Students with intellectual disabilities: assessment, monitoring and inclusion

Related article: “Intellectual and developmental disability”

Assessment of students with intellectual disabilities

Is evaluation process it requires the presence of well-trained professionals and the knowledge and application of a series of steps and procedures already provided for in the AAMR’s own manual and by various recognized authors in the field.

a) The structure of the evaluation

The evaluation proposed by the 2002 system revolves around what is called evaluation structure. The structure of the assessment is characterized by the following aspects:

  1. Assessment has three main functions: diagnosis, classification and planning of the necessary supports.
  2. Each function has a number of different objectives, ranging from establishing the provision of a particular service and research, to organizing the information and developing a support plan for the ‘individual.
  3. The choice of the most appropriate measures and instruments will depend on the function of the assessment and the specific objectives to be achieved.

the diagnosis

One of the purposes and functions of the Definition, Classification and Support System is the determination of the diagnosis of intellectual disability. The diagnosis of ID is made according to the following three criteria: significant limitations in intellectual functioning, significant limitations in adaptive behavior and age of onset.

classification

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

Media planning

The goal is to improve personal outcomes related to independence, relationships, contributions, school and community participation, and personal well-being. Media rating may have different relevance depending on whether it is done for classification or media planning purposes. Media rating scales, self-reports, some assessment components and the individual plan are measures for media planning.

b) Diagnostic criteria

Performing a diagnostic assessment of intellectual disability requires adequate training and preparation, knowledge and use around certain issues related to diagnostic criteria and with some considerations and precautions to be taken into account before complex situations. professionals they must complete an assessment of intellectual level and adaptive behavior, And set the age of onset.

Intelligence assessment

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

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

Adaptive behavior

It is the set of conceptual, social and practical skills that people learn to function in everyday life. Emphasizes the use or achievement of relevant skills, rather than the acquisition of skills.

This means that the limits of adaptive behavior include ignorance of how to exercise these skills, when to use them, and other motivating factors that affect the expression of the skills.

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

Assessment of this behavior should be done using standardized measures across the general population that include people with and without disabilities.

Guidelines to follow to assess adaptive behavior:

  • The limits of current functioning must be seen in the context of community environments typical of people of the same age and culture.
  • There is no single measure that fully assesses all aspects of adaptive behavior.
  • Since the subscale scores are moderately correlated, it should be assumed that there is a generalized deficit even if the one-dimensional score meets the criterion of two or more standard deviations below the mean.
  • Assessment depends on understanding that the behavior of a typical individual requires information that goes beyond what can be observed in a formal assessment situation.
  • An adaptive behavior score should not be considered an accurate score. A confidence margin of 67% and 95% should be applied for a true score.
  • Problematic behavior viewed as maladaptive is not a dimension or characteristic of adaptive behavior, although it may influence the acquisition and performance of adaptive behavior.
  • Adaptive behavior must be interpreted in relation to periods of development and in the context of an individual’s own culture.

Age of onset of intellectual disability

The period of the life cycle before adulthood is the diagnostic criterion of the 2002 definition. The age limit is set at 18 years, which corresponds to the moment when the adult role is acquired.

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

c) General considerations

Any diagnostic activity carries a risk. There are particularly critical situations such as dual diagnosis (ID and mental illness), in individuals with optimal ID and mild intellectual functioning.

They require special guidance to improve diagnostic accuracy, precision, and integration.

Four important guidelines should be considered when diagnosing people with complex situations:

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

The double diagnosis

Mental disorders have a higher prevalence in the population with ID. Two factors complicate the dual diagnosis: diagnostic eclipse and problematic behaviors.

The diagnostic eclipse occurs when all of a person’s issues and symptoms are attributed to the ID.

Problem behaviors that manifest at the time of the interview and in the assessment sessions can define the accuracy of the diagnosis.

To make a good double diagnosis, it is advisable to take into account the following guidelines:

  • Collection of relevant information about the person based on their personal history, behavioral observations in daily living environments, psychometric assessment, and medical and biological assessment.
  • Collecting community information from environmental assessments that include aversive situations, opportunities for sensory stimulation, and prospects for change in the person.
  • Identify the potential causes of the behavior rather than narrowing the cause down to an alleged mental illness.

People with a mild or limiting level of intellectual functioning: These people have limitations that are difficult to detect, especially skills related to academic and social competence.

