Students with intellectual disabilities: evaluation and inclusion

Related article: "Intellectual and developmental disability"

The evaluation of students with intellectual disabilities

East evaluation process requires the presence of well-trained professionals and the knowledge and application of a series of steps and procedures already contemplated in the AAMR manual itself and by various recognized authors in the field.

a) The structure of the evaluation

The evaluation proposed by the 2002 system is articulated around what is known as evaluation structure. The structure of the evaluation is characterized by the following aspects:

The evaluation has three main functions: the diagnosis, the classification and the planningn of the necessary supports.
Each function has a number of different objectives, ranging from establishing the provision of a certain service and research, the organization of information, and the development of a support plan for the individual.
The selection of the most appropriate measures and instruments will depend on the role of the evaluation and the specific objectives to be met.

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The diagnosis

One of the purposes and functions of the definition, classification, and support system is to determine the diagnosis of intellectual disability. Diagnosis of DI is carried out according to the triple criteria: significant limitations in intellectual functioning, significant limitations in adaptive behavior and age of appearance.

The classification

The objectives of the classification include the grouping of people for the financing of services, research, organization of services and communication on certain characteristics selected. Classification systems can be used to meet the needs of researchers, clinicians, and professionals. Classification systems can be based on intensity of supports, etiology, and levels of intelligence or adaptive behavior.

Support planning

The purpose is the improvement of personal outcomes related to independence, relationships, contributions, school and community involvement, and personal well-being. The evaluation of supports may have a different relevance depending on whether it is carried out with classifying or support planning objectives. The supports evaluation scales, self-reports, some components of the evaluation and the individual plan are measures for the planning of supports.

b) Diagnostic criteria

Carrying out a diagnostic evaluation of intellectual disability requires adequate training and preparation, knowledge and use around certain questions related to the diagnostic criteria and with some considerations and precautions that should be taken into account in situations complex. The professionals must carry out an assessment of intellectual level and adaptive behavior, and set the age of onset.

Intelligence assessment

The criterion used for the diagnosis of intellectual disability in relation to intellectual functioning is two standard deviations below the mean. The use of this criterion to carry out a valid evaluation requires knowledge and understanding of certain aspects:

The best way to understand intellectual functioning is through a general factor (g).
Appropriate standardized measures should reflect the social, linguistic and cultural background of the individual. Appropriate adaptations should be made for any motor or sensory limitations.
Psychometric instruments that assess intelligence work best when used with people whose scores are within two to three standard deviations of the mean; extreme scores are subject to greater measurement error.
The evaluation of intellectual functioning through intelligence tests runs the risk of misuse if possible measurement errors are not taken into account.

Adaptive behavior

Is the set of conceptual, social and practical skills that people learn to function in daily life. It emphasizes the use or performance of relevant skills, rather than the acquisition of skills.

This means that the limitations in adaptive behavior include the lack of knowledge of how to perform these skills, when to use them, and other motivational factors that affect the expression of skills.

Significant limitations in adaptive behavior are defined as a performance that places at least two standard deviations below the mean in one of the three types of adaptive behavior or an overall score on a standardized measure of conceptual, social and practices.

The evaluation of this behavior must be done using standardized measures calculated from the general population that include people with and without disabilities.

Guidelines to follow to assess adaptive behavior:

Limitations in current functioning should be considered within the context of typical community settings for people of the same age and culture.
There is no single measure that fully evaluates all aspects of adaptive behavior.
Because the subscale scores correlate moderately, it must be assumed that there is a general deficit even if the score in a single dimension meets the criterion of two or more standard deviations below the half.
Evaluation depends on understanding that the typical behavior of an individual requires information that goes beyond what can be observed in a formal evaluation situation.
An adaptive behavior score should not be considered an accurate score. A confidence margin of 67% and 95% would have to be applied for a true score.
Problematic behavior that is considered maladaptive is not a dimension or characteristic of adaptive behavior, although it may influence the acquisition and performance of adaptive behavior.
Adaptive behavior must be interpreted in relation to periods of development and within the context of the individual's own culture.

