FINAL

8.1 What Are Intellectual Disabilities?

Until 2012, intellectual disability was referred to, in the IDEA and elsewhere, as mental retardation. (See the feature box titled "Phasing Out the 'R' Word" for a discussion of the change in terminology.) Intellectual disability is one of the 13 IDEA 2004 categories.

Defining Intellectual Disabilities

People with ID generally struggle with learning, problem solving, and thinking. They also have difficulty with adaptive behaviors, which are those conceptual, social, and life skills that enable people to participate in everyday life activities. These include using money, engaging in conversations, and taking care of personal hygiene and safety (see Figure 8.1 for more examples). Adaptive behaviors enable people to be self-sufficient and live independently. When people do not initiate such behaviors, it limits their participation in school and society.

Students with ID typically develop at a slower rate than students without ID; they may learn to speak and walk later than normal and may have difficulty learning in school.

ID is sometimes grouped with developmental disabilities. This category, not recognized by IDEA 2004, includes all disorders and disabilities that occur during an individual's development, typically defined as the period from birth until adulthood (i.e., 22 years old). Autism is considered a developmental disability, as is cerebral palsy, epilepsy, and fetal alcohol spectrum disorder (FASD). Although ID may sometimes fall under the umbrella term of developmental disabilities, a student with a developmental disability does not necessarily have problems with intellectual functioning or adaptive behaviors.

Figure 8.1: Adaptive Behaviors

Adaptive behaviors include conceptual, social, and life skills. Typically, students with ID exhibit deficits in all three areas.

ID is different from mental illness. A mental illness affects how a person thinks and feels and has no connection to intellectual functioning. A mental illness can be positively influenced by treatment; examples include schizophrenia, bipolar disorder, anxiety disorder, post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (see Chapter 6). An ID, in contrast, is not an illness. ID is a condition that affects a student for life. Treatment can improve student outcomes, but it cannot change the condition of ID. Although institutions (which you will read about shortly) often housed both populations together, people with mental illness are distinctly different from those with ID in terms of the symptoms, treatments, and responses to treatments they experience.

Intellectual Disabilities and IDEA 2004

PL 94-142 included mental retardation as one of its original disability categories. IDEA 2004, because it was written before Rosa's Law took effect, still uses that term, but it will change to intellectual disability when IDEA 2004 is reauthorized. The IDEA 2004 definition is as follows: "significantly sub-average general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child's educational performance."

Typically, intellectual functioning is defined using an intelligence quotient (IQ). Students scoring below 70–75 often qualify as having an ID. They must exhibit deficits in one of the three areas of adaptive behavior (conceptual, social, or life skills). As with all the other disability definitions under the IDEA 2004, students can qualify as having an ID only if their disability affects their educational performance.

Prevalence of Intellectual Disabilities

Approximately 1% of U.S. students have an ID, and approximately 1–3% of the world population has an ID (Topper, Ober, & Das, 2011). Under the IDEA 2004, however, there is variability in identification by state. As happens in some of the other disability categories, minority students (especially African-American students) and students who are English language learners are identified with ID at a higher rate than students from other racial or ethnic backgrounds (Ford, 2012; Sullivan, 2011). Additionally, boys tend to be identified with ID more than girls (Ford, 2012). The rate of identification of students with ID has decreased over the last several years, especially since autism became its own IDEA category in 1990. Section 8.4 of this chapter discusses some of the syndromes and disorders that can cause ID.

8.2 How Has the ID Field Evolved?

In 7000 B.C.E., people with ID had holes drilled in their skulls to let their "diseases" escape (Manion & Bersani, 1987). More than two thousand years ago, the Greeks and Romans believed that evil spirits allowed children to be born with ID, and many of these children were left to die or were even killed. If their parents were wealthy, children with ID were sometimes permitted to live, but only if a guardian could take care of them.

Over the next two thousand years, some societies continued to exclude children with ID. In some places, they were sold as slaves or used for the amusement of others. People with ID lived in poorhouses, monasteries, or prisons. In other societies, though, children with ID were cherished as being blessed by a higher power and were treated as deities (Manion & Bersani, 1987).

The First Advocates for Individuals With ID

As discussed in Chapter 1, during the 19th century, people began to advocate for individuals with ID and built institutions to house and help them. One of the first researchers was Jean-Marc Gaspard Itard, who worked with Victor, the wild boy of Aveyron, who had characteristics of ID along with other disabilities (Feudtner & Brosco, 2011). His efforts were not entirely successful, but his mentee, Eduoard Seguin, brought Itard's teaching practices to the United States and published a book titled The Moral Treatment, Hygiene, and Education of Idiots and Other Backward Children.

Seguin, along with others, such as Dorothea Dix, helped spread a movement in the United States advocating that students and adults with ID should be treated humanely and be educated and trained to participate in society. As the 19th century progressed, institutions for the care of people with ID opened in cities across the United States. Many states, though, still preferred to place people with ID in state-controlled institutions so the state could prohibit their marriage or procreation.

Associations With Poverty and Crime

Many societal problems of the 19th century, such as crime and poverty, were blamed on people with ID, who were called "idiots," "dumb," or "feeble-minded." In 1869, Sir Francis Galton published a book called Hereditary Genius, in which he promoted the idea that an ID was inherited. This idea fueled the eugenics movement, which advocated that people with intellectual disabilities should be sterilized to prevent future generations of people with these disabilities.

