Module 3
Disorders of Learning and Intellectual Functioning
a. Developmental Tasks and Challenges Related to Intelligence and Cognition
“A child’s IQ is more closely related to the child’s later occupational success
than is the socioeconomic status of the family within which the child grows up, the
family’s income, the school the child attends, or any other variable that has been
studied” (Siegler, 2003, p. 314). The empirical data underscore the need to understand
the complex construct of intelligence and its contribution to typical and atypical
development across cultures and in a variety of settings. Given the many
controversies surrounding the nature and assessment of intelligence, the following
summaries are necessarily brief. They are organized around several key issues: (1)
What are the underlying components and mechanisms of intelligence? (2) How does
cognitive and intellectual development unfold over time? (3) What are the roles of
genes, brain structure and function, and the environment in the development of
intelligence?
The most basic question involves the nature of intelligence. Our working
definition of intelligence is provided by Gottfredson (1997, p. 13): “[Intelligence] . . .
involves the ability to reason, plan, solve problems, think abstractly, comprehend
complex ideas, learn quickly and learn from experience. It is not merely book
learning, a narrow academic skill, or test-taking smarts. Rather it reflects a broader
and deeper capability for comprehending our surroundings—‘catching on,’ ‘making
sense’ of things, or ‘figuring out’ what to do.” Hypotheses about the components of
intelligence range from a single, unitary competence that influences almost all that we
do (and that each child or adult possesses to a greater or lesser degree), to unique
collections of particular talents and skills that exhibit little overlap, to hierarchically
organized sets of both general and specific abilities.
Most researchers agree that intelligence involves the performance of basic
mental tasks, including perception of the environment, communication and language,
and higher-level tasks such as reasoning, problem solving, and planning. Although
traditional models emphasize the components or capacities of intelligence that are
related to academic, educational, and occupational outcomes (i.e., verbal and
mathematical abilities), various descriptions of intelligence also differentiate between
fluid intelligence (i.e., the ability to reason and solve problems in new situations) and
crystallized intelligence (i.e., the skills and knowledge acquired through education
and experience); include capacities for music, art, mechanics, and relationships,
and/or emphasize the constructs of practical intelligence and creativity (Sternberg,
2006). In addition, mechanisms such as speed (or efficiency) of mental processing and
working memory must be accounted for in models of intellectual functioning (Nisbett
et al., 2012). Motivational aspects such as achievement mindsets, curiosity, and effort
must also be understood.
To understand the particular pathways displayed by children with intellectual
developmental disorder and the ways in which learning is accomplished for typically
developing children and compromised for children with learning disorders, we must
examine both cognitive development, or general age-related trends, and intellectual
development, or individual differences observed across children at all ages. With
respect to cognitive development, we need to take into account the components and
processes of cognition (e.g., perception, attention, memory, concept formation, and
mental rules and representations).
Current models of cognition emphasize evolutionary contexts, experience–
expectant learning (an example of a brain–behavior relation), and both qualitative and
quantitative change across development (Newcombe, 2011; Pennington, 2015). In
general, it is well accepted that there is steady, linear progress in cognitive
achievements, with occasional reorganizations, or qualitatively distinct
“developmental leaps.” For example, children learn and remember more information
as they age, but they also become faster and more efficient at manipulating that
information; the pace of progress is greater through the preschool and elementary
school years and slows somewhat during adolescence.
With respect to intellectual development, there is a general emergence of
intellectual functioning, as well as specific patterns of strengths and weaknesses in
both components and mechanisms, reflected in individual differences in various
intellectual domains (Bjorklund, 2013). Components and mechanisms include factors
such as reasoning, complex problem solving, and speed of processing and learning.
Patterns of individual differences (e.g., some children displaying higher levels of
intelligence and other children displaying lower levels) appear relatively stable from
four or five years of age through adulthood, with growth, change, and decline
observed throughout the lifespan (Deary, 2014). One especially important outcome
related to cognitive and intellectual development is academic achievement. A recent
developmental cascade model of cognitive functioning identified a number of early
emerging cognitive abilities as the “building blocks” for later school achievement. In
this model, various child, parent, and environmental factors influenced the cascading
effects, and these types of factors are discussed in more detail in the following
section.
There is overwhelming evidence that both heredity and the environment
contribute to children’s cognitive and intellectual development. Data from numerous
twin, family, and adoption studies establish that genes influence about 50% of the
variation in intelligence. These genetic effects on intelligence increase with age. With
gene–environment transactions, “as children select and evoke experiences in line with
their genetic predispositions, and as these experiences, in turn, stimulate their
cognitive development, early genetic influences on cognition will become amplified”
Much of the genetic influence on intelligence is associated with brain structure
and function. Multiple brain regions (including the prefrontal cortex) are involved.
Synapse production and synaptic pruning (interacting with environments) and
myelination link brain development with cognitive development (Pennington, 2015).
Connectivity among brain regions is also linked to intelligence and becomes fine-
tuned over development. Differences in the dopamine system have been hypothesized
to underlie the tendency to be imaginative, curious, and intellectual (DeYoung et al.,
2011). The child’s immediate and larger environments also have considerable impact.
Prenatal and postnatal environments are very important. Maternal drug or alcohol use
or exposure to toxins negatively affects intelligence. Parental factors such as
education, interest in academics, and beliefs about children’s intelligence have all
been associated with more positive intellectual outcomes (Nisbett et al., 2012). Many
researchers have described within-family, nonshared effects on children’s intelligence
related to siblings’ differing expectations, roles, and birth order.
As noted in the previous section on genetic influence, the most frequently
mentioned factor in the larger environmental milieu is poverty, with damaging effects
on intellectual development and academic achievement. According to Siegler (2003,
p. 316), “poverty exerts its negative effects on intellectual development through
several mechanisms: inadequate diet, lack of timely access to health services, parental
preoccupation with other problems, and insufficient intellectual stimulation and
support in the home.” In contrast, excellent home and educational environments
provide a foundation for intellectual and academic success. The home environments
of very young children, for example, might include exposure to rich vocabularies, and
early school experiences might involve high-quality kindergarten and first grade
teaching. Interventions involving early enrichment promote typical development by
preventing adverse impacts on cognitive ability and other characteristics. How our
society addresses these kinds of inequalities and provides (or fails to provide)
effective interventions are ethical issues with far-reaching consequences.
Learning, of course, depends on intellectual and cognitive development. With
respect to academic tasks, there are a myriad of learning-related capacities and skills,
each with its own maturational and practice timeline. The development of self-
regulation is critical. These capacities and skills underlie children’s expected mastery
and progress in early school skills, such as reading and mathematics, with individual
variations in the timing and nature of children’s learning. In addition, there are well-
documented changes in the ways in which children appraise their cognitive and
academic abilities, with impacts on motivation, persistence, and later academic
achievement.