Age of onset of intellectual disability

The life cycle period prior to adult life is the diagnostic criteria of the 2002 definition. The age limit It is established at 18 years of age, the age that corresponds to the moment in which the adult role is acquired.

This period is characterized by rapid changes in cognitive, social, and practical skills.

c) General considerations

Any diagnostic activity involves a risk. There are particularly critical situations such as double diagnosis (DI and Mental illness), to individuals with ID and with optimal light intellectual functioning.

They require special guidance to improve the precision, accuracy, and integration of the diagnosis.

Four important guidelines should be taken into account when diagnosing people with complex situations:

Is there a correspondence between the measures used and the purposes of the diagnosis? The diagnosis of mental illness requires specific measures that are different from the assessment of intelligence and adaptive behavior.
Are the measurements suitable for the person? Are age, cultural group, communication system, comprehensive language level, sensory and motor limitations respected?
Is the person assessed in community living settings and is the role of their immediate environment integrated into the assessment? Is the information of significant others included, is the assessment of living conditions taken into account? community, the behavior of the person in the evaluation situation is compared with that presented in their surroundings usual?
Does the diagnostic evaluation take into account the possible limitations of the evaluation instruments?

The double diagnosis

Mental disorders have a higher prevalence in the population with ID. There are two factors that complicate the dual diagnosis: the diagnostic eclipse and the problem behaviors.

The diagnostic eclipse It occurs when all the problems and symptoms that a person presents are attributed to DI.

Problematic behaviors that manifest themselves at the time of the interview and in the evaluation sessions can limit the accuracy of the diagnosis.

To make a good double diagnosis, the following guidelines should be taken into account:

Collection of relevant information in relation to the person from their personal history, behavioral observations in the settings of daily living, psychometric evaluation and medical evaluation and biological.
Collecting community information from environmental assessments that include aversive situations, opportunities for sensory stimulation and the person's perspectives for change.
Identification of potential causes of the behavior rather than narrowing the cause down to a suspected mental illness.

People with a light or borderline level of intellectual functioning: these people have some hard-to-detect limitations, especially skills related to academic competence And social.

The following guidelines serve for an accurate diagnosis:

Assessment should focus on functional assessment systems, with a special emphasis on adaptive behavior.
The evaluation of academic skills must identify the acquisition of knowledge and curricular competence.
The evaluation of social competence should base interest on social perception, the generation of appropriate social strategies for solving problems and the person's knowledge of schemas social.

Retrospective diagnosis

It involves carrying out a diagnosis of DI when it has not been made during the developmental period. The corresponding guidelines will have to be followed to ensure a proper diagnosis.

Diagnosis in suboptimal assessment situations

There are certain situations in which determining the diagnosis of ID is complex and the use of formal evaluation measures is difficult to apply.

Are those individuals who have complex medical and behavioral conditions and situations in which cultural diversity and / or linguistic factors can have an effect on the information needed for decision-making.

It is advisable to take into account the following guidelines:

Use multiple sources of information in data collection.
Show clearly that the data obtained correspond to the critical questions that have been formulated.
Use assessment instruments that are sensitive to diversity and have acceptable psychometric properties.
Know and understand the culture and language of the individual.
Do not allow linguistic and cultural diversity to overshadow or minimize actual disability.

d) The use of clinical judgment

The clinical judgment it is required as good practice in the field of disability. Its proper use allows to improve the precision, accuracy and integration of the decisions and recommendations of the professionals.

It is a special type of judgment that arises directly from a large amount of data and is based on a high level of skill and clinical experience.

It has three characteristics: it is systematic, formal (explicit and reasoned) and transparent.

It should not serve to justify rapid assessments, substitute for the use of appropriate instruments, or the lack of sufficient information.

There are four orientations that are crucial to making an accurate clinical judgment:

The professional must carry out a complete social history and match the data collected with the questions asked.
Comprehensive evaluation systems must be applied.
The professional must work as a team to analyze the results of the evaluation and determine the necessary supports.
The necessary supports must be included in an individualized plan and the results evaluated.

e) The evaluation of the supports

The determination of support needs it constitutes the main objective of the evaluation and diagnosis process of ID.