The eugenics movement was spurred on by Richard Louis Dugdale's The Jukes: A Study in Crime, Pauperism, Disease, and Heredity and Henry Goddard's The Kallikak Family: A Study in the Heredity of Feeble-Mindedness. Both authors described "families" who had tendencies toward poverty, criminality, or feeble-mindedness, and eugenicists used these family histories to promote sterilization laws (Smith & Wehmeyer, 2012). (Modern scholars, of course, have debunked many of the claims put forth in Dugdale's and Goddard's books.)

By 1944, 30 states had sterilization laws. States could sterilize people who were "imbeciles" or were "unimproveable." States ultimately sterilized thousands of people, many of whom did not have an ID. After World War II, attitudes toward sterilization shifted, and by the 1960s all states had abandoned this practice.

The First Efforts at Schooling for Individuals With ID

Meanwhile, the use of standardized assessments began to help doctors and educators identify students with disabilities, and states slowly started to provide for the schooling of these students. In 1911—well before PL 94-142 in 1975—New Jersey was the first state to mandate education for students with ID.

Another major milestone for people with ID occurred in 1950 with the formation of the National Association of Parents and Friends of Mentally Retarded Children. This organization, now called ARC, helped advocate on behalf of students with ID. In 1962, President John F. Kennedy formed the President's Panel on Mental Retardation to provide funds for research and education of students with ID.

With the passing of PL 94-142 in 1975, students with ID received the right to a free, appropriate public education. While many public schools were providing an education to students with ID before 1975, the law made it mandatory.

The Shift From Home to Group Care Environments

As students with ID began to participate in schools more widely, educators and legislators began to reconsider how to best prepare them to be members of society and provide services as they became adults. Advocates believed that institutions were dehumanizing, and they started a movement to integrate adults with ID into local communities.

One such advocate was a professor of special education named Wolf Wolfensberger. Wolfensberger promoted the concept of "normalization," which involved providing the same opportunities and environment to people with disabilities as were available to people without disabilities (Mann & van Kraayenoord, 2011). Starting in the 1980s, states closed many of their mental institutions, where people with ID had usually been placed, and adults from these institutions went back to living with family members or in group and community homes with other adults with disabilities.

8.3 What Are the Characteristics of Students With ID?

By definition, all students with ID have lower intellectual functioning and have difficulty with adaptive behaviors. (See Figure 8.1 for examples of those.) In addition, they may exhibit certain physical characteristics or mobility issues as part of their disability. For example, students with ID may sit up, crawl, or walk later than other students; weigh less than students of the same age; be shorter than students of the same age; have difficulty with balance; or move around excessively or awkwardly.

Comorbidity With Other Disabilities

The most common type of comorbidity with ID is emotional and behavioral disorders, with comorbidity rates as high as 30–50% (Einfeld, Ellis, & Emerson, 2011). ADHD is another common disorder that often occurs in conjunction with ID (Neece, Baker, Blacher, & Crnic, 2011), although ADHD is sometimes difficult to diagnose in students with ID because the symptoms are manifested differently than in typical students with ADHD (Reilly & Holland, 2011).

Until autism became its own disability category with IDEA, students with autism were often categorized as having ID. With the creation of a separate autism category, the percentage of students with ID identified in school decreased. This decrease did not signal that fewer students had deficits in intellectual functioning and adaptive behavior, but only that the categories had changed (i.e., some students previously identified as ID were now identified with autism spectrum disorder [ASD]).

8.4 What Are the Causes of ID?

As with other disabilities, there is no single cause of ID. Genetics (i.e., the actions of genes in the body) and heredity (i.e., the passing of genetic traits from parent to offspring) commonly play a role. In addition, many causes of ID arise during pregnancy, childbirth, and childhood.

Genetic Causes

When a child inherits abnormal genes from one or both of their parents, or a gene mutates spontaneously, genetic abnormalities can cause disorders, such as Down syndrome, fragile X syndrome, Williams syndrome, Prader-Willi syndrome, and phenylketonuria (PKU).

Children with Down syndrome, or trisomy 21, have an extra copy of chromosome 21. They have a characteristic appearance that may include a small head, broad or flat face, slanting eyes, and a short nose. They also typically have health issues, including heart problems and vulnerability to infectious diseases, as well as intellectual impairments, which can range across a spectrum but are most often mild to moderate (Couzens, Haynes, & Cuskelly, 2011).

Fragile X syndrome is a disorder resulting from changes to the genetic code on a fragile area of the X chromosome. Both girls and boys can have fragile X syndrome, but because girls have two X chromosomes and the unaffected X chromosome helps mask the affected chromosome, boys usually have more severe symptoms. In this syndrome, the gene that makes a certain protein that the brain requires in order to grow has a defect, which leads to abnormal brain development. The syndrome is characterized by delays in speech or intellectual functioning. Some students with fragile X exhibit characteristic physical attributes, such as a long face with a wide forehead.

Children with Williams syndrome are born without approximately 25 genes. This causes atypical brain development. Unlike some other students with ID, students with Williams syndrome are very social and relate well to other students and adults. They often experience medical difficulties related to the heart and require medical care throughout their lifetime.

In Prader-Willi syndrome, children are born with part of chromosome 15 missing. Babies born with this syndrome often have difficulty eating and gaining weight and experience delays with motor development—for example, sitting, crawling, or walking (Yearwood, McCulloch, Tucker, & Riley, 2011). As toddlers, children with Prader-Willi may experience rapid weight gain. Physical characteristics include almond-shaped eyes, a narrow skull, and small hands and feet. Students with Prader-Willi almost always have delays in intellectual functioning.

