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Reducing Behavioral Issues Intellectual Disability

Intellectual disability
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Intellectual disability disorder is defined in terms of impairment of functioning in two areas with age of onset before 18 years including poor intellectual and adaptive functioning (APA, 2000).

Intellectual functioning is considered as ability to learn things, problem solving and judgment of things. It is more commonly measured in terms of Intelligence Cotenant (IQ). Normal intellect range is 70 to 110 but in case of disability the range variations are found such as,

  • Mild ID range is from 50-55 to 70
    • Moderate ID range is from 35-40 to 50-55
    • Severe ID range is from 20-25 to 35-40
    • Profound ID range is below 20-25

Adaptive functioning, which refers how effectively an individual cope up with his everyday life demands of earthly existence. There are three basic areas of adaptive functioning are considered:

  • Conceptual functions like ability to learnlanguage, reading, writing, reasoning, knowledge, and memorization.
  • Social functioning includes basic social functions as empathy, social judgments about others, communication skills and the ability to make and keep friends.
  • Practical like independence in areas such as personal care, job responsibilities, managing money, recreation and organizing school and work tasks

Causes of Intellectual Disabilities

Causes of Intellectual Disabilities are estimated as,

  • Chromosomal abnormalities up to 4-28%
  •  Syndromes at child birth up to 3-7%
  • Monogenic conditions up to 3-9%
  • Structural issues of CNS up to 7-17%
  • Complications of premature delivery up to 2-10%
  • Endocrine or metabolic causes up to1-5 %
  • Unique monogenic condition unknown up to 30-50%

Symptoms of Moderate Intellectual Disability

  • Delay in language development
  • Extreme behavior problems
  • Physical abnormalities
  • Neurological abnormalities

Diagnostic tools for Intellectual Disabilities

  • Coloured Progressive Matrix ( CPM)
  • The developmental screening test (DST)
  •  Wechsler Preschool and Primary Scale of Intelligence (WIPPSI)
  •  Wechsler Intelligence Scale for Children (WISC)
  • Stanford-Binet Intelligence Test

Interventions for Reducing Behavioral Issues

  • Functional Analysis of the Child

It is a process to identify specific behavior, its purpose and the factors that maintain that behavior (Anderson, 2018).  For example a child with Intellectual Disability disorder tried to harm himself by scratching his skin. There it is needed to evaluate his baseline frequency and intensity like

  • When this behavior is triggered?
  • Where most of the time it occurred?

While on second step a hypothesis is formed that it can be for the reason that boy wants to grab attention or want independence and try to own his all activities. Later on anintervention plan is formed.

The impression of challenging certain behavior on the principal of functional analysis is an effort to understand that behavior and to provide intervention as to challenge that behavior to and altar its level of development. Such behavior includes temper tantrums, aggression and self injurious acts (Iwata, Dorsey, Slifer, Bauman, & Richman, 1994; Ramasamy, Taylor, & Ziegler, 1996; Dunlap & Fox, 2011).

Intellectual Disability

  • Stereotypical Behavior

Repetitive cycles of behavior that a client do in a persistent manner for a very long periods of time is referred as stereotypical behavior including body rocking, finger flicking and hand flapping.

It may be caused because the child wants to stimulate himself or be in an active position because he finds it pleasurable. 

Problem

It can cause interferes in everyday life of a child especially his daily based learning or can be an only cause of hindrance in his involvement in society and social activities.

  • Self Injurious Behavior

These behaviors are defined as responsive actions that cause direct harm to the Individual himself such as skin pulling, slapping, biting and hurting.

It may be caused due to higher levels of pain tolerance and tact to grab attention and may be due to high level of production of endorphins hormone in the Central Nervous System.

Problem

Firstly it is harmful for him as it can be life threatening or painful as well as it can cause problem in social functioning too at a community level.   

Intellectual Disability

  • Aggression

Aggression is a state where a person provides unintentional and intentional harm to others or himself. It endangers others (Archer & Coyne, 2005).

It may be caused due to fear of things, anger like frustration or for the sake of manipulation of others.

Problems

I t may results in angry outbursts or harmful behavior such as crying or screaming, attacking others or damaging one’s or others properties.

  •  Non- compliant Behavior

These are the acts of refusing reasonable requests and going against those requests.

      It may be an attempt to get independence and unwantedness of someone else’s control over one’s activities

Problems

It is becoming limp and dropping to the floor, resisting transitions, not performing chores or duties.

  • Inappropriate social Behavior

 It is about failure to learn appropriate social skills and rules .It may be reasoned for not enough knowledge or not appropriate development of skills.

Problems

 Showing affection to strangers or stealing or touching other’s stuff as well as shouting in public

  • Lack of Physical Regulation

Limited physical control due to failure to acquire self-regulation

Problems

Such as enuresis, drooling, and tongue thrust.

Interventions

Define Behavior?

  1. When does it occur?
    1. Where does it occur?
    2. Why do you think it occurred?

Elimination Approach

In this approach behavior is taken as maladaptive or intrusive actions that causes hindrance in learning of child.

