Intellectual Disability Flashcards
Learning Objectives:
- Define intellectual disability
- Distinguish intellectual disability from learning disorders/difficulties such as dyslexia.
- Describe how a clinical psychologist assess a person for intellectual disability
- Be aware of the tools used in making a diagnosis
- Be able to describe the impact of having intellectual disability on a person’s life
- Be able to outline the role of a clinical psychologist in services for people who have intellectual disability.
- Define intellectual disability
Defining intellectual disability
Changing terms throughout history and globally
Historical medical terms:
- Mentally Sub-normal, Handicapped, Defective, Deficient
- Mental Retardation
Stigmatised, non-medical terms:
- Backward
- Moron, imbecile & idiot
- Feeble minded
The UK is the only region that uses the term learning disability (due to a government directive) as opposed to intellectual disability
- however within international academic circles and work intellectual disability is employed
In the USA, the term was only changed from “mental retardation” in 2003, the WHO only dropped the term in 2015.
Current Terms:
UK Learning Disabilities
USA Intellectual & Developmental Disabilities
WHO Intellectual Disability
Australia Intellectual & Developmental Disabilities
International Intellectual Disabilities
In the UK the term learning difficulty began to be used. The UK Government decided on learning disability. However, some prefer to continue to use difficulty rather than disability.
Intellectual Disability (ID) is now the agreed term in academic & research circles. In education, learning difficulty refers to specific disorders such as dyslexia/ dyspraxia – these are not learning disabilities they are specific to certain modalities of learning rather than global issue with learning.
- Define intellectual disability
Definition of intellectual disability
Several diagnostic systems – but they are all based on 3 criteria:
- Significant limitations in intellectual functioning.
- Significant limitations in adaptive behaviour.
- Acquired before adulthood.
This varies country to country, 18 in the UK, 21 in the US for example. This impacts on the death penalty in the US, people with intellectual disabilities cannot be put to death for murder.
UK Department of Health
Usually described as a significant impairment of intelligence and social functioning acquired before adulthood
American Psychiatric Association (2013) – DSM5
a) Deficits in intellectual functions.
b) Deficits in adaptive functioning that result in failure to meet developmental and socio-cultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation & independent living across multiple environments.
c) Onset of intellectual and adaptive deficits during the developmental period
Theory underlying intellectual disability
- Define intellectual disability
ID is different from other mental health disorders discussed in this series as:
- the underlying theory is statistical.
- based on the normal curve
Based on where an individual is situated on a normal curve of intelligence
A person with an intellectual disability sits in the bottom 2-3% of IQ scores (below 70) – why less than 70 as a cut off? It’s 2SD below the mean, average score is 100, 15 is a SD.
- Define intellectual disability
Significant impairment of intelligence
> 1959 1 SD below population mean
1961 1 SD below population mean
1973 2 SDs below population mean
At one point the cut off was 1SD below the mean (could have a score of 85 and be classed as having an intellectual disability). Political pressures and cost motivate these decisions.
- Define intellectual disability
Significant impairment of adaptive behaviour
Intellectual disability cannot be defined on IQ score alone, there have to additional deficits to adaptive behaviour – the way the individual functions in society
- Define intellectual disability
Incurable & Global
- Intellectual Disability is a life-long condition and cannot be cured.
- It impacts on all areas of functioning (General knowledge, Problem solving, reasoning, vocabulary, comprehension, information processing, attention, concentration etc.)
- However, its impact on the person can be ameliorated through education, training and supports.
- Through petitioning and education laws, now all children are educated and go to school
- Define intellectual disability
Why is diagnosis important?
- Access to services and supports
- Benefits & Entitlements
- Protection
- Mitigation
- Understanding
Historically there was the concept of the village idiot (unfortunately), a person who had trouble learning and going about their day to day life but eventually would find a way to function as a member of that society. However, when the industrial revolution came about workers were required to attain specific skill sets to do certain jobs. Those with intellectual disabilities fell outside of the skilled workforce, often finding themselves in work houses.
