Week 6 Flashcards
Lexicon
Mental retardation
Intellectual disability. Current international term
Learning disability. Official UK term. Designates specific learning difficulty in many countries
Learning difficulty used by educational services in UK probably preferred by people with LD
Mental impairment legal term used differently in the DDA and the mental health acts
WHO definition
Intellectual disability means a significantly reduced ability to understand new or complex information and to learn and apply new skills (impaired intelligence). This results in a reduced ability to cope independently (impaired social functioning) and begins before adulthood with a lasting effect on development
Definition summarised
General impairment of intellectual functioning
Consequences in terms of severe impairment of social functioning
Onset before physical maturity
Therefore excludes people who develop cognitive impairments in adult life and people with specific impairments such as dyslexia
Measurement: IQ tests
Developed to identify children who needed special educational help. Includes questions measuring a range of intellectual skills and knowledge summed and weighted to give a composite score. Scores standardised with 100 as population mean
Soon reified as supposed measure of innate and fixed ability and used to identify those deemed incapable of education and to rank sexes and ‘races’
IQ grades
Mild. IQ 50-70 holds conversations full independence in self care basic literacy
Moderate IQ 35-50 limited language needs supervision in self care usually fully mobile
Severe IQ 20-35 uses words/gestures for basic needs activities need to be supervised marked motor impairment likely
Profound. IQ less than 20 very limited words gestures or none. Severely limited mobility. Incontinent
Grades are not discrete groups and assessment should take account of sensory impairment
Four grade system often modified eg into mild and severe. Term ‘profound and multiple learning disability’ used in UK. Also ‘borderline LD’ for people with significant social impairments
Problems with IQ tests
Measure narrow range of skills results do not always reflect how someone copes in everyday life
Under-performance subject may not understand why test is used may have additional disabilities which affect score
Invalid application IQ tests not designed for or standardised on people with LD who may have very uneven balance of strengths and weaknesses
Measurement: adaptive behaviour
Adaptive behaviour scales (Vineland ABS etc) measure skills in daily living by checklists, interviews with carers and observations in activities such as self help basic academic skills, communication mobility everyday coping skills and social competence
Generate a series of rating scales rather than an overall score
Use measurement to
Identify areas in which people most need help to learn and achieve use multiple measures to get a profile of strengths and weaknesses
Measure changes in performance over time and as a result of therapeutic action
Identify eligibility for specific services for disabled people or where there is a risk of mistreatment (eg in criminal proceedings)
Problems with AB scales
Ignore extent of support from a carer or whether communication aids available
May be variability in performance between settings (transferability problem)
Include assumptions about activities appropriate to a particular culture
Poor performance may indicate lack of opportunity rather than lack of skills
Core skills change over time eg cooking less important but skill in use of a computer being redefined as a core competence
Epidemiology- problems
Problems in estimating numbers because no UK national register of learning disability (although exists in some EU countries)
Local GP registers, local service registers but usually record people in contact with services (mainly moderate/severe/ profound LD or mild LD with additional disabilities)
GP records now more effective but also under record people with mild LD
All learning disability numbers
Theres ~ 1.5mil people with learning disability in UK
~1.2mil of those are in England
~2.16% of adults in the UK are believed to have a learning disability
~2.5% of children in UK are believed to have learning disability
350000 people have a severe learning disability
Epidemiology- mild LD
18/1000 people across all ages
Most dont have identified organic cause
Strongly associated with poverty and disadvantage
Most not in contact with specialist services and rates on registers therefore increase through school years (as more children identified) and then decrease after leaving school
Epidemiology more severe LD
About 3-4/1000 people have moderate, severe or profound LD
Much more likely to have identified organic cause
Less association with poverty than mild LD
Contact with specialist services continues after school but high mortality rates result in declining proportion among the elderly
Trends
Possible increase because of:
-limited impact of preventative measures
-increasing number of premature babies surviving often with LD
-increased number of children with severe LD surviving into adulthood
-greater life expectancy of adults with LD
Communication
Distinguish receptive from expressive communication. More people can understand language than speak it while many more can communicate than can understand language
Understanding may be limited to key words.
Significance of communication
Communication problems associated with ‘challenging behaviour’ which may be a substitute form of communication
In terms of healthcare services think of people with LD as a ‘communication minority’ comparable to people who are deaf, blind, illiterate or who do not speak the host language
Assisting communication
Communication minorities need:
-environmental adaptation (signs, colour, coding etc)
-interpreters (translators, sign language, inc makaton)
-assisted communication (braille, symbol systems, message board etc) but also use of simpler English
Communication environments
Communication therapists identify need for ‘total communication’ approach which uses all of above methods
But this requires commitment from staff and theres a common failure to adapt buildings, use Makaton, adapt speech etc
top tips of communication
Use accessible language
Avoid jargon or long words
Be prepared to use different communication tools
Follow the lead of the person
Go at the pace of the person
Three evangelical phases
Early 19th century commitment to human care and education (pinel and Itard) led to creation of special schools and residences
Early 20th century eugenics (Galton) application of social Darwinism. Led to total institutions
Late 20th century normalisation (Nirje, Wolfernsberger) led to community integration
Eugenics
Developed by Galton in 1880s and attracted wide intellectual support by early 20th century
Concern that fitness of the’ race’ imperilled by higher reproduction of least intelligent and social welfare preserving the ‘weak’
Aimed to prevent reproduction by the ‘weak’ and encourage the strongest to reproduce ‘thoroughbreds’
Impact of eugenics
Prevention of reproduction. Sterilisation, separation of sexes and separation from society in institutional care
Failure to educate. Children formally classed as ‘uneducable’
Failure to treat diverse health needs of people with LD not investigated and high mortality rates
Discrediting. People with LD seen as threat to survival of the race
The end of eugenics
Eugenics adopted by Nazis, murder of 200000+ disabled people hadamer clinic
Post 1945 triumph of ‘universalism’ (ie the idea that all human life is of worth, expressed in declarations of rights (universal declaration of human rights and the European convention of human rights)). Reflected much earlier religious and humanitarian ideals
Rights of disabled people
Neither UDHR or ECHR specified disabled people
Subsequent UN declarations have asserted application of universal rights to disabled people, statements of entitlement to an ordinary life and entitlement to compensating services to enable disabled people achieve their potential and make use of their rights
Normalisation 1
Scandinavian approach (eg Nirje) emphasises the importance for the disabled person to attain adulthood by overcoming the ordinary challenges of life
Compensatory services are needed to enable the disabled person overcome these challenges and also to live a life comparable to that of other people in society
Normalisation 2 (social role valorisation)
US approach (wolfensberger) notes the ease by which disabled people are assigned derogatory labels because of the separateness of their appearance, environment or way of life
Therefore wary of specialist services which identify disabled people as different proposes importance of them being associated with valued social roles. Now renamed ‘social role valorisation’
Impact of universalism
Closure of large institutions. Preference for ordinary domestic settings, domiciliary care. Suspicion of separate disabled services, schools
Greater access for disabled people to universal public services, employment and community facilities this is enforced by law and political action
Challenge to universalism
Rise of consumerism with people defining self as what they purchase from competing corporations
Diminished sense of collective responsibility arising from less engagement with others and perception of others as a threat (culture of fear)
May lead to loss of sense of people sharing universal rights disabled seen as ‘negative consumers’