Intellectual Disability

Goal

 Its goal is to eliminate such behaviors before teaching of desired behaviors.

 Negative behaviors are regarded as high priority intervention goals because they are viewed as interfering with learning.

A – B – C Analysis

  • A stand for antecedents of certain behavior
  • B is that behavior
  • C is the causes of behavior
  • Positive reinforcement

Athens et al., 2008 used a BCADAC design to study an 11 year old boy with intellectual and learning disabilities.l

Problem

He exhibited loud, repetitive no contextual or unintelligible verbalizations

Interventions

  • Not giving contingent attention
  • Time out on contingent demands
  • Response costs in a playroom in his home.

Results

The sessions took place for 5 minutes, 2-3 times per day, 3 days per week. Results showed a decrease in stereotypy, and successful

  • Over-correction 

It is about making individual do restitution for what he or she is doing. It is about over attentiveness or rebuking behavior.

  • Desists

It is about verbal reprimands.

  • Satiation

 It is about providing a reinforcer to a child for a long span of time so that he may form aversive response with it. Define Behavior in Observable, measurable terms.

  • Consider Alternatives (Non Contingent Reinforcement)

Lane et al., 2006 used an ABCBAB design to study a 9 year old child diagnosed with moderate mental retardation (Intellectual Disability, DSM 5).

Problem

Skin picking was determined through an interview with his teacher and the intervention was administered in his classroom during school hours.

Intervention

 The intervention consisted of asking the boy to choose of one of three manipulative (malleable plastic balls with different textures) to occupy his hands during instruction. A teaching assistant recorded the duration of object manipulation and the duration of skin picking.

Results

 Results showed a general decrease in SIB while having the manipulative in his hands, and baseline levels or higher when he had no manipulative.

  • Positive Punishment (differential reinforcement)

Roane et al., 2001 used an ABACD design to study a child diagnosed with moderate mental retardation (Intellectual Disability, DSM 5).

Problem with hands rubbing

Intervention

 The intervention consisted of saying “hands down” and manually bringing her hands down to her waist for 20 seconds after an episode of hand rubbing. At least eight sessions took place daily in a hospital therapy room, and the percentage of duration of hand rubbing was reduced by 50.5%.

  • Prompting

Prompting can be employed with these children in order to give clues about learned things. Here, gestural and physical both kind of prompting can be employed.

  • Shaping

Shaping and Channing can also be helpful in this regard as the target behavior is learned and demonstrated in most of life skills training.

  • Token Economy

Token can be rewarded o desirable behavior to moderate Intellectual Ability children it can be helpful in behavioral modification.

  • Time Out

Time out can be described as taking away desired stimulus from them and let the wait for 2 minutes or in setup where they are learning basic skills it can also be employed.

  • Social Skills Training

Social skills are highly needed to teach them in order to their better placement in social setup and daily life like

  • Verbal skills as talking and speaking
  • Non verbal as buttoning, shirt wearing
  • Emotional recognition

Conclusion

            Children with Intellectual Disability disorder is found primarily in different special schools and there is a proper behavioral schedule or plan is needed for their management and intervention but the most important thing is that they are unique in their own ways and no certain plan is applicable for everyone. There a psychologist is needed to make a plan on individual basis and presenting complaints based on the techniques described above. 

Intellectual Disability

References

American Psychiatric Association. (2000). Practice guidelines for the treatment of           

patients with intellectual disability disorders (2nd ed.). Washington, DC: Author.

AMERICAN PSYCHIATRIC ASSOCIATION. (2000) Diagnostic and statistical

annual of mental disorders. (4th ed.) Washington, DC: APA. DOI: 10.1176/appi.books.9780890423349.

Archer, J., & Coyne, S. M. (2005). An integrated review of indirect, relational, and social

aggression. Personality and Social Psychology Review, 9(3), 212–230.

Athens ES, Vollmer TR, Sloman KN, St. Peter Pipkin C (2008) An analysis of vocal

stereotypy and therapist fading. Journal of Applied Behavior Analysis 41:291–297.

IWATA , B. A. , DORSEY , M. F. , SLIFER , K. J. , BAUMAN , K. E. , & RICHMAN ,

G. S. (1994) toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27, 197 – 209 .DOI: 10.1901/jaba.1994.27-197.

Lane K, Thompson A, Reske C, Gable L, Barton-Arwood S (2006) Reducing skin

picking via competing activities. Journal of Applied Behavior Analysis 39:459-

462.

Roane HS, Piazza CC, Sgro GM, Volkert VM, Anderson CM (2001) Analysis of aberrant

behavior associated with Rett syndrome. Disability and Rehabilitation 23:139-148.

Scott, T. M., Anderson, C. M., & Spaulding, S. A. (2008). Strategies for Developing and  

carrying out Functional Assessment and Behavior Intervention planning. Preventing School Failure,  52(3), 39-50.

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