Effective Teaching Methods For People
With Intellectual Disabilities
Individuals with intellectual disabilities (ID, formerly mental retardation) benefit from the
same teaching strategies used to teach people with other learning challenges. This includes
learning disabilities, attention deficit/hyperactivity disorder, and autism.
One such strategy is to break down learning tasks into small steps. Each learning task is
introduced, one step at a time. This avoids overwhelming the student. Once the student has
mastered one step, the next step is introduced. This is a progressive, step-wise, learning
approach. It is characteristic of many learning models. The only difference is the number and
size of the sequential steps.
A second strategy is to modify the teaching approach. Lengthy verbal directions and abstract
lectures are ineffective teaching methods for most audiences. Most people are kinesthetic
learners. This means they learn best by performing a task “hands-on.” This is in contrast to
thinking about performing it in the abstract. A hands-on approach is particularly helpful for
students with ID. They learn best when information is concrete and observed. For example,
there are several ways to teach the concept of gravity. Teachers can talk about gravity in the
abstract. They can describe the force of gravitational pull. Second, teachers could
demonstrate how gravity works by dropping something. Third, teachers can ask students
directly experience gravity by performing an exercise. The students might be asked to jump
up (and subsequently down), or to drop a pen. Most students retain more information from
experiencing gravity firsthand. This concrete experience of gravity is easier to understand
than abstract explanations.
Third, people with ID do best in learning environments where visual aids are used. This
might include charts, pictures, and graphs. These visual tools are also useful for helping
students to understand what behaviors are expected of them. For instance, using charts to map
students’ progress is very effective. Charts can also be used as a means of providing positive
reinforcement for appropriate, on-task behavior.
A fourth teaching strategy is to provide direct and immediate feedback. Individuals with ID
require immediate feedback. This enables them to make a connection between their behavior
and the teacher’s response. A delay in providing feedback makes it difficult to form
connection between cause and effect. As a result, the learning point may be missed
Applied Behavioral Analysis (ABA) And
Intellectual Disabilities
So far, we have discussed four effective teaching strategies for people with intellectual
disabilities (ID, formerly mental retardation). However, these effective teaching strategies did
not develop by happenstance. Instead, these teaching strategies emerged from an educational
method known as Applied Behavioral Analysis (ABA). Applied Behavioral Analysis rests on
a solid foundation of research. This research has investigated how humans (and animals)
learn. It comprises a large body of literature known as behavioral psychology.
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The ABA approach utilizes two, well-researched learning theories. These are: 1) classical
conditioning and 2) operant conditioning. The ABA does not require great intellectual ability
in order for learning to be successful. Thus, ABA is ideally suited for people with mental
challenges. This includes people with intellectual disabilities.
In its most basic form, ABA is very simple and common sense. It rewards a person for
making a correct choice. Incorrect choices are ignored, or not rewarded. Therefore, students
learn by making simple associations between cause and effect. With repetition, a student
learns to associate a correct action with a reward. As such, this correct choice will be
repeated. An incorrect action does not earn a reward. When not rewarded, behaviors begin to
slowly fade away. This process is known as extinction.
Here is the basic approach for ABA: First, complex tasks or behaviors are broken down into
smaller steps. For instance, suppose a student needs to learn to raise his hand before speaking
in a classroom. This might be broken down into five steps: 1) Raise the hand. 2) Raise the
hand while remaining silent. 3) Keep the hand raised, remaining silent, until the teacher
acknowledges you. 4) Once the teacher acknowledges you, put the hand down. 5) After the
hand is down, speak. Skills are systematically introduced in small steps. As one small skill is
mastered, the next step is introduced. Students learn by making simple associations between
cause and effect. If they respond correctly for that step, they are immediately rewarded. If
they respond incorrectly, nothing happens. Once a step is consistently mastered, the next step
is rewarded, not the previously mastered step. This process is known as chaining.