The sociocultural context of academic pathways, with an emphasis on cultural
values related to education and achievement, must be considered. For instance, studies
of immigrant families and American Indian and Alaska Native youth illustrate the
ways in which parents and communities, as well as factors such as SES and access to
quality educational practices, influence children’s academic outcomes. Across all
cultures and backgrounds, children’s learning occurs in the context of transactions
among individuals (children, parents, teachers), settings (home, school, child care),
and institutions (communities, schools, governments). One last point about
environmental factors, in the context of culture and global awareness: Our
understanding of children’s intelligence across countries and continents requires
consideration of the “Flynn effect,” the gradual increase in IQ scores over many
decades (Flynn, 1987, 2007). With data on IQ trends in 30 nations, researchers
suggest that the Industrial Revolution (and the modernization that followed) combined
with a need for more advanced skills led to higher levels of intelligence in many
countries. In addition, better nutrition, better health, and better schooling continues to
contribute to large-scale gains in intelligence.
b. Intellectual Developmental Disorder
Intellectual developmental disorder (also known as intellectual disability)
involves deficits in intellectual functioning and deficits in adaptive behavior, both of
which emerge early in development (American Association on Mental Retardation
(AAMR)/American Association on Intellectual and Developmental Disabilities
(AAIDD), 2002; American Psychiatric Association, DSM-5, 2013). Deficits in
intellectual functioning are evaluated with respect to the range and distribution of
intelligence (IQ) scores in typically developing individuals. One of the most important
distinctions related to the clinical presentation of intellectual developmental disorder
is level of severity. Mild, moderate, severe, and profound levels of severity indicate
the degree of impairment in adaptive functioning. According to the American
Association on Intellectual and Developmental Disabilities (AAIDD) and DSM-5,
adaptive functioning refers to how well an individual negotiates everyday tasks and
challenges in conceptual, social, and practical domains. Some children with poor
adaptive functioning exhibit significant problems with basic activities of daily living,
such as getting dressed and maintaining hygiene; others do well with basic tasks but
struggle with more complex activities, such as performing household chores or
managing finances.
Although both the DSM-5 and AAIDD conceptualizations of intellectual
developmental disorder recognize the interdependent nature of intellectual and
adaptive functioning, as well as multiple etiologies and outcomes, the AAIDD
emphasizes a more holistic perspective. In this view, intellectual developmental
disorder is not a physical or mental disorder, but rather a developmental disability that
involves significant limitations, both in intellectual functioning and in adaptive
behavior leading to impaired conceptual, social, and practical skills. Each area of
dysfunction includes a corresponding description of the support necessary for
maximizing the individual’s well-being: intermittent, limited, extensive, or pervasive
support. Rather than emphasizing the degree of deficit, the AAIDD emphasizes the
possibility of adaptation. Indeed, the AAIDD model describes several domains of
functioning that should be considered in addition to intellectual and adaptive domains;
these include health, participation, and context (Schalock, 2011). Whether the
definition of intellectual developmental disorder emphasizes deficits or supports, it is
important to acknowledge the impact that the actual name of a disorder or a disability
has on individuals who are diagnosed, on family members, and on society.
Taking into account various definitions of intellectual developmental disorder
and the difficulties associated with accurate calculations, epidemiological estimates of
the prevalence of intellectual developmental disorder range between 1% and 2% of
the population. Most individuals (85%) with intellectual developmental disorder are
diagnosed with mild levels of severity, requiring intermittent support (as described
here in the case of Katherine). Approximately 10% are diagnosed with moderate
levels, requiring limited support; 3% to 4% with severe levels, requiring extensive
support; and 1% to 2% with profound levels, requiring pervasive support. Intellectual
developmental disorder is observed much more frequently in boys.
Several of the most important and affirming proposals about children with
intellectual developmental disorder were put forth by Edward Zigler (1969, 1971),
who described two groups. The first group included individuals with mild forms of
intellectual disability, reflecting the low end of the normal distribution of intelligence
in the general population. Because this type of intellectual disability appeared to run
in families, it was (and still is) often called familial intellectual developmental
disorder. The second group included individuals with more severe forms of
intellectual disability, usually the result of pathological processes such as genetic
disorders.
Zigler’s developmental approach asserted that the majority of children with
intellectual developmental disorder (i.e., children with mild forms of disability)
display developmental pathways that are similar to children without intellectual
developmental disorder. Although delayed in their mastery of most motor, cognitive,
emotional, and social tasks, and stopping short of the eventual achievements of their
typically developing peers, children with intellectual developmental disorder exhibit
the same kinds of sequences and coherent growth that are characteristic of most
children. That is, children with intellectual developmental disorder develop slowly,
but in organized ways. Broadening his concern beyond deficits and dysfunctions,
Zigler also emphasized a holistic perspective, the critical need to understand patterns
of strengths and weaknesses, and the motivations and personalities of children with
intellectual developmental disorder.
A number of models have focused on identifying and understanding children
with intellectual developmental disorder by grouping them according to etiology, with
much attention focused on various genotypes—the underlying genetic causes—
associated with intellectual developmental disorder. These genetic syndromes are
medical diagnoses rather than psychiatric or psychological categories; the genotype
assumption is that different etiological explanations correspond to differences in
specific dysfunction and disability and differences in the course of intellectual
developmental disorder. Hundreds of individual genetic variants (e.g., mutations,
duplications, deletions) and major chromosome abnormalities are linked with specific
forms of intellectual developmental disorder. Most individuals with these identifiable
genetic etiologies display more severe forms of disorder.
The related construct of behavioral phenotypes emphasizes the likelihood that
a child will display a particular pattern of difficulties given a particular genetic
etiology. In other words, most children—but not all children—with a particular
genetic background will display similarities related to physical characteristics,
cognitive and linguistic profiles, perceptual skills and deficits, socioemotional
patterns, and overall outcomes (Hodapp & Dykens, 2005). Genotype-phenotype
research goals include the descriptions of both general and specific patterns of deficits
and dysfunction (Pennington, 2015). One example of a distinctive behavioral
phenotype is the extreme eating behaviors observed in individuals with Prader-Willi
syndrome (and not in other individuals with other genetically influenced disorders).
Another example of a behavioral phenotype involves the more commonly noted
patterns of cognitive deficits, emotion regulation difficulties, and impulsivity in
children with many different genetic etiologies.
Three brief descriptions of genetic syndromes illustrate this genotype-
phenotype classification approach to intellectual developmental disorder. Down
syndrome, caused by an extra chromosome 21 (i.e., trisomy 21), is among the most
widely known genetically influenced forms of intellectual developmental disorder.
The vast majority of cases of Down syndrome are nonfamilial—that is, Down
syndrome does not run in families (Pennington, 2015). “The genetic etiology of Down
syndrome involves a whole extra chromosome (and an extra dose of the gene products
of all its genes), so tracing the developmental pathways from genotype to phenotype
is much more difficult in Down syndrome than in fragile X syndrome or Williams
syndrome”
As with many forms of intellectual developmental disorder, there are
accompanying physical characteristics, including microcephaly, distinctive facial
features, heart problems, and poor muscle tone. Intellectual challenges almost always
involve language difficulties, with expressive speech more problematic than receptive
speech (Abbeduto, Warren, & Conners, 2007). Visual short-term memory is often a
relative strength. In contrast to many other genetic etiologies, there is a wide range of
intellectual disability (Pennington, 2015). With respect to personality and
psychopathology, parents often report that their children with Down syndrome are
happy and outgoing; indeed, Down syndrome is sometimes referred to as “Prince
Charming” syndrome (Dykens, 2000). Compared to others with intellectual
developmental disorder, children with Down syndrome display relatively few
maladaptive behaviors during childhood, although both internalizing and
externalizing symptoms occur in some children.
