Intellectual and developmental disability

The intellectual and developmental disabilities (DIyD) is the most frequent personal disability condition in the population and among students.

Intellectual disability concept

The expression “intellectual and developmental disability” was adopted in June 2006, after having been voted on by the members of the American Association on Intellectual and Development Disabilities (AIDD). Previously it was called American Association on Mental Retardation (AAMR).

At least three names have been known for this group: "mental deficiency", "mental retardation" and "intellectual and developmental disability".

The AIDD has modified the name, definition, diagnosis and classification as consequence of the advances in the different disciplines involved in this topic: medicine, psychology and education.

A term that avoids stigmatization

The previous concept was changed for this new one so that labels or social prejudices were minimized such as: visions focused on the deficit, on the slow and maladjusted mental functioning, etc.

The new name aims to take advantage of a new conception of development that is nourished by the contributions of theories sociocultural Y ecological.

Allows a functional vision of development, which indicates that a person can have different contexts and throughout the life cycle. In turn, it provides the concept of disability that is nourished by the contributions of the International Classification of Functioning, Disability and of the who, and that it recognizes the social origin of the difficulties experienced by the person suffering from IDD.

On the other hand, he also understands intellectual disability as a developmental disorder it has a lot in common with other developmental problems that can affect children.

Objectives of this monograph

In this article we will try to provide a current view of intellectual and developmental disabilities based on the supports paradigm and in a conception of this disability as a function of the interaction between the independent functioning of the person and the contexts in which he lives, learns, works and enjoys; provide a general framework and some instruments for the evaluation of students with IDD; and offer some answers to promote their development.

What do we understand by intellectual and developmental disability?

First of all, we are going to define intellectual disability and the categories that constitute it.

What is intellectual disability?

exist four approximations in this field:

• Social approach: historically these people were defined as mentally handicapped or retarded people because they were unable to adapt socially to their environment. The emphasis on intellectual difficulties did not come until later, and for a time it was inappropriate social behavior that was of greatest concern.

• Clinical approach: With the rise of the clinical model, the definition objective was changed. The focus was on the symptoms and clinical manifestations of the various syndromes. More attention was paid to the organic and pathological aspects of DI.

• Intellectual approach: from the interest in intelligence as a construct and in intelligence tests, the approach to ID undergoes another change. It involves an emphasis on the measure of the intelligence of these people expressed in terms of IQ. The most important consequence was the definition and classification of people with ID based on the scores obtained in the intelligence tests.

• Intellectual and social approach: it was not until 1959 that the importance of these two components in the conception of ID was recognized: the bass intellectual functioning and difficulties in adaptive behavior, which have persisted to our days.

Theoretical and practical models on intellectual disability

Models with which people with intellectual disabilities have been conceptualized and which justified certain professional practices. Are distinguished three great models:

Charity-assistance model

From the end of the 19th century and during almost the middle of the 20th, people with disabilities were separated from society and entrusted to large charitable nursing homes. The care they received was of a charitable nature and obeyed the charitable conception of public action. They didn't think of it as something social or rehabilitative.

Rehabilitation-therapeutic model

It has spread in Spain since the end of the IIGM, in the 70s. Assumes the adoption of the clinical model in the diagnosis and treatment of people with ID, and the predominance of specialization. The model coincides with the rise of the aforementioned clinical approach. The diagnosis of ID focuses on the individual's deficit and they are classified into categories according to their IQ. It is considered that the problem is within the subject and specialized institutions are created according to the nature of the problem to attend to them.

Educational model

It started in our country in the 80s. It is characterized by the adoption of normalization principle in all stages of the lives of these people. They are beginning to be considered with the same rights as their peers to education, health, work and a decent life. Education should be imparted if possible in ordinary centers, the diagnosis should prioritize the capacities of these people and focus on the supports they will need to respond to the demands of different work environments. lifetime.

History on the definition of the concept

The AAIDD the definition of DI has changed up to 10 times. The last one was in 2002. This is a definition that goes beyond the 1992 one but maintains some of its key exceptions: the fact that mental retardation is not taken as an absolute trait of the person, but as the expression of the interaction between the person, with some intellectual and adaptive limitations, and the environment; and the emphasis on supports.

In the 1992 definition, the categories disappear. They are explicitly rejected and it is stated that people with mental retardation should not be classified on the basis of traditional categories, but you have to think about the supports they may need to increase their participation Social.

