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FOUNDATIONS OF SPECIAL AND INCLUSIVE EDUCATION

Lesson 11: Types, Characteristics, and Identification of Learners with Difficulty
with Self-Care
Learning Outcomes:
At the end of the chapter, the student is expected to be able to:
 understand the history of intellectual disability
 define intellectual disability
 distinguish the different types of learners with difficulty with self-care.

This chapter focuses on learners having difficulty with self-care, specifically, those with intellectual
disabilities.

HISTORY OF INTELLECTUAL DISABILITY

The following timeline presents the milestones in the history of intellectual disability.
Table 1 Milestones in the History of Intellectual Disability
Date Events/Descriptions
1900 Accepted clinical terms for intellectual disability include "imbecility," "feeble
mindedness," and "mental deficiency."
Segregation and isolation are the norm. The popular belief is that intellectual disability
is synonymous with poverty, sloth, crime, and sexual profligacy.
1904 First textbook about intellectual disability: Martin Barr published Mental Defectives, the
first text that suggests that hereditary factors play an important role in intellectual
disability.
1933 American Association for the Study of the Feebleminded changes its name to the
American Association on Mental Deficiency.
1930-1950 Institution overcrowding: Number of people with intellectual disability in state-funded
institutions grew from around 60,000 in 1930 to nearly 140,000 in 1950.
1950 Nationwide parent movement begins: To offer help and support to parents across the
country, representatives from 23 parent groups form the National Association of
Parents and Friends of Mentally Retarded Children (now known as The Arc of the
United States).
1950, 1953 Parents in the spotlight speak out: Author Pearl S. Buck (The Child Who Never Grew)
and actress Dale Evans Rogers (Angels Unaware) write candid stories about their
daughters who were born with disabilities. Their stories quickly become touchstones
for advocates of people with intellectual disability.
1959 The American Association on Mental Deficiency's 1959 manual uses the term
"mentally retarded" in place of "mentally deficient."
1968 The first national Special Olympics games are held in Chicago, with athletes from 25.
states and Canada.
1971 Landmark court case: Pennsylvania Association for Retarded Children vs.
Commonwealth of Pennsylvania supports the rights of all children with intellectual
disabilities to a public education.
1975 Separate is never equal: President Gerald Ford signs into law the Education for All
Handicapped Children Act, or PL 94-142 (now IDEA), compelling schools to provide
full educational opportunities to all children with disabilities.
1979 Community inclusion: The Center on Human Policy at Syracuse University issues The
Community Imperative, a declaration affirming the right of all people with disabilities to
live in and be part of a community.
1981 Bill opens eyes: A TV movie about Bill Sackter, a man with intellectual disability who
ran a popular coffee shop at the University of lowa, advances the idea that people with
intellectual disability can be productive, valued members of a community.
1990 The Americans with Disabilities Act is passed, protecting the civil rights of all people
with disabilities.
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1996 Medical milestone: Originally denied a heart-lung transplant because of her Down
syndrome diagnosis, Sandra Jensen becomes the first person with intellectual
disability to receive an organ transplant.
2004 Inclusion takes off: The reauthorization of Individuals with Disabilities Education Act
(IDEA) furthers the transition toward inclusive classrooms. All students receiving
special education services must now also be involved with and progress in the general
classroom.
2010 IDEA celebrates 35 years: The U.S. Department of Education commemorates the 35th
anniversary of IDEA. President Obama calls the 1975 passage of PL 94-142 a
landmark civil rights act.
The term "mental retardation" is replaced with "intellectual disability" in all federal
legislation.
2013 More opportunities-and more to come. Professionals, families, and self-advocates are
working together to advance inclusive education, college, and career readiness, and
real jobs for real pay.

DEFINITION OF INTELLECTUAL DISABILITY

During the early times, the term idiots (from a Greek word meaning "people who did not hold
public office") have been used for those with severe cognitive deficits. In the 19th century, the term
imbecile (from the Latin word for "weak and feeble") was given as a label for a less severe degree of
intellectual disability. For mild intellectual disability, the terms feeble-minded and simpleton were
used. These terms were then used by professionals in medicine, psychology, and education to refer to
intellectual disabilities, although nowadays, these labels are seen as inappropriate and stigmatizing.
These terms were replaced by mental retardation, which at the time was seen as more appropriate.
In 2007, the American Association on Mental Retardation changed its name to the American
Association of Intellectual and Developmental Disabilities (AAIDD), consistent with the term intellectual
disability now deemed as more appropriate (Heward, Alber-Morgan, & Konrad, 2017)

According to IDEA
The Individuals with Disabilities Education Act (IDEA) defines intellectual disability as
"significantly subaverage general intellectual functioning, existing concurrently with deficits in adaptive
behavior manifested during the developmental period, which adversely affects a child's educational
performance."