Williams syndrome, caused by a microdeletion on chromosome 7, is
associated with its own distinctive pattern of intellectual developmental disorder
(Mervis & John, 2010; Pennington, 2015). Williams syndrome has a lower prevalence
than Down syndrome or fragile X syndrome. Similar to Down syndrome (and distinct
from fragile X syndrome), Williams syndrome does not run in families (Pennington,
2015). Compared to fragile X syndrome, where one gene product is affected, multiple
gene products are affected in Williams syndrome, which again is similar to Down
syndrome.
Williams syndrome is characterized by deficits in general cognitive function
and visual–spatial skills and relative strengths in language and music domains,
although these relative strengths are still below agetypical performance (Mervis &
Becerra, 2007; Pennington, 2015). Even though the language of children with
Williams syndrome is less impaired compared to children with other types of
intellectual developmental disorder, many studies provide data suggesting that there
are specific language difficulties that have an impact on reading and require
educational interventions (Mervis & John, 2010). Children with Williams syndrome
exhibit “sparkling dispositions” and “a remarkable and contagious zest for life”
(Dykens, 2006, p. 190). That said, social disinhibition is a frequent concern for
children with Williams syndrome, who “crave attention and interaction” and who
frequently display overly friendly and talkative behaviors (p. 190). Children with
Williams syndrome usually demonstrate a special facility for facial and emotion
recognition and are known for their displays of empathy. The most common
symptoms of psychopathology include numerous fears and anxieties.
Individuals with Williams syndrome are more engaged and accomplished than
individuals with other forms of intellectual developmental disability, and similar in
many ways to typically developing individuals (Bhatara, Quintin, & Levitin, 2012).
Many individuals with Williams syndrome display a particular affinity for music.
Levitin et al. (2004, p. 238) provide this example of the experience of music: “As the
parent of a WS child reported, her daughter began weeping after a couple of notes
were played at a Mozart concert. The girl’s reaction was so strong that she left the
concert and after returning, once again burst into tears. After hearing a more uplifting
Mozart song some months later, she explained to her mother, ‘there are two kinds of
Mozart: the kind that hurts and the kind that does not hurt.’”
Fragile X syndrome, caused by atypical gene expression on the FMR1 gene, is
the most common type of inherited intellectual developmental disorder in boys,
affecting 1 in 4,000 boys and 1 in 8,000 girls; it is seen in all racial and ethnic groups.
Fragile X syndrome has “the simplest genetic etiology . . . because it is a single gene
disorder,” in which one gene becomes inactivated via methylation; “nonetheless, it
has a complex behavioral phenotype, illustrating once again that the developmental
pathways from etiology to cognition and behavior are complicated.” Fragile X
syndrome is an “epigenetic disorder because it results from abnormal gene expression
rather than a mutation” (Pennington, 2015, p. 1031). Boys, who have only a single
fragile X gene, are likely to be more severely affected and are more frequently
diagnosed with moderate intellectual developmental disorder. Girls usually are
diagnosed with mild intellectual developmental disorder. There are fewer physical
characteristics of fragile X syndrome, although some babies do have large head
circumferences, somewhat unusual facial features, and loose joints. Speech and
communication difficulties underlie the fragile X cognitive profile.
Psychopathological symptoms associated with fragile X syndrome range from
social difficulties to autism; boys are more likely to experience severe behavioral
problems such as high activity, poor attention, and low adaptability. With 20 years of
research following the identification of the FMR1 gene, fragile X syndrome is the
“best understood” genetic syndrome associated with intellectual disability.
Researchers describe several benefits to an approach emphasizing genetic
etiology. The most important of these benefits is the potential for prevention and early
diagnosis. Taking into account different patterns of strengths and weaknesses,
treatments might be able to be more effectively specialized. Others note the
drawbacks to this kind of approach. These include the possibility that with increasing
numbers of subtype classifications (numbering now in the hundreds), clinicians and
others may overlook key similarities among children with intellectual developmental
disorder, with negative implications for both diagnosis and intervention. Given the
current variety of outcomes for individuals with the same etiologies, Pennington
(2002, p. 250) suggests that for “any psychopathology, there is no doubt that
etiological definitions will help focus medical interventions, but short of a medical
cure, we will also need behavioral definitions to guide treatments.”
So far, our emphasis has been on describing several genotypes associated with
intellectual developmental disorder, each of which is usually associated with a
diagnosis of moderate to severe intellectual developmental disorder. We must keep in
mind that the majority of cases of children diagnosed with intellectual developmental
disorder are, in fact, diagnosed with mild intellectual developmental disorder, as the
case of Katherine illustrates. Children with mild intellectual developmental disorder
are not readily identified by genetic assays, physical characteristics, unique language
or social presentations, or other sets of difficulties (Iarocci & Petrill, 2012). These
children must not be overlooked; indeed, efforts to identify and support these children
must be renewed and reinvigorated.
c. Etiology
A number of prenatal, perinatal, and postnatal risk factors associated with
intellectual developmental disorder have been identified. We have already
summarized information related to the specific genetic etiologies associated with
particular forms of intellectual developmental disorder. These more severe forms
occur independent of family and sociocultural risk factors (Iarocci & Petrill, 2012).
With respect to genetic risk associated with mild (or familial) forms of intellectual
developmental disorder, we refer back to the opening section and the description of
genetic and environmental influences on intelligence in typically developing children.
In this section, we emphasize that for almost all children with mild forms of
intellectual developmental disorder, there is “not just one but several genetic
mechanisms and consequent brain processes which are disrupted”. That is,
“impairments in development do not occur in an isolated form but affect a multitude
of critical stages during gestation, infancy, and early childhood,” with escalating
negative impacts on intelligence.
Research connecting genetic influences with brain structure and function are
focused on synaptic processes and connectivity. Atypical brain development is
observed across all severities of intellectual developmental disorder (Kiser et al.,
2015; Pennington, 2015). Gene-by-environment processes are hypothesized to work
in similar ways for individuals at the low end of the distribution of intellectual
functioning (with IQ scores just above the cutoff for intellectual developmental
disorder) and individuals with mild forms of intellectual developmental disorder.
Family patterns of intellectual developmental disorder help illustrate these
different etiological explanations. For families with a child with mild intellectual
developmental disorder, we expect that other children in the family, who share many
of the same genes as their parents and their sibling with intellectual developmental
disorder, would display below-average intelligence, and they do. In contrast, for
families with a child with intellectual developmental disorder associated with a
specific genetic error, the genetic variant is not part of a parent’s genetic makeup
passed on to other children; in these families, the siblings of the affected child display
more typical intellectual functioning.
