Course Code: SNIE3031 Module Code: SNIE- M3031

Course Title: Education of Persons with Intellectual Limitations

Module Name: Inclusive Education II ECTS Credits (CP): 5

Unit I: Understanding Intellectual Disability

1.1 Terminology:

In 2007, the American Association on Mental Retardation, the leading professional

organization concerned with the study, treatment, and prevention of mental retardation, changed
its name to the American Association on Intellectual and Developmental Disabilities (AAIDD).
Consistent with the practice of most special educators today, this text uses the term intellectual
disabilities, except for instances where the terminology itself is being discussed.

IDEA Definition
In 1973, the American Association on Mental Retardation (AAMR) published a
definition of mental retardation that, with minor rewording, was incorporated into the Individuals
with Disabilities Education Act (IDEA) and continues to serve today as the basisby which most
states identify children for special education services under the disability category of intellectual
disabilities. In IDEA, intellectual disability is defined as

“Significantly sub average general intellectual functioning, existing concurrently

with deficits in adaptive behavior and manifested during the developmental period that
adversely affects a child’s educational performance”

AAIDD’s (American Association on Intellectual and Developmental Disabilities)Definition

“Intellectual disability is characterized by significant limitations in both intellectual

functioning and in adaptive behavior as expressed in conceptual, social, and practical
adaptive skills. This disability originates before age 18.”
1.3 Prevalence
Many factors contribute to the difficulty of estimating the number of people with
intellectual disabilities. Some of these factors include changing definitions of intellectual
disabilities, the schools’ reluctance to label children with mild intellectual impairment, and the
changing status of schoolchildren with mild intellectual disabilities (some are declassified during
their school careers; others are no longer identified after leaving school) (Drew & Hardman,
2007). Historically, the federal government estimated the prevalence at 3% of the general
population, although recent analyses find little objective support for this figure. If prevalence
figures were based solely on IQ scores, 2.3% of the population theoretically would have
intellectual disabilities.
Basing prevalence estimates on IQ scores only, however, ignores the other necessary
criterion for intellectual disabilities—deficits in adaptive functioning and the need for supports.
Some professionals believe that if adaptive behavior is included with intellectual ability when
estimating prevalence, the figure drops to about 1%. In fact, two national studies estimated the
prevalence of intellectual disabilities at 0.78% (Larson et al., 2001) and 1.27% of the U.S.
population (Fujiura, 2003).
During the 2009–10 school year, 460,964 students ages 6 through 21 received special
education under the disability category of intellectual disabilities (U.S. Department of Education,
2011). These students represented about 7.8% of all school-age children in special education.
Intellectual disability is the fourth-largest disability category after learning disabilities, speech or
language impairments, and other health impairments.
Prevalence rates vary greatly from state to state. For example, the prevalence of
intellectual disabilities as a percentage of the school-age population in 2008–09 ranged from a
low of 0.29% (Maine) to a high of 2.18% (West Virginia) (U.S. Department Education, 2010e).
Such differences in prevalence are in large part a function of the widely differing criteria for
identifying students with intellectual disabilities (Denning, Chamberlain, &Polloway, 2000;
Scullin, 2006).

Early History of Intellectual Disability

Some of the very first references to intellectual disability date back to the ancient
Egyptians, where this concept is mentioned in the Papyrus of Thebes over 3500 years ago. The
ancient Romans and Greeks viewed that children are born with an intellectual disability
because the gods are angry. Many of these children were simply left to die in the wild as a result.
Of course, exceptions did occur. For instance, if the child was born to a wealthy Roman family,
they had some legal rights and even guardians. But in the Middle Ages, people with intellectual
disabilities were sometimes employed (willingly or not) as jesters whose sole purpose was to
entertain the upper class.

Prior to the 1700s, the way societies treated people with intellectual disabilities differed.
Those that had a mild intellectual disability may not have been viewed any differently from
anyone else, at least not in the legal or clinical sense. Those with severe intellectual disabilities
were sometimes thought of as people who could receive divine revelation. Some of the people
who had these more severe conditions may have received care from their family or even a
monastery. Other, less fortunate people with ID, were sometimes put into 'idiot cages' in town
centers to probably serve as entertainment for people under the official justification of keeping
the person with the ID 'out of trouble'.

It wasn't until the 1700s and 1800s that more serious and suitable forms of interventions
for people with intellectual disabilities began. For example, Edouard Seguin established a
program in Salpetriere Hospital in Paris, France. This program utilized behavioral management
techniques and individualized instruction for people with such disorders.
 Unit II Assessment of Individuals with Intellectual Disabilities
2.1 Assessment of Intelligence
Assessment of a child’s intellectual functioning requires the administration of an
intelligence (IQ) test by a school psychologist or other trained professional. An IQ test consists
of a series of questions (e.g., vocabulary, similarities), problem solving (e.g., mazes, block
designs), memory, and other tasks assumed to require certain degrees of intelligence to answer or
solve correctly. The child’s performance on those items is entered into a formula that yields a
score representing her intelligence.

IQ tests are standardized tests; that is, the same questions and tasks are always presented
in a prescribed way, and the same scoring procedures are used each time the test is administered.
IQ tests are also norm-referenced tests. During its development, a norm-referenced test is
administered to a large sample of people selected at random from the population for whom the
test is intended. Developers then use the scores of people in the forming sample to represent how
scores on the test are generally distributed throughout that population.

IQ scores seem to be distributed throughout the population according to a phenomenon

called the bell-shaped curve, or normal curve, shown in Figure 4.2 . A mathematical concept
called the standard deviation describes how a particular score varies from the mean, or average,
of all the scores in the norm sample. Test developers apply an algebraic formula to the scores
achieved by the norm sample on a test to determine what value equals 1 standard deviation for
that test. A child’s IQ test score can then be described in terms of how many standard deviations
above or below the mean it is. Theoretically, an equal number of people score above and below
the mean, and about 2.3% of the population falls _2 standard deviations below the mean.

