Genetic causes account for 45% of ID (Batshaw et al., 2013). Please see the American Association on Intellectual and Developmental Disabilities page on Intersectionality for further details. Limitations in adaptive functioning in specific skill areas are a necessary criterion for diagnosis under the AAIDD and DSM-5 definitions. Speech intelligibility problems, which may result from disturbances in voice, articulation, resonance, fluency, or prosody (Kent & Vorperian, 2013). Restricted and repetitive use of language (e.g., echolalia, perseveration; APA, 2013). Developmental Medicine & Child Neurology, 47(1), 5763. Communication intervention for ID focuses on interactions that may occur within an individuals natural environment to reflect social norms of their community. https://doi.org/10.1044/0161-1461(2007/012), Cohen, A., & Demchak, M. A. https://doi.org/10.1177/0022219410374236, Shott, S. R. (2006). Students with language learning disabilities are at a disadvantage in school due to having reduced/limited background knowledge and language proficiency as compared to typically developing peers. It is important for individuals with ID to have the opportunity for literacy intervention, including a focus on phonological processing/word decoding and reading comprehension (Barker et al., 2013). Although there has been a global movement to encourage deinstitutionalization of individuals with ID and improve access to quality care and social integration, this is not yet a reality in all countries. See ASHAs resource on collaboration and teaming. Quality of life and quality of support for people with severe intellectual disability and complex needs. Frea, W. D., & McNerney, E. K. (2008). Journal of Autism and Developmental Disorders, 41(4), 405426. Cultural beliefs may influence some individuals perceptions about the causes of ID (Allison & Strydom, 2009; Scior, 2011). Difficulties with social communication (Coggins et al., 2007). Based on data from the 2011 meta-analysis of international studies, the female-to-male ratio of adults with ID varied between 0.7 and 0.9 (i.e., seven to nine females with ID for every 10 males with the condition; Maulik et al., 2013). For example, evaluators determine if failure to recognize a photo of a party reflects word retrieval challenges or is due to an unfamiliar representation of a party to an individual. Individuals with ID and associated language and communication disorders may demonstrate signs and symptoms of spoken and written language disorders across the domains of phonology, morphology and syntax, semantics, and pragmatics. Social and pragmatic skill strengths that vary depending on executive function and ToM skills (Lee et al., 2017). https://doi.org/10.1044/leader.FTR2.08192003.6, Roberts, J. E., Price, J., & Malkin, C. (2007). Families also provide useful information about communication skills during daily routines. Definitions of ID have changed from being strictly IQ based to including strengths in adaptive behavior (Schalock et al., 2021; Tass, 2017). https://doi.org/10.1177/108835769701200205, Burt, D. B., Primeaux-Hart, S., Loveland, K. A., Cleveland, L. A., Lewis, K. R., Lesser, J., Pearson, P. L., & MacLean, W. E., Jr. (2005). (aa) meet the child's needs that result . Overview of fetal alcohol spectrum disorders for mental health professionals. (2017). Publication manual of the American Psychological Association (7th ed.). These and other features include the following: Communication delays or limitations in social functioning may signal ASD, ID, or other conditions. SLPs ensure that symbols used with individuals who require AAC reflect the cultural and linguistic identity of the individual and are in line with the individuals preference. Prevalence of cooccurring psychiatric disorders in adults and adolescents with intellectual disability: A systematic review and metaanalysis. Adults with ID experience the same age-related health problems and functional decline observed in the general elderly population (Lazenby-Paterson & Crawford, 2014). The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association. Studies reported results based on gender; however, there were no indications whether the data collected were based on sex assigned at birth, gender identity, or both. Aging in adults with intellectual disabilities. The following examples may be considered for children with ID. (2011). The SLPs input may be useful to the medical team when considering comorbidity or differential diagnosis between the two disorders. See Treatment Principles for Individuals With an Intellectual Disability. Communication abilities in individuals with ID vary and may be nonsymbolic (e.g., gestures, vocalizations, specific behaviors) and/or symbolic (e.g., words, signs, pictures). See ASHAs resource on family-centered practice for general guidelines. Environmental arrangement is a technique that involves arranging the environment to encourage communication by increasing interest in the environment and setting the occasion for communication. (2010b). https://doi.org/10.1007/s10803-007-0395-z, Lin, J.