As noted in earlier sections, environmental factors affect the development of
some types of intellectual developmental disorder. Family instability and adversity are
associated with negative impacts on intelligence (Nisbett et al., 2012). Atypical levels
of cortisol, a consequence of chronic stress, may negatively affect early brain
structure and function and cognitive outcomes. Although low SES is an important risk
factor, keep in mind that the vast majority of children from low-SES backgrounds do
not display intellectual developmental disorder.
d. Developmental Course
Given the various etiologies, marked differences in children’s developmental
trajectories and outcomes are expected and observed. In general, poorer prognoses are
associated with identifiable genetic etiologies. Not only are these genetic etiologies
related to more severe intellectual developmental disorder, but many are also
associated with life-threatening physical disease and dysfunction. For many of the
most impaired children, outcomes may include institutionalization, total dependence
on others for care, and briefer lives. More positive health outcomes are observed in
children with mild or moderate degrees of intellectual developmental disorder.
Common medical conditions include epilepsy, heart problems, sensory disorders,
deafness, and physical abnormalities. Although both immediate and long-term growth
and health are often compromised, medical advances have made a lifespan approach
to intellectual developmental disorder essential. For all these children, keeping in
mind the holistic approach favored by Zigler and others, we can examine the course
of disorder as it plays out in various domains of development and pay meaningful
attention to individual strengths as well as weaknesses.
Children with intellectual developmental disorder exhibit different trajectories
of intellectual development relative to the rate and timing of growth for typically
developing children (Pennington, 2015). Across all neurodevelopmental disorders,
there is “a slower rate of cognitive development, and often an earlier plateau”
(Pennington, 2015, p. 1005). In addition, children with intellectual developmental
disorder show “less solid, more ‘fragile’ developments of their highest stages”. These
changes are likely tied to innate characteristics but are also influenced by the
interaction of the child’s abilities and environmental factors. For many children with
intellectual developmental disorder, cognitive and linguistic profiles of strengths and
weaknesses also change over time, with strengths becoming stronger and weaknesses
becoming weaker. Specific patterns of language and communication are observed for
children, adolescents, and adults with Down syndrome.
General outcomes related to academic skills vary by severity, with children
with mild intellectual developmental disorder displaying sixth-grade academic skills
by late adolescence and children with moderate intellectual developmental disorder
displaying second-to fourth-grade skills. Attention and motivational deficits may
complicate the development of these skills (Tylenda et al., 2014). Academic
difficulties may increase in adolescence, as the gap widens between students with and
without intellectual disabilities (Tylenda et al., 2014). Children with more severe and
profound levels typically display very limited language. For many children with
intellectual developmental disorder, deficits in language and communication skills are
associated with increased behavior problems. One particularly relevant environmental
variable is education. In the United States, the Individuals with Disabilities Education
Act (IDEA) mandates diagnostic, educational, and support services from birth to age
21, with individual education plans developed with input from parents, teachers, and
mental health professionals. Educational approaches have changed over previous
decades and now emphasize inclusion of children with developmental disabilities in
age-appropriate classrooms. Success in these classrooms depends on many variables,
and behavior difficulties are often the main reason for lack of success in mainstream
placements. Inclusion strategies designed to enhance children’s success focus on
better teacher training and parent participation, increased classroom resources, and
more extensive supports for student learning.
The general course of adaptive functioning is variable. Some groups of
children with intellectual developmental disorder show improvements over time,
others display up-and-down patterns of adjustment, and still others exhibit declines
(Hodapp & Burack, 2006). For all groups, however, the emphasis remains on
supporting personality development and functioning and achieving a positive quality
of life. As we have already discussed, Zigler’s “approach was aimed at understanding
the ‘whole child’ with intellectual developmental disorder, in all of that child’s
psychological complexity”. Research on emotion, attachment, and play in children
with Down syndrome, for example, has long supported Zigler’s position that children
with intellectual developmental disorder exhibit basic emotion skills, appreciate
humor, and experience complex emotional relationships. An appreciation of children’s
overall mix of emotion strengths and weaknesses is important.
Children also display characteristic patterns of social competence and peer
relationships, depending on their etiological backgrounds and surrounding
environments. Compared to typically developing children, for instance, children with
intellectual developmental disorder appear more motivated to seek and obtain
approval and positive reinforcement from others and to look more frequently to others
for information and guidance (Hodapp & Zigler, 1995). Self-esteem and perceived
competence develop over time in numerous interactions with parents, teachers, and
environments (Tylenda et al., 2014). Friendships are clearly important to many
children with intellectual developmental disorder. Strained friendships and new
difficulties may appear in adolescence, when social skills deficits become more
pronounced.
With respect to leisure activities, etiology-associated patterns are again
observed, with differences in the selection and practice of social activities, television
and computer activities, musical activities, and physical activities. With age,
individuals with Down, Williams, and Prader-Willi syndromes all increase their
participation in social activities; other increases and decreases in specific activities
also were observed (Sellinger et al., 2006). It is important to understand that children
with intellectual developmental disorder are not just occupying themselves or
following others’ directives related to various activities. In many cases, selection and
pursuit of specific activities appear to be related to a number of positive internal
strengths (Dykens, 2006). Individuals with Williams syndrome, for instance, may be
assisted in their drive for relationships to make safe, appropriate, and reciprocated
overtures to others. Given their pleasure, skill, and deep engagement in music, they
also may be encouraged, challenged, and supported in their musical journeys.
Depending on the etiology and severity of intellectual developmental disorder,
estimates of maladaptive behavior patterns and comorbid conditions range widely
(Dykens, 2000), with three to four times the risk for psychopathology in children with
intellectual developmental disorder compared to typically developing children
(Tylenda et al., 2014). For children diagnosed with mild intellectual developmental
disorder, internalizing symptoms, such as anxiety and mood disturbances, and
externalizing problems, such as oppositional defiant disorder and attention deficit
hyperactivity disorder (ADHD), are frequently observed. For children diagnosed with
more severe forms of intellectual developmental disorder, autistic symptoms and self-
injurious behaviors are frequently reported. For many children, as noted previously,
problematic behaviors are linked to communication difficulties; “the child’s inability
to describe discomfort leads to physical expression of pain and frustration”
Certainly, shared genetic and physiological vulnerabilities contribute to
overlapping psychopathologies. But Dykens (2000) suggests that another reason that
children with intellectual developmental disorder struggle in multiple ways is related
to the nature of lower intellectual functioning. That is, children with intellectual
developmental disorder generate fewer problem-solving strategies and have fewer
cognitive resources, leading to unrealistic appraisals of tasks and abilities and less
successful outcomes for a variety of intellectual and social challenges. Distress is
likely, along with increasingly negative self-evaluation. Over time, particularly for
children and adolescents with mild intellectual developmental disorder, anxiety,
mood, and behavioral symptoms may exacerbate intellectual and adaptive
functioning. In another negative cycle, physical aggression and destructive behavior
may lead to increases in social isolation (Tylenda et al., 2014). These kinds of
difficulties also increase the cost of care for children and adolescents.