Let’s illustrate these concepts. Suppose Billy has learned the first step. The first step is
simply to raise his hand. He talks while his hand is raised because he hasn’t learned step two
yet. Now step two is introduced. Billy will not receive a reward when he raises his hand and
is talking. At first, he will be puzzled by this. He previously earned a reward for raising his
hand. He may be instructed to stop talking and will receive a reward when he does.
Alternatively, he might raise his hand without talking by sheer coincidence. He would
immediately receive a reward. Step two is learned because once Billy discontinues speaking
and chattering while his hand is raised, he will immediately receive a reward. This step is
repeated until Billy can consistently raise his hand while remaining silent. Then he will begin
practicing the next step and so on. This continues until the entire behavioral chain is
mastered.
ABA’s emphasis on providing immediate rewards for correct behavior is crucial to
motivation. However, the reward must be valuable or desired. Each student will find different
things rewarding. Only rewards that are intrinsically rewarding have a motivational effect.
Rewards that are not gratifying will not reward or motivate someone. For instance, if you
dislike chocolate candy, Hershey kisses ® would not be rewarding. Therefore, they would not
serve to motivate and teach a new behavior.
When the ABA is initially introduced, rewards must be immediate and concrete. Snacks and
food rewards work well for this purpose. For behaviors that require more sustained effort,
such as remaining on task for 30 minutes, a more sustained reward may be appropriate. This
might be permission to watch a favorite TV show, or to play an exciting game.
As students become familiar with the instruction and reward process, a more abstract “token”
reward system can be introduced. Token reward systems use visual representations. Common
examples are stickers placed on a chart, or beads placed on a bracelet. These represent a
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student’s progress towards an ultimate, concrete reward. For example, once the child earns
five stickers he can play a game or watch a program. The token reward system is a little more
complex and abstract than immediate and concrete rewards. However, it is very effective for
increasing on-task behavior. Furthermore, it teaches students to delay their gratification.
ABA’s modern emphasis provides rewards for correct behavior and ignoring incorrect
behavior. However, this was not always so. In the early days of ABA, incorrect choices were
not merely ignored. Rewards were balanced with punishments for undesired behavior. Today,
negative or undesired behaviors are usually ignored or redirected, rather than punished. The
only exceptions are “non-negotiable” circumstances.
Dangerous behaviors are considered “non-negotiable.” These types of behavior may require
immediate negative consequences. For obvious reasons, dangerous behavior cannot be
ignored. Ignoring someone who is starting a fire is a bad idea! Dangerous behaviors include
any behaviors that threaten, or cause significant harm to anyone. Some examples are banging
one’s head against the wall, or biting other children. The other non-negotiable behaviors are
ones that cause significant damage to property. This might include setting fires or throwing
computer equipment off a desk. Common consequences include time-outs, or loss of
preferred play items and activities. In the case of self-harm, the least restrictive rule prevails.
Physical restraints or protective devices (such as a helmet) may be used. These behaviors and
consequences are outlined in the safety crisis management plan. An individualized safety
crisis management plan is routinely developed for at-risk children. It spells out what the
negative consequences are for dangerous behaviors
Physical Therapy And Sensory Skills
Training
Sometimes the individualized education plan (IEP) specifies certain therapies. Physical
therapy is one such therapy. Intellectual capacity is highly influenced by the ability to receive
and correctly interpret sensory data. We receive this data from our five senses: sight, sound,
touch, taste, smell. Sensory integration is a natural process used by the body to interpret
sensory information. Normally, the various senses work together in unison. This helps people
navigate their surroundings. However, some children with intellectual disabilities have
difficulty interpreting, integrating, and coordinating sensory input. Sensory integration
activities help these children strengthen these abilities.
There are two different sorts of sensory problems. Some children have hyperactive
(overactive) systems. These children have difficulty blocking out signals that should be
ignored. In response to this overactive system, they avoid motion activities like climbing
stairs. They may also be very prone to motion sickness. They may seek support from others
while walking.
Other children have hypoactive (underactive) systems. These children have difficulty
attending to signals that should be heeded. Children with hypoactive sensory systems may
actively seek out motion. They may enjoy swinging and climbing activities, and do not
become dizzy after spinning.