PKU is a metabolic genetic disorder in which the child's body lacks the enzyme needed to break down the amino acid phenylalanine. A buildup of this amino acid can lead to brain damage that may affect intellectual functioning. As opposed to Down syndrome, Williams syndrome, and fragile X syndrome, PKU can be treated with a strict diet. Thus, newborns are routinely tested for PKU so that a diet can be started immediately, before damage has occurred.

Prenatal and Perinatal Causes

In addition to its genetic causes, ID can also result from factors, complications, or difficulties during pregnancy or childbirth. For example, excessive alcohol consumption during pregnancy, especially during the first trimester, can result in fetal alcohol spectrum disorder (FASD). One of the most common difficulties associated with FASD is deficits in intellectual functioning. Individuals with FASD often have noticeable physical characteristics, such as a smaller head with atypical facial features such as smaller eyes and thinner lips.

Exposure of a fetus to certain infectious agents can also result in ID. If a mother contracts rubella (also known as the German measles) while pregnant, her child may be born with birth defects, such as hearing or visual impairments. With the advent of the rubella vaccine, the number of babies born with complications due to a mother's rubella has dwindled to near zero in the United States, but babies with unvaccinated mothers, who may come from other countries or have visited other countries, are still at risk. Toxoplasmosis is another disease that can affect a fetus. It is caused by a parasite that can be present in contaminated or undercooked meats. If a mother contracts toxoplasmosis while pregnant, the infection can affect the fetus. Babies may experience deficits related to the brain and neurological system, which can lead to ID. They may also be born with visual impairments.

Complications during labor and delivery can sometimes lead to intellectual disability in a newborn, particularly if the child's brain experiences a lack of oxygen (when, for example, the umbilical cord accidentally wraps around the neck). The incorrect use of medical instruments, such as forceps, may also cause injury to the brain.

Childhood Causes

Infectious agents can also lead to development of ID during childhood, as can exposure to certain toxins. They are now rare, but childhood illnesses like measles, whooping cough (pertussis), polio, meningitis, or chicken pox can contribute to changes to the brain or central nervous system, which in turn can lead to ID. Often, these illnesses cause encephalitis, a swelling of the brain that can damage brain cells or cause bleeding in the brain.

Environmental toxins like mercury (which can be found in fish) or lead (which is sometimes still found in paint in older homes), can also lead to brain damage and ID, particularly if the exposure occurs over a long period of time and the toxins build up in the child's body.

8.5 How Are Students Diagnosed With ID?

As you will remember, students must demonstrate deficiencies in both adaptive ability and intelligence to qualify for special education under the ID category in IDEA 2004—and these deficiencies must adversely affect their academic performance. Schools administer measures of intelligence and adaptive ability to diagnose students with ID.

Each district or school chooses the exact assessment and cut-off scores to consider students for ID. This results in discrepancies from state to state in the classification of students, and state prevalence rates range from 0.4% to 2% (Polloway, Patton, & Nelson, 2011).

Assessing IQ

An intelligence quotient (IQ) test is the primary measure used to diagnose ID. "Intellectual age" or "mental age" are terms used to describe the level at which a student performs on an IQ test. An intelligence quotient (IQ) is determined by comparing "intellectual age" or "mental age" to the student's actual age. A student's IQ score falls somewhere along a normal distribution, or "bell curve," (shown in Figure 8.2) in the general population, with a mean (or average) score of 100 (Simonoff, 2006). As mentioned, most students scoring lower than 70–75 are considered to have ID, though cut-off scores vary, and there are additional criteria (Polloway et al., 2011).

Figure 8.2: The Bell Curve

The shape formed on a line graph of IQ test scores is called a "bell curve" because it looks like a bell. Most students fall in the middle, or average, range. As the bell curves down, fewer students fall into the categories. Typically, students who qualify for difficulties in intellectual functioning score below 70–75 on an IQ test. IQ test scores vary, which is why a range is used for identifying students with ID.

There are many examples of IQ tests. Some of the most common include:

Cognitive Assessment System (CAS)

Kaufman Brief Intelligence Test (K-BIT)

Raven's Progressive Matrices

Reynolds Intellectual Assessment Scales (RIAS)

Stanford-Binet Intelligence Scale

Wechsler Abbreviated Scale of Intelligence (WASI)

Wechsler Adult Intelligence Scale (WAIS)

Wechsler Intelligence Scale for Children (WISC)

Woodcock-Johnson Tests of Cognitive Abilities

Classroom teachers will never have to decide which IQ test to administer to a student. The choice of assessment and the administration of it is the role of a school psychologist or other trained assessment professional.

The use of IQ tests to diagnose any disability has a controversial history (Gallagher, 2008). Some of this is related to test bias, as earlier chapters have discussed. Educators also argue about whether an IQ score really captures a student's intelligence—and to a further degree, what is intelligence? If intelligence is an elusive quality that is hard to define, then how can we administer a test for it? Also, does an IQ score correlate with achievement in the classroom? Researchers have improved existing IQ tests and created new ones, but the questions related to IQ scores (and similar instruments) still remain (Kaufman, Reynolds, Liu, Kaufman, & McGrew, 2012). Until recently, IQ was also used as a determining factor for identifying students with specific learning disabilities (SLD).