The evaluation of the profile and the intensity of the necessary supports constitutes a basic strategy to improve the results personal, promote independence, relationships, contributions, school and community participation and well-being emotional.

There are two ways to define the supports.

The processes carried out in evaluation and in the development of support plans for the definition and concretion of the functions and support activities, as well as the natural supports that the person will have at their provision.
The use of support scales. The publication of the aid intensity scale (EIA) and its adaptation to Catalan and Spanish means having a tool of great value and strong impact. The EIA is a multidimensional instrument developed to measure the level of practical support required by people with IDD.

This scale has three sections:

Section 1. Support Needs Scale. It evaluates 49 life activities grouped into 6 subscales: home life, community life, lifelong learning, employment, health and safety, and social activities. Support measures for each activity are examined in relation to frequency, daily support time, and type of support.

Section 2. Complementary scale of protection and defense. Evaluates 8 activities related to topics that refer to self-defense, opportunities and access, exercise of social responsibilities and help in the acquisition and expression of skills.

Section 3. Exceptional medical and behavioral support needs. Evaluates 15 medical conditions and 13 problem behaviors.

The intensity scale of supports for children is currently being developed. This evaluates the intensity of the supports in the following areas: life at home, community and neighborhood, school engagement, school learning, health and safety, self defense, and medical and behavioral needs exceptional.

How to promote the development of students with intellectual disabilities?

For schools, the 2002 system has introduced two changes in the way of thinking and acting:

The diagnostic process is directly related to the provision of supports.
The emphasis is not on programs, but on the design and delivery of individualized supports.

This model assumes the perspective of special education as a support system rather than a place, and that the meaning of school-age aid is to provide access to the school curriculum, encourage achieving valuable personal results and enhancing participation in school, social and community settings typical.

a) An inclusive school environment

The basic principle is that students with IDD must have access to ordinary educational situations with additional aids and services that allow overcoming barriers to participation and learning.

It is important how to establish a better fit between the capabilities of the person and the demands and opportunities of the environment in which they live, learn and socialize.

At the school stage, greater attention is needed to modifications and adaptations that facilitate participation and learning.

This functional approach to disability means putting a greater interest in support. The task that the advisors must solve is to identify and design, in an adjusted and appropriate way, the supports that allow them to be successful in school and in life.

The organization of supports in the school stage must be done around some essential components. The development of an educational environment requires that the school adopt quality organization and teaching systems that are sensitive to diversity.

The educational approach incorporates a series of strategies in the school and classroom environment. There are certain conditions that seem to have a positive effect on the improvement of educational centers and that enable her to face change processes and provide a more tailored attention to the diversity.

These dimensions allow the school to advance its goal of increasing opportunities for participation and learning for all students. They allow the functions and tasks of the advisor to be articulated around him.

Approaches that take into account teacher reflection and collaborative processes are sensitive to the development of inclusive cultures, policies, and practices.

Keys for the correct inclusion of students with disabilities

There are a number of conditions that ensure that all students actively participate in teaching and learning activities.

Modify the nature and complexity of the content curricular
Diversify teaching processes and learning
Adapt the demands and the type of responses that you can promote to create a more inclusive educational environment in the classroom.

Promote a safe climate and positive relationships between teachers and students it is considered a critical aspect. Clear expectations and limits must be defined and maintained that promote the acquisition of positive norms, behaviors and attitudes towards learning and school work.

It is important that teachers reflect on their own activity and that they share their reflections and proposals.

Adaptations to the physical environment facilitate students' ability to participate in classroom learning activities.

b) Access to the curriculum and universal design of learning

There are different types and levels of access to the mainstream curriculum for students with IDD. The most significant are the strategies in the general field, and the use of universal learning design, and the individualized curricular adaptations.

The universal design of learning represents a support system that allows to overcome certain barriers to the participation and learning of a significant number of students.

To facilitate access to the curriculum, it must be ensured that students actively participate in the activities of teaching and learning and that these are stimulating and cognitively significant enough to promote development personal.

Curriculum materials often present physical, sensory, affective and cognitive barriers that limit access and participation.