The AAIDD’s criterion for “significant limitations of intellectual functioning,” a

requirement for a diagnosis of intellectual disability, is an IQ score approximately 2 standard
deviations below the mean, which is a score of 70 or below on the two most widely used
intelligence tests, the Wechsler Intelligence Scale for Children (WISC-IV) (Wechsler, 2003) and
the Stanford-Binet Intelligence Scales (Roid, 2003a). According to the AAIDD, the IQ cutoff
score of 70 is intended as a guideline and should not be interpreted as a hard-and-fast
requirement. A higher IQ score of 75 or more may also be associated with intellectual disabilities
if, according to a clinician’s judgment, the child exhibits deficits in adaptive behavior thought to
be caused by impaired intellectual functioning.
FIGURE 4.2
Even though the major intelligence tests are among the most carefully constructed and
researched psychological assessment instruments available, they are still far from perfect and
have both advantages and disadvantages. Following are several additional important
considerations (Overton, 2012; Salvia, Ysseldyke, & Bolt, 2011; Venn, 2007):

• Intelligence is a hypothetical construct. No one has ever seen a thing called intelligence;we
infer it from observed performance. We assume it takes more intelligenceto perform some tasks
at a given age than it does to perform others.

• An IQ test measures only how a child performs at one point in time on the itemsincluded on the
test. An IQ test samples only a small portion of an individual’sskills and abilities; we infer from
that performance how a child might perform inother situations.

• IQ scores can change significantly. IQ scores often increase over time, particularlyin the 70–80
range where diagnostic decisions are not so clear-cut (Whitaker,2008). Examiners are hesitant to
give a diagnosis of intellectual disabilities on thebasis of an IQ score that might increase after a
period of intensive, systematicintervention.

• Intelligence testing is not an exact science. The standard error of IQ tests is 3 to5 points in
either direction. Among the many variables that can affect a person’sIQ score are motivation, the
time and location of the test, inconsistency or biasby the test administrator in scoring responses
that are not precisely covered bythe test manual, which IQ test was selected, and which edition of
that test was used. Because each of the widely used IQ tests measures a child’s performanceon a
different set of tasks, when “an IQ score appears in isolation we must ask the question, ‘IQ as
measured by which test?’” (Venn, 2007, p. 145). IQ scores onthe Wechsler series of intelligence
tests increased steadily during the 20th centuryat a rate of about .3 IQ points per year (Flynn,
1987, 2006, 2007; Kanaya, Scullin,&Ceci, 2003). This rise, known at the “Flynn effect,” has
been masked by theperiodic renorming of IQ tests to reset the mean at 100 (Scullin, 2006).

• Intelligence tests can be culturally biased. The Binet and Wechsler IQ tests tend tofavor
children from the population on which they were normed—primarily white,middle-class
children. Some of the questions may tap learning that a middle-classchild is more likely to have
experienced. Both the Binet and Wechsler, whichare highly verbal, are especially inappropriate
for children for whom English is asecond language (Venn, 2007).

Assessing Adaptive Behavior

Adaptive behavior is “the collection of conceptual, social, and practical skills that
havebeen learned by people in order to function in their everyday lives” (AAIDD Ad
HocCommittee on Terminology and Classification, 2010, p. 43). The systematic assessment of
adaptive behavior is important for reasons beyond the diagnosis of intellectual disabilities.

The adaptive skills exhibited by a person with intellectual disabilities—as wellas the
nature and severity of maladaptive behaviors—are critical factors in determiningthe supports a
student requires for success in school, work, community, and homeenvironments (Schalock,
1999; Thompson et al., 2004). Numerous instruments for assessingadaptive behavior have been
developed. Most consist of a series of questionsthat a person familiar with the individual (e.g., a
teacher, parent, or caregiver) answers.
AAMR - ADAPTIVE BEHAVIOR SCALE
A frequently used instrument for assessing adaptivebehavior by school-age children is the
AAMR Adaptive Behavior Scale—School(ABS-S:2) (Lambert, Nihira, & Leland, 1993). The
ABS-S:2 consists of two parts. Part 1contains 10 domains related to independent functioning and
daily living skills (e.g., eating,toilet use, money handling, numbers, time); Part 2 assesses the
individual’s level ofmaladaptive (inappropriate) behavior in seven areas (e.g., trustworthiness,
self-abusivebehavior, social engagement). Another form, the ABS-RC:2, assesses adaptive
behaviorin residential and community settings (Nihira, Leland, & Lambert, 1993).
AAIDD - DIAGNOSTIC ADAPTIVE BEHAVIOR SCALE
The Diagnostic Adaptive BehaviorScale (DABS), designed for use with individuals from 4 to 21
years old, includes acutoff point at which an individual is considered to have significant
limitations in adaptivebehavior. Thus, the DABS provides critical information on determining a
diagnosisof intellectual disability.
VINELAND ADAPTIVE BEHAVIOR SCALES
The Vineland Adaptive Behavior Scales areavailable in three versions. The Interview Editions in
Survey Form or Expanded Formare administered by an individual who is very familiar with the
person being assessed,such as a parent, teacher, or a direct caregiver (Sparrow, Balla,
&Cicchetti, 2005).
ADAPTIVE BEHAVIOR ASSESSMENT SYSTEM-II
The ABAS-II provides a comprehensiveassessment of 10 specific adaptive skills in three
domains (conceptual, social andpractical) (Harrison & Oakland, 2003). Five different forms are
available for use withindividuals from birth to age 89.

Measurement of adaptive behavior has proven difficult in large part because ofthe
relative nature of social adjustment and competence: Actions that may be consideredappropriate
in one situation or by one group may not be in another situation orby another group. No universal
agreement exists concerning exactly which adaptivebehaviors everyone should exhibit. As with
IQ tests, cultural bias can be a problemin adaptive behavior scales; for instance, one item on
some scales requires a child totie a laced shoe, but some children have never had shoes with
laces.
Unit III. Causes and Classification of Intellectual Disability
3.1 Causes
More than 350 risk factors associated with intellectual disabilities have been identified
(Dykens, Hodapp, &Finucane, 2000). Approximately 35% of cases have a genetic cause, another
third involve external trauma or toxins, and etiology remains unknown for another third of cases
(Heikua et al., 2005; Szymanski & King, 1999). Nevertheless, knowledge of etiology is critical
to efforts designed to lower the incidence of intellectual disabilities and may have implications
for some educational interventions (Hodapp&Dykens, 2007; Powell, Houghton, & Douglas,
1997).

