Intellectual Disability (ID)

Legal definition
The Individuals With Disabilities Education Act (IDEA) of 2014 defined ID as
significant subaverage general intellectual functioning, existing concurrently with
deficits in adaptive behavior and manifested during the developmental period, that
adversely affects a child’s educational performance.
Practical Definition
American Speech-Language-Hearing Association: The person demonstrates a
significant limitation of intellectual functioning and adaptive behavior which has an
onset before age 18.
Practical Definition
Myers (2014): a condition of limited mental ability, indicated by an intelligence
score of 70 or below and difficulty in adapting to the demands of life.
Prevalence
● 8.7 to 36.8 per 1000, the wide range of variation is due to the inclusion of
mild ID (IQ of 50-70)

● Severe ID (IQ less than or equal to 50) is consistent at 2.5 to 5 per 1000

● High-Incidence Disability
Diagnostic Feature 1
A deficiency of cognitive ability. An IQ of 70, which corresponds to at least two
standard deviations below the mean or average IQ of 100, is generally considered
the cut off for ID.
Diagnostic Feature 2
Limited adaptive behavior expressed in

1. Conceptual skills: language, literacy, concepts of numbers and time, setting

goals
2. Social skills: interpersonal skills, ability to follow rules and law, avoid being
victimized
3. Practical skills: personal care, occupational skills, healthcare
Diagnostic Feature 3
Onset before age of 18
Etiology
In most cases no cause is found
Etiology - Genetic
● Genetic cause in 30-50%