Assessing Adaptive Behavior

Adaptive behavior assessment also plays a role in identifying students with ID. Social and behavioral ability is typically assessed with an adaptive behavior scale, instrument, or checklist (for an example, see Figure 8.3). The assessment measures students' use of skills that are conceptual (e.g., literacy, understanding of time, use of money), social (e.g., working with or relating to others), and practical (e.g., care of self, safety, transportation) in the context of everyday life (Polloway et al., 2011). Data from adaptive behavior assessment informs individualized education program (IEP) goals and classroom instruction centered on learning social and life skills.

Three of the most popular ways to assess adaptive behavior include:

Adaptive Behavior Assessment System (ABAS)

Diagnostic Adaptive Behavior Scale (DABS)

Vineland Adaptive Behavior Scales

Adaptive behavior checklists or scales are similar to IQ tests in that they should be chosen and administered by a trained professional who is familiar with adaptive behavior. In many schools, this is a special education teacher or school psychologist.

Figure 8.3: Adaptive Behavior Checklist

These questions are from checklists used to assess adaptive behavior in Tennessee schools. In answering the questions, the teacher compares the student's behavior with that of other students who are the same age.

Assessing Degree of ID

After assessment, some schools may go a step further and describe the degree of ID for a student. This practice is not universally applied, but you may see a descriptor, such as mild, moderate, or severe, in front of the ID label for some students at some schools.

Students with a mild ID typically have an IQ between 50 and 70. These students may struggle with learning in school, but they will probably learn the basics of reading, writing, and mathematics. Many of these students will go on to live on their own and may have a job to support themselves. Students with a moderate ID usually have an IQ ranging from 35 to 50. These students may learn to recognize certain words or phrases. They will need assistance with learning to care for themselves and will likely require lifelong care. Students with a severe ID (IQ between 20 and 35) or a profound ID (IQ below 20) will struggle with speech and communication throughout life. These students will have limited skills in all areas and will require lifelong care and assistance.

When Are Students Diagnosed?

Children can exhibit characteristics of ID at a very young age, particularly if they have a condition with visible characteristics, such as Down syndrome or Williams syndrome. Genetically caused conditions such as these also may be identifiable before birth, and doctors may classify a fetus as having a high risk for ID. Events during and after birth, such as oxygen deprivation, may also cause an ID that can be identified soon after birth.

In young children, an ID may first be detected as the child develops language, social habits, and early academic skills. The majority of students with ID are identified early in their education, once academic learning starts to accelerate. A child will not be officially diagnosed, however, until his IQ and functional ability are measured. For this reason, many children are not officially classified until they enter preschool or elementary school. Prior to the diagnosis, very young students are often categorized as having a developmental delay. Definitions of ID all include the criterion that it be manifested before the ages of 18–22 (Polloway et al., 2011).

8.6 How Does ID Differ Across Grade Levels?

Depending upon the severity of their ID, some students at all grade levels participate in the general classroom for some, if not all, of the school day. Other students with ID spend most of their time in self-contained classrooms or schools.

Instructional services should be based on IEP goals and post-secondary life plans. Students with ID typically receive instruction in adaptive behavior and academics. Students with more severe ID may receive instruction that is less focused on academics and more focused on social and life skills, such as communication and self-care. Such skills include eating and drinking, expressing a physical or emotional need, managing money and household responsibilities, and staying safe in a variety of settings (Aldridge, 2010). Skills related to self-awareness, self-sufficiency, and self-care, however, should be integrated into the education of all students with ID. This section provides an overview of educational programming for students with ID, from early childhood to post-secondary options.

Early Childhood

Part B of IDEA 2004 mandates a free and appropriate public education (FAPE) for all eligible children aged 3–5 years. Young students with ID are eligible to receive early childhood special education services under IDEA. Early childhood services focus heavily on developmental skills, such as language and social interaction. Social skills include cooperation with adults and peers on everyday tasks, appropriately expressing feelings, and self-control (McIntyre, Blacher, & Baker, 2006). Early childhood teachers can explicitly model the appropriate behavior, create structured environments for students to practice the behavior, and provide positive reinforcement when students perform the social behavior appropriately.

Early special education services can prepare students with ID for later future instruction and social interactions (Yoder & Warren, 2002). Part C of IDEA 2004 allots state funding to provide programming for infants and toddlers at risk for ID before the age of 3 (Polloway et al., 2011). Young children who show developmental delays in language, communication of needs (i.e., hunger, comfort), and motor skills may be considered "at risk" (Tomasello, Manning, & Dulmus, 2010). Early special education services often focus on increasing child communication, motor skills, and social skills.

Not all students with ID are classified as such by age 3, however, since ID manifests in different ways and at different times for each individual. As a result, many students who fall into the "at risk" category before the age of 3 years are not identified and thus do not receive services. This situation has created concern for children 3 to 5 years old who are considered "at risk" for, but not yet identified with, ID. Such children may have been eligible for services as an infant or toddler under Part C, but may not be eligible for pre-school special education services under Part B if they have not been officially identified as having an ID.

Elementary School

As mentioned in Chapter 2, schools are increasingly moving toward inclusion of students with disabilities in general education. Over the last decade, this trend has brought many students with ID into the elementary general education classroom, but more are still placed in separate special education classrooms (Polloway et al., 2011). Depending on their individual needs and the support given, some elementary students with ID can be successful in the general education classroom.

