INTELLECTUAL DISABILITY AND HOW TO HELP

INTELLECTUALLY DISABLED PEOPLE LEARN

Materials adopted from 1. “Intellectual disability and how to help intellectually disabled people learn” By Joan Foo – LGS Psychologist 2000 2. BKTG Handbook 3. Volunteer feedback

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PART ONE: INTELLECTUAL DISABILITY

1. DEFINITION Diagnostic and Statistical Manual of Mental Disorders (4th Edition)-DSM IV “Significantly subaverage intellectual functioning (an IQ of approximately 70 or below)

with an onset before age 18 years and concurrent deficits or impairments in adaptive functioning.”

American Association of Mental Retardation – AAMR (1992) “..significantly subaverage intellectual functioning level (IQ) of below 70-75, existing concurrently with related limitations in two or more adaptive skills areas and manifested before age 18.”

Both definitions agree upon 3 important points:-

• Subaverage intellectual functioning

• Impairments in adaptive functioning • Evident from childhood (below age 18)

An individua l must fit into ALL THREE criteria above to be classified as intellectually disabled.

2. CHARACTERISTICS OF INTELLECTUAL DISABILITY 2.1 INTELLECTUAL FUNCTIONING It is the intelligence quotient (IQ) obtained by assessment with one or more standardized individua lly administered intelligence test.

• Intelligence = ability to adapt, achieve, solve problems, interpret incoming

information, to modify behaviour, accumulate knowledge, or respond to items on an intelligence test. It is difficult to measure directly.

• Intellectual disability = subaverage intellectual functioning • IQ level = be low 70-75

2.2 ADAPTIVE BEHAVIOUR The ability to cope effectively with common life demands and the level of personal

independence expected from an individua l of the particular age group, sociocultural background and community setting.

AAMR (1992) Areas of adaptive behaviour

Communication Community use Self-Care Health and safety

Home living Functional academics

Social skills Leisure world

Self direction Work

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3. CLASSIFICATIONS OF INTELLECTUAL DISABILITY (DSM-IV) Four levels of severity of Intellectual Disability:-

SEVERITY IQ LEVEL

Mild retardation 50-55 to approximately 70

Moderate retardation 35-40 to 50-55 Severe retardation 20-25 to 35-40

Profound retardation Below 20 or 25

MILD RETARDATION • Makes up the largest group of those with intellectual disability (approximately 85%) Typical Characteristics

• Develops social and communication skills during preschool years (0-5 years) • Minimal impairments in sensorimotor areas • By late teens, they are usually able to acquire academic skills up to Primary 6 level.

• As adults, they usually require minimal support and supervised guidance for social and vocational areas.

MODERATE RETARDATION • Makes up approximately 10% of the intellectually disabled population. Typical Characteristics

• Most will acquire communication skills during early childhood years. • Will require training in socia l and occupational skills. • With moderate supervision, they should be able to attend to their personal care.

• Usually able to acquire academic skills up to Primary 3 level. • As adults, the majority are able to perform unskilled or semiskilled work under

supervision in sheltered workshops or in the general work force.

SEVERE RETARDATION • Makes up approximately 3-4% of the intellectually disabled population.

Typical Characteristics • Will acquire little or no communicative speech during early childhood. • In school, may learn to talk and can be trained in elementary self-care skills

• Will have limited profit from instructions in pre-academic skills but can master sight reading of survival words.

• As adults, they may be able to perform simple tasks in closely supervised settings.

PROFOUND RETARDATION • Makes up approximately 1-2% of the intellectually disabled population.

Typical Characteristics • Considerable impairments in sensorimotor functioning • Will require constant aid and an individua lized re lationship with the caregiver.

• With appropriate and intensive training, self-care and communication may improve.

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Intellectual disability and related disorders: Intellectual disability is NOT a mental illness. It is a state of functioning that begins in childhood but is characterized by limitations in both intelligence and adaptive behaviour.

Mental disorder is a severe disturbance in mood, thought processes and or social and interpersonal relationships.

4. CAUSES OF INTELLECTUAL DISABILITY 4.1 Chromosomal Changes in the structure of the chromosome, too many or too few chromosomes. This usually happens sporadically.

