type of curriculum could be adapted to use different types of instructional strategies. Some have used a pictorial shopping list. This is helpful for students with reading difficulties. Some have given the students a certain amount of money to cover the items so that they would not have to be confused by counting and money skills if they have not yet developed these skills. For more able students it is an opportunity to continue developing their calculator skills. Using picture prompt money cards has also worked for some. These authors have actually developed an initial grocery shopping curriculum for use with elementary students with moderate intellectual disabilities. The students were involved in activities such as using a daily schedules as they determined when it was time to go shopping; they prepared the materials they would need for shopping; travelling to the store and back to school; and putting away the groceries when they got back to school. The curriculum can be expanded to include more advanced training for students. More advanced money skills and social skills can be taught. Khatib and Khatib (2008) have examined the state of education for students with intellectual disabilities in Jordan. They have demonstrated that the situation is similar to the global one. At present they report only five hundred and eleven part time resource rooms in public schools offering remedial and special education services to 12, 300 second to sixth grade students with special needs, including children with mild intellectual disabilities. These resource rooms exist in geographical areas where there are no special education schools or schools that have demonstrated a commitment to inclusion. An individualized IEP is identified for each student (a standard requirement for all special education students in the US and other countries. The difficulty starts though with identifying the students with mild intellectual disabilities since they do not have reliable intelligence test and adaptive behavior scales and there is a shortage of teachers trained or qualified to carry out these tests. The students are therefore classified as having a learning disability or being a slow learner based only on teachers’ observations and other subjective measures. The educators therefore recognize a need for educational programs to meet the unique needs of these students. They have recommended that for teaching children with intellectual disabilities that they pay more attention to early intervention and transition services and that the services extend beyond the second and sixth grades. They are also calling for support for the special education and regular classroom teachers in the form of teacher assistants and guides for adapting the academic and life skills curricula. They also recognize the usefulness of peer tutoring to support students with special needs. If a teacher knows that there will be a student with intellectual disabilities in her classroom there are some things she can do to prepare for that student, according to the British Columbia Department of Education. It is important to first gather as much information about the student as possible. This can be done by talking to the school psychologist or whoever is responsible for special services at the school, the parents and to the previous teachers and gaining access to the child’s education file and/or IEP and studying it beforehand. The teacher must then make adaptations to her instructional strategies to accommodate the student with intellectual disabilities. Some of the strategies outlined by the British Columbia Department of Education are as follows: Giving the student extra time to complete assignments. Reducing the amount of examples the student must do. Providing more concrete examples for the student to understand the work. Placing the student closer to the teacher or to the board. In some cases the method of assessment of the student needs to be varied, for example assessing a student orally instead of by written work. One of the difficult processes for students with intellectual disabilities is transitions. There are several places along the education process that the child has to experience a transition- firstly entering school at pre-kindergarten, then transitioning from one grade to another, transitioning from primary to secondary school and then transitioning from school to a job and living independently. Schools must help the students with these transition processes. The IEP should include strategies to help the particular child with the transitions they must encounter. Careful planning and good emotional and psychological support should be included in the IEP. In summary, intellectual disability is a very prevalent issue. There is still not enough understanding of the causes of intellectual disability and the varying implications of the different levels of disability to be able to completely prevent and even assess the disability in every child. Research must continue to provide this information so that the intervention and education of these students can be improved. 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