With emphases on quality of life and appropriate support for individuals with
intellectual developmental disorder, we look to the future with hope. For some
individuals with mild intellectual disabilities, leaving the academic- and achievement-
focused school system leads to meaningful improvements in adaptation. These
individuals often have the social and vocational skills to live and work independently
(Tylenda et al., 2014). For individuals with moderate intellectual disabilities,
increased support, supervision, and assistance in living and work are necessary. For
individuals with severe and profound intellectual disabilities, extensive and around-
the-clock assistance and supervision are required (Tylenda et al., 2014). Other
predictable developmental challenges are observed as well. One of the most difficult
challenges involves adult sexuality. Historically, both mental health professionals and
the general public exhibited strong negative attitudes about sexual behavior in adults
with intellectual developmental disorder; sexual freedom was rarely permitted.
Sexuality is increasingly understood as an important aspect of life satisfaction for
persons with intellectual developmental disorder. Sex education, therefore, is
essential. With respect to sexuality, we need to pay close attention to the possibility of
victimization. Victimization also may occur connected to finances and other daily or
life tasks (Tylenda et al., 2014). Finally, adult outcomes must include the multiple
health disparities experienced by individuals with intellectual developmental disorder.
As children with intellectual developmental disorder develop, so do their
families. Many patterns of emotional response and eventual adjustment to babies with
disabilities have been described, including sadness, denial, and anger (Tylenda et al.,
2014). Different adjustments depend on family characteristics, the perception and
meaning of the individual child, and the type of intellectual developmental disorder.
These factors may underlie what has been described as the “Down syndrome
advantage”—the tendency for families of children with Down syndrome to cope
better than families of children with other forms of intellectual developmental
disorder (Hodapp, 2007). Significant impacts on family time, family activities, and
family finances must be addressed, with support and ongoing resources for parents
and siblings across child and adolescent development. Specific supports target the
transition from adolescence into young adulthood, related to autonomy, residence and
work decisions, and the increasing involvement of external agencies (Carroll, 2013a;
Tylenda et al., 2014). There are many different types of informal and professional
support available, which may vary by culture or country.
Considering the many unique family contexts, many stress-and-coping models
of ongoing family adjustment discuss both the positive and negative aspects of having
a child with intellectual developmental disorder (Gerstein, Crnic, Blacher, & Baker,
2009). With respect to stress, for instance, there are difficulties associated with
children’s transitions and milestones. According to Hodapp and Burack (2006),
families of children with intellectual developmental disorder attend to developmental
issues (such as the first smile), chronological issues (such as entrance into school),
and familial issues (such as a younger child achieving an academic or social goal
before an older child) that may all be problematic; each event may lead to parents
reexperiencing sadness. Chronic stress is related to poor health outcomes for parents.
With respect to coping and resilience, many researchers have documented
effective personal, familial, and environmental strategies. Some of the most positive
rewards of having a child with intellectual developmental disorder that families
describe include the joy that the child brings to the family, a sense of purpose,
expanded personal and social networks, personal growth, and increased tolerance
(Dykens, 2006). Overall, our understanding of parents and family members has
shifted to “a more positive, coping perspective”. The role of siblings of individuals
with intellectual developmental disorder is a recent focus of investigation. Many
siblings, early in their own development, report increased caregiving responsibilities,
as well as expectations for greater responsibilities and additional support as they age.
Siblings also report many benefits, including closer relationships with their siblings
with intellectual developmental disorders; closeness was associated with their own
well-being.
e. Assessment and Diagnosis
The American Association on Intellectual and Developmental Disabilities
(AAIDD, 2002) report sets forth a number of assumptions that must be considered
before a diagnosis of intellectual developmental disorder is made: “(1) limitations in
present functioning must be considered within the context of community
environments typical of the individual’s age, peers, and culture; (2) valid assessment
considers cultural and linguistic diversity as well as differences in communication,
sensory, motor, and behavioral factors; (3) within an individual, limitations often
coexist with strengths; (4) an important purpose of describing limitations is to develop
a profile of needed supports; (5) with appropriate personalized supports over a
sustained period, the life functioning of the person with intellectual developmental
disorder generally will improve.” With these assumptions in mind, we now examine
the ways in which assessments and diagnoses are made.
Medical and developmental histories are a key component of the assessment
of intellectual developmental disorder. With the physical abnormalities and medical
problems that are part of the overall clinical picture of several forms of intellectual
developmental disorder, the identification of young children with more severe forms
of disorders happens more quickly (i.e., after birth or within the first year). Delays in
achieving motor-or language-related developmental milestones also lead to early
diagnosis for some children. Children with more mild forms of intellectual
developmental disorder are often assessed and diagnosed in the early school years,
when expectations for academic performance increase (Tylenda et al., 2014). Across
all ages, assessments for a variety of genetic and nongenetic etiologies may occur.
Clinicians must evaluate whether the presence of more specific developmental
delays in speech, language, and reading account for intellectual and adaptive delays;
in those cases, DSM-5 diagnoses such as Language Disorder or Speech Disorder
would be appropriate. Physical concerns such as hearing difficulties or hearing loss
also may have an impact on cognitive and language development.
Standardized tests of intelligence, such as the StanfordBinet or one of the
Wechsler tests (e.g., the Wechsler Intelligence Scale for Children), are administered
individually. In addition to a general evaluation of intellectual functioning,
evaluations of particular cognitive processes may be included. It is important to note
that these types of tests have both technical and nontechnical concerns. With respect
to technical issues, there is one clear advantage to current instruments: “A score of
130 at age 5 means that a child’s performance exceeds that of 98% of age peers; a
score of 130 at age 10 means exactly the same thing” (Siegler, 2003, p. 313). And,
although they provide no information about the etiology or course of the disorder,
scores on intelligence tests allow comparisons among groups of children with
intellectual developmental disorder. Other assessment concerns involve a focus on
formal academic skills and predicting school achievement in standardized tests, as
well as the comparability of scores for children of different ethnic and racial
backgrounds on traditional and nontraditional intelligence tests. Assessments of
practical intelligence or creativity are not usually part of the comprehensive
examination, although they might provide important information about the child’s
overall intellectual functioning.
Of the various standardized scales for assessment of adaptive functioning, the
most common are the Vineland Social Maturity Scale and the AAIDD Adaptive
Behavior Scale. These instruments are designed to measure basic skills in different
developmental domains, including communication, self-care and health, social skills,
and leisure and work, at various ages. They are usually completed by adults who
know the child well. Given the somewhat variable course of intellectual and adaptive
functioning for different groups of children with intellectual developmental disorder,
repeat assessments throughout the growing years are important. Following the
collection of information on significant disabilities related to intellectual and adaptive
functioning and the diagnosis of intellectual developmental disorder, additional
assessment may be especially valuable. Information about maladaptive behaviors and
psychopathology must be included. Specific behavioral assessments, socially oriented
assessments, and personality measures such as happiness may provide a more
complete picture of a whole child. Plans for supporting physical and psychological
well-being depend on this more comprehensive approach.
f. Intervention
When considering intervention for children and adolescents with intellectual
developmental disorder, two points are worth emphasizing. First, in general, we are
not trying to treat the condition as we would most episodes of psychopathology.