Etiologic factors associated with intellectual disabilities that the AAIDD categorizes as
Prenatal (occurring before birth), Perinatal (occurring during or shortly after birth), or
Postnatal (occurring after birth). Each of these etiologic factors can be classified further as
biomedical or environmental (social, behavioral, and educational).However, a combination of
biological and environmental factors is often involved in individual cases of intellectual
disabilities, making specific determination of etiology extremely difficult (Heikua et al., 2005;
van Karnebeek et al., 2005).

BIOMEDICAL CAUSES Researchers have identified specific biomedical causes for about
two-thirds of individuals with more severe levels of intellectual disabilities (Batshaw, Pellegrino,
& Roizen, 2007). Table 4.2 describes some of the more common prenatal conditions that often
result in intellectual disabilities. The term syndrome refers to a number of symptoms or
characteristics that occur together and provide the defining features of a given disease or
condition. Down syndrome and fragile X syndrome are the two most common genetic causes
of intellectual disabilities (Roberts et al., 2005).
 IGURE 4.3ETIOLOGIC RISK FACTORS FOR INTELLECTUAL DISABILITIES

T i m i n g B i o m e d i c a l S o c i a l Behavioral Educational
.1. Parental cognitive
1. Chromosomal
1 . P o v e r t y 1.Parental Drug use disability without
Disorders
supports
2. Single-gene disorders 2. Maternal malnutrition 2.Parental Alcohol use
Prenata l 3 . S y n d r o m e s 3. Domestic Violence 3.Parental Smoking
4. Metabolic disorder s
2. Lack of preparation for parenthood
5. Cerebral dysgenesi s
4. Lack of access to prenatal care 4.Parental Immaturity
6. Maternal illnesses
7. Parental age
1. Parental rejection of
1 . P r e m a t u r i t y caretaking
1. Lack of access to birth 1.Lack of medical referralfor intervention services
Perinatal care at discharge
2. Birth injury
2. Parental abandonment of child
3. Neonatal disorders
1. Traumatic brain injury 1.Impaired child caregiver 1. Child abuse and neglect 1. Impaired parenting

2. Lack of adequate
2. Malnutrition 2. Domestic violence 2. Delayed diagnosis
stimulation

3. Inadequate earl y
3. Meningoencephalitis 3. Family poverty 3. Inadequate safety measures
Postnatal intervention services

4. Chronic illness in the 4. Inadequate special educational

4. Seizure disorders 4. Social deprivation
family services

5. Inadequate family
5. Degenerative disorders 5. Institutionalization 5. Difficult child behaviors
support

ENVIRONMENTAL CAUSES

Individuals with mild intellectual disabilities, those who require less intensive supports,
make up about 90% of all people with intellectual and developmental disabilities (Drew &
Hardman, 2007). The vast majority of those individuals shows no evidence of organic pathology
—no brain damage or other biological problem. When no biological risk factor is evident, the
cause is presumed to be psychosocial disadvantage, environmental influences such as poverty,
minimal opportunities to develop early language, child abuse and neglect, and/or chronic social
or sensory deprivation. Professionals sometimes use the term to intellectual disability of cultural-
familial origin when referring to the result of a poor social environment early in the child’s life
(AAIDD Ad Hoc Committee, 2010).
Although no direct evidence proves that social and environmental deprivation causes intellectual
disability, researchers generally believe that these influences cause many cases of mild
intellectual disabilities. Empirical support for the causal influence of poverty is found in research
showing that children who live in poverty have a higher than normal chance of being identified
as having intellectual disabilities (Fujiura&Yamaki, 2000).

3.2 Prevention of Intellectual Disability

Preconception

The health of a baby can depend on how healthy a mother is before pregnancy. Ideally, she
should obtain a general health assessment six months before pregnancy that includes:

 updating immunizations;
 reviewing use of medications;
 reviewing diet and vitamin supplementation, including folic acid;
 considering genetic counseling; and
 stopping use of alcohol, cigarettes
 or other tobacco forms, illegal drugs, and legal drugs not approved by the doctor.

Prenatal care should begin as soon as she suspects she is pregnant. During pregnancy, a woman
can protect the developing fetus by:

 getting plenty of rest and sleep;

 eating nutritious meals;
 avoiding alcohol, cigarettes and drugs;
 avoiding people who are sick;
 wearing seat belts in a car; and
  Not lifting heavy objects.

Genetic counseling should be considered if:

 the child may inherit a genetic or chromosomal disorder because of a specific condition
in the family;
 a previous birth to either parent resulted in a child with a genetic disorder, unexplained
intellectual disability or a birth defect;
 the mother has had two or more miscarriages or a baby who died in infancy;
 the mother is 35 years of age or over;
 either partner is of a race or ethnic group with a high incidence of a genetic condition;
and
 The partners are blood relatives.

At the time of delivery

Intellectual disability can be prevented during childhood by knowing the causes and
taking steps to keep children safe and healthy. These steps include:

 Premature delivery
 Prolonged labour when the oxygen supply to the child’s brain may be insufficient thus
damaging the brain.
 Abnormal presentation of the baby at delivery, too small sized pelvis of the mother to
allow easy birth of the baby.
 Inappropriate use of forceps or improperly attended delivery by untrained person.
 Delayed birth cry of the baby.

 Childhood immunizations to protect children from at least six diseases that can lead to
brain damage. These include measles, mumps, pertussis (whooping cough), Hib disease,
varicella (chicken pox), and pneumococcal disease.
 Newborn screening to identify treatable genetic conditions.
  Reducing the incidence of Reye’s syndrome caused by giving medicines containing
salicylate (aspirin); instead, using medicines containing acetaminophen (such as Tylenol)
to reduce the brain damage caused by Reye’s syndrome.
 Reducing exposure to lead, mercury and other toxins in the environment that are known
to cause brain damage.
 Protecting children from household products that are poisonous.

Early childhood
Early childhood spans the pre-natal period to eight years of age. It is the most intensive
period of brain development throughout the lifespan and therefore is the most critical stage of
human development. What happens before birth and in the first few years of life plays a vital role
in health and social outcomes

Early childhood intervention (ECI) programmes are designed to support young children
who are at risk of developmental delay, or young children who have been identified as having
developmental delays or disabilities. ECI comprises a range of services and supports to ensure
and enhance children’s personal development and resilience, strengthen family competencies,
and promote the social inclusion of families and children.