The following guidelines are used for an accurate diagnosis:

  • Assessment should focus on functional assessment systems, with particular emphasis on adaptive behavior.
  • The assessment of academic skills should identify the acquisition of curriculum knowledge and skills.
  • Social competence assessment to base interest on social perception, generation of appropriate social strategies to solve problems, and the person’s knowledge of social patterns.

retrospective diagnosis

It is a question of carrying out an identification diagnosis when this one has not been carried out during the period of development. Appropriate guidelines should be followed to ensure correct diagnosis.

Diagnosis in suboptimal assessment situations

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

These are the individuals who they have complex medical and behavioral conditions and the situations in which cultural diversity and / or linguistic factors may have an effect on the information necessary for decision-making.

It is advisable to take into account the following guidelines:

  • Use multiple sources of information in data collection.
  • It clearly shows that the data obtained correspond to the critical questions that were asked.
  • Use assessment instruments that are sensitive to diversity and have acceptable psychometric properties.
  • Know and understand the culture and language of the individual.
  • Don’t let linguistic and cultural diversity overshadow or minimize a real handicap.

d) Use of clinical judgment

the clinical test is required as good practice in the field of disability. Proper use can improve the accuracy, precision and integration of the decisions and recommendations of professionals.

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

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

It should not be used to justify rapid assessments, to replace the use of appropriate instruments or the lack of sufficient information.

there is four orientations which are crucial to perform an accurate clinical trial:

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

e) The evaluation of the supports

the identification of support needs is the primary goal of the assessment and diagnosis process for ID.

Assessing the profile and intensity of support needed is a basic strategy for improving personal outcomes, promoting independence, relationships, contributions, school and community participation, and emotional well-being.

There are two ways to delimit the supports.

  1. The processes that are carried out in evaluation and in the development of support plans for the definition and implementation of support functions and activities, as well as the natural supports that the person will have at his disposal.
  2. The use of support ladders. The publication of the Media Intensity Scale (EIA) and its adaptation to Catalan and Spanish supposed to have a tool of great value and impact. The EIA is a multidimensional instrument designed to measure the level of practical support required by people with DIyD.

This scale has three sections:

section 1. Scale of support needs. Evaluates 49 life activities grouped into 6 subscales: home living, community living, lifelong learning, employment, health and safety and social activities. The supports for each activity are reviewed based on frequency, daily support time, and type of support.

section 2. Complementary scale of protection and defense. Evaluate 8 activities related to topics that relate to self-defense, opportunities and access, exercising social responsibilities and helping to acquire and express skills.

section 3. Exceptional needs for behavioral and medical support. Evaluate 15 medical conditions and 13 problem behaviors.

The scale of intensity of aid to children is under development. It assesses the intensity of supports in the following areas: home, community and neighborhood life, school participation, school learning, health and safety, self-defense and medical needs and exceptional behavior.

How to promote the development of students with intellectual disabilities?

For schools, the 2002 system introduced two changes in the way we think and act:

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

this model it assumes the perspective of special education as a support system rather than a place, And that the meaning of helping school-aged children is to provide access to the school curriculum, to encourage the achievement of valuable personal results and to strengthen participation in typical school, social and community contexts.

a) An inclusive school environment

The basic principle is that students with DIyD should have access to ordinary educational situations with additional aids and services that overcome barriers to participation and learning.

It is important to know how to better match a person’s capabilities with the demands and opportunities of the environment in which they live, learn and socialize.

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

This functional approach to disability supposes to put a greater interest in the supports. The task that counselors must solve is to identify and to design, in an adjusted and appropriate manner, the supports which allow them to succeed in school and in life.

The organization of support at the school stage must be based on a few essential components. The development of an educational environment obliges the school to adopt organizational and educational systems sensitive to quality and diversity.

The pedagogical approach incorporates a number of strategies in school and in the classroom. There are certain conditions which seem to have a positive effect on the improvement of the school and which allow it to cope with the processes of change and to pay more focused attention to diversity.

These dimensions allow the school to move forward in its goal of increasing the opportunities for participation and learning for all students. They allow the functions and tasks of the adviser to be articulated around them.

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

Keys for the correct inclusion of students with disabilities

A number of conditions ensure that all students actively participate in teaching and learning activities.

