8.1 What Are Intellectual DisabilitiesUntil 2012, intellectual .docx

8.1 What Are Intellectual Disabilities?
Until 2012, intellectual disability was referred to, in the IDEA
and elsewhere, as mental retardation. (See the feature box titled
"Phasing Out the 'R' Word" for a discussion of the change in
terminology.) Intellectual disability is one of the 13 IDEA 2004
categories.
Defining Intellectual Disabilities
People with ID generally struggle with learning, problem
solving, and thinking. They also have difficulty with adaptive
behaviors, which are those conceptual, social, and life skills
that enable people to participate in everyday life activities.
These include using money, engaging in conversations, and
taking care of personal hygiene and safety (see Figure 8.1 for
more examples). Adaptive behaviors enable people to be self-
sufficient and live independently. When people do not initiate
such behaviors, it limits their participation in school and
society.
Students with ID typically develop at a slower rate than
students without ID; they may learn to speak and walk later than
normal and may have difficulty learning in school.
ID is sometimes grouped with developmental disabilities. This
category, not recognized by IDEA 2004, includes all disorders
and disabilities that occur during an individual's development,
typically defined as the period from birth until adulthood (i.e.,
22 years old). Autism is considered a developmental disability,
as is cerebral palsy, epilepsy, and fetal alcohol spectrum
disorder (FASD). Although ID may sometimes fall under the
umbrella term of developmental disabilities, a student with a
developmental disability does not necessarily have problems
with intellectual functioning or adaptive behaviors.
Figure 8.1: Adaptive Behaviors

Adaptive behaviors include conceptual, social, and life skills.
Typically, students with ID exhibit deficits in all three areas.
ID is different from mental illness. A mental illness affects how
a person thinks and feels and has no connection to intellectual
functioning. A mental illness can be positively influenced by
treatment; examples include schizophrenia, bipolar disorder,
anxiety disorder, post-traumatic stress disorder (PTSD), or
obsessive-compulsive disorder (see Chapter 6). An ID, in
contrast, is not an illness. ID is a condition that affects a
student for life. Treatment can improve student outcomes, but it
cannot change the condition of ID. Although institutions (which
you will read about shortly) often housed both populations
together, people with mental illness are distinctly different from
those with ID in terms of the symptoms, treatments, and
responses to treatments they experience.
Intellectual Disabilities and IDEA 2004
PL 94-142 included mental retardation as one of its original
disability categories. IDEA 2004, because it was written before
Rosa's Law took effect, still uses that term, but it will change to
intellectual disability when IDEA 2004 is reauthorized. The
IDEA 2004 definition is as follows: "significantly sub-average
general intellectual functioning, existing concurrently with
deficits in adaptive behavior and manifested during the
developmental period, that adversely affects a child's
educational performance."
Typically, intellectual functioning is defined using an
intelligence quotient (IQ). Students scoring below 70–75 often
qualify as having an ID. They must exhibit deficits in one of the
three areas of adaptive behavior (conceptual, social, or life
skills). As with all the other disability definitions under the
IDEA 2004, students can qualify as having an ID only if their
disability affects their educational performance.
Prevalence of Intellectual Disabilities