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Sensory integration activities address children’s sensory needs by either lessening or
amplifying the intensity of the sensory stimulation they receive. Most sensory integration
activities work with children’s vestibular, proprioceptive, and tactile sensory systems. These
are described below.
The vestibular sensory system enables us to stand and coordinate movement. It involves
sensory input from vision and from sensory organs in the inner ear. Activities that stimulate
the vestibular system involve movement. Swinging, jumping, and spinning are good
examples. A physical therapist working with hypoactive children might engage them in
structured movement exercises. This meets their sensory needs within socially acceptable
boundaries.
The proprioceptive sensory system provides information about the body’s positioning.
Proprioceptive feedback helps people coordinate fine motor activities. Examples include
coloring within lines or buttoning a shirt. It also helps with motor planning. This refers to the
ability to coordinate different motor tasks to complete an activity. Activities that stimulate the
proprioceptive system include deep pressure, hugging, and climbing.
Not all children with intellectual disabilities require physical therapy. Physical therapy may
be conducted in schools, homes, or institutions. Sometimes children go to specialized
physical therapy facilities. Physical therapy promotes the development of gross motor skills
required for everyday activities. It also increases flexibility and stimulates learning abilities
through sensory integration activities.
The underlying condition that caused the intellectual disability determines whether physical
therapy is needed. For example, the Fragile X syndrome is often accompanied by sensory
challenges. People with Fragile X are easily distracted by noises or smells. People with
Cockayne syndrome may need physical therapy to limit joint contractions that interfere with
walking. People with Prader-Willie syndrome have poor muscle tone. Physical therapy helps
to correct this.
In addition to physical therapy, an IEP may also include speech therapy and occupational
therapy. These types of therapies are discussed in the next section
Individualized Support Plans: Adaptive
Functioning & Life Skills
Tammy Reynolds, B.A., C.E. Zupanick, Psy.D. & Mark Dombeck, Ph.D. May 21, 2013
Previously we discussed that intellectual disabilities have two defining features. These are
limitations in: 1) intellectual functioning and 2) adaptive functioning. In the previous section,
we discussed how Individualized Educational Plans (IEP) are developed to improve
intellectual functioning. This is accomplished by providing educational supports.
Specifically, we discussed the individual educational plans (IEPs) created for school-age
children with intellectual disabilities (ID, formerly mental retardation).
Although similar, the IEPs and individualized support plans (ISPs) are not the same. An ISP
is much broader than an IEP. This is because an ISP covers both intellectual functioning (e.g.
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education) and adaptive functioning. For school age children, the IEPs will usually address
both intellectual and adaptive functioning. Adaptive functioning refers to a set of skills
needed for daily living. Three broad sets of skills make up adaptive functioning. These are
conceptual skills, social skills, and practical life skills. These skills were previously reviewed.
In this section, we turn our attention to the ISP and adaptive functioning.
For many adults with intellectual disabilities, the adaptive functioning component of their ISP
is primary. ISPs are developed as part of the public and private services available to people
with intellectual disabilities. Therefore, these ISPs emphasize the supports needed to improve
adaptive functioning. As we have mentioned, the availability of services varies by state and
county. We review services that are commonly available. You can get information about the
specific services available in your community by contacting your county or state office of
human services.
Individual support plans (ISPs) and supportive services are typically provided through
community-based, social service programs. Supportive services may continue throughout a
person’s lifetime. Alternatively, they may be delivered on an intermittent “as needed” basis.
The ISP will describe what services and supports are needed to ensure each individual’s
ongoing success. These plans promote independence and self-determination of people with
intellectual disabilities.