  • Change the nature and complexity of the content curriculum
  • Diversify teaching processes and learn
  • Adapt the requirements and the type of responses which can help create a more inclusive educational environment in the classroom.

Promote a safe climate and positive relationships between teachers and students is considered a critical aspect. Clear expectations and boundaries must be set and maintained to foster the development of positive norms, behaviors and attitudes towards learning and schoolwork.

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

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

b) Access to curriculum and universal design for learning

There are several types and levels of access to the regular program for students with DIyD. The most important are the strategies in the general domain, And the use of universal learning design, And the individualized curricular adaptations.

Universal Design for Learning represents a support system that overcomes certain barriers to the participation and learning of large numbers of students.

To facilitate access to the program, it is necessary to ensure that students actively participate in teaching and learning activities and that these are sufficiently stimulating and cognitively meaningful to promote personal development.

Educational materials often present physical, sensory, emotional and cognitive barriers that limit access and participation.

The design of universal learning is defined as “the design of educational materials and activities that make learning objectives available to individuals with great differences in the abilities to see, hear, to talk, move, read., Write, understand the language, pay attention, get organized, be busy and remember. “

Adapting to Students with Special Needs

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

  • fair use: Those who speak a different language can use the materials. The materials are organized from different levels of cognitive taxonomy and present alternatives that appear to be similar.
  • flexible use: The materials are characterized by multiple forms of representation, presentation and expression.
  • Simple and intuitive use: The materials are easy to use and avoid unnecessary difficulties. The instructions are clear and precise and examples are presented.
  • perceptible information: The material presents the necessary information for the student; essential information is underlined and repetitions are included.
  • Error tolerance: Students have sufficient time to respond, receive information to correct errors, can correct previous answers, track their progress and practice for the required time.
  • Reduction of physical and cognitive effort: The material presents information to work in groups that can be taken from a case within a reasonable amount of time.

universal design

Features of Universal Design for Learning that facilitate access to information from academic content:

  • It provides multiple forms of representation and presentation.
  • They promote different forms of expression.
  • It facilitates multiple forms of participation

c) The organization of the provision of supports in class

To participate in classroom activities with classmates, students with DIyD need adaptations and supports which must be organized in an appropriate way.

There is a three-phase model to accomplish this task. It is used for planning and implementing classroom supports and accommodations:

  1. identification support needs.
  2. Planning and implementation of supports and adaptations.
  3. Evaluation the provision of supports and adaptations.

The identification phase requires the collection of information about the student and the class. It is important to share information about the student, his characteristics and his needs. It is advisable to know the activities and the materials used. Sometimes it may be necessary to make direct observations of the classroom environment. The objective is to identify what type of adaptations and support to the needs of the pupils and in which curricular areas or school assignments.

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

You must consider three types of adaptations:

  1. Curriculum: They modify the content of what is taught. This involves changing the difficulty level of materials and activities, and reducing the quantity, number or complexity of objectives.
  2. pedagogic: Change the way education is taught and how it is demonstrated. It may be necessary to vary teaching methods in order to facilitate and enhance learning. Provide clear demonstrations, use specific strategies, develop study guides for textbooks, include more corrective comments … It may be necessary to change the type of responses and demonstrations required from the student.
  3. alternatives: Modify learning objectives and activities. We can consider whether the pupil needs alternative adaptations to ensure his progress. These include the introduction of goals and activities parallel to those achieved in the classroom.

This phase is generally carried out in two moments. The one in which it is performed at the start of the course and serves to adapt the student to the daily activities and routines of the class and school. And another is the planning and adaptation of the classroom work that is done throughout the course in coordination meetings.

the monitoring and evaluation phase it requires continuous and coordinated work to assess both the impact of the decisions taken in relation to the type of adaptations and supports to be provided, and the student’s progress.

There must be some frequency of meetings where the necessary changes are made to allow the student to participate actively in the activities of the class and to be able to progress according to the objectives proposed in his individual program.

d) Learning certain skills

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

This should not harm the development and progress of students with ID cards who acquire as many skills and abilities as possible.

A large majority can have access to the content and objectives of the regular program.