The universal design of learning is defined as “the design of instructional materials and activities that allow the learning objectives to be within the reach of individuals with large differences in the abilities to see, feel, speak, move, read, write, understand language, pay attention, organize, be busy and remember."

Adapting to Students with Special Needs

Principles that facilitate the development and evaluation of educational materials for the education of students with IDD:

Equitable use: those who speak in a different language can use the materials. The materials are organized from various levels of cognitive taxonomy and present alternatives that appear similar.
Flexible use: the materials are characterized by multiple forms of representation, presentation and expression.
Simple and intuitive use: the materials are easy to use and avoid unnecessary difficulties. The instructions are clear and precise, and examples are presented.
Perceptible information: the materials present the necessary information for the student; essential information is underlined and repetitions are included.
Tolerance for error: students have enough time to respond, they are provided with information to correct the mistakes, they can rectify previous answers, monitor their progress and practice timing necessary.
Reduced physical and cognitive effort: the materials present the information to be worked on in groups that can be carried out in a reasonable amount of time.

Universal design

Characteristics of the universal design of learning that facilitate access to information on academic content:

Provides multiple forms of representation and presentation.
They promote different forms of expression.
Facilitates multiple forms of participation

c) The organization of the provision of supports in the classroom

To participate in classroom activities together with your classmates, students with ID&D require accommodations and supports that must be organized appropriately.

There is a three-phase model for accomplishing this task. It is used for the planning and implementation of supports and adaptations in the classroom:

ID of support needs.
Planning and implementation of supports and accommodations.
Evaluation of the provision of supports and adaptations.

The identification phase requires the collection of information about the student and the classroom. It is important to share information about the student and its characteristics and needs. Know the activities and materials that are used. Sometimes it may be necessary to carry out direct observations of the classroom environment. The objective is to identify what type of adaptations and supports the student needs and in what curricular areas or school tasks.

The planning phase and implementation requires the responsible team of professionals to make decisions about how and who will develop and implement the identified accommodations and supports.

Must take into account three types of adaptations:

Curriculars: they modify the content of what is taught. It represents modifying the level of difficulty of materials and activities, and reducing the quantity, number, or complexity of the objectives.
Instructional: modify how learning is taught and demonstrated. Teaching methods may need to be varied in order to facilitate and enhance learning. Provide clear demonstrations, use specific strategies, develop study guides for textbooks, include more corrective feedback… It may be necessary to change the type of responses and demonstrations required of the student.
Alternatives: modify learning objectives and activities. It may be considered whether the student needs alternative accommodations to ensure her progress. These include introducing objectives and activities that parallel those carried out in the classroom.

This phase is usually carried out in two moments. One in which it is carried out at the beginning of the course and helps the student adapt to the daily activities and routines of the class and school. And another is the planning and adaptation of the classroom work that is carried out throughout the course in coordination meetings.

The monitoring and evaluation phase It requires a continuous and coordinated work to assess both the impact of the decisions made in relation to the type of adaptations and supports that should be provided, as well as the student's progress.

There must be a certain period of meetings where the necessary changes are made to allow the student to actively participate in classroom activities and can progress according to the objectives proposed in your program individual.

d) The learning of certain competences

The functional model of intellectual disability involves putting increased emphasis on supports and on modifications and adaptations of the environment in order to improve individual functioning.

This should not take away the role of the development and progress of students with ID who acquire the greatest possible number of skills and abilities.

A large majority can have access to ordinary curricular content and objectives.

Skills that allow access and participation in other learning or educational activities and environments:

Foundational skills: Are those that open doors to people and facilitate access to other learning, meaningful activities and relevant environments. They provide the basis for interacting with people and with information in a multicultural society. It is important that they learn the skills that facilitate independence, relationships, contributions, school and community involvement, and personal well-being.
Self-directed learning strategies: Students use learning strategies that allow them to plan, carry out and control homework, and modify and regulate their own behavior. The objective is to get students to participate actively in the educational process. The use of these strategies facilitate the development and learning of skills, favors inclusion school, improves self-determination and promotes the involvement of the student and the processes of generalization.
Self determination: there is a close relationship between self-directed learning and self-determination. Self-determination is an educational outcome and represents the ability to act as the main causal agent in one's own life and in select and make decisions regarding one's quality of life that are free from outside influences and interference unnecessary. It refers to the right of people to take control and make choices that have an impact on their lives. It includes components: skills to make choices, make decisions, solve problems, etc.
The social competence: it is the result of the combination of adaptive behavior, social skills and acceptance of peers. Socially competent behavior is important for successful functioning in everyday life settings.