Rather, we are attempting to maximize the potential of the individual to meet
developmental demands, while at the same time modifying the environment to better
match the individual’s deficits and strengths. Consequently, mental health
professionals, educators, and advocacy groups stress the importance of intervention
plans that focus on specific person–environment contexts, target multiple points along
the developmental continuum, and include the range of relevant social and
educational systems within which the child functions (Shogren, Luckasson, &
Schalock, 2014). These include, for example, early screening and identification, early
intervention for the child and the family, appropriate school programming, and
coordination of the various persons and agencies involved in the child’s care.
These types of quality-of-life interventions emphasize support and inclusion in
family, school, and community environments so that individuals with intellectual
disabilities can participate and thrive. Activities such as athletics, music, and scouting
provide opportunities for connections and achievements that all children deserve. To
include as many children as possible, we need to pay attention to cultural attitudes,
national guidelines and practices, and stigma that may negatively affect support and
inclusion. The identification of special services and support for families with children
with intellectual developmental disorder as a result of particular genetic etiologies
(e.g., Down syndrome or Williams syndrome) is also important.
The second point to emphasize is that mental health is an important issue for
everyone, regardless of level of intellectual functioning. We must be careful not to
define a person by a single, if salient, attribute like intellectual developmental disorder
(or, for that matter, being intellectually gifted or a star athlete). Psychological
variables such as emotional experiences and social relationships are every bit as
relevant for individuals diagnosed with intellectual developmental disorder as for
those who are not. Intervention strategies, then, must be designed to address all
relevant problem areas. Finally, although exceptional progress in the treatment of
mental illness has been made in recent years, these advances are often delayed in their
application to special needs populations such as children and adolescents with
intellectual developmental disorder. The mental health field has a clear obligation to
improve its efforts to apply effective treatment approaches to all groups, including
individuals with intellectual disabilities.
Genetic screening of parents, prenatal testing, and genetic counseling afford
many specific intervention opportunities. However, with “technology . . . advancing
more rapidly than the ethical and practical guidelines for its use, we must be careful to
respect many different viewpoints (see Box 6:3). Broad-based prevention approaches,
such as public information campaigns discouraging drinking while pregnant, are
critical (Cannon et al., 2015). Prevention that is focused on minimizing or eliminating
a variety of poverty experiences may provide meaningful returns on investment
(Nisbett et al., 2012). Providing parents with resources that enhance their efforts to
support their children’s intellectual development is another basic prevention strategy.
Once intellectual developmental disorder has been diagnosed, there are a
variety of treatment options that share similar goals: to develop and maintain skills,
increase positive attributes, and decrease negative characteristics of intellectual
developmental disorder. Pharmacological treatments of associated maladaptive
behaviors and comorbid disorders are common, with the majority of individuals with
intellectual developmental disorder who reside in institutions on some sort of
psychotropic medication, with multiple medications prescribed. Accepted practice
parameters, however, suggest that individuals with intellectual developmental
disorder be prescribed psychotropic medications cautiously, given difficulties related
to informed consent, enhanced sensitivity to drugs and their side effects, and poor
monitoring of outcomes.
Psychological treatments are complex and comprehensive, and there is
research and clinical consensus that children and adolescents with intellectual
developmental disorder benefit from individual, family, and group therapies. Better
outcomes are associated with therapeutic practices that take into account multiple
domains and contexts of development (Shogren et al., 2014). Therapies include
behavioral treatments, cognitive treatments, and socioemotional programs, as well as
family, educational, and vocational planning (Tylenda et al., 2014). Educational
interventions often have dramatic impact, depending on the factors underlying
impaired intellectual functioning (Rutter et al., 2004). As with many other treatment
strategies, early intensive efforts are associated with better outcomes. Including the
individual with intellectual disabilities in treatmentplanning decisions is important, as
is supporting self-advocacy skills (Simplican et al., 2015). Following educational
interventions, behavior modification therapies are among the most frequently used.
The goals of behavioral strategies include enhancing adaptive skills and teaching
appropriate behaviors. Given that maladaptive behaviors are a major source of
difficulty at home and at school, these strategies are essential.
Given the lifelong nature of intellectual developmental disorder, the family’s
role in treatment is a prime concern. Parents often serve as co-clinicians and
educational advocates, and both direction and support are necessary. For instance,
some parents are reluctant to set strict behavioral limits for their children with
intellectual developmental disorder. Although based on empathy or sympathy, this
reluctance also may reflect a lack of understanding about the need for structure and
clear expectations (Hodapp, 2004). For children and adolescents with intellectual
developmental disorder, positive adjustments and outcomes depend on integrated,
collaborative efforts that provide as much information, support, and optimism as
possible.
g. Learning Disorders
Ethan is 10 years old and in fifth grade. He was referred for
neuropsychological assessment at the request of his parents, who are concerned about
his difficulty completing tasks and academic underachievement. Language processing
difficulties were identified early in Ethan’s development, and he received speech and
language therapy before entering elementary school. Ethan’s parents note that
although they have no current concerns about his language skills, Ethan is reluctant to
initiate writing tasks, often getting upset and claiming, “It’s impossible!” This is true
even when the writing is not related to his schoolwork (for example, making cards or
writing notes to family members). He loves to have books read to him but argues
when his parents try to encourage him to read on his own. His parents are concerned
that an underlying learning disorder might be contributing to his increasing resistance
to school. Although respectful of their concerns, Ethan’s teacher feels that his issues
are more likely related to anxiety and his tendency to procrastinate.
The neuropsychologist assessing Ethan noted that he struggled with writing
tasks. He had difficulty forming letters, which were printed awkwardly. In addition,
his spelling and written output appeared slow and labored. Ethan made frequent
erasures as he worked and, on an untimed test involving math problems, he appeared
reluctant to use a paper and pencil to work on the problems, preferring to do them in
his head. Test results showed Ethan’s general cognitive abilities to be in the high
average range, with processing speed (measured by timed tests with pencil and paper)
to be the one area of relative weakness. Ethan’s executive functioning skills are
generally typical for his age, although his parents state that he has difficulty
controlling his emotions at home, especially in regard to completing his homework,
when he can quickly become frustrated and angry. Achievement testing showed that
Ethan has strong math reasoning ability and good reading comprehension scores.
However, his writing skills are more problematic and discrepant from most of his
other abilities. Ethan needs considerably more time than average on writing tasks. He
appears to struggle as he thinks about how to form each letter as he writes it. He
shows poor visual–motor control, but his fine motor speed and coordination are not
delayed.