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

  1. Core skills: They are the ones who open doors to people and facilitate access to other learning, meaningful activities and relevant environments. They provide the basis for interacting with people and information in a multicultural society. It is important that they acquire the skills that facilitate their independence, relationships, contributions, school and community participation, and personal well-being.
  2. Independent learning strategies: Students use learning strategies that allow them to plan, perform and control their homework, and modify and regulate their own behavior. The aim is to actively involve students in the educational process. The use of these strategies facilitates the development and learning of skills, promotes inclusive education, enhances self-determination, and promotes participation in student and generalization processes.
  3. self-determination: There is a close relationship between independent learning and self-determination. Self-determination is an educational outcome and represents the ability to act as a major causal agent in one’s life and to choose and make decisions about one’s quality of life without unnecessary external influences and interference. It refers to the right of people to take control and make choices that impact their lives. It includes components: skills for making choices, making decisions, solving problems, etc.
  4. the social competence: It is the result of a combination of adaptive behavior, social skills and peer acceptance. Socially competent behavior is important for proper functioning in everyday living environments.

The nature and extent of skills and peer relationships affect self-esteem, intellectual development, academic performance and daily functioning.

It is practical to identify variables that may influence social relationships and interactions between peers with and without disabilities, and establish strategies that foster positive relationships and adequate social competence.

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

a) Service evaluation

The presence of evaluation culture is hardly visible in our country in services for people with DIyD. Especially in schools.

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

Education administrations have proposed various initiatives but have not been favorably received by the educational community.

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

The proposed model was adopted by FEAPS and was designed to help professionals overcome the potential resistance mentioned above. Control of the process is centrally located and is oriented towards improvement. It combines the advantages of self-assessment with external assessment, leaving the responsibility for decisions to the centers.

The model consists of three phases:

  1. self evaluation: Professionals, property / management, families, students participate and conclude in a self-assessment report.
  2. external evaluation: By some experts on the basis of the report prepared by the center and interviews with a sample of professionals, executives, families and students. It is reflected in a final report which is sent to the center.
  3. Improvement plan: The center prepares it itself based on the findings of the final report as opposed to its own self-assessment report.

Advantages of the model:

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

they can be distinguished three models that obey three different ways of conceiving this relationship:

  • A power relationship based on expert knowledge: who knows what happens to the identified person, the causes and what to do is the professional. It is a completely asymmetrical relationship which relegates the parents to a role of mere accomplices of what the professional indicates, without recognizing any contribution beyond the answer to certain questions asked by the professional.
  • Parents as co-therapists: relationship based on an agreement which assumes that parents have to do at home what the professional does at the center.
  • Parents as collaborators: there is a change in culture and expectations in the relationship with families. Recognize that not all expertise resides with professionals, parents have as valuable knowledge as professionals, albeit from a different perspective. Parents are treated equally, this means that each respects and values ​​that the other provides knowledge and information relevant to the collaborative process.

aspects which they contribute to the quality of the relationship and its dimensions in practice:

  • Communication: The quality of communication. It must be positive, understandable and respectful of all.
  • commitment: Be sensitive to the emotional needs of families, be available, share the importance for families of the objectives pursued.
  • Equal treatment: Share decision-making, ensure that everyone can influence decisions, promote family empowerment.
  • professional competence: Shows high expectations of the child’s possibilities, gives an appropriate response, the willingness to continue learning.
  • trust: Key in the relationship. Trust and deserve parents, use strong arguments, keep confidentiality.
  • the respect: Treat families with dignity, respect cultural diversity, be kind, strengthen strength, do not judge.

Bibliographical references:

  • Gilman, CJ, Morreau, LI ALSC; Adaptive skills curriculum. Personal skills. Messenger editions.
  • Gilman, CJ, Morreau, LI ALSC; Adaptive skills curriculum. Home life skills. Editions Messenger.
  • Gilman, CJ, Morreau, LI ALSC; Adaptive skills curriculum. Community life skills. Messenger editions.
  • Gilman, CJ, Morreau, LI ALSC; Adaptive skills curriculum. Professional skills. Messenger editions.
  • FEAPS. Positive behavioral support. Some tools to manage difficult behavior.
  • FEAPS. Person-centered planning. Experience of the Sant Francesc de Borja foundation for people with intellectual disabilities.
  • Botxí Alonso, MA 2006. How to improve the quality of life of people with disabilities. Assessment tools and strategies. Amarú editions. Salamanca, Spain.

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