Approximately 1% of U.S. students have an ID, and
approximately 1–3% of the world population has an ID (Topper,
Ober, & Das, 2011). Under the IDEA 2004, however, there is
variability in identification by state. As happens in some of the
other disability categories, minority students (especially
African-American students) and students who are English
language learners are identified with ID at a higher rate than
students from other racial or ethnic backgrounds (Ford, 2012;
Sullivan, 2011). Additionally, boys tend to be identified with ID
more than girls (Ford, 2012). The rate of identification of
students with ID has decreased over the last several years,
especially since autism became its own IDEA category in 1990.
Section 8.4 of this chapter discusses some of the syndromes and
disorders that can cause ID.
8.2 How Has the ID Field Evolved?
In 7000 B.C.E., people with ID had holes drilled in their skulls
to let their "diseases" escape (Manion & Bersani, 1987). More
than two thousand years ago, the Greeks and Romans believed
that evil spirits allowed children to be born with ID, and many
of these children were left to die or were even killed. If their
parents were wealthy, children with ID were sometimes
permitted to live, but only if a guardian could take care of them.
Over the next two thousand years, some societies continued to
exclude children with ID. In some places, they were sold as
slaves or used for the amusement of others. People with ID
lived in poorhouses, monasteries, or prisons. In other societies,
though, children with ID were cherished as being blessed by a
higher power and were treated as deities (Manion & Bersani,
1987).
The First Advocates for Individuals With ID
As discussed in Chapter 1, during the 19th century, people
began to advocate for individuals with ID and built institutions
to house and help them. One of the first researchers was Jean-
Marc Gaspard Itard, who worked with Victor, the wild boy of

Aveyron, who had characteristics of ID along with other
disabilities (Feudtner & Brosco, 2011). His efforts were not
entirely successful, but his mentee, Eduoard Seguin, brought
Itard's teaching practices to the United States and published a
book titled The Moral Treatment, Hygiene, and Education of
Idiots and Other Backward Children.
Seguin, along with others, such as Dorothea Dix, helped spread
a movement in the United States advocating that students and
adults with ID should be treated humanely and be educated and
trained to participate in society. As the 19th century progressed,
institutions for the care of people with ID opened in cities
across the United States. Many states, though, still preferred to
place people with ID in state-controlled institutions so the state
could prohibit their marriage or procreation.
Associations With Poverty and Crime
Many societal problems of the 19th century, such as crime and
poverty, were blamed on people with ID, who were called
"idiots," "dumb," or "feeble-minded." In 1869, Sir Francis
Galton published a book called Hereditary Genius, in which he
promoted the idea that an ID was inherited. This idea fueled the
eugenics movement, which advocated that people with
intellectual disabilities should be sterilized to prevent future
generations of people with these disabilities.
The eugenics movement was spurred on by Richard Louis
Dugdale's The Jukes: A Study in Crime, Pauperism, Disease,
and Heredity and Henry Goddard's The Kallikak Family: A
Study in the Heredity of Feeble-Mindedness. Both authors
described "families" who had tendencies toward poverty,
criminality, or feeble-mindedness, and eugenicists used these
family histories to promote sterilization laws (Smith &
Wehmeyer, 2012). (Modern scholars, of course, have debunked
many of the claims put forth in Dugdale's and Goddard's books.)

By 1944, 30 states had sterilization laws. States could sterilize
people who were "imbeciles" or were "unimproveable." States
ultimately sterilized thousands of people, many of whom did not
have an ID. After World War II, attitudes toward sterilization
shifted, and by the 1960s all states had abandoned this practice.
The First Efforts at Schooling for Individuals With ID
Meanwhile, the use of standardized assessments began to help
doctors and educators identify students with disabilities, and
states slowly started to provide for the schooling of these
students. In 1911—well before PL 94-142 in 1975—New Jersey
was the first state to mandate education for students with ID.
Another major milestone for people with ID occurred in 1950
with the formation of the National Association of Parents and
Friends of Mentally Retarded Children. This organization, now
called ARC, helped advocate on behalf of students with ID. In
1962, President John F. Kennedy formed the President's Panel
on Mental Retardation to provide funds for research and
education of students with ID.
With the passing of PL 94-142 in 1975, students with ID
received the right to a free, appropriate public education. While
many public schools were providing an education to students
with ID before 1975, the law made it mandatory.
The Shift From Home to Group Care Environments
As students with ID began to participate in schools more
widely, educators and legislators began to reconsider how to
best prepare them to be members of society and provide services
as they became adults. Advocates believed that institutions were
dehumanizing, and they started a movement to integrate adults
with ID into local communities.
One such advocate was a professor of special education named
Wolf Wolfensberger. Wolfensberger promoted the concept of
"normalization," which involved providing the same