According to AAIDD
AAIDD's definition of intellectual disability specifies significant limitations in both intellectual
functioning and adaptive functioning, which should occur before the age of 18 years.

According to APA
American Psychiatric Association (2013) defines intellectual disability as deficits in general
mental abilities, including reasoning, problem-solving, planning, abstract thinking, judgment, academic
learning, and learning from experience. These deficits result in impairment of adaptive functioning, such
as one's inability to meet standards of personal independence and social responsibility in one or more
aspects of daily life, including communication, social participation, academic or occupational
functioning, and personal independence at home or in community settings.

ETIOLOGY/CAUSES OF INTELLECTUAL DISABILITIES

Intellectual disabilities can have a wide range of etiologies. These could include innate factors
(genetic and biological), which an individual has no control of, and environmental factors (e.g., toxins,
teratogens), which can often be prevented. Examples of genetic conditions and chromosomal
abnormalities resulting to intellectual disabilities are Down syndrome, Prader-Willi syndrome, Williams
syndrome, and Fragile X syndrome. Environmental toxins (teratogens), infectious diseases, or birth
trauma could also result intellectual disabilities. Examples of such are the following: substance
use/abuse of licit drugs, lead-based paint, birth trauma due to complicated deliveries, and other health
problems and injuries such as nutritional deprivation or encephalitis or meningitis (Brue Wilmshurst,
2016).
Table 2 Etiologic Risk Factors for Intellectual Disabilities
Timing Biomedical Social Behavioral Educational
Prenatal Chromosomal Poverty; maternal Parental drug Parental
disorders; single-gene malnutrition; use; parental cognitive
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disorders; syndromes; domestic violence; alcohol use; disability without

metabolic disorders; lack of access to parental support; lack of
cerebral dysgenesis; prenatal care smoking; preparation for
mental illnesses; parental parenthood
parental age immaturity
Perinatal Prematurity; birth injury; Lack of access to Parental Lack of medical
neonatal disorders birth care rejection of referral for
caretaking; services at
parental discharge
intervention
abandonment of
child
Postnatal Traumatic brain injury; Impaired child Child abuse and Impaired
malnutrition; caregiver; lack of neglect; parenting;
meningoencephalitis; adequate domestic delayed
seizure disorders; stimulation; family violence; diagnosis;
degenerative disorders poverty; chronic inadequate inadequate early
illness in the family; safety measures; intervention
institutionalization social services;
deprivation; inadequate
difficult child special
behaviors educational
services;
inadequate
family support
Heward (2017)

RANGE OF INTELLECTUAL DISABILITY

Individuals with intellectual disability are classified according to their IQ scores, which could
range from 70 (plus or minus 5 points of measurement error) to below 20. The characteristics of those
with intellectual disability whose IQ scores are within this range vary widely. Majority of children with
intellectual disability (85%) fall within the mild range (IQ range from 55 to 75), while those children
whose IQ is on the lower ranges (IQ less than 40) often have multiple disabilities. The table below
describes the range of intellectual disability and their characteristics.
Table 3 Range of Intellectual Disability
Range of Intellectual Percentage of ID Expectations
Disability (ID) Population
Mild (IQ Range 50/55 to 85 May appear to be delayed, but prior to school
70) entrance may be similar to peers with respect
to social skills, motor skills, and
communication; overall academic levels up to
Grade 6 level; vocational success with minimal
support and supervision
Moderate (IQ Range 10 Academic expectations about Grade 3 level;
35/40 to 50/55) vocational success in sheltered workshops,
highly structured tasks supported with
behavioral methods and trainings
Severe (IQ Range 3-4 Increased medical, motor, and neurological
20/25 to 35/40) problems; basic pre-academic skills, limited
sight vocabulary; success in group homes
where they can be monitored closely
Profound (IQ Range 1-2 Often multiple, motor, and neurological
below 20 to 25) problems; augmentative communication
systems (picture boards) can help
communicate basic needs; long-term
placement in sheltered settings to allow for
close monitoring
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On the other hand, the Diagnostics and Statistical Manual of Mental Disorders also
known as DSM-5 (American Psychiatric Association, 2013) classifies the severity level of
intellectual disability based on characteristics in the conceptual, social, and practical domains.
The following table describes the severity levels.
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CHARACTERISTICS OF LEARNERS WITH INTELLECTUAL DISABILITY

The following are characteristics of learners with intellectual disability in terms of cognitive
functioning, adaptive behavior, behavioral excesses and challenging behavior, and positive attributes
(Heward et al., 2017).