Eg. Down Syndrome and Fragile X 4.2 Genetic Disorders

Abnormality of genes inherited from parents, errors when genes combine and other disorders of genes from various factors during pregnancy (eg. Infections, overexposure to X-rays etc.) Eg. PKU (phenylketonuria)

4.3 Congenital a) Problems occurring during pregnancy as a result of

• Harmful substances eg. Use of alcohol and drugs by mother (fetal alcohol

syndrome etc) • Maternal disease eg. Rubella, syphilis and blood group incompatibility

b) Problems at birth There is higher risk of intellectual disability with prematurity, low birth weight and head injury

4.4 Environment Children are at a higher risk in conditions of poverty, malnutrit ion, inadequate medical care and environmental hazards. Understimulation is also a possible cause.

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PART TWO: LEARNING DIFFICULTIES FOR PEOPLE WITH SPECIAL NEEDS AND HOW TO HELP 1.1 ATTENTION At the encoding level, attention is the main learning process vital for receiving incoming information. Research has shown that people with intellectual disability have problems in

the level of attention, focusing attention and selective attention. How can you help?

General suggestions to increase attention level and focus 1) Designate an area of work where full attention and focus is required then. Place

pictorial symbols to remind your client that he/she needs to pay attention and focus. 2) Ensure that the material is of your client’s level. 3) Make the tasks interesting and attractive (use colourful material and vary the tasks).

For instance, while teaching numbers, you can use a stack of UNO cards to play a

number game, count marbles etc. 4) Divide the tasks into those that are interesting and less interesting and alternate

them. 5) Use colour cues to direct attention to important information, key words and directions.

6) Give your client a choice for an activity. Your client will feel more involved and hence more focused.

7) Provide the element of surprise to gain client’s continued attention. For instance when

teaching puzzle arrangement, give your client each piece one at a time. Eye contact and focus Some intellectually disabled persons may have difficulties maintaining eye contact and

focusing on an object. Here are a few helpful suggestions:- 1) Tie bells to the tool your client is using (eg. broom when he is sweeping) to attract

his/her attention to the tool. 2) Attach an object (eg. ball with bells attached)) to a string and swing it like a

pendulum. Encourage your client to follow its movements. 3) Move a noisy object (squeaky toy, bell etc.) at a horizontal line your client’s eye level.

Start from an extreme left to your client’s extreme right. Repeat it with movement of the object up and down and the four principal diagonal directions.

4) Sit in front of your client. Push a bead/roll a ball along a string within your client’s view. Encourage him/her to follow its movements.

Selection and Discrimination Intellectually disabled people have difficulties differentiating the visual objects presented

to them. This concept is important to learn how to acquire concepts like colour, shape, size etc. Some research has suggested that people first acquire the concept of shapes (form) before colour and three dimensional before two dimensiona l discrimination. The following are a few suggestions to help your client take note of differences in the

visual field:- 1) Spot the difference games. Eg. pictures that are similar except for minute details,

colour, shape etc.

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2) Copying block formations. Help your client build model shapes from an example. Start by using blocks of the same colour before varying the difficulty of the task by adding different colour patterned.

1.2 MEMORY Memory is important to help your client store new information gained for future use.

Research shows that people with intellectual disability have difficulties in short-term memory but have normal abilities for long-term memory. Most short-term memory problems are related to a deficit in the ability to use rehearsal strategies or adequate rehearsal activities. This means that they do not practice or repeat the new information

sufficiently or effectively to remember it. How can you help? 1) teach your client rehearsal strategies

• verbal rehearsal –teach your client to verbalise the steps of a task. After becoming expert at the task, verbalization usually ceases to silent verbalizations.

For example, when teaching the a puzzle formation, teach your client to repeat

verbally the required steps “look for the triangle, then the blue, then turn to fit together.” • image rehearsal-teach your client to associate aspects of the task with a visual

image. Eg. Tie shoelaces by making a rabbit ear, another rabbit ear and a big knot together.

When teaching your client, remember to use the same instructions and verbal or

image prompt. 2) Six common strategies to remember when helping your client to remember:

The Steps Example task: identification of modes

of transportation

1) actively label and repeat presented

items

-label each picture of the transport mode

with the corresponding spelling (eg. car, boat, aeroplane)

2) group common items together -group transportation by air, land and sea 3) use category cues -show that these are categorized under

modes of transportation 4) repeat items presented earlier -eg. repeat ‘car’ and ‘boat’ that was

learned the week before

5) develop distinct visual images -eg. the aeroplane is like a bird. Teach your client to stretch his arms like a bird/aeroplane

6) develop verbal links -eg. the aeroplane flies in the sky

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1.3 GENERALIZATION This is crucial to ensure that your client is able to independently apply available skills in novel situations. Most intellectually disabled people find generalizations difficult as they do not know the appropriate moment to use the information/processing strategy.

