Demystifying Intellectual Disabilities: Understanding ...

Demystifying Intellectual Disabilities: Understanding ...

Demystifying Intellectual Disabilities (ID): Understanding Capabilities and Workplace Success Strategies June 2015 2 Presenters Dr. Suzanne Martin, PsyD, MPH Diane Fairchild, B.A.

Atlanta Regional Mental Health Specialist Disability Program Consultant 3 Learning Objectives Identify the criteria necessary for an intellectual disability. Dispel common

myths about ID. Identify common challenges that are faced by individuals with ID. Understand the most common issues that impact individuals with ID in the workplace. Identify strategies that may assist students with ID in improving their skills in the

workplace. Identify possible reasonable accommodations for students with ID specific to their functional limitation manifestations. 4 Understanding ID MAECENAS PORTTITOR MASSA. Lorem ipsum dolor

sit amet, consectetuer adipiscing elit. Maecenas porttitor congue massa. Fusce posuere, magna sed pulvinar ultricies, purus lectus malesuada libero, sit amet commodo magna eros 5 Definition of ID a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains.

Diagnostics and Statistical Manual Fifth Edition (DSM-5) 6 Causes of ID Genetic conditions Problems during pregnancy Problems at birth Health problems 7 Prevalence of ID ID is the most common developmental disability. 6.5


1 IN EVERY 10 CHILDREN WHO NEED SPECIAL EDUCATION HAVE SOME FORM OF ID. 8 American Association of Intellectual & Developmental Disabilities (AAIDD) The AAIDD designates four possible levels of supports, based on how much and how long assistance is needed: 1. Intermittent (i.e., occasional, in time of crisis) 2. Limited (i.e., short-term)

3. Extensive (i.e., long-term) 4. Pervasive (i.e., constant) 9 DSM-5 Changes and Considerations 10 Diagnostic and Statistical Manual 5th Edition (DSM-5): Changes

Intellectual disability (intellectual developmental disorder) The parenthetical name (intellectual developmental disorder) is included in the text to reflect deficits in cognitive capacity beginning in the developmental period. No more Axis II as of DSM-5 With DSM-5, all mental disorders will be considered on a single axis and given equal weight. 11 DSM-5: Comprehensive Assessment

Emphasizes the need to use both clinical assessment and standardized testing of intelligence when diagnosing ID. Severity of impairment is based on adaptive functioning rather than IQ test scores alone. 12 Diagnostic Considerations It is important to note that IQ

or similar standardized test scores should still be included in an individuals assessment. In DSM-5, intellectual disability is considered to be approximately two standard deviations or more below the population, which equals an IQ score of about 70 or below. 13 Rationale for IQ Changes Misuse of IQ Tests

Definition of Intelligence IQ Tests in DSM-5 Cognitive Profiles Intelligence is a IQ test number Assessment Cognitive general mental has often been profiles are procedures and

ability that used diagnosis must generally involves inappropriately to take into account more useful reasoning, define a persons other factors that for describing problem solving, overall ability in may limit intellectual

planning, thinking forensic cases abilities than performance abstractly, without (e.g., a single fullcomprehending adequately sociocultural scale IQ complex ideas, considering score, and background,

judgment, adaptive native language, clinical academic functioning. associated training and learning, and communication/ judgment are learning from language required for experience. disorder, motor or interpretatio

sensory n of test handicap). results. Elimination of IQ based Subtypes DSM-5 does not list mild, moderate, severe, and profound subtypes. Instead, it

lists mild, moderate, and severe severity levels. 14 How do you measure adaptive behavior? Adaptive Behavior Domains Adaptive Behavior Scales are based on a semi-structured interview that is

administered to caregivers of children with developmental disabilities. 15 Example of an Adaptive Behavior Scale 16 Comparison of Diagnostic Criteria Old Criteria IQ 70 or below

Concurrent deficits or impairments in present adaptive functioning Onset is before age 18 years Severity: Mild, Moderate, Severe, Profound, Based on IQ level Current Criteria Deficits in general mental abilities Impairment in adaptive functioning for the individuals age and sociocultural background All symptoms must have an onset during the developmental period

Severity: Mild, Moderate, Severe, based on Adaptive Behavior 17 Myths and Functional Limitations 18 Myths vs Facts Myth Persons with ID are

incapable of thinking or doing anything constructive Persons with ID don't have feelings or emotions Persons with ID are unable to learn Fact Every individual has the ability to learn Persons with ID have feelings like any other person, although they may not be able to express them as expected by society

Persons with ID should be given the opportunity to learn 19 Myths vs Facts Myth Persons with ID cannot make decisions Adults with developmental disabilities cannot live independently Fact

Every person can make decisions according to his or her level of intellectual functioning Some individuals require daily assistance, and others prefer to live with their families, but many are completely capable of safely living in their own home. 20 Functional Limitations Trouble understanding new

concepts Inappropriate behavior Deficits in memory Limited vocabulary Struggle to learn social rules Difficulty accomplishing complex tasks 21 Individual Differences Individual functioning varies depending on a number of factors including: Ones personality

Ones coping skills Other disabilities For example, physical, social or sensory The amount of support provided by family, friends and the community What is demanded of them in different situations For example, at home or at work 22 Functional Limitations & Accommodations

23 Functional Limitations Intellectual Functioning Adaptive Behavior Understanding new concepts Problem-Solving Memory Difficulty accomplishing complex tasks Limited vocabulary