Standardized tests are frequently used to assess adaptive abilities and limitations. One such
test is the Supports Intensity Scale (Thompson, et. al, 2004). The first section of this
commonly used assessment tool rates a person’s abilities and limitations in six areas. These
are: 1) home living; 2) community living; 3) life-long learning; 4) employment; 5) health and
safety; and 6) social activities. Once support needs are identified, the ISP proposes support
strategies to meet those needs. More information about the Support Intensity Scale can be
found at www.aaidd.org. For adults with intellectual disabilities, the ISP typically targets the
skills and supports needed for independent living. These include social skills training,
supported employment, and supported housing
Social Skills Training
Tammy Reynolds, B.A., C.E. Zupanick, Psy.D. & Mark Dombeck, Ph.D. May 21, 2013
Our success in life is greatly determined by our social skills. We often take these skills for
granted. Sometimes we are not even aware of these skills. It is easier to spot the absence of
these skills, than to detect the presence of them. These skills are usually learned by
observation. Many people with intellectual disabilities (ID, formerly mental retardation),
have underdeveloped social skills. This is because the development of social skills relies
heavily on certain intellectual abilities.
Social skills enable people to function well in any social situation. This includes work,
school, and interpersonal relationships. Some examples of good social skills include:
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Understanding and honoring the standards of dress and decorum at different social
occasions;
The acceptable forms of social interaction for different social occasions;
Knowing when to make eye contact and when to avert the eyes;
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Determining when physical contact is acceptable and what type (e.g. a handshake
versus a hug);
Being able to politely start and stop conversations;
Being able to make small talk;
Understanding how to notice and respond to non-verbal body language;
Appreciating social nuance such as sarcasm and humor;
Understanding the differences between literal and figurative speech;
Being able to express feelings and respond to the feelings of others.
Social skills are closely linked with language and communications skills. Effective
communication involves the accurate use and interpretation of both verbal and nonverbal
communication. It includes the ability to understand non-literal, figurative speech. For
example, the weather is a popular way to make small talk. Suppose someone steps into an
elevator and says, “It’s raining cats and dogs out there.” People might begin to nod or laugh
with amusement. However, someone with an ID might become horrified. They might begin
crying imagining cats and dogs dropping from the sky. They do not understand this nonliteral figure of speech.
Good social skills also require behavioral management skills. For example, impulses must be
kept under control across a wide variety of social situations. Self-care and grooming skills
must be demonstrated. People with IDs often need to be explicitly taught behavioral
management skills. For instance, they must learn to refrain from talking out of turn. They also
need to speak at the appropriate volume when conversing. When provided direction, they
learn to follow rules and social conventions. For example, with proper coaching, they know it
is correct to wait in line to purchase a ticket.
Social skills are taught in a kinesthetic manner. This means that individuals learn by doing.
They repeatedly practice proper social interactions in a step-by-step manner. The process of
repetition helps solidify social skills. Examples of this stepwise learning are provided in the
Applied Behavioral Analysis section.
Social skills must be learned in a social environment. Therefore, social skills training is
usually conducted in a social skills training group. These groups usually include two or more
professional instructors and peer support specialists. Peer support specialists are people with
ID who have mastered these skills. They serve in the role of coach.
First, instructors and coaches introduce a social skill. Then, they demonstrate the skill
through a role-play activity. Students are provided familiar examples. This helps students
connect the learning to their own everyday experiences. It provides a reference point.
When skills are first introduced, they are practiced in a classroom. The classroom provides a
safe learning environment. Here, they can make mistakes and receive corrective feedback.
They are rewarded for correct responses. Role-played interactions are similar to real-life.
Usually the learning experience is generalized to real-life situations.
Students are given homework assignments. They are asked to note and record real-life
experiences that required the skills they learned. They may be asked to demonstrate how they
handled the situation. Students are also encouraged to discuss real-life experiences that
challenged them. The instructors use these experiences as teaching points. They guide the
class to practice solutions to these problematic social interactions.
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After students demonstrate some mastery of the skill, they begin to practice the skill in the
real world. For example, the instructors may demonstrate getting into an elevator with a
stranger. The stranger is standing near the buttons that select the floors. The stranger turns
and asks, “Where ya going?” Obviously, this does not literally mean, “What is your ultimate
destination?” It means, “What floor do you want?” However, many people with IDs interpret
questions literally. They might blurt out, “I’m going to the doctor because I have diarrhea.”