Examples include specialized services such as: medical; rehabilitation (e.g. therapy and
assistive devices); family-focused support (e.g. training and counselling); social and
psychological; special education, along with service planning and coordination; and assistance
and support to access mainstream services such as preschool and child-care (e.g. referral).
Services can be delivered through a variety of settings including health-care clinics, hospitals,
early intervention centres, rehabilitation centres, community centres, homes and schools.

3.3 Classification of Mental Retardation

AAMD Classification
Intellectual disability and people so diagnosed have traditionally been classified by
thedegree or level of intellectual impairment as measured by an IQ test. The most widelyused
classification system consists of four levels of severity according to the range ofIQ scores. The
range of scores at the low and high ends of eachlevel represents the inexactness of intelligence
testing and highlights the importance of clinical judgment in diagnosis and classification.

For many years, students with intellectual disabilities were classified as Educable
mentally retarded (EMR) or Trainable mentally retarded (TMR). These terms referredto mild
and moderate levels of intellectual disability, respectively. This two-level classification system
did not include children with severe and profound intellectual disabilities, because they were
often denied a public education and were likely to reside in a state-operated institution. The
terms EMR and TMR are considered archaic and inappropriate because they suggest
predetermined achievement limits (Beirne-Smith, Patton, & Kim, 2006).
Classification of Intellectual Disabilities by IQ Score

L e v e l I Q S c o r e s
M i l d 50–55 to approximately 70
M o d e r a t e 3 5 – 4 0 t o 5 0 – 5 5
S e v e r e 2 0 – 2 5 t o 3 5 – 4 0
P r o f o u n d B e l o w 2 0 – 2 5
Unit IV Characteristics of Persons with Intellectual Disability
Many children with mild retardation are not identified until they enter school and
sometimes not until the second or third grade, when more difficult academic work is required.
Most students with mild mental retardation master academic skills up to about the sixth-grade
level and are able to learn job skills well enough to support themselves independently or semi-
independently. Some adults who have been identified with mild mental retardation develop
excellent social and communication skills and once they leave school are no longer recognized as
having a disability.
Children with moderate retardation show significant delays in development during their
preschool years. As they grow older, discrepancies in overall intellectual development and
adaptive functioning generally grow wider between these children and age mates without
disabilities. People with moderate mental retardation are more likely to have health and behavior
problems than are individuals with mild retardation.

Individuals with severe and profound mental retardation are almost always identified at
birth or shortly afterward. Most of these infants have significant central nervous system damage,
and many have additional disabilities and/or health conditions. Although IQ scores can serve as
the basis for differentiating severe and profound retardation from one another, the difference is
primarily one of functional impairment.

Cognitive Functioning

Deficits in cognitive functioning and learning styles characteristic of individuals with

mental retardation include poor memory, slow learning rates, attention problems, difficulty
generalizing what they have learned, and lack of motivation.

Memory:-

Students with mental retardation have difficulty remembering information. As would be

expected, the more severe the cognitive impairment, the greater the deficits in memory. In
particular, research has found that students with mental retardation have trouble retaining
information in short-term memory (Bray, Fletcher, & Turner, 1997). Short-term memory, or
working memory, is the ability to recall and use information that was encountered just a few
seconds to a couple of hours earlier—for example, remembering a specific sequence of job tasks
an employer stated just a few minutes earlier. Merrill (1990) reports that students with mental
retardation require more time than their nondisabled peers to automatically recall information
and therefore have more difficulty handling larger amounts of cognitive information at one time.
Early researchers suggested that once persons with mental retardation learned a specific item of
information sufficiently to commit it to long-term memory—information recalled after a period
of days or weeks—they retained that information about as well as persons without retardation
(Belmont, 1966; Ellis, 1963).

More recent research on memory abilities of persons with mental retardation has focused
on teaching metacognitive or executive control strategies, such as rehearsing and organizing
information into related sets, which many children without disabilities learn to do naturally
(Bebko&Luhaorg, 1998). Students with mental retardation do not tend to use such strategies
spontaneously but can be taught to do so with improved performance on memory-related and
problem-solving tasks as an outcome of such strategy instruction (Hughes &Rusch, 1989;
Merrill, 1990).

Learning Rate.

The rate at which individuals with mental retardation acquire new knowledge and skills is
well below that of typically developing children. A frequently used measure of learning rate is
trials to criterion—the number of practice or instructional trials needed before a student can
respond correctly without prompts or assistance. For example, while just 2 or 3 trials with
feedback may be required for a typically developing child to learn to discriminate between two
geometric forms, a child with mental retardation may need 20 to 30 or more trials to learn the
same discrimination.

Because students with mental retardation learn more slowly, some educators have
assumed that instruction should be slowed down to match their lower rate of learning. Research
has shown, however, that students with mental retardation benefit from opportunities to learn to
“go fast” (Miller, Hall, &Heward, 1995).
Attention:-

The ability to attend to critical features of a task (e.g., to the outline of geometric shapes
instead of dimensions such as their color or position on the page) is a characteristic of efficient
learners. Students with mental retardation often have trouble attending to relevant features of a
learning task and instead may focus on distracting irrelevant stimuli. In addition, individuals with
mental retardation often have difficulty sustaining attention to learning tasks (Zeaman& House,
1979). These attention problems compound and contribute to a student’s difficulties in acquiring,
remembering, and generalizing new knowledge and skills.

Generalization of Learning:-

Students with disabilities, especially those with mental retardation, often have trouble
using their new knowledge and skills in settings or situations that differ from the context in
which they first learned those skills. Such transfer or generalization of learning occurs without
explicit programming for many children without disabilities but may not be evident in students
with mental retardation without specific programming to facilitate it. Researchers and educators
are no longer satisfied by demonstrations that individuals with mental retardation can initially
acquire new knowledge or skills. One of the most important and challenging areas of
contemporary research in special education is the search for strategies and tactics for promoting
the generalization and maintenance of learning by individuals with mental retardation. Some of
the findings of that research are described later in this chapter and throughout this text.