How you can help? 1) Expose your client to as many different contexts to maximize the ability to transfer. For

instance, when teaching time telling, once your client has mastered the basic skills, show him/her as many different clock faces for both digital and analog clocks.

1.4 PROBLEM SOLVING This involves higher level processing, an analysis of problems, anticipation of outcomes and decisions on how a problem should be solved. With exposure and experience, your client will learn the necessary skills to enable him/her to approach problems.

How you can help? 1) The most direct way is to teach your client to stop and think. For example, ‘Am I doing

this the right way? Is this correct?’ This ties in closely with verbalization skills mentioned above where verbalizations remind your client to systematically solve problems. 2) Group the information/material presented to your client in a meaningful way. For

instance, in puzzle solving, teach your client to look out for general colour similarities, form and shape. Also remind your client to check the picture against the model he/she is building.

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PART THREE: DO’S & DON’TS WHEN TAKING YOUR TRAINEE

Do’s 1. Provide your trainee with a positive model of appropriate behaviour and social skills.

2. Be certain that your behaviour mirrors the skills that you are teaching your trainee. 3. Correct your trainee behaviour if it is inappropriate.

4. Before the start of the task, you have to demonstrate the steps to your trainee,

explain to him/her the objectives of the task and what you expect from him/her.

5. Do the task with your client. Hold your client’s hands and bring him through the task.

Initially you may end up completing the whole task but once you’ve guided your client three or four times, reduce your physical assistance. Let your client take more

responsibility in completing the task. 6. Be willing to interact with your trainee.

7. Be committed. 8. Talk to your trainee more even if he/she doesn’t speak because he/she will

understand and may respond through body language. For those who can speak, encourage them to talk.

9. Volunteers to seek help from each other if lost and ask around if not sure.

Don’ts 1. Don’t leave your trainee alone. 2. Don’t encourage your frustrated trainee to relieve stress via pointless activities.

3. Don’t share plates, forks, spoons, cups with your trainee as he/she have lower body

resistance and are prone to illness.

4. Don’t place your trainee in a highly competitive/dangerous situation. 5. Don’t assume that your trainee understood your oral directions or instructions just

because he/she did not ask any questions. 6. Don’t rush your trainee into completing the tasks, let him/her take his/her time and

enjoy the process.

7. Don’t treat your trainees as kids, children. Treat them as adults, maybe with

mentality years younger than their age.

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PART FOUR: HOW TO TRAIN PEOPLE WITH INTELLECTUAL DISABILITY 1. Think of what you want him to learn before you give any command, and

directions must be clear and extremely s imple. Give short, concise and clear instructions. Use s imple words.

2. Attract his attention by calling his name and establishing eye contact.

3. Provide a task within his ability.

4. Break down the task into simple steps. 5. Show rather than tell him how to do a task. Modelling an action/ the steps for

your client helps him/her understand what you want your client to do and imitate your

action. Your demonstrations help your verbal instructions. For instance, ‘do this..’ as you stack blocks or as you cut with the knife. This is only effective when done slowly with careful exaggeration.

6. Work on one thing at a time. 7. Try to have each task completed as finishing the job keeps up his interest, gives

him pride and creates a good work habit. 8. Keep supervising him while a llowing him to do as much as possible for himself.

9. Give positive reinforcer eg. A praise or a tap on his shoulder when a task is done well or a good attempt has been made.

10. Be very patient because the trainee may not readily carry over ideas from one situation to another, thus we usually have to treat each situation individually.

11. Be firm to the trainees. Do not let them manipulate you.

12. Have faith in the trainees regardless of their capabilities.

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Finally, allow your client to develop at his/her own pace but provide plenty of help, support, encouragement and most of all LOVE.

Quote from the BKTG handbook… In doing volunteer work, we begin to appreciate what we have, whether in terms of our physical or material well being. We also learn that it is our responsibility to live and to contribute to our fullest potential. Being a volunteer, you may share your valuable experience with your family and friends so that they understand more about the lesser fortunate ones in this world. Last but not least, be a volunteer for your own reasons and enjoy every bit of it.