Inappropriate behavior(s) Struggle to learn social rules (following rules and taking responsibility) Difficulty learning practical skills (daily living and employment skills) 24 Understanding New Concepts Be as concrete as possible. Provide direct instruction. Demonstrate what you mean rather

than just giving verbal directions. Show pictures or videos of new concepts. Provide hands on materials and experiences. Provide opportunities to try things out. 25 Problem-Solving Teach concepts in context to make ideas real. Provide direct instruction to assist students through the problem-solving process. Provide opportunities for choice in activities, tasks,

assignments. Build problem-solving skills using puzzles, games, and logic problems. Model problem-solving by breaking down thought process and saying out loud. 26 Memory Deficits Adjust setting/environment free of distractions (possibly preferential seating) Adapt task to bypass/reduce impact of problem

reduce length of tasks teach memory strategies (mnemonics) repetition study breaks highlight important concepts Adapt instruction/presentation of information 27 Limited Vocabulary Limited vocabulary impacts learning in many areas

Reading, writing, and communication Use assistive technology to support while remediating skill deficits/teach independence Graphic communication boards, computer voiced systems to supplement language skills & aid learning Teach basic language skills Spelling rules Decoding Root words 28 Lets Talk!

How could you allow a student with limited vocabulary to demonstrate knowledge and mastery of content? Picture or use of visual aids to respond Use PowerPoint! Projects and portfolios Auditory responses or audio taping responses 29 Complex Tasks Break down into small tasks that can be verified and reinforced.

Provide immediate feedback when a step is done correctly. Repetition and teach the skill(s) in multiple environments. 30 Behavioral Concerns Investigate triggers Teach replacement behaviors Provide positive reinforcement Consider changing the environment (i.e., you suspect noise is the triggerchange to

a quieter setting) Use differential reinforcement of other behaviors Provide or use functional communication training 31 Positive Behavior Interventions The Technical Assistance Center on Positive Behavioral Interventions and Supports is established by the U.S. Department of Education's Office of Special Education Programs (OSEP).

32 Social Rules Teach new social rules/skills in the setting where they are most likely to be used. Teach the rules/skills with a variety of mediums. For example, use books, pictures, videos, role playing, observing peer behavior, games, software Provide multiple opportunities to practice in a number of different settings. Post a clear and predictable daily schedule. 33

Make your own resources! 34 Practical Skills Real life connections (students strengths and interests) Teaching practical skills in more than one environment (Career Tech, Dorms, Recreation, and Work-Based Learning) Assistive technology Manipulatives (low tech) Software programs (high tech) 35

Lets Practice! Exercise #1 Applicant Anthony 19 years old Diagnosed with an ID and has an overall borderline IQ score Reading skills are GE 4.5 and math at GE 5.0 Memory deficits Sensory issues related to light touch/noise Strong visual learner Solid basic communication skills Generally sociable Dependable

36 How can we support Anthony? First, there is no set of right answers. The configuration of supports can be varied and may change over the course of Anthonys enrollment! Picture-based supports Memory and reading deficits Ear phones and weighted lap items or breaks to do activities that provide strong proprioceptive input (e.g., pushing something with a little weight on it, for example) Sensory concerns

Peer mentor Role modeling, tutoring, mentoring, etc. Consider more learn on the job activities if available on-center rather than waiting for work-based learning 37 Lets Practice! Example #2 Melanie requires the use of lists and/or visual supports like the use of pictures or graphics. How could a visually supported task or process list type accommodation be applied to and implemented in the various areas of the

center? Career Technical and Academics Learning a new skill or concept Residential Learning dorm duties or trying to master a specific assignment Discipline Aiding understanding of the sequence of the discipline system Counseling Guiding student on how to work through a conflict 38

Written List for Residential Cleaning the Toilet 1. Go to the storage supply cabinet and get cleaning supplies. 2. Spray cleaner under rim of toilet bowl and let sit for 5 minutes. 3. Use scrub brush and scrub inside of toilet bowl. 4. Flush commode and make sure bowl is clean. 5. Use disinfecting wipe and wipe down outside of toilet. 39 Visually Supported List for Residential Step 1 Go to the storage supply cabinet.

Step 2 Get cleaning supplies.* Note: *Use pictures of the actual supplies the student would need to retrieve. 40 Conclusions Students with ID can learnespecially when given the appropriate support and services (accommodations). Job Corps is not the appropriate training environment for all students with ID, just as it is not the appropriate training environment for all typical students. Each persons application must be evaluated on an individualized basis.

A strength-based approach to teaching & learning will contribute to independence and workplace success. 41 42 Resources for Supporting Students with ID 43 Think College! Think College is a national organization dedicated to developing, expanding, and improving inclusive higher education options for people with ID. Job Corps Disability Website default.aspx 44 Job Corps Health & Wellness Website default.aspx

45 46 Job Accommodation Network 47 Regional Mental Health Specialists Boston David Kraft, MD, MPH [email protected]

Maria Acevedo, PhD (Puerto Rico) [email protected] Philadelphia Valerie Cherry, PhD [email protected] Atlanta Suzanne Martin, PsyD, MPH [email protected] Dallas Lydia Santiago, PhD

[email protected] Chicago Helena MacKenzie, PhD [email protected] San Francisco Vicki Boyd, PhD [email protected] 48 Regional Disability Coordinators Boston, Philadelphia & Atlanta Regions Kristen Philbrook

[email protected] Dallas Region Laura Kuhn [email protected] Chicago and San Francisco Regions Kim Knodel [email protected] Questions? Thank you for attending!

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