Motivation:-

Some students with mental retardation exhibit an apparent lack of interest in learning or
problem-solving tasks (Switzky, 1997). Some individuals with mental retardation develop
learned helplessness, a condition in which a person who has experienced repeated failure comes
to expect failure regardless of his or her efforts.

Adaptive Behavior:-

By definition children with mental retardation have substantial deficits in adaptive

behavior. These limitations can take many forms and tend to occur across domains of
functioning. Limitations in self-care skills and social relationships as well as behavioral excesses
are common characteristics of individuals with mental retardation.

Self-Care and Daily Living Skills:

Individuals with mental retardation who require extensive supports must often be taught
basic self-care skills such as dressing, eating, and hygiene. Direct instruction and environmental
supports such as added prompts and simplified routines are necessary to ensure that deficits in
these adaptive areas do not come to seriously limit one’s quality of life. Most children with
milder forms of mental retardation learn how to take care of their basic needs, but they often
require training in self-management skills to achieve the levels of performance necessary for
eventual independent living.

Social Development:-

Making and sustaining friendships and personal relationships present significant

challenges for many persons with mental retardation. Limited cognitive processing skills, poor
language development, and unusual or inappropriate behaviors can seriously impede interacting
with others. It is difficult at best for someone who is not a professional educator or staff person
to want to spend the time necessary to get to know a person who stands too close, interrupts
frequently, does not maintain eye contact, and strays from the conversational topic. Teaching
students with mental retardation appropriate social and interpersonal skills is one of the most
important functions of special education.

Behavioral Excesses and Challenging Behavior:-

Students with mental retardation are more likely to exhibit behavior problems than are
children without disabilities. Difficulties accepting criticism, limited self-control, and bizarre and
inappropriate behaviors such as aggression or self-injury are often observed in children with
mental retardation. Some of the genetic syndromes associated with mental retardation tend to
include abnormal behavior (e.g., children with Prader-Willi syndrome often engage in self-
injurious or obsessive-compulsive behavior). In general, the more severe the retardation, the
higher the incidence of behavior problems. Individuals with mental retardation and psychiatric
conditions requiring mental health supports are known as “dual diagnosis” cases. Data from one
report showed that approximately 10% of all persons with mental retardation served by the state
of California were dually diagnosed (Borthwick-Duffy &Eyman, 1990). Although there are
comprehensive guidelines available for treating psychiatric and behavioral problems of persons
with mental retardation (Rush & Francis, 2000), much more research is needed on how best to
support this population.

Positive Attributes:-

Descriptions of the intellectual functioning and adaptive behavior of individuals with

mental retardation focus on limitations and deficits and paint a picture of a monolithic group of
people whose most important characteristics revolve around the absence of desirable traits. But
individuals with mental retardation are a huge and disparate group composed of people with
highly individual personalities (Smith & Mitchell, 2001b). Many children and adults with mental
retardation display tenacity and curiosity in learning, get along well with others, and are positive
influences on those around them (Reiss & Reiss, 2004; Smith, 2000).

4.1 Characteristics of Persons with Mild Intellectual Disability

Many children with mild intellectual disabilities are not identified until they enter school
and some not until they reach the second or third grade, when more difficult academic work is
required. Moststudents with mild intellectual disabilities master academic skills up to about the
sixth-grade level and can learn vocational and daily living skills well enough to support
themselves independently or semi independently in the community.
Mild intellectual disability

 IQ 50 to 70
 Slower than typical in all developmental areas
 No unusual physical characteristics
 Able to learn practical life skills
 Attains reading and math skills up to grade levels 3 to 6
 Able to blend in socially
 Functions in daily life
About 85 percent of people with intellectual disabilities fall into the mild category and many
even achieve academic success. A person who can read, but has difficulty comprehending what
he or she reads represents one example of someone with mild intellectual disability.

Moderate intellectual disability

 IQ 35 to 49
 Noticeable developmental delays (i.e. speech, motor skills)
 May have physical signs of impairment (i.e. thick tongue)
 Can communicate in basic, simple ways
 Able to learn basic health and safety skills
 Can complete self-care activities
 Can travel alone to nearby, familiar places

People with moderate intellectual disability have fair communication skills, but cannot
typically communicate on complex levels. They may have difficulty in social situations and
problems with social cues and judgment. These people can care for themselves, but might need
more instruction and support than the typical person. Many can live in independent situations,
but some still need the support of a group home. About 10 percent of those with intellectual
disabilities fall into the moderate category.

Severe intellectual disability

 IQ 20 to 34
 Considerable delays in development
 Understands speech, but little ability to communicate
 Able to learn daily routines
 May learn very simple self-care
 Needs direct supervision in social situations

Only about 3 or 4 percent of those diagnosed with intellectual disability fall into the severe
category. These people can only communicate on the most basic levels. They cannot perform all
self-care activities independently and need daily supervision and support. Most people in this
category cannot successfully live an independent life and will need to live in a group home
setting.

Profound intellectual disability

 IQ less than 20
 Significant developmental delays in all areas
 Obvious physical and congenital abnormalities
 Requires close supervision
 Requires attendant to help in self-care activities
 May respond to physical and social activities
 Not capable of independent living

People with profound intellectual disability require round-the-clock support and care. They
depend on others for all aspects of day-to-day life and have extremely limited communication
ability. Frequently, people in this category have other physical limitations as well. About 1 to 2
percent of people with intellectual disabilities fall into this category.

Intellectual disability in reading

Two types of intellectual disability occur in reading. One type manifests when your child has
difficulty understanding relationships between letters, sounds, and words. The other shows up in
problems with reading comprehension where your child has issues grasping the meaning of
words, sentences, and paragraphs. Signs of intellectual disability in reading:

 problems in letter and word recognition

 problems understanding words and ideas
 slow reading speed and low fluency
 poor vocabulary skills

Intellectual disability in writing

This type of intellectual disability can involve either the physical activity of writing, the
mental activity of comprehending and putting together information, or both. Children with this
intellectual disability have problems forming letters, words, and written expression. Signs of an
intellectual disability in writing include:

 messy writing
 problems copying letters and words with accuracy
 problems with spelling
 issues with coherence and organization when writing

Intellectual disability with motor skills

Children with an intellectual disability that affects motor skills have problems with both
gross and fine motor skills. They may seem uncoordinated for their age and have significant
problems with movements that require hand to eye coordination.