-D., Wu, C.-L., Lin, P.-Y., Lin, L.-P., & Chu, C. M. (2011). The impact of aging on eating, drinking, and swallowing function in people with Downs syndrome. See ASHAs Practice Portal page on Late Language Emergencefor further information. The speech-language assessment incorporates an evaluation of skills needed to support the individuals changing communication needs. These individuals may have physical, programmatic, or communication Identification and evaluation of mental retardation. Information provided above under the Co-Occurring Conditions and Disorders section above may be helpful in developing an assessment protocol to document an individual performance profile. For example: The professional roles and activities in speech-language pathology include clinical/educational services (assessment, planning, and treatment); prevention and advocacy; and education, administration, and research. See the Assessment section of the Intellectual Disability evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. https://doi.org/10.1111/j.1365-2788.2008.01115.x, Cheslock, M. A., Barton-Hulsey, A., Romski, M. A., & Sevcik, R. A. Promote early identification of risk for ID and help implement services to maximize the potential of young children. Cognitive referencing is the practice of comparing IQ scores and language scores to help determine eligibility for SLP intervention. Abbeduto, L., & Sterling, A. They may also benefit from a detailed evaluation of social communication relative to language structure and function. Mood disorders were found to be the most prevalent psychiatric disorder to co-occur in adults with ID (6.7%; Mazza et al., 2020). Prenatal alcohol and cocaine exposure: Influences on cognition, speech, language, and hearing. Journal of Autism and Developmental Disorders, 38(2), 312323. Studies reported results based on gender; however, there were no indications whether the data collected were based on sex assigned at birth, gender identity, or both. Components of these programs include parent instruction, joint interaction with parents/caregivers and individuals with developmental delays and other deficits, and video coaching (Weitzman et al., 2017). Individuals with Disabilities Education Improvement Act of 2004, Pub. See ASHAs Preferred Practice Patterns for the Profession of Speech-Language Pathology for a more detailed outline of the major components of communication intervention for individuals across the life span (ASHA, 2004). https://doi.org/10.1016/j.ridd.2011.07.005, Shifrer, D. (2018). Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting. Tass, M. J., Schalock. Rosenbaum, P., & Rosenbloom, L. (2012). 820). Intellectual disability in cerebral palsy: A population-based retrospective study. Small groups of children play together under the guidance of an adult facilitator. Gallaudet University. Increased risk for language disorders (Pennington et al., 2005). World Health Organization. Language impairments in children with fetal alcohol spectrum disorder. Focused stimulation is a treatment approach in which a child is given multiple examples of a specific target (e.g., vocabulary item) within meaningful contexts. Rates of co-occurring disorders in male and female adults with ID were similar, with 19% and 20%, respectively (Mazza et al., 2020). Limiting communication means limiting access to peer groups and daily life activities. According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed. Language comprehension is better than production, particularly syntax (J. E. Roberts et al., 2007). Journal of Speech, Language, and Hearing Research, 50(2), 459474. (2018). https://doi.org/10.1352/1944-7558-122.4.289, Liber, D. B., Frea, W. D., & Symon, J. American Journal on Intellectual and Developmental Disabilities, 122(4), 289309. Position statement on access to communication services and supports: Concerns regarding the application of restrictive eligibility policies [Position statement]. Conducting a hearing screening to rule out hearing loss as a possible contributing factor to language difficulties. Cultural differences in the attitudes, beliefs, and perceptions of individuals with ID are well documented within the United States and in other countries (Allison & Strydom, 2009; Scior, 2011; WHO, 2010a). Variations in study design, terminology definitions, sample