Inclusion in general academic content classes can be beneficial for students with ID to ensure they are receiving instruction on grade-level content. In this setting, a special education teacher pushes into the general education classroom with the student to provide academic and behavioral support. Support may include accommodations (i.e., text read aloud, use of a calculator) or modifications (i.e., length of assignment, scribe) for instructional delivery, class assignments, and assessments.

For some students with ID, receiving the majority of instruction in the general education classroom may not be appropriate. A child's specific needs and IEP goals can vary significantly from what is covered by the general education curriculum. In these cases, students may receive most of their instruction in a special education classroom. These classes are typically small and can service multiple grade levels. Special education teachers and teaching assistants work to ensure that all students are making progress toward their academic and adaptive behavior goals as stated in their IEPs.

The most appropriate school placement for elementary students with ID continues to be debated among researchers, policy-makers, administrators, and teachers. However, most agree that some inclusion throughout the school day with general education peers is beneficial for developing social and behavioral skills and preparing students for secondary school and adult interactions. Evidence-based research has shown that while inclusion can be effective for students with severe disabilities in increasing academic, social, and communication skills, further work is needed to improve overall instructional effectiveness for students with ID in the general education setting (Alquraini & Gut, 2012).

Secondary School

Most students with ID will have been identified and will have begun receiving services by the time they enter middle or high school. As at elementary levels, secondary students with ID receive instruction either in the general education class with support, in a separate special education class, or some combination of the two. Curriculum for secondary students with ID will vary depending on their IEP goals and learning environment.

Academic IEP goals for students with ID often include a modified version of state standards. These modified state standards often focus on academic skills critical for independent living, such as word recognition, reading and listening comprehension, addition and subtraction, understanding time, and using money. Additionally, students with ID often have behavior goals and social skills built into their curriculum. Adaptive behavior instruction should be explicitly connected to independent living and outside interests to keep secondary students engaged in learning social skills.

Behavior and social skill instruction should be aimed at empowering students to pursue a variety of post-secondary options. This is often referred to as self-determination, or the ability to make decisions and set goals. High self-determination is associated with higher quality of life for individuals with ID, and self-determination can increase through supportive environments that promote choice (Nota, Ferrari, Soresi, & Wehmeyer, 2007).

Teaching self-determination to students with ID is especially important in middle and high school. After graduation, it is less likely that students will have the opportunity to practice decision-making and receive feedback in safe, supportive environments. Facilitating student self-determination while students are receiving school services may improve their quality of life post-graduation.

Goals, curriculum, and instruction for students with ID are highly tailored to each individual's strengths, interests, and needs. Since instruction can differ drastically from the general education curriculum, it is important to consider where students with ID receive instruction. Secondary placement decisions are based on several factors, including severity of disability, school and district inclusion policies, and post-secondary plans.

Transition

Transition goals and post-secondary school plans are critical for secondary students with ID and are included in the IEP to ensure that students are prepared for their next stage of life. For students with ID, post-secondary school options can range from continuing their education at a community college or university, entering the work force, moving to a residential home, or a combination. This decision is made by the IEP team and should include input from the student, family members, teachers, administrators, and any other health or service providers. Within all of these options, skills in communication and self-care are vital for success.

Post-secondary opportunities are influenced by a student's education, which is often measured by a high school diploma. There is a great deal of controversy regarding the awarding of high school diplomas to students with ID (see the feature box titled "The High School Diploma Debate" for a discussion of this). Students receiving instruction in secondary special education classrooms may not take all classes typically required for high school graduation. As a result, states have differing policies on whether or not completion of a modified high school curriculum warrants a traditional high school diploma. Some states choose to provide an alternative certificate, while other states make course allowances for students with ID and award them the traditional diploma. This issue continues to be debated, particularly since it is linked to the topics of school accountability and school performance.

Some students with ID take advantage of an option called Comprehensive Transition and Postsecondary Programs (CTPS), in which they take classes at the college or vocational school level (Kleinert, Jones, Sheppard-Jones, Harp, & Harrison, 2012). Students may take these classes while they are still in high school or after graduating or completing high school.

Special grants and work-study monies are available for students with ID to take classes that will help them in a future career. For example, a student with an interest in working at a print shop might take graphic design classes at a community college (Kleinert et al., 2012). Students may take the college or vocational courses for credit, or they may audit the courses. To help students with ID gain access to coursework, colleges and schools sometimes have different entrance requirements (e.g., not requiring a graduation diploma and not requiring the student to take a college entrance exam). Some students graduate with a college degree, while many others take only a few classes to help them with a career.

8.7 How Do I Teach Students With ID?

As you have seen, students with ID vary tremendously in their strengths and abilities. The optimal classroom placement also varies from student to student. In the era of inclusion, some students participate in the general classroom, so teachers must use appropriate teaching strategies in reading, writing, mathematics, and the content areas, while emphasizing social skills.

Classroom Settings

As you learned in Chapter 1, a student's least restrictive environment must be considered when the IEP team determines the student's school placement. Since the reauthorization of IDEA in 1997, all students have been required to have meaningful access to the general curriculum (Cooper-Duffy, Szedia, & Hyer, 2010). The IEP team needs to place students in settings that allow the most access to the curriculum of the school or district.

When students spend most or all of their day in the general classroom, they may have a special education teacher who comes into the general classroom to provide extra support. The general and special education teachers work together to develop appropriate modifications for the student with ID. Other students spend time in a resource room receiving individualized or small-group instruction in reading or math, as well as time in the general classroom for instruction related to science, art, music, or physical education (Bouck, 2011).