On standardized tests, Ethan scored below age expectations in terms of his
ability to write conventionally (e.g., use of paragraphs and punctuation) and had even
more difficulty with his contextual language skills (e.g., with fragmentary sentences,
run-on sentences, absence of compound sentences). However, with a topic of his
choosing, Ethan was able to show good story construction, with sequence and plot,
and scored in the average range. The neuropsychologist concluded that Ethan meets
the criteria for Learning Disorder of Written Expression, as evidenced by his
differentiated difficulties with handwriting, conventional writing skills, and clarity of
written expression. With this understanding, Ethan’s teachers worked with his parents
to develop a plan that included decreasing the amount of written work required of
Ethan, while at the same time providing him with greater support in an effort to
improve his writing skills, increase his confidence in his writing, and decrease his
feelings of frustration and inadequacy. Additional strategies, such as reducing
unnecessary copying, providing additional time for tasks requiring written work, and
increasing the use of keyboarding and dictating for longer written assignments, were
also recommended.
Children, adolescents, and adults with learning disorders display persistent
difficulties in the acquisition and application of academic skills. These difficulties are
associated with significant impairment in school, work, and/or everyday living. Given
the dimensionality of learning (i.e., the continuity between typical and atypical
performance) and the inferences involved in making a diagnosis of learning disorder
(e.g., how to make a decision related to lack of skills), it is not surprising that
definitions of learning disorders change over time. The most common approach to
conceptualizing learning disorders, over the past several decades, emphasized the
discrepancy between an individual’s aptitude (usually measured with an intelligence
test) and achievement.
According to Fletcher, Lyon, Fuchs, and Barnes (2007), this approach lacks
external validity because it does not specify what exactly is disordered in learning
disorders. Alternative models that focus solely on low achievement or intraindividual
patterns (e.g., unevenness in academic skills, with particular patterns of cognitive
strengths and weaknesses) are also problematic. Response to intervention (RTI)
models focus on students who do not respond to appropriate instruction and high-
quality interventions. Fletcher, Lyon, Fuchs, and Barnes (2007) suggest that an
integrated model of learning disorders is more useful. In their model, students’
responses to appropriate instruction, low achievement, and intraindividual differences
in academic skills all contribute to the construct of learning disorders.
DSM-5 describes three domains of specific learning disorder: reading, written
expression, and mathematics. Disorders are associated with “unexpected
underachievement” (Fletcher et al., 2007). Exclusionary factors that might
compromise learning include problems involving sensory or perceptual skills, low
intelligence, emotional and behavioral difficulties, economic disadvantage, and
inadequate instruction. Children may display one or more specific learning disorders.
Descriptions of specific learning disorders overlap somewhat with the related
constructs of verbal learning disabilities and nonverbal learning disabilities. Verbal
learning disabilities are similar to language-based reading and writing learning
disorders. Nonverbal learning disabilities include atypical difficulties involving motor
skills, visual–spatial skills, and social skills. These specific descriptions are not
included in DSM-5, although categories for social communication disorder and motor
disorders are included.
Specific learning disorders involving reading include difficulties related to
word recognition, reading fluency, and reading comprehension. Each of these
difficulties is associated with an academic skill deficit and a core cognitive process
(Fletcher et al., 2007). The academic skill deficit in word recognition (i.e., dyslexia)
involves single-word decoding (Peterson & Pennington, 2012). The core cognitive
process is phonological awareness (i.e., the metacognitive understanding that the
words that we hear and read have internal structures based on sound). Other processes
related to word recognition are the rapid naming of letters and digits, and working
memory for verbal and/or acoustic information. The academic skill deficit in reading
fluency is reading speed (i.e., accuracy and automaticity). The core cognitive deficit is
rapid automatized naming. Compared to other languages (e.g., German, Dutch,
Swedish, French, Spanish, and Finnish), the English language is especially difficult to
master. The academic skill deficit in reading comprehension involves extracting
meaning from text. The core cognitive deficits (in children who are typical with
respect to decoding) include language skills, working memory, and inferencing
(making interpretations and/or integrations).
For learning disorders related to mathematics, the academic skill deficits
include computation and problem solving. Although there is much less research
compared to reading problems, core cognitive deficits are observed in working
memory, executive functions, and language. Researchers have described several
patterns of math skills, math performance, and math anxiety that are associated with
various achievement outcomes (Hart et al., 2015). For disorders related to written
expression, academic skill deficits include handwriting, spelling, and composition.
The core cognitive processes include fine motor skills, the automaticity of
handwriting, and spelling.
Prevalence rates for learning disorders involving reading range from 10% to
15% in school-age populations, and from 80% to 90% of those in special education
programs in the United States. Boys are somewhat more frequently diagnosed. Rates
are similar for learning disorders involving mathematics in samples of school-aged
children; there do not appear to be gender differences in these rates (Fletcher et al.,
2007). There is not much data on rates of learning disorders involving written
expression. Learning disorders are frequently diagnosed with other disorders,
including ADHD, autism, and mood disorders.
Because languages and writing systems differ (often in significant ways), and
various countries and societies have particular ways of understanding learning,
education, and individual differences in children, it is important to examine learning
disorders in a sociocultural context. Learning disorders are common in many
countries. For example, approximately half of children receiving special education
services in Guatemala and Spain are children with learning disorders. Rates are much
lower in Taiwan and South Korea, which may reflect differences in the writing
system, emphasis on education and academic performance, and a reluctance on the
part of parents to label their children as disabled.
h. Developmental Course
Even when special education efforts are taken into account, learning disorders
involve persistent difficulties rather than developmental delays in the acquisition and
use of academic skills. With a developmental progression from oral language skills at
3 ½ years, to word literacy skills at 5 ½ years, to reading comprehension at 8 ½ years,
the early identification of at-risk children is critical. Indeed, the learning and
achievement gaps between typically developing children and children with learning
disorders often widen over time, although some children with learning disorders do
display compensatory cycles of growth.
Problematic learning experiences have many outcomes, including poor
achievement and poor personal and social adjustment (Blair & Dennis, 2010).
Learning disorders are also associated with the development of both internalizing and
externalizing disorders in the elementary school years. The role of parents in
influencing children’s developmental pathways of achievement and adjustment is
noteworthy.
Related to special education efforts, parents play a crucial and multifaceted
role in the identification and management of learning problems. Their involvement is
essential in ensuring that their children's educational needs are adequately met and
that they receive the support necessary to thrive academically. Parents are often the
first to notice signs of learning difficulties in their children, and their observations and
insights can provide valuable information for early identification and intervention.
Once a potential learning problem is identified, parents collaborate closely
with school professionals, including homeroom teachers, special education teachers,
school psychologists, and aides. This collaboration is fundamental to developing an
accurate understanding of the child's strengths and weaknesses and creating an
effective individualized education program (IEP). During this process, parents share
their observations and concerns, participate in assessments, and help set realistic and
attainable goals for their child's education.
In addition to collaborating with teachers and school staff, parents are also
involved in regular IEP meetings, where they review their child's progress and make
necessary adjustments to the education plan. These meetings provide a platform for
parents to voice their concerns, celebrate their child's achievements, and work with
the school team to address any challenges that arise. Their active participation ensures
that the education plan remains relevant and responsive to their child's evolving
needs.