Intellectual disability with language

This type of intellectual disability involves the ability to speak and to understand spoken
words. Signs of this type of impairment include:

 problems retelling a story

 problems in speech fluency
 issues with understanding word meanings
 issues carrying out directions
 problems understanding parts of speech

Severe Intellectual Disability

A combination of medical or environmental conditions may cause severe intellectual

disability, which is generally defined as someone who has an IQ from 20 to 35. This number
does vary from person to person and is not the only indicator. Other factors include behavioral
problems and trouble learning. All of these can have a serious impact on a person’s ability to
take care of themselves in life. There are varying degrees to which people with a severe
intellectual disability are able to survive in the world, but most need some form of help.
Definition of Severe Intellectual Disability

A severe intellectual disability is defined as having an IQ score of 20-35 as well as

learning and adaptive behavior problems. With therapy, there is a chance that someone with a
severe intellectual disability still may be able to live a fulfilling and productive life.

Symptoms of / Reasons for Severe Intellectual Disability

 Trouble with language development

 Slow social development
 Physical abnormalities
 Neurological abnormalities
 Problems dressing
 Problems eating

Education of Severely Intellectual Disabled Individuals

Emphasis should generally be on
 Language development
 Self-help skills
 Socialization
 Preparation for living and working in sheltered environments
Methods of Teaching for Persons with Intellectual Disability
Commonly used methods for Teaching are
 Shaping
 Prompting
 Modeling
 Task analysis and Chaining
Shaping:-
Shaping means rewarding a childfor a behavior that is a step towards the desired
behaviour. Thus if a child whose target behaviour is to ask verbally for water, he will be
rewarded forattempting to say “wa” initially. Gradually the reward wil be given when the
progress is made in reaching the target, perhaps “wat” followed by “water” finally. This is
generally called as reinforcing successive approximations.

Prompting:-
Prompting is simple assisting a child in various degrees depending on his current level of
functioning. For instance, a physical prompt is one where one physically assists the child by
holding him. Helping a child by holding his hand to pick up food and direct it to his mouth is a
physical prompt. On the other hand, telling him to pick up food, and telling him to direct to his
mouth is a verbal prompt.
Modeling:-
Modeling is visual prompt. When the child is watching, performing the desired task for
him to follow is modeling. Brushing one own teeth when the child is watching and making him
do is an example of modeling. This is a very powerful mode of teaching. Children learn very fast
if the model looks like themselves. Therefore, use peer models whenever possible for teaching a
skill.

Task Analysis and Chaining:-

Task analysis is a method of breaking up a task into small components according to its
sequence. Chaining is a method where each of these steps are taught in a sequential manner and
practiced. In forward chaining, the client is taught the first step and he does it independently, and
the therapist does the rest of the steps. Next, the client does the first two steps, and the therapist
does the rest. In this manner, the client learns the task one step at a time. In backward chaining,
the client is taught the last step first. The therapist does the task and the client completes it with
the last step. Chaining, is a good method to teach life skills, and can be used with positive
reinforcement strategies.
UNIT-V. Programming and Issues Across the Life span of persons with Intellectual
Disability

5.1 Early Intervention?

Early childhood is the period from prenatal development to eight years of age. It is a crucial
phase of growth and development because experiences during early childhood can influence out
comes across the entire course of an individuals life.

Rationale

Early intervention services delivered within the context of the family can aid with the below
through the services of physical, occupational, and speech therapy. Some examples include:

• Help prevent child abuse and neglect

• Mitigate the effects of abuse and neglect

• Improve parenting skills

• Strengthen families

• Improve the child's developmental, social, and educational gains;

• Reduce the future costs of special education, rehabilitation and health care needs;

• Reduce feelings of isolation, stress and frustration that families may experience.

Assessing, Designing and Implementing programmes for young children:-

• At age one month most children can:

• Raise their heads slightly when lying on their stomachs

• Briefly watch objects

• Pull away from a blanket on their face

• At age three months most children can:

• Lift their heads and chest while lying on their stomachs

• Make cooing sounds

• Follow a moving person with their eyes

• Smile back at someone

• At age six months most children can:

• Sit with minimal support

• Roll from their back to their stomach

• Respond to their name by looking

• At age 12 months most children can:

• Pull themselves up to stand and take steps with hands held

• Follow with their eyes in the direction that you are pointing

• Start a game of peek-a-boo, imitate clapping hands, point to show you something

• Say two or three words on a regular basis

• Sit up when prompted

• At age 18 months most children can:

• Walk backwards

• Walk down stairs holding an adult's hand

• Use words and gestures (like taking you by the hand) to get needs met

• Perform simple pretend play like talking on the phone, feeding a stuffed animal.

• At age 24 months most children can:

• Kick a large ball

• Describe an injury or illness to an adult (bumped my head)

• Show interest in other children by offering them a toy or taking their hand.

• At age 32 months most children can:

• Pretend to be an animal or favorite character

• Talk about the past/future

• Answer "what", "where", and "who" questions easily

• Imitate drawing a horizontal line after being shown

• Hold a crayon with 3 fingers.

• FAMILY INVOLMENT:-
Family members should observe the following things how to contribute to make their job easy.

(a) If the child does not sit unassisted even much after 12-15 months (b) Or starts to walk even
much after 2 ½ years. © Or starts to talk even much after 2 ½ years. (d) If a child has undue
problems in doing independently any of the following activities by the age of 6 years: · Eating ·
Dressing or · Toilet activity (e) Problems in holding a pencil/ or using a scissors (f) Unable to
play with a ball; or play ‘guilli- danda’ with his peers. (g) Frequent tantrums, while playing with
the peers. (h) Usual inattentiveness to the spoken speech or addressal. (i) Requires too many
repetitions to remember simple things. (j) Problems in naming even 5 fruits, vegetables or plants.
(k) Problems in naming the days of the week. (l) Exhibit problems in expressing the needs in a
clear language unlike the other peers. (m) Unable to concentrate on tasks even for a short period
of time. (n) Inappropriate oral responses. (o) Difficulty in performing daily routine work. (p)
Poor comprehension of lessons taught in the school class. (q) Difficulty in learning new things.
(r) Difficulty in conceptualization. (s) Does not get well along with the children of same age
group. (t) More efforts are required in learning or practicing as compared to the peers. (u) Takes
an unreasonable amount of time in perfecting any work. (v) Poor academic achievements. (w)
Show an undue dependency on visual clues or material for learning.