Students with moderate or severe ID may be placed in one of two settings. The first is a self-contained classroom where the teacher concentrates on adaptive behavior skills and academic skills that are appropriate for the student. The student might participate in extracurricular activities with peers without disabilities (i.e., recess, art, field trips), but most of the student's time is spent in a classroom devoted to the education of students with severe disabilities.

The second setting is a specialized school operated by the school district or a private school for students with disabilities that the district chooses for the student. At these schools, the staff members are highly trained to provide appropriate training and services to students with severe disabilities. Fewer than 20% of students with ID are placed in self-contained classrooms or specialized schools. If the district makes the decision to place a student in a setting other than the student's local school, the cost is covered by the district.

Teaching Academic Skills

Many of the accommodations and modifications discussed in Chapter 2 are appropriate for teaching academic skills, such as reading, writing, and mathematics, to students with ID, but it is important for teachers to receive appropriate training in designing this instruction (Lee, Soukup, Little, & Wehmeyer, 2008). In the general classroom or resource room, students with ID may benefit from working in small groups or in pairs (Carter, Sisco, Chung, & Stanton-Chapman, 2010). When pairing a student with ID and a typical student, the teacher needs to ensure proper training and appropriate activities for the pair; the teacher must train the students to work together in a positive way and to provide appropriate feedback.

Students with ID may benefit from extended time to take tests or complete assignments. Additionally, these students may need assignments or assessments broken into smaller sections. The IEP team makes many of these decisions, but the general and special education teachers may recognize a further need to break instruction into smaller segments.

Reading

Until recently, many students with ID did not receive reading and literacy instruction (Allor, Champlin, Gifford, & Mathes, 2010). Many people thought that these students could not learn to read, but recent evidence supports the idea that many students with ID can and should learn basic reading skills (Lemons, Mrachko, Kostewicz, & Paterra, 2012). Even students with severe ID can potentially identify letters and read sight words (Agran, 2011). Reading and literacy skills not only improve the academic outcomes of students with ID but also can improve their social skills by enabling the student with ID to be more of a participant in the classroom and with peers (Forts & Luckasson, 2011).

Some suggestions for reading instruction include the following:

Teach print concepts (Allor, Mathes, Roberts, Cheatham, & Champlin, 2010). Teach students where to find the title and author of a book and how to read a book by turning the pages one by one.

Teach phonological awareness and phonics (Lemons et al., 2012). Students should learn letter names and letter sounds. They should also practice blending sounds into words.

Teach decoding skills (Lemons et al., 2012). Students should learn how to "sound out" a word. For example, "cat" can be broken into three sounds: /c/ /a/ /t/. By decoding, students use their phonics skills to read a word.

Teach sight words (Allor, Champlin, et al., 2010). Students should learn important words that they recognize when they see them. Sight words include high-frequency words that are difficult to "sound out" using phonics skills (e.g., "the," "about," and "and"). Students can practice sight words via flash cards, games, reading, or puzzles (Allor, Mathes, Jones, Champlin, & Cheatham, 2010; Ruwe, McLaughlin, Derby, & Johnson, 2011).

Conduct read-alouds (Knight, Browder, Agnello, & Lee, 2010). The teacher and student can read together or the teacher can read aloud while the student follows along. The teacher pauses frequently during the reading to ask comprehension or prediction questions.

Teach vocabulary (Allor, Mathes, Roberts, et al., 2010). Explicit instruction in vocabulary, where teachers teach vocabulary words and their meaning (e.g., "This word is allow. Allow means to let someone do something.") is important. Providing cards with pictures that go along with key vocabulary words (as shown in Figure 8.4) is a very helpful strategy for students with ID (Cooper-Duffy et al., 2010).

Figure 8.4: Vocabulary Picture Cards

To help students understand vocabulary, teachers can create cards with pictures to represent specific words. Students can use the picture cards to understand the word, write the word, or communicate the idea.

Focus on comprehension (Evmenova, Behrmann, Mastropieri, Baker, & Graff, 2011). Teachers can help students understand the main concepts in a text by highlighting important words or phrases and using pictures to accompany the text. Teachers can conduct read-alouds and sprinkle comprehension questions throughout the reading.

Use graphic organizers (Morgan, Moni, & Jobling, 2006). Graphic organizers (i.e., visuals that help organize information) help students organize the main idea of a story, remember vocabulary, or understand other types of information.

Use technology (Machalicek et al., 2010). Augmentative and alternative communication (AAC) devices can be used to read text to students, allow students to respond to questions, or help students understand and use vocabulary (Ruppar, Dymond, & Gaffney, 2011). These devices—for example, an electronic reader—can highlight sentences or words for students or provide illustrations of stories or concepts.

Read, read, read (Schnorr, 2011). Teachers should read as much as possible with their students, especially students with ID. Many students like knowing a story and reading it again and again, and they can begin making connections with the known story and the printed text. Teachers can also echo read with students. In echo reading, the teacher reads a phrase or sentence and then the student reads the same phrase or sentence.

Instruction on reading and literacy should be intensive and explicit (Taylor, Ahlgrim-Delzell, & Flowers, 2010). That is, teachers model and demonstrate activities and skills and provide students with multiple practice opportunities. Students need daily, intensive teaching sessions that occur over an entire school year or several school years (Allor, Champlin, et al., 2010). Instructional sessions should last 30–60 minutes. They should be fast-paced and include brief activities that are repeated each day (Allor, Mathes, et al., 2010). Student progress must be monitored so that instruction is provided at the appropriate level, and teachers should use progress monitoring data to determine whether current instruction is adequate. Teachers should explicitly connect instruction with the student's vocabulary and speech (i.e., teach using words the student knows and understands). Teachers should use a motivational system, such as a token economy, to keep students engaged and on task (Allor, Champlin, et al., 2010).