size and characteristics, and diagnostic tools can also affect incidence and prevalence data. National Joint Committee for the Communication Needs of Persons With Severe Disabilities. Brookes. The treatment modes/modalities described above (e.g., AAC) may be used to implement these treatment options. Administering formal screening assessments that have normative data and/or cutoff scores and that have demonstrated evidence of adequate sensitivity and specificity. Intervention for individuals with ID involves a variety of communication partners (peers and adults) in different settings and may address the following areas: Treatment programs often incorporate teaching or coaching models for communication partners, including peers, so they may support the individuals language comprehension and expression. Defining language delay in young children by cognitive referencing: Are we saying more than we know? Infants & Young Children, 25(2), 122135. (2006). Brookes. Communication intervention is sensitive to cultural and linguistic diversity and addresses components within the International Classification of Functioning, Disability and Health (WHO, 2001) framework, including body structures/functions, activities/participation, and contextual factors (personal and environmental). See ASHAs Practice Portal pages on Bilingual Service Delivery, Cultural Responsiveness, and Collaborating With Interpreters, Transliterators, and Translators for additional information. Journal of Intellectual & Developmental Disability, 25(3), 181205. ASD is a neurologically based, heterogeneous condition, characterized by a range of social communication skills and the presence of restricted, repetitive behaviors, which are present in early childhood. Screening may not be a needed step for individuals with intellectual disability (ID), particularly those with more severe limitations in intellectual or adaptive functioning. Common challenging behaviors include aggressive, disruptive, self-injurious, and stereotypic behaviors. Families offer important information about the strengths, challenges, and needs for the individual with ID. Functional skills are those skills a student needs to live independently. https://doi.org/10.1007/s00455-007-9096-1, Lazenby-Paterson, T., & Crawford, H. (2014). It includes training in everyday environments and activities, rather than only at therapy time. Students with intellectual disabilities are among the least likely students to spend a significant amount of time in general education classrooms. In R. J. McCauley, M. E. Fey, & R. B. Gillam (Eds. Individuals transitioning from school to employment need communication skills specific to the work setting (e.g., talking with co-workers and supervisors, interacting with customers). Make decisions about the management of communication disorders. Developmental delay (DD), ASD, and LD may be conditions commonly considered when making a differential diagnosis. Promote academic engagement and communication of students with autism spectrum disorder in inclusive settings. https://doi.org/10.1352/1944-7558-115-5.364, Spreckley, M., & Boyd, R. (2009). social interaction and social communication. https://doi.org/10.1017/S0142716400008900, Colle, L., Baron-Cohen, S., Wheelwright, S., & van der Lely, H. K. J. The focus of prior studies was to review and discuss health care disparities across racial/ethnic groups. https://doi.org/10.1352/0895-8017(2005)110[268:AIAWID]2.0.CO;2, Carr, D., & Felce, D. (2000). (n.d.). Cognitive referencing rests on the assumption that language skills cannot improve beyond cognitive ability. For example, the time delay between initial instruction and any additional instruction or prompting is gradually increased as the individual becomes more proficient at the skill being taught. Problem behaviors can be eliminated through extinction, the gradual weakening of a conditioned response (i.e., withholding reinforcers). act appropriately in various settings (e.g., Cohen & Demchak, 2018). Ruiter, I. D. (2000). Video-based instruction for children with autism. Language development and Fragile X syndrome. https://doi.org/10.1097/IYC.0b013e31824cbac4, Cceres, A. S. J., Keren, N., Booth, R., & Happ, F. (2014). SLPs work to maximize the participation and independence of individuals with ID as they experience life transitions that place new demands on communication. Examples of such considerations follow: Persons with ID and their families are integral to assessment, goal selection, and treatment. United Statesbased studies reported the prevalence of ID to be 7.9 per 1,000 adults (L. L. Anderson et al., 2019). S.M.A.R.T. Vocabulary intervention for children with Down syndrome: Parent training using focused