Intellectual disability treatment

Intellectual Disability (ID) treatment is a likely scenario that speech language pathologists will encounter during the course of their careers. 

An estimated 1 to 3% of the population has an Intellectual Disability, which is considered a neurodevelopmental disorder. In addition to cognitive delays, language disorders are one characteristic of individuals with an Intellectual Disability. 

According to the Centers for Disease Control (CDC), the term Intellectual Disability is used “when there are limits to a person’s ability to learn at an expected level and function in daily life.” 

There are 3 features that characterize an Intellectual Disability:

• Cognitive deficits
• Delays in adaptive function 
• An onset of anytime before a child turns 18 (even prior to birth) 

Intellectual Disability can be caused by prenatal factors (genetic syndromes such as Fragile X Syndrome and Down Syndrome). Environmental factors can also cause ID, with the largest one being Fetal alcohol syndrome.

Other possible causes of ID include incidents occurring at birth and after birth (including seizures and traumatic brain injury). However, the cause of an intellectual disability for many children is unknown.  

Speech therapy is an integral component of care for those needing Intellectual Disability treatment. 

As part of Intellectual Disability treatment, SLPs can target receptive and expressive language skills, speech production skills, and social/pragmatic skills to help clients with Intellectual Disability live a more independent life and interact with others in a variety of environments. 

Here’s what you need to know about Intellectual Disability treatment from assessment to intervention, including best practices for collaborating with a team of professionals and special considerations for treatment.  

Overview of Intellectual Disability treatment

An Intellectual Disability is a type of Developmental Disability. In fact, ID is the most common Developmental Disability. Autism, ADHD, and others are also types of Developmental Disorders.  

ID can be classified as mild, moderate, severe, or profound. This depends on the severity of delays that the individual demonstrates. 

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In addition to deficits in intellectual functioning, individuals with ID also have deficits in language and pragmatic skills including areas such as:

• Language development
• Executive functioning skills (planning, reasoning)
• Abstract thinking
• Problem solving
• Expressive Language (vocabulary, grammar)
• Receptive Language (comprehension)
• Social skills (using appropriate judgment, understanding social rules) 

As a result of these deficits, individuals with ID require support with functional, daily activities like successfully functioning at school or work, completing household tasks, using transportation, and completing personal care tasks. 

The goals of intellectual disability treatment involving speech therapy are centered around collaborating with the individual’s family to help the client improve his or her independence and use of functional communication skills. 

A strengths-based approach for intellectual disability treatment is recommended by ASHA. The individual’s strengths should be utilized to form a bridge for achieving functional life outcomes. This approach also involves taking the client’s natural environment and support available into account when planning goals and therapy strategies.  

Assessment of Intellectual Disability

Components of a speech therapy assessment for a client with ID can include:

• An age-appropriate language assessment
  • Standardized tests such as the CELF-5 or Receptive/Expressive One Word Picture Vocabulary Test may be used. 
  • The client’s cognitive skills (such as IQ score) should be taken into account when interpreting scores from language testing. 

• Social/pragmatic assessment
  • Utilize clinical observation, caregiver report, and standardized tests such as the Clinical Assessment of Pragmatics (CAPs). 

• Assessing the need for AAC use

• Referrals for the client for other relevant professionals, such as ST for a feeding evaluation, occupational therapy, and physical therapy. 

• Articulation assessment with concerns about speech intelligibility

When working with both children and adult clients with ID, it’s important to actively involve the client’s family and caregivers in the assessment and treatment planning processes. 

SLPs should discuss any of the caregiver/family’s concerns with the client’s ability to complete functional daily tasks or specific social skills that impact their life as part of Intellectual Disability treatment.

Intervention

Using a family-centered, strengths-based approach when providing intervention to clients with an Intellectual Disability is considered to be best practice by ASHA.

SLPs are encouraged to involve peers in Intellectual Disability treatment and intervention. Because peer relationships are important for clients of any age, therapists can incorporate others in therapy activities. Through this, the SLP can work on goals such as improving social communication skills (such as using greetings or taking turns in conversations) as part of Intellectual Disability treatment. 

Intellectual Disability Treatment should also occur within the client’s natural environments when possible. For example, SLPs may provide teletherapy while the client is at home, school, or a vocational setting. 

Therapists might use a variety of intervention approaches when working with a client with ID.

These can include: 

1. Augmentative and Alternative Communication (AAC)

High-tech AAC such as a speech generating device (SGD) or low-tech AAC (like a communication board) may be considered for a client who has delays in expressive communication skills. 

AAC can provide the individual with an alternate modality to express their feelings, wants, needs, and thoughts, other than through verbal speech as a component of Intellectual Disability Treatment.

2. Functional Communication Training (FCT) 

In this type of behavioral intervention, the SLP works on eliminating problem behaviors through extinction. Therapists use a combination of ABA procedures with the problem behaviors the client uses to fulfill communicative functions. A target of Speech Therapy is to replace those behaviors with more appropriate ways of communicating. 

3. Incidental Teaching

In this approach, the client initiates a communicative action (such as reaching for a desired item). The SLP then uses prompts to encourage the client to use a functional way to communicate a request (such as verbally or through an AAC device).  

Other approaches, such as providing literacy intervention, incorporating Mileu Therapy, and other techniques can be used with clients needing Intellectual Disability Treatment as part of speech therapy.