opportunities and environment to people with disabilities as
were available to people without disabilities (Mann & van
Kraayenoord, 2011). Starting in the 1980s, states closed many
of their mental institutions, where people with ID had usually
been placed, and adults from these institutions went back to
living with family members or in group and community homes
with other adults with disabilities.
8.3 What Are the Characteristics of Students With ID?
By definition, all students with ID have lower intellectual
functioning and have difficulty with adaptive behaviors. (See
Figure 8.1 for examples of those.) In addition, they may exhibit
certain physical characteristics or mobility issues as part of
their disability. For example, students with ID may sit up,
crawl, or walk later than other students; weigh less than
students of the same age; be shorter than students of the same
age; have difficulty with balance; or move around excessively
or awkwardly.
Comorbidity With Other Disabilities
The most common type of comorbidity with ID is emotional and
behavioral disorders, with comorbidity rates as high as 30–50%
(Einfeld, Ellis, & Emerson, 2011). ADHD is another common
disorder that often occurs in conjunction with ID (Neece, Baker,
Blacher, & Crnic, 2011), although ADHD is sometimes difficult
to diagnose in students with ID because the symptoms are
manifested differently than in typical students with ADHD
(Reilly & Holland, 2011).
Until autism became its own disability category with IDEA,
students with autism were often categorized as having ID. With
the creation of a separate autism category, the percentage of
students with ID identified in school decreased. This decrease
did not signal that fewer students had deficits in intellectual
functioning and adaptive behavior, but only that the categories
had changed (i.e., some students previously identified as ID

were now identified with autism spectrum disorder [ASD]).
8.4 What Are the Causes of ID?
As with other disabilities, there is no single cause of ID.
Genetics (i.e., the actions of genes in the body) and heredity
(i.e., the passing of genetic traits from parent to offspring)
commonly play a role. In addition, many causes of ID arise
during pregnancy, childbirth, and childhood.
Genetic Causes
When a child inherits abnormal genes from one or both of their
parents, or a gene mutates spontaneously, genetic abnormalities
can cause disorders, such as Down syndrome, fragile X
syndrome, Williams syndrome, Prader-Willi syndrome, and
phenylketonuria (PKU).
Children with Down syndrome, or trisomy 21, have an extra
copy of chromosome 21. They have a characteristic appearance
that may include a small head, broad or flat face, slanting eyes,
and a short nose. They also typically have health issues,
including heart problems and vulnerability to infectious
diseases, as well as intellectual impairments, which can range
across a spectrum but are most often mild to moderate
(Couzens, Haynes, & Cuskelly, 2011).
Fragile X syndrome is a disorder resulting from changes to the
genetic code on a fragile area of the X chromosome. Both girls
and boys can have fragile X syndrome, but because girls have
two X chromosomes and the unaffected X chromosome helps
mask the affected chromosome, boys usually have more severe
symptoms. In this syndrome, the gene that makes a certain
protein that the brain requires in order to grow has a defect,
which leads to abnormal brain development. The syndrome is
characterized by delays in speech or intellectual functioning.
Some students with fragile X exhibit characteristic physical
attributes, such as a long face with a wide forehead.