● More than 500 genetic causes of ID and developmental disabilities are known

● Fragile X Syndrome most common

● Down Syndrome

● Prader-Willi syndrome

● Phenylketonuria (PKU)
Etiology - Non-genetic
Prenatal
● Brain malformation
● Maternal disease (e.g., placental disease such as abruption, accreta,
percreta)
● Environmental influence (e.g., alcohol, drugs, toxins, teratogens)
● Multiple gestation
● Maternal hypertension
Etiology - Non-genetic
Perinatal
● Labor and Delivery-related events (such as fetal distress which leads to
anoxia and brain injury)
● Preterm birth
Etiology - Non-genetic
Postnatal
● Hypoxic ischemic injury
● Traumatic brain injury
● Infections
● Demyelinating disorders
● Seizure disorders
● Severe and chronic social deprivation
● Toxic metabolic syndromes
● Intoxications (e.g., lead, mercury)
● Male sex
● Low birth weight
Characteristics
● A large majority of individuals with ID are in the mild range with an IQ of 50-
70.
● The accuracy of IQ tests (e.g. Flynn Effect, restandardization) can have
profound effects on the placement of these children and the availability of
special education.
● An impaired cognitive ability causes extensive detrimental effects for the
individual with ID.
● Difficulties learning new skills, remembering and transferring knowledge to
new and different situations.
● Short-term and long-term memory is impaired.
● Things can be remembered incorrectly, slowly or without adequate detail.
Characteristics
● difficult to remember events or the proper sequence
● low motivation
● difficulty with problem solving
● learned helplessness
● socially marginalized
● can be independent and well adjusted as adults
Signs and Symptoms (Warning Signs)
Tracking a child’s milestones is essential to early detection of ID.
● Learning and developing slower than same age cohort
● Learning difficulties in school
● Difficulty with problem-solving or logical thinking
● Delayed milestones: rolling over,sitting up, crawling and walking
Signs and Symptoms (Warning Signs)
● Difficulty communicating and socializing
● Low IQ score
● Difficulty talking or delayed talking
● Difficulty remembering
● Unable to connect actions with consequences
● Inability to perform everyday tasks such as getting dressed or inabilty to
independently use a bathroom
Must Know Facts
● Diagnosis requires a cognitive deficit and deficits in adaptive behavior. Early diagnosis is important
to plan interventions (medical and educational).
● Continuum of severity: mild, moderate, severe, profound. Severity dictates potential of the individual.
● Increased risk for violent and sexual victimisation and offending (Fogden, Thomas, Daffern & Ogloff,
2016) Role of abuse, substance abuse, limited adaptive abilities.
● Hope: Evolving evidence-based education will yield improved results such that more affected
children can enter HE which provides better employment opportunities and improved life outcomes.
● This is a diverse group regarding etiology, severity, disabilities and abilities (use abilities to offset
or minimize deficiencies). IFSPs and IEPs are essential to unlock potential which will allow
improved integration into society and a more enjoyable and fulfilling life.
● Society can benefit from the self-actualization of individuals with ID.
Evidence-based teaching strategies
● Lemons, Allor, Al Otaiba and LeJeune (2016) assert that literacy research has been driven by
increased societal expectations for individuals with ID, advocacy efforts and legislative priorities.
● The authors state that the research indicates that children and adolescents can achieve higher
levels of achievement than previously thought.
● The historic focus on functional reading (signs, restaurant words) is too limited and incorporating
traditional reading instruction (e.g., phonics) will lead to improved independent reading skills for
students with ID and result in better postsecondary outcomes (e.g., employment, independence and
quality of life.
● The authors discuss 10 research-based teaching tips which can be used by special and general
education teachers and other professionals.
Research-Based Tip #1: Keep Big-Picture Goals in
Mind
● The teaching team should spend time thinking about long-term goals and how
to achieve them in the time available.
● Long-term goals to keep in mind include increasing independence as readers.
● Small incremental improvements in reading skills over many years can result
in drastic improvements in the student’s quality of life.
Research-Based Tip 2: Set Meaningful, Measurable
Goals
● Once the team has a solid understanding of the student’s current abilities, it
should generate a set of individual education plan (IEP) goals that are
focused on essential reading skills.
● The team should select skills which will benefit the student’s life both
immediately and long-term.
● Achievement standards can include Common Core State Standards (CCSS)
and standardized measures (e.g. Woodcock Reading Mastery Test),
● A Curriculum based measurement (CBM) can evaluate students as to
graduate to higher grades.
Research-Based Tip 3: Provide Explicit, Systematic
Reading Instruction
● The authors believe the use of many resources can result in instruction which is disorganized and
disconnected for children with ID.
● Instruction should be kept organized and unified.
● Teachers should choose one evidence-based program which provides explicit models, corrective
feedback, scaffolding, reinforcement, cumulative review and a focus on systematic instruction in
phonic skills and phonological awareness.
● The chosen base program can be supplemented.
● Teachers should apply skills across contexts and make connections among related skills (e.g.,
reading and writing; general education classroom, resource room). The authors also suggest
systematic review, ongoing cumulative practice and integration of skills.
● The team must be logical and consistent to avoid confusing the child with ID.
Research-Based Tip 4: Provide Instruction With
Sufficient Intensity to Accomplish Goals
● Although inclusion in general education classes is an important goal it must
not preclude sufficient intensive education such that reading goals will not be
met.
● The authors state that it is difficult to provide the appropriate intensity, for as
long as it is needed, in the general classroom.
● It is up to the IEP team to ensure that the required intensive education is
provided. ID children generally need multiple years of intervention to achieve
goals.
Research-Based Tip 5: Seek Out Professional
Development Opportunities
● Many educators who teach ID children do not have sufficient training on how
children learn to read.
● In service training can improve teacher skills.
● There are two aspects which in service training should focus on.
● First, educators should learn what skilled readers do and how this skill
develops. Second, educators should understand theoretical models of
reading development.
Research-Based Tip 6: Remember That Language
Abilities Are the Underlying Foundation for Reading
Skills
● Reading is the process of translating print into language.
● Reading instruction should take into consideration language abilities.
● Good readers make immediate links between print and meaning, which should be goal for the ID
child.
● Speech language pathologists (SLP) have the ability to identify and intervene on the language roots
of reading problems.
● Teachers of English as a second language and bilingual educators can provide guidance with ID
children whose first language is not English.
Research-Based tip 7: Scaffold Working Memory
● Many ID students have deficiency in working memory which impedes learning. For example when
blending sounds to form a word the student can forget the first sound, thus creating the wrong word
(e.g. at instead of bat).
● Scaffolding encompasses a variety of techniques used to move students progressively toward
stronger understanding leading to greater independence in the learning process.
● The term is a metaphor as teachers provide successive levels of temporary support which are
incrementally removed when they are no longer needed as the teacher gradually shifts more
responsibility of the learning process to the student.
● Scaffolding can help students manipulate phonemes even if limited working memory makes this task
difficult.
● A phoneme is the smallest unit of speech distinguishing one word (or word element) from another
(e.g. bat from cat)
Research-Based tip 8: Target Specific Parts of a
Scope and Sequence to Focus Instruction
● A scope and sequence plan summarises what is to be taught and the
sequence in which it will be taught.
● A systematic approach moving through a curriculum’s scope and sequence
will ensure focused and consistent instruction which will allow students to
master content. Some examples follow.
● Learning can be enhanced when lesson content is matched with the student’s
instructional level.
● If skills are learned unequally the teacher should reinforce the deficient skill.
● Pairing a student who lacks a skill with one who has mastered the skill will
foster peer-pair practice.
● The scope and sequence can also be targeted by limiting the amount of
material to be learned at a time.
● Student assessment is important to identify the areas to be targeted.
Research-Based tip 9: Use Data to Guide Instruction
and Adaptation
● The use of data to monitor progress and guide ongoing adaptations is one of
the most important things teachers can do.
● The authors suggest teachers learn about and consider using curriculum-
based measurements (CBMs).
● CBM is a direct measurement system used to monitor a student’s progress
mastering basic academic skills (Bryant et al, 2017).
● Data-based individualism (DBI) can be used to determine when and how to
change instruction. The idea is to evaluate progress and modify instruction if
students are not responding.
● Teachers must supply targeted and individualized instruction.
Research-Based Tip 10: Involve Service Providers
and Family Members
● It is important that IEP team members consider how they can provide support for agreed-upon
reading goals and ensure consistency across that support.
● For example, a general education teacher, special education teacher and SLP should use common
instructional language to target similar skills and review data frequently.
● Educators should encourage parental participation.
● Parents should be made aware of the potential to learn.
● Parents can read to children, repeat readings if necessary and discuss lessons with their children;
these are only several endeavors that are possible.
● Educators should provide parents support including activities at home which would reinforce school
lessons.
● Parents should not be responsible for initial instruction.
References
Boat, T.F. & Wu, J.T. (Eds). (2015). Mental Disorders and Disabilities Among Low-Income Children.
Washington (DC): National Academies Press. Retrieved from:
http://www.ncbi.nlm.nih.gov/books/NBK332894/