5.2 school years

• 5.2a)Educational environment option:

• The physical arrangement of the classroom must support the planned activities.
Designing an effective preschool classroom requires thoughtful planning to ensure that
play are as and needed materials are accessible to and safe for all students, boundaries
between areas minimized is tractions, and, most important, the environment makes
children want to explore and play. Suggestions for setting up a preschool classroom
include the following:

• Organize the classroom into a number of different well defined are as to accommodate
different kinds of activities (e.g., quiet play, messy play, dramatic play, constructive play,
active play).

• •Locate quiet activities together, away from avenues of traffic, and loud activities
together. Equip each area with abundant, appropriate materials that are desirable to
children.

• •Locate materials where children can easily retrieve them and do not depend on adults.

• •Have an open area, perhaps a large rug, to conduct large-group activities such as circle
time and story reading.

• •Label or color code all storage areas so that aides and volunteers can easily find needed
materials.
 • 5.2b) Assessment and Programme Planning

• An IQ test consists of a series of questions (e.g., vocabulary, similarities), problem

solving (e.g., mazes, block designs), memory, and other tasks assumed to require certain
amounts of intelligence to answer or solve correctly.

• The IQ cut off score of 70 is intended only as a guideline and should not be interpreted as
a hard-and-fast requirement. An IQ score of 75 or higher may be associated with
intellectual disability if, according to a clinician’s judgment, the child exhibits deficits in
adaptive behavior thought to be caused by impaired intellectual functioning.

5.2c) Programme for elementary age learners:

• Teachers in preschool programs for children with disabilities face the challenge of
organizing the program day into a schedule that meets each child’s individual learning
needs and provides children with many opportunities to explore the environment and
communicate with others throughout the day. The schedule should include a balance of
child-initiated and planned activities, large-and small-group activities, active and quiet
times, and indoor and out door activities; it should allow easy transition from activity to
activity. In short, the schedule should provide a framework for maximizing children’s
opportunities to develop new skills and practice what they have learned while remaining
manageable and flexible. In addition, how activities are scheduled and organized has
considerable effect on the frequency and type of interaction that occurs between children
with and without disabilities and on the extent to which children with disabilities benefit
from instructional activities.

• 5.2.d) Programme for secondary age learners

Students who do not complete high school are likely to face more difficulties in
adult adjustment than are those who do Special education students who do not complete high
school face lower levels of employment and wages, reduced access to post secondary
education and training opportunities, higher rates of problems with the criminal justice
system, and less overall satisfaction with life in general.

5.2e) Transition Years

• The literature review took an in depth look at transition experiences of young people with
intellectual disabilities and their families and identified many aspects of transition that
may be different for this group of people.

5.3 ADULT YEARS

• Residential and community Leaving:

 • Where one lives determines a great deal about how one lives. It influences where a
person can work, what community services and resources will be available, who her
friends will be, what opportunities for recreation and leisure exist, and, to a great extent,
what feelings of self and place in the community will develop.

Employment and occupation:-

Strategies for facilitating successful placement in a general education class

include planning for the student’s inclusion through team games, collaborative learning, and
group investigation projects and by directly training all students in specific skills for
interacting with one another.

The relative appropriateness of inclusion in the general education classroom

changes for some students with intellectual disabilities as they move from the elementary
grades to the secondary level, when opportunities for community-based instruction in
vocational and life skills are critical.

Determining the extent to which a general education classroom is the most

appropriate placement for a student with intellectual disabilities must consider the student’s
individual needs.

The principles of normalization, social role valorization, and self-determination

are important in helping people with intellectual disabilities achieve acceptance and
membership in society.

Aging with intellectual disability

1. To understand how ageing affects people with an intellectual disability and their careers.2. To
develop and refine suitable models of care and support for people with IL and their careers as
they age.3. Disability and health professionals who provide quality services in the prevention,
assessment & management of health conditions associated with ageing in people with an IL. 4.A
focus on the health of adults with IL at an under graduate level5.The availability of enhanced
material for postgraduate studies in relevant fields and for professional associations 6.A health
and disability work force strategy which includes a focus on ageing in IL (Vocational training,
competency frameworks) 7. The development of specialist models of practice in health and
disability fields with a focus on age related conditions (geriatricians, psychiatry of old age,
behaviour support specialists). 8•Education and training in age-related health conditions in IL (an
opportunity)for: disability workers health professionals.

Community involvement:

Movement of persons with mental retardation out of institutions and into community settings is
occurring at a never-increasing pace. Yet, physical integration is not synonymous with full
community inclusion. Numerous barriers remain that serve as obstacles to successful as
similation into community life. For instance, successful social integration depends on attitudinal
changes of persons without mental retardation—families, friends, Service-delivery professionals,
and the general public—toward persons with mental retardation.

Barriers to Full Inclusion:

Young adults with mental retardation are confronted with numerous barriers to community
integration as they move from the dependence of childhood and early adolescence to the
autonomy and independence of adulthood. The most obvious of all barriers is lack of access to
community living environments.

A second obstacle to full inclusion within the community stems from the rather restrictive
attitudes of parents and family members. Many parents express concern about impending moves
from institutions to small community facilities. Reasons for apprehension include fears about the
appropriateness of available community settings, anxiety that the move will have a negative
impact on the family, and concerns that the young adult does not possess necessary skills to
function adequately with in the community.

A third major barrier to community inclusion results from opposition on the part of community
members. Some community members resist development of group homes in their neighborhoods
(A fourth and equally critical barrier to community inclusion has resulted from lack of funding
necessary to provide quality services in small community-based settings.