Despite this, the 1992 definition meant a significant improvement for people with ID, but was not without criticism:

• Imprecision for diagnostic purposes: it did not make it possible to clearly establish who was or was not a person with mental retardation, who was eligible for certain services.
• Lack of operational definitions for research.
• The fact that evolutionary aspects are not sufficiently considered of these people.
• Imprecision and the impossibility of measuring the intensity of the support that these people require.

For this reason, the AAIDD proposes a new definition built from that of 1992. A system is created to diagnose, classify and plan supports for people with mental retardation.

The current definition

The new definition of mental retardation proposed by AAMR is as follows:

“Mental retardation is a disability characterized by significant limitations both in the intellectual functioning as well as adaptive behavior expressed in conceptual, social and practices. This disability originates before the age of 18. "

• "Mental retardation is a disability": a disability is the expression of limitations in the individual's functioning within a social context that pose significant disadvantages.

• "... characterized by significant limitations in both intellectual functioning": the intelligence It is a general mental capacity that includes reasoning, planning, problem solving, abstract thinking, etc. The best way to represent them is by means of the IQ, which is two standard deviations below the mean.

• "... as in adaptive behavior expressed in conceptual, social and practical skills": adaptive behavior is the set of conceptual skills, social practices and practices that people learn to function in daily life. Limitations in life affect typical performance, although they do not make life impossible daily.

• "This capacity originates before the age of 18": 18 years correspond to the age at which individuals assume adult roles in our society.

With this definition the cognitive basis of the problem is again influenced, but based on a model that emphasizes social and practical competence, which reflects the recognition of the existence of different types of intelligence; a model that reflects the fact that the essence of mental retardation is close to difficulties in coping with daily life, and the fact that that limitations in social and practical intelligence explain many of the problems that people with ID have in the community and in the job.

It extends the concept to other population groups, in particular the forgotten generation: an expression that includes people with borderline intelligence.

The aspects that change with this last definition They are:

• It includes a criterion of two standard deviations for the measure of intelligence and adaptive behavior.
• It includes a new dimension: participation, interaction and social role.
• A new way of conceptualizing and measuring supports.
• Develop and expand the three-step assessment process.
• A greater relationship is favored between the 2002 system and other diagnostic and classification systems such as the DSM-IV, the ICD-10 and the ICF.

As in 1992, the definition incorporates the following five assumptions:

1. Limitations in current functioning have to be considered within the context of the typical community settings of peers of my age and culture.
2. An adequate assessment has to consider cultural and linguistic diversity, as well as differences in communication, sensory, motor and behavioral factors.
3. Within the same individual, limitations often coexist with strengths.
4. An important goal in describing limitations is to develop a profile of the supports needed.
5. With appropriate personalized supports over a sustained period of time, the way of life of people with mental retardation will generally improve.

The Mental retardation is understood within the framework of a multidimensional model that provides a way of describing the person through five dimensions that include all aspects of the individual and the world where it lives.

The model includes three key elements: person, the environment in which you live, Y the supports.

These elements are represented in the framework of the five dimensions that are projected in the daily functioning of the person through the supports. Supports have a mediating role in the lives of people with intellectual disabilities.

A broader concept of ID is reached than It involves understanding that the explanation of people's daily behavior is not exhausted from the effect of the five dimensions, but from the supports they can receive in their living environments.

Trends that have prevailed in the field of ID

• An approach to ID from an ecological perspective that focuses on the interaction between the person and their environment.
• Disability is characterized by limitations in functioning, rather than by a permanent trait of the person.
• The multidimensionality of ID is recognized.
• The need to link evaluation and intervention more firmly.
• The recognition that an accurate diagnosis of ID often requires, along with the information available from evaluation, sound clinical judgment.

Characteristics and causes of intellectual and developmental disabilities

Three important characteristics are found: limitations in intellectual functioning, limitations in adaptive behavior, and need for supports.

1. Limitations in intellectual functioning: intelligence refers to the student's ability to solve problems, pay attention to information relevant, abstract thinking, remembering important information, generalizing knowledge from a scenario to other, etc.

It is generally measured by standardized tests. A student has ID when her score is two standard deviations below the mean.