Parents' involvement extends beyond the academic aspects of their child's
education to encompass issues related to equity and advocacy. They advocate for their
child's right to receive appropriate accommodations and services, ensuring that their
child has equal access to educational opportunities. This advocacy can include
requesting specific accommodations, such as extra time on tests, specialized
instructional strategies, or assistive technology, to support their child's learning.
Moreover, parents often engage with school administrators and policy-makers
to address broader issues of equity within the education system. They may participate
in school board meetings, join parent-teacher associations, or collaborate with
advocacy organizations to promote inclusive education practices and policies.
Through these efforts, parents work to create a more equitable and supportive learning
environment not only for their child but for all students with learning differences.
Parents also play a vital role in educating and raising awareness among other
parents, teachers, and the community about learning disabilities and the importance of
early intervention and support. By sharing their experiences and knowledge, they help
reduce stigma and promote understanding and acceptance of students with special
educational needs.
In addition to their advocacy work, parents often seek out and engage in
professional development opportunities to better understand their child's learning
difficulties and the best strategies to support their education. This may involve
attending workshops, conferences, and training sessions focused on special education,
learning disabilities, and effective teaching methods. By staying informed and
educated, parents are better equipped to support their child's learning at home and
collaborate effectively with school professionals.
Furthermore, parents provide critical emotional and motivational support to
their children. They help foster a positive attitude towards learning, build self-esteem,
and encourage perseverance in the face of challenges. This emotional support is
crucial in helping children with learning difficulties develop resilience and confidence
in their abilities.
In summary, parents are deeply involved in various aspects of special
education efforts, from the initial identification of learning problems to ongoing
collaboration with school professionals and advocacy for equitable education
practices. Their engagement is essential in ensuring that children with learning
difficulties receive the support and accommodations they need to succeed
academically and develop to their full potential. By working closely with educators,
advocating for their child's rights, and providing emotional support, parents play a
pivotal role in the special education process and contribute to creating a more
inclusive and equitable education system.
With respect to motivation, it is critical to address intelligence mindsets and
the beliefs of both child and parent about intelligence (i.e., whether intelligence is
fixed or malleable), success, and failure (Haimovitz & Dweck, 2016). Understanding
the motivation to learn also requires an appreciation of the impact of genetics,
environments, and culture (Kovas et al., 2015). Keep in mind, of course, that many,
many children and adolescents diagnosed with learning disorders are successful in
both school and life.
i. Assessment, Diagnosis, and Intervention
Early models of learning disorder assessment began with diagnosis and testing
of struggling children and then progressed to treatment. Recent models of assessment
emphasize that large-scale screenings and instruction implementation should be
provided to all students. Those who do not learn on typical timetables can then be
provided with increasingly intensive interventions.
The goals of this type of assessment and intervention plan are multifaceted,
aiming not only to prevent disabilities but also to enhance educational opportunities
for all children. These objectives are rooted in the belief that early identification and
intervention can significantly alter the trajectory of a child's educational and
developmental outcomes, leading to more positive and inclusive experiences
throughout their academic journey.
One primary goal is the early detection of potential learning and
developmental disabilities. By implementing comprehensive assessment procedures,
educators and specialists can identify children who are at risk for or are already
exhibiting signs of learning difficulties or developmental delays. Early detection
allows for timely intervention, which can mitigate the impact of these issues before
they become more pronounced and harder to address. This proactive approach is
critical in preventing the progression of disabilities and in promoting better
educational outcomes.
Another key objective is to design and implement individualized intervention
plans that address the specific needs of each child. These plans are tailored to the
child's unique strengths and challenges, ensuring that they receive the appropriate
support and resources. Individualized plans often include a combination of specialized
instruction, therapeutic services, accommodations, and modifications to the learning
environment. By customizing interventions, educators can provide targeted support
that maximizes each child's potential and fosters their academic and social
development.
Enhancing educational opportunities for all children is another central goal of
assessment and intervention plans. This involves creating inclusive educational
environments where all students, regardless of their abilities, have access to high-
quality education. Inclusive education is built on the principle that every child
deserves to learn in a supportive and accommodating setting. Assessment and
intervention plans play a crucial role in promoting inclusivity by ensuring that
students with disabilities receive the necessary supports to participate fully in general
education classrooms alongside their peers.
In addition to supporting individual students, these plans also aim to build the
capacity of schools and educators to address diverse learning needs. Professional
development and training for teachers, administrators, and support staff are integral
components of successful intervention plans. Educators are equipped with the
knowledge and skills to implement evidence-based practices, differentiate instruction,
and use data to inform their teaching. This ongoing professional development helps
create a more responsive and adaptive educational system that can effectively meet
the needs of all students.
Furthermore, assessment and intervention plans strive to foster strong
partnerships between schools, families, and communities. Parental involvement is a
critical aspect of these plans, as parents provide valuable insights into their child's
learning and development and play a key role in supporting their child's education at
home. Collaborative efforts between schools and families ensure that interventions are
consistent and comprehensive, addressing both academic and non-academic factors
that influence a child's success. Community resources and supports, such as health
services, social services, and extracurricular programs, also contribute to a holistic
approach to education.
Another goal is to monitor and evaluate the effectiveness of interventions
continuously. Ongoing assessment and progress monitoring allow educators to track a
child's development, adjust interventions as needed, and make data-driven decisions.
This iterative process ensures that interventions remain relevant and effective,
ultimately leading to better educational outcomes. It also helps identify best practices
and areas for improvement, contributing to the overall advancement of special
education practices.
Additionally, assessment and intervention plans aim to promote self-advocacy
and independence in students with disabilities. By providing them with the skills and
strategies to understand and manage their learning needs, these plans empower
students to take an active role in their education. Self-advocacy skills, such as
understanding their strengths and weaknesses, communicating their needs, and setting
personal goals, are essential for success in school and beyond. Developing these skills
helps students become more confident and autonomous learners, better prepared for
future academic and career challenges.
In conclusion, the goals of assessment and intervention plans in special
education are comprehensive and far-reaching. They encompass early detection and
prevention of disabilities, individualized support and interventions, inclusive
education, professional development for educators, collaborative partnerships with
families and communities, continuous monitoring and evaluation, and the promotion
of self-advocacy and independence. By addressing these goals, assessment and
intervention plans play a crucial role in enhancing educational opportunities for all
children, ensuring that every student has the chance to succeed and reach their full
potential.
Advances in intervention research and practice are taking place around the
world (for instance, in Africa, in Israel, and in Europe) and take into account
educational systems, differences in ethnicity and socioeconomic backgrounds, and
access to effective services. In the United States, special education and remediation
efforts are often based on individualized education plans (IEPs) designed for students
with learning disorders. Individual and small-group lessons are often components of
an IEP and are focused on specific academic skills and cognitive deficits (Wills,
2007). Empirically informed adaptive software is a relatively recent innovation.
Related characteristics, such as self-regulation abilities, are also targets of change.
The earlier the intervention, the better the outcome.