5.4 Assistive Technology Application:

a)Definition of Assistive Technology

According to the United States Assistive Technology Act of 1998, assistive technology (also
called adaptive technology) refers to any "product, device, or equipment, whether acquired
commercially, modified or customized, that is used to maintain, increase, or improve the
functional capabilities of individuals with disabilities. "Common computer-related assistive
technology products include screen magnifiers, large-key keyboards, alternative input devices
such as touch screen displays, over-sized track balls and joysticks, speech recognition programs,
and text readers.

b) Benefits of Assistive Technology:

1. It gives them self-confidence Learning disabilities like dyslexia can often result in a lack of
self-confidence. Sufferers struggle on a daily basis with tasks their peers find easy and this may
chip away at their enthusiasm. Eventually, it can result in a feeling of failure. However, being
able to keep up with everything other people are doing allows them to break this vicious circle
and feel more positive.
Sophisticated spell-checkers can also give youngsters confidence that they are handing in work
they can be proud of-and that won't come back covered in red pen.

2. Students can better reach their potential

i) It is commonly assumed that children with disabilities are not as intelligent as their peers
without them, but this is simply not true. Infact, they often have very high IQs, but are not able to
demonstrate this because of the obstacles in their way.

ii) For instance, a child who cannot speak may have been placed in a special, segregated
classroom and had to spend significant amounts of time on speech therapy just so educators
could understand them.

iii) It can help them be more independent Dyslexic children and those with limited mobility in
their hands used to be easy to pinpoint in the classroom or examination room because they would
have a note-taker assigned to them, who would write down everything they said so it would be
legible to markers.

iv) Assistive Technology can boost engagement among users

When children think they can’t do a subject like maths or English, they can often get
disheartened and not want to participate in it. However, with greater confidence in their abilities,
they won't be put off and will even join in with enthusiasm, boosting their performance even
further.

V) These are just a few of the advantages that AT can offer-if you have examples of more after
using these types of products, we'd love to hear about them.

c) Teacher Training in Assistive Technology

A particular student with a disability may require assistive technology solutions from one or
more of the above categories. For example, a student with a severe intellectual disability may use
an augmentative communication device to supplement his or her communication skills, adaptive
switch toys to participate in leisure activities, and an adapted key board for accessing the
software applications on the classroom computer.

Any service that directly assists a child with a disability in the selection, acquisition, and use of
an assistive technology device. The term includes-

A) The evaluation of the needs of a child with a disability, including a functional evaluation of
the child in the child’s customary environment;

B)Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices
by children with disabilities;
C) Selecting, designing, fitting, customizing, adapting, applying, retaining, repairing, or
replacing assistive technology devices;

D) Coordinating and use other therapies, interventions, or services with assistive technology
devices, such as those associated with existing education and rehabilitation plans and programs;

E) Training or technical assistance for a child with a disability or, if appropriate, that child’s
family.

F)Training or technical assistance for professionals (including individuals or rehabilitation

services), employers, or other individuals who provide services to employ, or are otherwise
substantially involved in the major life functions of children with disabilities.

d)Barriers to Assistive Technology

Awareness and Expertise

Aggressive awareness initiatives are needed to educate individuals who could benefit from
assistive technology, their families and friends, service providers, and the public about the
assistive technology available today. Assistive technology expertise needs to be cultivated and
expanded in pre-service preparation programs, consumer empowerment activities, and other
training venues.

Accessible Product Development and Deployment

All technology products and services should be accessible to people with disabilities. Assistive
technology must be thought of in the context of the full range of mainstream technology—
information technology, educational technology, instructional technology, entertainment
technology, medical technology, and so on.

Comprehensive and Coordinated Funding

Existing laws and policies that fund assistive technology have gaps that fail to address the needs
of many individuals with disabilities. In addition, the laws and policies are frequently
misinterpreted or implemented in appropriately by those charged with service delivery and
oversight. Federal agencies and others that implement federal policy (such as states and local
agencies) commonly lack the expertise and resources necessary to implement existing AT laws
and policies.

Research, Development, and Technology Transfer, Research and development should be

sufficient to ensure that a full range of mainstream and specialized technology is available.

e) Accommodations, Modifications, and Assistive Technology

The difference between accommodations, modifications, and assistive technology is a common
question. IDEA and its regulations do not define accommodations and modifications, but it is
generally agreed up on that: Accommodations allow a student to complete the same assignment,
test, or activity as other students, but with a change in timing, for matting, setting, scheduling, or
presentation. The material is the same, but a student learns the material in a different way.

Modifications adjust an assignment, test, or activity in away that changes the standard or alters
the original measurement. Modifications change what a student is taught or expected to learn.

Assistive Technology / Environmental Modification

Assistive technology is a HCBS (Home and Community Based Service) that provides funding
for Environmental Modification (E-mod). "E-mods“ are adaptations to an individual's
environment that allow for more independence or address issues related to health and safety.
Some examples are ramps, lifts, bathroom and kitchen modifications, fences, and safety devices
for individuals who are blind or deaf and widened door ways and hallways.

Home modifications

Housing and Assistive Technology, Inc.(HAT) provides home modifications for private clients
with disabilities and seniors. Below is an overview of the services provided by HAT. For more
information, please contact us. Complete on-site environmental assessment using a full review
and check list inspection. The assessment will include are view of the entire home (all rooms and
spaces utilized by the client). Other interior and exterior are as of the home for accessibility and
health and safety concerns will be reviewed.

The assessment will also include the need and or determination of the home's appropriateness for
the client' s needs based on his medical necessity, and his care giving needs will be included as
part of this assessment.

Academic modification

Listening and Speaking

Auditory processing difficulties can impact on a person’s ability to hear subtle differences in
sounds. Not hearing subtle differences can then impact how a person pronounces the sounds they
hear.

Poor working memory can impact a person’s ability to hold on to a train of thought or to retain
several verbal instructions.

Reading and Comprehension

Reading disability is characterized by difficulties with accurate and / or fluent word recognition.
This impacts reading accuracy, fluency and comprehension.
For students with difficulties in reading the task is often laborious and time consuming with only
some of the read information retained.

Some students can also appear to read with little difficulty but do not understand or recall what
they have read due to the energy required to focus on the processes involved in the task of
reading and deficits they have in their working memory.

Writing and Spelling

Poor phonemic awareness (letter sound relationships) and decoding skills will impact spelling.
Students with poor phonemic awareness have difficulty associating speech sounds with letters or
groups of letters and may also have working memory difficulties where they are unable to store
and retrieve whole words.

A lack of ability to organize academic tasks and resources can also result in lost information,
overdue assessments, late library returns, and a general sense of feeling overwhelmed.