The specific difficulties that people with ID present

They usually present difficulties in these three areas:

to) Memory: people with ID often show limitations in their memory, especially what is known as MCP, which has to do with their ability to remember information that must be stored for seconds or hours, as is usually the case in class. It is more evident in the cognitive aspects than in the emotional ones. Strategies can be used to improve capacity.

b) Generalization: refers to the ability to transfer knowledge or behaviors learned in one situation to another. (from school to home, for example).

c) Motivation: research reveals that the lack of motivation it is associated with previous experiences of failure. Difficulties in successfully overcoming certain challenges of daily life at home and in the center make them more vulnerable. If you can change the sign of your experiences, your motivation will also improve.

d) Limitations in adaptive behavior: People with ID often have limitations in adaptive behavior. Adaptive behavior refers to the ability to respond to the changing demands of the environment; people learn to adjust / self-regulate behavior to different situations and life contexts according to age, expectations, etc.

To identify the abilities of a student in this field, conceptual, social and practical capacities are usually explored through scales constructed for it. From the results, educational activities can be designed that must be integrated into the curriculum.

Self-determination is the most central expression of the capacities inherent to adaptive behavior and it is of special relevance for people with ID. Its development is associated with a perception of a higher or lower quality of life.

Causes of intellectual disability

Regarding the causes, there are four categories:

1. Biomedical: factors related to biological processes, such as genetic disorders or malnutrition.
2. Social: factors related to the quality of social and family interaction, such as the stimulation or sensitivity of the parents to the needs of the son or daughter.
3. Behavioral: factors that refer to behavior that can potentially cause a disorder, such as accidents or the use of certain substances.
4. Educational: factors that have to do with access to educational services that provide supports to promote cognitive development and adaptive skills.

Keep in mind that these factors can be combined in different ways and proportions.

Intellectual disability and quality of life

One of the four characteristics of the emerging disability paradigm is personal well-being, which closely associates the concept of quality of life.

The recognition of the rights that people with ID have implies the recognition of the right to a quality life.

Over time, the concept of quality of life has been applied to people with ID. This implies access to services, the efficiency and the quality of these services that allow them to enjoy the same opportunities as others.

Access to a quality life involves recognizing the right to difference and the need for the services offered to be permeable to their particular conditions.

People with ID have certain characteristics that generate specific needs throughout their development, These needs outline the type of support they require to access the services that make living conditions possible. optimal.

Quality of life is defined as a concept that reflects the living conditions desired by a person in relation to her life at home and in the community; at work, and in relation to health and well-being.

Quality of life is a subjective phenomenon based on the perception that a person has of a set of aspects related to her life experience.

The concept of quality of life

According to Schalock and Verdugo, the concept of quality of life (CV) is being used in three different ways:

• As a sensitizing concept that serves as a reference and guide from the perspective of the individual, indicating what is important to him.
• As a unifying concept that provides a framework to conceptualize, measure and apply the CV construct.
• As a social construct that becomes a predominant principle to promote the well-being of the person.

Promoting well-being in people with intellectual disabilities

In the work to promote the well-being and quality of life of people with ID, the importance of eight central dimensions and of certain indicators are recognized:

• Emotional well-being: happiness, self concept, etc.
• Relationships: intimacy, family, friends, etc.
• Material well-being: belongings, security, work, etc.
• Personal development: education, skills, competences, etc.
• physical well-being: health, nutrition, etc.
• Self determination: elections, personal control, etc.
• Partner inclusionl: acceptance, participation in the community, etc.
• Rights: privacy, freedoms, etc.

Services and resources for people with intellectual disabilities

The services and resources offered to people with ID throughout the life cycle must be aimed at satisfying their needs. needs in order to be able to respond to the demands of the various contexts in which they develop and enable a life of quality.

Characteristics that define a optimal environment:

• Presence in the community: sharing ordinary places that define the life of the community.
• Elections: the experience of autonomy, making decisions, self-regulation.
• Competence: the opportunity to learn and perform meaningful and functional activities.
• I respect: the reality of being valued in the community.
• Community involvement: the experience of being part of a growing network of family and friends.

About people with ID in the educational context: "Students with intellectual disabilities: evaluation, monitoring and inclusion"

Bibliographic references:

• Gilman, C.J., Morreau, L.E. ALSC; Adaptive Skills Curriculum. Personal life skills. Messenger editions.
• Gilman, C.J., Morreau, L.E. ALSC; Adaptive Skills Curriculum. Home life skills. Messenger editions.
• Gilman, C.J., Morreau, L.E. ALSC; Adaptive Skills Curriculum. Community life skills. Messenger editions.
• Gilman, C.J., Morreau, L.E. ALSC; Adaptive Skills Curriculum. Work skills. Messenger editions.
• FEAPS. Positive behavioral support. Some tools to deal with difficult behaviors.
• FEAPS. Person-centered planning. Experience of the San Francisco de Borja foundation for people with intellectual disabilities.