Children with Williams syndrome are born without
approximately 25 genes. This causes atypical brain
development. Unlike some other students with ID, students with
Williams syndrome are very social and relate well to other
students and adults. They often experience medical difficulties
related to the heart and require medical care throughout their
lifetime.
In Prader-Willi syndrome, children are born with part of
chromosome 15 missing. Babies born with this syndrome often
have difficulty eating and gaining weight and experience delays
with motor development—for example, sitting, crawling, or
walking (Yearwood, McCulloch, Tucker, & Riley, 2011). As
toddlers, children with Prader-Willi may experience rapid
weight gain. Physical characteristics include almond-shaped
eyes, a narrow skull, and small hands and feet. Students with
Prader-Willi almost always have delays in intellectual
functioning.
PKU is a metabolic genetic disorder in which the child's body
lacks the enzyme needed to break down the amino acid
phenylalanine. A buildup of this amino acid can lead to brain
damage that may affect intellectual functioning. As opposed to
Down syndrome, Williams syndrome, and fragile X syndrome,
PKU can be treated with a strict diet. Thus, newborns are
routinely tested for PKU so that a diet can be started
immediately, before damage has occurred.
Prenatal and Perinatal Causes
In addition to its genetic causes, ID can also result from factors,
complications, or difficulties during pregnancy or childbirth.
For example, excessive alcohol consumption during pregnancy,
especially during the first trimester, can result in fetal alcohol
spectrum disorder (FASD). One of the most common difficulties
associated with FASD is deficits in intellectual functioning.
Individuals with FASD often have noticeable physical

characteristics, such as a smaller head with atypical facial
features such as smaller eyes and thinner lips.
Exposure of a fetus to certain infectious agents can also result
in ID. If a mother contracts rubella (also known as the German
measles) while pregnant, her child may be born with birth
defects, such as hearing or visual impairments. With the advent
of the rubella vaccine, the number of babies born with
complications due to a mother's rubella has dwindled to near
zero in the United States, but babies with unvaccinated mothers,
who may come from other countries or have visited other
countries, are still at risk. Toxoplasmosis is another disease that
can affect a fetus. It is caused by a parasite that can be present
in contaminated or undercooked meats. If a mother contracts
toxoplasmosis while pregnant, the infection can affect the fetus.
Babies may experience deficits related to the brain and
neurological system, which can lead to ID. They may also be
born with visual impairments.
Complications during labor and delivery can sometimes lead to
intellectual disability in a newborn, particularly if the child's
brain experiences a lack of oxygen (when, for example, the
umbilical cord accidentally wraps around the neck). The
incorrect use of medical instruments, such as forceps, may also
cause injury to the brain.
Childhood Causes
Infectious agents can also lead to development of ID during
childhood, as can exposure to certain toxins. They are now rare,
but childhood illnesses like measles, whooping cough
(pertussis), polio, meningitis, or chicken pox can contribute to
changes to the brain or central nervous system, which in turn
can lead to ID. Often, these illnesses cause encephalitis, a
swelling of the brain that can damage brain cells or cause
bleeding in the brain.
Environmental toxins like mercury (which can be found in fish)

or lead (which is sometimes still found in paint in older homes),
can also lead to brain damage and ID, particularly if the
exposure occurs over a long period of time and the toxins build
up in the child's body.
8.5 How Are Students Diagnosed With ID?
As you will remember, students must demonstrate deficiencies
in both adaptive ability and intelligence to qualify for special
education under the ID category in IDEA 2004—and these
deficiencies must adversely affect their academic performance.
Schools administer measures of intelligence and adaptive ability
to diagnose students with ID.
Each district or school chooses the exact assessment and cut-off
scores to consider students for ID. This results in discrepancies
from state to state in the classification of students, and state
prevalence rates range from 0.4% to 2% (Polloway, Patton, &
Nelson, 2011).
Assessing IQ
An intelligence quotient (IQ) test is the primary measure used
to diagnose ID. "Intellectual age" or "mental age" are terms
used to describe the level at which a student performs on an IQ
test. An intelligence quotient (IQ) is determined by comparing
"intellectual age" or "mental age" to the student's actual age. A
student's IQ score falls somewhere along a normal distribution,
or "bell curve," (shown in Figure 8.2) in the general population,
with a mean (or average) score of 100 (Simonoff, 2006). As
mentioned, most students scoring lower than 70–75 are
considered to have ID, though cut-off scores vary, and there are
additional criteria (Polloway et al., 2011).
Figure 8.2: The Bell Curve
The shape formed on a line graph of IQ test scores is called a
"bell curve" because it looks like a bell. Most students fall in
the middle, or average, range. As the bell curves down, fewer
students fall into the categories. Typically, students who qualify