The nature and breadth of skills and peer relationships have an effect on self-esteem, intellectual development, academic performance, and daily functioning.

It is convenient to identify the variables that can influence the relationships and social interactions between peers with and without disabilities, and establish strategies that promote positive relationships and adequate social competence.

Contributions to the education and quality of life of students with disabilities

a) The evaluation of services

The presence of the evaluation culture it is not very visible in our country in the services for people with IDD. Especially in educational centers.

Anglo-Saxon culture, for example, is associated with accountability procedures before the authorities that finance services.

The educational administrations have proposed different initiatives but they have not been favorably received by the educational community.

The Spanish Federation in Favor of People with Intellectual Disabilities It is committed to promoting the evaluation of the different services as an integral part of its quality plan.

The proposed model has been adopted by the FEAPS and has been designed to help professionals overcome the possible resistance referred to above. The control of the process is located in the center itself and is oriented towards improvement. The advantages of self-evaluation are combined with external evaluation, leaving the responsibility for decisions to the centers.

The model comprises three phases:

Self appraisal: professionals, ownership / management, families, students participate and concludes in a self-assessment report.
External evaluation: by some experts based on the report prepared by the center and interviews with a sample of professionals, management, families and students. It is reflected in a final report that is sent to the center.
Improvement plan: the center itself prepares it from the conclusions of the final report contrasted with its own self-evaluation report.

Advantages of the model:

The evaluation process allows individual and shared reflection on the organizational and educational practices of the center based on the dimensions and quality indicators of the model.
The participation of families and students allows us to know what they value and what their degree of satisfaction is.
The debate to reach a consensus on both the content of the self-assessment report and the improvement plan makes it possible to refine the diagnosis and facilitate personal involvement in the search for solutions.
The improvement plan is a commitment to innovation and change.
The quality of the relationship between professionals and families: With few exceptions, the relationship between professionals and families is not easy. It is subject to different pressures, beliefs and expectations, misgivings, organizational difficulties, etc. They have contributed to an insurmountable barrier.

They can be distinguished three patterns that obey three different ways of conceiving this relationship:

A power relationship based on expert knowledge: the one who knows what happens to the person with ID, the causes and what should be done is the professional. It is a completely asymmetric relationship that relegates parents to playing a role as mere adherents of what the professional indicates, without acknowledging any contribution beyond answering some questions posed by the professional.
Parents as co-therapists: relationship based on an agreement that assumes that parents must do at home what the professional does at the center.
Parents as collaborators: there is a change in culture and expectations in relation to families. It is recognized that not all expertise resides in professionals, parents have knowledge as valuable as that of professionals, although from another perspective. Parents are treated equally, this means that each respects and values that the other contributes a certain knowledge and information relevant to the collaboration process.

Aspects that contribute to the quality of the relationship and its dimensions in the practices:

Communication: the quality of communication. It should be positive, understandable, and respectful to everyone.
Commitment: be sensitive to the emotional needs of families, be available, share the importance for families of the objectives pursued.
Equal treatment: share decision-making, ensure that everyone can influence decisions, promote family empowerment.
Professional competence: show high expectations in relation to the child's possibilities, give an appropriate response, willingness to continue learning.
Confidence: key in the relationship. Trust and deserve parents, use strong arguments, keep confidentiality.
I respect: treat families with dignity, respect cultural diversity, be kind, reinforce strengths, do not judge.

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.
Verdugo Alonso, M.A. 2006. How to improve the quality of life of people with disabilities. Assessment tools and strategies. Amarú editions. Salamanca, Spain.