A. Cognitive Functioning
 Learning Rate - Children with intellectual disability acquire new knowledge at rate well below
that of typically developing children. Because students with learning disabilities learn more
slowly than their peers, some educators assume that instruction should be slowed down to
match their lower learning rates. However, students with intellectual disabilities, just like their
peers without disability, benefit from participating in lively paced instruction with frequent
response opportunities.
 Memory - They have difficulty remembering information, especially those with more severe
impairment. Some students have difficulty with working memory, or the ability to remember one
thing while performing another task, as well as short term memory, or the ability to recall and
use information encountered just a few seconds to a couple of hours earlier.
 Attention - They typically attend slower on relevant features of a learning task than students
without disabilities. They often have difficulty keeping attention on learning tasks. This results
to other problems, including difficulties in acquiring, remembering, and generalizing new
knowledge and skills.
 Generalization and Maintenance - They have difficulty in transferring or generalizing newly
learned knowledge and skills to settings or situations that differ from conditions where they
learned the skill.
 Motivation - Some students lack interest in learning or participating in problem- solving tasks.
Some develop learned helplessness, in which one's repeated experiences of failure results to
expectation of failure regardless of effort. Some also develop outer-directedness, in which an
individual distrust one's own responses to situations and rely on others for assistance and
solutions.

B. Adaptive Behavior
 Self-care and Daily Living Skills - Direct instruction and environmental supports such as
added prompts and simplified routines are important in ensuring that limitations in their adaptive
areas do not severely affect their quality of life. Those with less severe intellectual disability can
benefit from training in self-management skills in order to achieve levels of performance needed
to live independently and to have successful employment.
 Social Relationships - Their poor communication skills, inability to recognize others' emotional
state, and unusual or inappropriate behaviors can result to social isolation. It is important to
teach them appropriate social and interpersonal skills.

C. Behavioral Excesses and Challenging Behavior

 Students with intellectual disability are more likely to exhibit behavior problems than those
without. For instance, they may have difficulty accepting criticisms, limited self-control, and
bizarre and inappropriate behaviors such as aggression or self-injury.

D. Positive Attributes
 Individuals with intellectual disabilities may display tenacity and curiosity in learning, have good
relationship with others, and positively influence other individuals around them.
ASSESSMENT OF INTELLECTUAL DISABILITIES
 Calculation of IQ Score - IQ scores relate mental age (MA) or the mental capacity based on
the test score, to chronological age (CA) or the actual birth age. IQ score is calculated by
dividing the MA by the CA and then multiplying the result by 100(Wilmshurst & Brue, 2010). For
example:
(MA/CA) x 100 = 1Q
A student's mental age (MA) = 4 years
A student's chronological age (CA) = 5 years
(4/5) x 100 = 80
The student's IQ = 80
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Assessment:

The Case of Lana: A Student with Intellectual Disability

Lana is an 8-year old student currently enrolled in the third grade in an inclusive school. She
has been identified with significant developmental delay and was referred for reevaluation for intellectual
disability. Tests of intelligence were administered and results showed that Lana's level of intellectual
functioning is within the very low range. In terms of behavior, her teacher reported that Lana has
significant problems with hyperactivity, aggression, social skills, activities of daily living (ADL), and
functional communication. Likewise, her mother confirmed the same behaviors at home. Moreover, her
adaptive skills have been rated low as reported by both her mother and teacher as she could not perform
simple tasks like dressing herself without supervision, though she has already improved significantly
through constant training. Nevertheless, Lana's parents are very supportive in her education and are in
constant communication with her teacher in providing her with her educational and ADL training needs.

Answer the following questions.

1. What features of Lana are characteristic of intellectual disability?

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2. What challenges do these features pose for Lana and what are possible ways to address
these?
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3. How do you think would inclusive education help Lana?
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4. Review the cases on previous lessons. In what way is Lana similar to the individuals in other
cases? In what way is she different?
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