for difficulties in intellectual functioning score below 70–75 on
an IQ test. IQ test scores vary, which is why a range is used for
identifying students with ID.
There are many examples of IQ tests. Some of the most common
include:
Cognitive Assessment System (CAS)
Kaufman Brief Intelligence Test (K-BIT)
Raven's Progressive Matrices
Reynolds Intellectual Assessment Scales (RIAS)
Stanford-Binet Intelligence Scale
Wechsler Abbreviated Scale of Intelligence (WASI)
Wechsler Adult Intelligence Scale (WAIS)
Wechsler Intelligence Scale for Children (WISC)
Woodcock-Johnson Tests of Cognitive Abilities
Classroom teachers will never have to decide which IQ test to
administer to a student. The choice of assessment and the
administration of it is the role of a school psychologist or other
trained assessment professional.
The use of IQ tests to diagnose any disability has a
controversial history (Gallagher, 2008). Some of this is related
to test bias, as earlier chapters have discussed. Educators also
argue about whether an IQ score really captures a student's
intelligence—and to a further degree, what is intelligence? If
intelligence is an elusive quality that is hard to define, then how
can we administer a test for it? Also, does an IQ score correlate
with achievement in the classroom? Researchers have improved
existing IQ tests and created new ones, but the questions related
to IQ scores (and similar instruments) still remain (Kaufman,
Reynolds, Liu, Kaufman, & McGrew, 2012). Until recently, IQ
was also used as a determining factor for identifying students
with specific learning disabilities (SLD).
Assessing Adaptive Behavior

Adaptive behavior assessment also plays a role in identifying
students with ID. Social and behavioral ability is typically
assessed with an adaptive behavior scale, instrument, or
checklist (for an example, see Figure 8.3). The assessment
measures students' use of skills that are conceptual (e.g.,
literacy, understanding of time, use of money), social (e.g.,
working with or relating to others), and practical (e.g., care of
self, safety, transportation) in the context of everyday life
(Polloway et al., 2011). Data from adaptive behavior assessment
informs individualized education program (IEP) goals and
classroom instruction centered on learning social and life skills.
Three of the most popular ways to assess adaptive behavior
include:
Adaptive Behavior Assessment System (ABAS)
Diagnostic Adaptive Behavior Scale (DABS)
Vineland Adaptive Behavior Scales
Adaptive behavior checklists or scales are similar to IQ tests in
that they should be chosen and administered by a trained
professional who is familiar with adaptive behavior. In many
schools, this is a special education teacher or school
psychologist.
Figure 8.3: Adaptive Behavior Checklist
These questions are from checklists used to assess adaptive
behavior in Tennessee schools. In answering the questions, the
teacher compares the student's behavior with that of other
students who are the same age.
Assessing Degree of ID
After assessment, some schools may go a step further and
describe the degree of ID for a student. This practice is not
universally applied, but you may see a descriptor, such as mild,
moderate, or severe, in front of the ID label for some students at
some schools.

Students with a mild ID typically have an IQ between 50 and
70. These students may struggle with learning in school, but
they will probably learn the basics of reading, writing, and
mathematics. Many of these students will go on to live on their
own and may have a job to support themselves. Students with a
moderate ID usually have an IQ ranging from 35 to 50. These
students may learn to recognize certain words or phrases. They
will need assistance with learning to care for themselves and
will likely require lifelong care. Students with a severe ID (IQ
between 20 and 35) or a profound ID (IQ below 20) will
struggle with speech and communication throughout life. These
students will have limited skills in all areas and will require
lifelong care and assistance.
When Are Students Diagnosed?
Children can exhibit characteristics of ID at a very young age,
particularly if they have a condition with visible characteristics,
such as Down syndrome or Williams syndrome. Genetically
caused conditions such as these also may be identifiable before
birth, and doctors may classify a fetus as having a high risk for
ID. Events during and after birth, such as oxygen deprivation,
may also cause an ID that can be identified soon after birth.
In young children, an ID may first be detected as the child
develops language, social habits, and early academic skills. The
majority of students with ID are identified early in their
education, once academic learning starts to accelerate. A child
will not be officially diagnosed, however, until his IQ and
functional ability are measured. For this reason, many children
are not officially classified until they enter preschool or
elementary school. Prior to the diagnosis, very young students
are often categorized as having a developmental delay.
Definitions of ID all include the criterion that it be manifested
before the ages of 18–22 (Polloway et al., 2011).
8.6 How Does ID Differ Across Grade Levels?