stimulation. American Journal of Medical Genetics, 117C(1), 314. https://doi.org/10.1044/1058-0360.0101.38, Krahn, G. L., Hammond, L., & Turner, A. The term `individualized education program' or `IEP' means a written statement for each child with a disability that is developed, reviewed, and revised in accordance with this section and that includes. Support individuals with ID in vocational and community settings. varied communication settings/contexts, such as, early communication skills (e.g., pointing, turn-taking, joint attention), pragmatic conventions (spoken and nonspoken) for communicating appropriately in varied situations, spoken and written language for social, educational, and vocational functions, increased complexity of spoken and written language for more effective communication, contextual factors that influence the individuals relative success or difficulty in a given activity, compensatory communication techniques and strategies, including the use of AAC or other assistive technology. Based on data from the 2011 meta-analysis of international studies, the female-to-male ratio of children and adolescents with ID varied between 0.4 and 1.0 (i.e., four to 10 females with ID for every 10 males with the condition; Maulik et al., 2013). An intellectual disability is a neurodevelopmental condition that develops in childhood. Inclusive practices for preschool children with specific language impairment. The addition of functional performancenonacademic skills necessary for independent living (e.g., behavior, social skills, communication, independent living skills, and mobility)reflects an awareness that students with disabilities require more than academic supports if they are to meet their individual goals for long-term success. https://doi.org/10.1177/027112149201100405, Oeseburg, B., Dijkstra, G. J., Groothoff, J. W., Reijneveld, S. A., & Jansen, D. E. M. C. (2011). https://www.jstor.org/stable/26420429, Cole, K. N., Dale, P. S., & Mills, P. E. (1990). https://doi.org/10.1111/jar.12654, McGee, G. G., Morrier, M. J., & Daly, T. (1999). Appropriate roles for SLPs include the following. ABA techniques have been used by SLPs in collaboration with ABA therapists to help build a variety of skills (e.g., communication, social skills, self-control, and self-monitoring) and help generalize these skills to other situations. IEP Goals for Functional Communication Continue a behavior when praised, encouraged, and otherwise orally reinforced. Intellectual disability is a disorder marked by below-average intellectual function and a lack of skills necessary for independent daily living. gain sensory input (sensory reinforcement). SLPs help ensure that communication partners recognize and respond to communication attempts and build on the interests, initiations, and requests of persons with ID. Public awareness, attitudes and beliefs regarding intellectual disability: A systematic review. https://doi.org/10.1044/2018_AJSLP-17-0013, Thorne, J. C., Coggins, T. E., Olson, H. C., & Astley, S. J. Refer to other professionals to rule out other conditions, determine etiology, and facilitate access to comprehensive services (e.g., physical therapy, occupational therapy). Family-centered care is well suited to individuals with intellectual disability (ID) because of the complexity of their health, educational, vocational, and community living challenges across settings and over time. Terms like individuals with intellectual disability have replaced the older terms of mentally retarded persons or the mentally retarded. The treatment effect was . Intervention is customized based on the individuals needs, interests, and family situation. 2756). (2005). Assessment prompts and treatment materials are reviewed for relevance for each individual. Down syndrome is the largest genetic cause of ID, and Fragile X syndrome is the largest inherited cause of ID. Journal of Intellectual Disability Research, 54(9), 787794. ABA is a treatment approach that uses principles of learning theory to bring about meaningful and positive change in behavior. Selection of target behaviors for individuals with ID has increased alongside understanding of the specific communication disorders associated with various diagnoses. Autism Research, 7(5), 608616. The incidence/prevalence data in this section pertain to United Statesbased populations. Timing refers to the scheduling of intervention relative to the diagnosis. Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. Journal of Intellectual Disability Research, 53(1), 2943. Yoder, P. J., & Warren, S. F. (2002). More severe disabilities are more likely to result in early identification of ID (Daily et al., 2000). B. G. (2008). (2009). The life expectancy of most persons with developmental disabilities now approaches that of the general population. Participate as a member of the school or adult service planning team to determine appropriate educational and/or community services. https://doi.org/10.1044/1092-4388(2008/033). American Journal of Speech-Language Pathology, 20(3), 180199. A state of double jeopardy: Impact of prenatal alcohol exposure and adverse environments on the social communicative abilities of school-age children with fetal alcohol spectrum disorder. More contextually based models of service delivery that occur in everyday contexts are consistent with the natural environments philosophy and the move toward inclusive educational programming (Paul-Brown & Caperton, 2001). It's all about getting to know your student, their future goals, and collaborating with parents/caregivers on what areas they find important. (2020). This paper presents goals to develop specific communication skills needed to function independently in the community. (2009). Delayed speech and language acquisition (Cone-Wesson, 2005; Terband et al., 2018). These changes reflect the movement away from a medical model and institutionalization and toward inclusive practices, self-advocacy, and self-determination. speech patterns (e.g., prosody) as well as receptive and expressive pragmatic and sociolinguistic communication skills. Psychiatry, 8(9), 355357. Collaborate with persons with ID and their families regarding communication-related issues and provide education aimed at enhancing communication development and preventing further complications related to ID. https://doi.org/10.1044/lle13.3.21, Guralnick, M. J. ICF-CY: International Classification of Functioning, Disability and Health: Children & Youth version. Interprofessional collaboration may also improve communication skills. Lucyshyn, J., Kayser, A., Irvin, L., & Blumberg, E. R. (2002). Intervention in multiple contexts allows the person with ID to practice functional skills in meaningful situations. Findings from the communication and hearing assessments are analyzed in the context of findings from other professionals who assess and/or treat ID (e.g., psychologists). Twenty years of communication intervention research with individuals who have severe intellectual and developmental disabilities. Child Language Teaching and Therapy, 15(2), 4152. For children with ID and other DDs, intervention may focus on factors influencing cognitive development and social competence (e.g., Guralnick, 2017; Mahoney & Perales, 2005). (2020) also revealed that the following psychiatric disorders were also found to be prevalent in adults with ID: It is important to distinguish signs and symptoms of intellectual disability (ID) from communication differences through case history and comprehensive assessment. Using time-delay to improve social play skills with peers for children with autism. Assessment for individuals with ID involves multiple professionals due to the varying and far-reaching needs across developmental domains. Understanding the communicative intention of challenging behaviors serves as the basis for replacing problem behaviors with more appropriate communication skills, including AAC, that would serve the same functions (see the Functional Communication Training (FCT) subsection in the Treatment section). It can be caused by injury, disease, or a problem in the brain. Treatment may begin as early as these disorders are detected, and early intervention is critical in identifying and providing services that will support both the child and the family (Guralnick, 2019). [PDF], World Health Organization. American Journal of Speech-Language Pathology, 27(4), 14051425. For example, a physical therapist and an SLP may work together to improve respiratory support, which can, in turn, enhance speech production and intelligibility. (Eds.). Video recordings of desired behaviors are observed and then imitated by the individual (Darden-Brunson et al., 2008). A lack of culturally and linguistically sensitive assessment measures and inherent assessment bias contribute to misrepresentation and disproportionality in the identification of individuals with ID. Relevant research indicates that language intervention benefits children with ID even when no languagecognition discrepancy exists (Carr & Felce, 2000; Cole et al., 1990; Snell et al., 2010). Terry is an 18-year-old woman with a diagnosis of moderate-to-severe intellectual impairment of unknown etiology. SLPs may be part of a team making a differential diagnosis between ID and autism spectrum disorder or other conditions. Perspectives on Gerontology, 19(1), 3643. 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