Coyne, Pisha, Dalton, Zeph, and Smith (2010) suggest incorporating the principles of Universal Design for Learning (UDL) into reading instruction. For example, students with ID can use multiple representations by having text highlighted, having hyperlinks embedded within text, and having illustrations that accompany written text. Multiple modes of action and expression can be provided through the use of prompts, questions, and think-alouds, as well as by allowing students to use different response options (e.g., multiple choice, open ended, true or false). Teachers can employ multiple modes of engagement by using popular books or by having students listen to recordings of text.

Writing

Many students with ID can learn to write. Writing has two major aspects: (1) the action of writing letters to make words and (2) the putting together of ideas into sentences and paragraphs.

Some students with ID, especially severe ID, may not possess the fine motor skills required to grasp a marker or pen in a way that allows them to form letters on paper. AAC devices can help these students communicate. Speech-to-text applications and software are readily available, and students can speak while a technology translates their speech into a written form. Other students can learn to write letters with practice. Using a variety of mediums (e.g., sand and rice), students can learn the action of writing the letter "p" or the word "car."

Strategy instruction has emerged as one of the better approaches for teaching students with ID how to put ideas together into sentences and paragraphs (Joseph & Konrad, 2009). Teachers provide explicit instruction on a specific writing strategy and allow ample practice opportunities for students to apply the formula. One example is POW: Pick my idea, Organize my notes, Write and say more (Sandmel et al., 2009). Figure 8.5 illustrates some of these writing strategies. If students struggle with the physical action of writing as they use any of the strategies, they may use scribes (i.e., a teacher or adult who does the writing for the student) or the speech-to-text applications mentioned above.

Figure 8.5: Writing Strategies

These two posters highlight common writing strategies for students. When teaching students with ID, it can be helpful to further simplify the strategies and provide picture prompts for each step.

Mathematics

Teaching mathematics to students with ID can involve many of the teaching strategies employed for students with LD. Students should learn to recognize numbers and understand what they represent. Students can use the concrete-representational-abstract sequence to learn many different mathematics concepts. By using manipulatives at the concrete stage, students have the opportunity to understand how math works both conceptually and in practical terms.

One popular method for helping students understand the concept of small amounts is TouchMath (Fletcher, Boon, & Cihak, 2010), shown in Figure 8.6. Each number is "drawn" with the appropriate number of dots on the printed number to show the students the quantity. For example, "3" has 3 dots; the student can count and touch "1, 2, 3" dots to understand what "3" represents.

Figure 8.6: TouchMath Numbers

In TouchMath, dots represent the quantity indicated by each written numeral. Students use these aids to understand quantity and to add and subtract single-digit amounts.

Students can also use TouchMath to learn the steps in solving addition, subtraction, multiplication, and division problems. Solving specific problem types can be taught by using task analysis, which describes each step necessary for solving a problem. (See Figure 8.7 for an addition example.)

Figure 8.7: Task Analysis of Addition without Regrouping

This task analysis breaks a double-digit plus double-digit problem (without regrouping) into manageable steps. By breaking down and teaching each step, students can learn to successfully solve this type of problem.

Pegword mnemonics have proven to help students memorize answers to basic facts, such as math tables (Zisimopoulos, 2010). In using pegwords for math, students first use rhymes that are similar to numbers; for example, 6 times 7 is "six sticks and seven heaven." Then, the students create a picture that puts sticks and heaven with the rhyming answer, "forty-two warty-shoe." The student might draw sticks in a warty shoe in heaven. It may sound complicated, but students who are familiar with pegwords find it very easy to use this system to remember facts.

Many students with ID need explicit instruction on identifying and using money, as well as on telling and managing time. It is best to let students practice with real money or manipulative coins. They should also practice using money in real-life situations (e.g., grocery shopping, eating at a restaurant).

Time management can be learned using tools—for example, an elapsed time calculator or a vibrating watch (Green, Hughes, & Ryan, 2011). To use an elapsed time calculator, the student types in two dates or times, and the calculator computes the time between the two events. A vibrating watch can keep students on task by vibrating at set intervals to remind students to complete a task or pay attention.

To solve word problems in math, students should use cognitive strategies (Chung & Tam, 2005). Cognitive strategies help students break down an otherwise overwhelming task into manageable parts. For example, students might use the following strategy when solving a word problem:

Read the problem.

Find key words.

Draw a picture.

Write an equation and compute.

Check your work.

See Figure 8.8 for an example of student work that uses this cognitive strategy.

Figure 8.8: Solving a Word Problem Using Cognitive Strategies

A student used the strategy Read, Find key words, Draw a picture, Write an equation and compute, and Check your work to solve this word problem.

Just as when they are learning to read and write, students learning math can use AAC to understand mathematical concepts and solve problems (Knight et al., 2010). They may use AAC to practice basic facts or computation problems or to learn to manage money.

Content Areas

Many of the strategies discussed here to teach reading, writing, and math are also helpful in teaching students with ID in the content areas, such as science and history. For example, it is important to highlight important vocabulary and allow students to practice concepts with hands-on materials.