Bryant, D.P., Bryant, B.R., Smith, D.D. (2017). Teaching Students With Special Needs In Inclusive
Classrooms. Thousand Oaks, California: Sage.

Butler, L.N., Sheppard-Jones, K., Whaley, B., Harrison, B., & Osness, M. (2016). Does participation in
higher education make a difference in life outcomes for students with intellectual disability? Journal of
Vocational Rehabilitation, 44, 295–298. DOI:10.3233/JVR-160804

Eligibility and Qualifying for Services: New York State Office for People With Developmental Difficulties.
(n,d.). Retrieved from https://opwdd.ny.gov/opwdd_services_supports/eligibility/faqs#q5
References
Fogden, B.C., Thomas, S.D.M., Daffern, M., & Ogloff, J.R.P. (2016). Crime and victimisation in people
with intellectual disability: a case linkage study. BMC Psychiatry, 16, 170.
http://doi.org/10.1186/s12888-016-0869-7

Huang, J., Zhu, T., Qu, Y., & Mu, D. (2016). Prenatal, Perinatal and Neonatal Risk Factors for Intellectual
Disability: A Systematic Review and Meta-Analysis. PLoS ONE, 11(4), e0153655.
http://doi.org/10.1371/journal.pone.0153655

Informational Letter: New York State Office of Children and Family Services. (August 5, 2016). Retrieved
from https://ocfs.ny.gov/main/policies/external/OCFS_2016/INFs/16-OCFS-INF-
08%20Substituting%20Intellectual%20Disabilities%20for%20Mental%20Retardation.pdf

Intellectual Disability. (n.d.). Retrieved from https://www.asha.org/Practice-Portal/Clinical-

Topics/Intellectual-Disability/
References
Intellectual Disability: Causes. (n.d.). Retrieved from
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942540&section=Causes

Lemons, C.J., Allor, J.H., Al Otaiba, S., LaJeune, L.M. (2016, Sep/Oct). 10 Research-Based Tips for
Enhancing Literacy Instruction for Students With Intellectual Disability. Teaching Exceptional Children:
49(1), 18-30. Retrieved from
http://predator.oldwestbury.edu:2411/ehost/pdfviewer/pdfviewer?vid=7&sid=ee30685c-afdc-487c-83d8-
1c8712e6c219%40sessionmgr103

Myers, D.G. (2014). Myers’ Psychology for AP. (2nd ed). NY,NY: BFW/Worth.

Phoneme. (n.d.) Retrieved from https://www.britannica.com/topic/phoneme

Scaffolding. (April 6,2015). Retrieved from https://www.edglossary.org/scaffolding/

Trahan, L., Stuebing, K.K., Hiscock, M.K., & Fletcher, J.M. (2014). The Flynn Effect: A Meta-Analysis.
Psychological Bulletin, 140(5), 1332-1360. http://doi.org/10.1037/a0037173