With training, they learn the stranger isn’t interested in those details.
After mastering the basic elevator scenario, the instructors increase the complexity. They may
demonstrate the same scenario with a twist. What if someone asks the same question but isn’t
standing by the floor selection buttons? Students learn environmental cues serve to determine
the meaning of a communication.
The role-playing and rehearsal process is usually the most difficult part. It requires students
to demonstrate the skills that the instructors have modeled. The instructors guide the students
during rehearsal. Students are provided immediate feedback. This helps students gain
confidence in their abilities.
Instructor feedback is typically positive in nature. They praise and reward the students’
efforts. The instructors do not criticize students who have difficulty with a skill. Instead, they
correctly model the desired skill again. With repetition, practice, and support the students’
gain mastery and confidence
Therapies For Intellectual Disabilities And
Outdated/Unproven Treatments
Tammy Reynolds, B.A., C.E. Zupanick, Psy.D. & Mark Dombeck, Ph.D. May 21, 2013
Various therapeutic services can improve a person’s adaptive behavioral skills. These
therapies are helpful for many people with intellectual disabilities (ID, formerly mental
retardation).
Occupational therapy
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Meaningful and purposeful activities;
Self-care (e.g., grooming, dressing, feeding, bathing);
Employment activities and skills;
Leisure activities (e.g., knitting, playing games);
Domestic activities (e.g., cooking, cleaning, laundry).
Speech therapy
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Improves communication skills;
Improves receptive and expressive languages skills;
Improves speech articulation;
Improves vocabulary.
Physical therapy
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Enhances quality of life by maximizing mobility and self-locomotion;
Provides adaptive solutions to mobility problems;
Increases sensory integration
Outdated, Unproven ‘Treatments’ for Intellectual Disabilities
Effective skills training and educational approaches for people with intellectual disabilities
(ID, formerly mental retardation) have already been discussed. These approaches are
concrete, systematic, and straightforward. These evidence-based practices are supported by a
large body scientific research. In this section, we review several so-called ‘treatments.’ As we
have emphasized, there is no ‘treatment’ for a disability. At best, some medical treatments are
effective at reducing the symptoms of the conditions causing the disability. Nonetheless,
unsubstantiated claims are made about alternative treatments. There are no reliable research
studies to support claims of effectiveness.
Orthomolecular therapy: We all know diet and nutrition are important for good health. Just
like many other folks, some people with IDs don’t eat a healthy diet. In these cases,
nutritional supplements may be beneficial. However, diet and nutritional supplements have
not been proven to enhance cognitive functioning, performance, or learning in individuals
with IDs. Orthomolecular therapy claims vitamins and minerals can treat (reverse) a number
of different conditions including IDs. Proponents of orthomolecular therapy contend that
cognitive disorders can be improved by ‘molecular balance’ via nutritional supplements.
These claims have not been substantiated using accepted scientific methods.
Medications: Medications are legitimately prescribed when neurocognitive disorders are the
root cause of the disability. Currently, no medication can treat the entire spectrum of
disorders that cause IDs. Nonetheless, the use of “nootropic” medicines (i.e., ‘smart drugs’)
to improve people’s learning abilities is a growing area of interest. At this time, there is
insufficient evidence to suggest that nootropic drugs facilitate learning in persons with IDs.
Talk therapy: Talk therapy refers to psychotherapy. Psychotherapy is useful for many
psychiatric disorders. However, psychotherapy cannot treat, arrest, or cure disabilities. Some
types of psychotherapy may be a helpful adjunct for some people with mild ID, and who have
psychiatric disorder such as depression. Nonetheless, psychotherapies have not proven
effective for people with ID. Such therapies rely on a person’s cognitive, emotional, and
verbal abilities in order to promote change. Therefore, people with ID are not good
candidates for such therapies.
Genetic manipulations: Someday it may be possible to use genetic manipulations. This area
of research attempts to correct the genetic causes of some IDs. However, this promising area
of research is still in its infancy.
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