Now, diagnosis helps those with disabilities access systems of support e.g. personal independence payments (you need evidence of a disability to be granted that money).
- Individuals can also be put on their council and GP surgery’s disability register in order to access support.
- There is some protection in law – if an individual gets in trouble with the law, the courts will receive specialist advice on how to support that individual through the court process, how to adjust the trial so that the individual can participate and comprehend what’s going on. Can also be used as a mitigating factor during legal proceedings.
- Describe how a clinical psychologist assess a person for intellectual disability
- Be aware of the tools used in making a diagnosis
× Assessment of intellectual functioning
× Assessment of intellectual functioning
IQ must be established on a fully standardised scale of intelligence such as the Wechsler Adult Intelligence Scale – 4th Edition (WAIS-IV). This is the gold standard test.
Half the test is verbal, half is not.
Vocabulary tests, arithmetic, speed tests, coding
Ten tests in total, on a range of academic skills
Clinical Population – that 2% that falls below 70IQ points
- Describe how a clinical psychologist assess a person for intellectual disability
- Be aware of the tools used in making a diagnosis
× Assessment of adaptive behaviour
Assessment of adaptive behaviour
- Wide range of scales available but few with psychometric properties – which is preferred (mean and SD, so you can compare your client with a population table)
- Standardised assessment instruments do exist.
- Enables comparison with a person’s peers
- Most instruments designed to assess children
- Vineland Adaptive Behaviour Scales have adult norms.
Don’t assess with the disabled individual directly, because they can try to “pass” as more functional than they are as sometimes it’s embarrassing to not be able to do things e.g. a mobile phone, microwave, reading, writing, telling the time etc
- Describe how a clinical psychologist assess a person for intellectual disability
Causes of intellectual disability
In most cases the cause is unknown. To be expected under the normal curve
When the disability is severe or profound there is usually a known cause
- Prenatal/genetic 50%
- Perinatal 20%
- Postnatal 10%
- Unknown 20%
- Be able to outline the role of a clinical psychologist in services for people who have intellectual disability.
Role of the Clinical Psychologist
- Diagnostic assessment
- Assessment of behaviour and mental health
- Assessment of support needs
- Service design e.g. living environment (lighting, curved walls, padding etc)
- Provision of psychological interventions
Individuals
Groups
Families
Systems (Organisations, Carer Networks etc.)
- Be able to describe the impact of having intellectual disability on a person’s life
What is the experience of people with intellectual disabilities?
What are the different ways in which people are valued in society?
Psychological Needs
– What might they need help with?
– How might their condition affect them?
- Understanding of day-to-day life
- Day-to-day functioning e.g. cooking, finances, toileting etc
- Context - Value, Disability, Dependency – can be bullied or not provided for e.g. disabled toilet
- Complex relationships
- Trauma & Loss
- Neglect & Abuse
- Mental Health Problems – depression or anxiety surrounding their disability
- Sexuality – should they be able to have sex?
- Annihilation – when people look at someone and wish they were dead
- Be able to outline the role of a clinical psychologist in services for people who have intellectual disability.
Maslow’s Hierarchy of Needs
Work with people with intellectual disabilities aims to move them up the hierarchy of needs e.g. from providing appropriate accommodation and keeping them safe right up to facilitating their social relationships and safe sexual practices
- Be able to outline the role of a clinical psychologist in services for people who have intellectual disability.
What do they assess?
Assessment • Diagnostic • Mental Health • Challenging Behaviour • Neuropsychological (Memory, Cognitive Decline) • Autism • Capacity • Parenting Skills • Risk & Forensic Risk
Psychologists do a lot of assessment in this field, not just whether the person has an intellectual ability or not but what else they may be experiencing e.g. complex neurological problems, people with downs syndrome have early onset dementia, a lot of people with intellectual disabilities also have autism. Capacity to have contact with people, to consent to have sex etc. Whether they are able to bring up a child etc.