One approach commonly used for science instruction in the general classroom—the use of inquiry-based activities, in which students explore topics with teacher facilitation—is not typically the most effective teaching strategy for students with ID (Stavroussi, Paplexopouloes, & Vavougios, 2010), who require explicit instruction and hands-on modeling. For example, when learning about the life cycle of plants, a teacher should model with videos or hands-on materials how a seed turns into a plant. The teacher explains what happens to the seed by explaining each stage of the plant's life cycle. Students should have opportunities to plant seeds, document the life cycle of the plant, and engage in discussion with the teacher and class.

Peer tutoring may also be useful in the content areas. Jimenez, Browder, Spooner, and Dibiase (2012) put students with ID in pairs with general education students. The pairs learned how to use the KWHL strategy to work through problems:

K: What do you know?

W: What do you want to know?

H: How will you find out?

L: What did you learn?

For example, when learning about Pearl Harbor, the pair might say:

K: We know that Pearl Harbor is in Hawaii. We know that Japanese bombed Pearl Harbor.

W: We want to know why Pearl Harbor was bombed. We want to know about the damage of the bombing. We want to know when this happened.

H: We will read our history book section about Pearl Harbor. We will research Pearl Harbor online. We will look at newspaper articles from the time of the bombing.

L: We learned that Pearl Harbor was bombed in 1941. The Japanese bombed Pearl Harbor because the United States had sided with China (and China and Japan were at war). At least 18 ships sank and over 2300 people died.

The KWHL strategy is helpful because it can be applied across subject areas and across grade levels.

Teaching Adaptive Skills

Instruction to help improve adaptive skills is crucial for students with ID to function as members of society (Bouck, 2010). The IEP team will decide which adaptive behaviors should be included in the student's instructional program. Adaptive skills may be taught alone or in conjunction with conceptual (academic) skills (Miller, 2012).

Social Skills

Teachers should provide instruction on communication, such as engaging in a conversation, taking turns when talking, and interacting in social situations (Boden, Ennis, & Jolivette, 2012; Solish, Perry, & Minnes, 2010). Students with ID may participate in lunch or some classes with general classroom students, but neither the general education students nor students with ID may always understand how to engage in appropriate conversations. Students without disabilities are sometimes afraid to talk to students with ID or unsure of how to respond to students who have different speech patterns (Hughes et al., 2011). Teachers can help bridge the gap between these groups of students with meaningful instruction and practice.

It can be helpful to teach students with ID how to solve problems that arise with friends, at work, or at home (Cote et al., 2010). A general problem-solving approach may be the most helpful, because students can use it in a variety of situations. The following example shows how a general approach can help students think through their choices when presented with a challenging situation:

What's the problem?

How can you fix it?

Why would it work?

Life Skills

Teachers may need to teach students how to take care of their personal needs (Bouck & Flanagan, 2010). They may guide students in practicing how to pick out clothes and get dressed. They may teach students how to brush their teeth, take a shower, or go to the bathroom. If preparing to live on their own, students may need to learn how to shop for groceries, do their laundry, and cook simple meals. Some students need to learn how to navigate a bus system in the city where they will live. Many of the skills that other students pick up indirectly by observing adults need to be explicitly taught to students with ID.

Task analysis, which was introduced in the discussion of teaching math, is a good way to teach many life skills. Figure 8.9 illustrates a task analysis related to brushing teeth.

Figure 8.9: Brushing Teeth Task Analysis

In task analysis, each part of a process is described as a separate step. A student who learns all the steps in the process—here, brushing teeth—will learn to be successful at the task!

Another way to teach life skills is through video modeling (Hammond, Whatley, Ayres, & Gast, 2010). With video modeling, a student watches a video instructing how to do something. By watching the visual presentation multiple times, the student learns how to do a task. This method has proven successful for teaching students with ID how to cook a meal and get around the community via bus (Mechling & O'Brien, 2010; Stock, Davies, Wehmeyer, & Lachapelle, 2011; Taber-Doughty et al., 2011).

Task analysis and video modeling might be used to teach students and adults with ID to perform tasks, such as watering a plant, delivering the mail, or changing paper towels (Mechling & Ortega-Hurndon, 2007). Checklists generated from a task analysis can provide reminders of how to do tasks, such as preparing food. It is often helpful for these checklists to be accompanied by pictures showing each step (Lancioni & O'Reilly, 2002; Minarovic & Bambara, 2007).

Students with ID also need to receive training on safety skills (Agran, Krupp, Spooner, & Zakas, 2012), which can be provided via explicit instruction or, when feasible, with video modeling. Students should learn how to change batteries in a smoke detector and what to do in case of a fire or crime. Working adults with ID must be trained on appropriate work safety skills (e.g., not walking through an area with a "wet floor" sign).

People with ID should also receive education on relationships that could involve sex. They are at greater risk of sexual abuse (Swango-Wilson, 2011), and appropriate education and training can decrease this risk. For example, teachers may teach students about inappropriate touching and what to do when someone makes you feel uncomfortable.

Students and adults with ID also need to learn of the dangers of drug and alcohol abuse and how to avoid improper use of medication (Agran et al., 2012). While many safety topics may be more useful for adults, students should also receive training and education at appropriate times during their school career. This is especially important with teenage students, who may be influenced by the actions of their peers.

References

Powell, S. R., & Driver, M. K. (2013). Working with exceptional students: An introduction to special education [Electronic version]. Retrieved from https://content.ashford.edu/