Depending upon the severity of their ID, some students at all
grade levels participate in the general classroom for some, if not
all, of the school day. Other students with ID spend most of
their time in self-contained classrooms or schools.
Instructional services should be based on IEP goals and post-
secondary life plans. Students with ID typically receive
instruction in adaptive behavior and academics. Students with
more severe ID may receive instruction that is less focused on
academics and more focused on social and life skills, such as
communication and self-care. Such skills include eating and
drinking, expressing a physical or emotional need, managing
money and household responsibilities, and staying safe in a
variety of settings (Aldridge, 2010). Skills related to self-
awareness, self-sufficiency, and self-care, however, should be
integrated into the education of all students with ID. This
section provides an overview of educational programming for
students with ID, from early childhood to post-secondary
options.
Early Childhood
Part B of IDEA 2004 mandates a free and appropriate public
education (FAPE) for all eligible children aged 3–5 years.
Young students with ID are eligible to receive early childhood
special education services under IDEA. Early childhood
services focus heavily on developmental skills, such as
language and social interaction. Social skills include
cooperation with adults and peers on everyday tasks,
appropriately expressing feelings, and self-control (McIntyre,
Blacher, & Baker, 2006). Early childhood teachers can
explicitly model the appropriate behavior, create structured
environments for students to practice the behavior, and provide
positive reinforcement when students perform the social
behavior appropriately.
Early special education services can prepare students with ID
for later future instruction and social interactions (Yoder &

Warren, 2002). Part C of IDEA 2004 allots state funding to
provide programming for infants and toddlers at risk for ID
before the age of 3 (Polloway et al., 2011). Young children who
show developmental delays in language, communication of
needs (i.e., hunger, comfort), and motor skills may be
considered "at risk" (Tomasello, Manning, & Dulmus, 2010).
Early special education services often focus on increasing child
communication, motor skills, and social skills.
Not all students with ID are classified as such by age 3,
however, since ID manifests in different ways and at different
times for each individual. As a result, many students who fall
into the "at risk" category before the age of 3 years are not
identified and thus do not receive services. This situation has
created concern for children 3 to 5 years old who are considered
"at risk" for, but not yet identified with, ID. Such children may
have been eligible for services as an infant or toddler under Part
C, but may not be eligible for pre-school special education
services under Part B if they have not been officially identified
as having an ID.
Elementary School
As mentioned in Chapter 2, schools are increasingly moving
toward inclusion of students with disabilities in general
education. Over the last decade, this trend has brought many
students with ID into the elementary general education
classroom, but more are still placed in separate special
education classrooms (Polloway et al., 2011). Depending on
their individual needs and the support given, some elementary
students with ID can be successful in the general education
classroom.
Inclusion in general academic content classes can be beneficial
for students with ID to ensure they are receiving instruction on
grade-level content. In this setting, a special education teacher
pushes into the general education classroom with the student to

provide academic and behavioral support. Support may include
accommodations (i.e., text read aloud, use of a calculator) or
modifications (i.e., length of assignment, scribe) for
instructional delivery, class assignments, and assessments.
For some students with ID, receiving the majority of instruction
in the general education classroom may not be appropriate. A
child's specific needs and IEP goals can vary significantly from
what is covered by the general education curriculum. In these
cases, students may receive most of their instruction in a special
education classroom. These classes are typically small and can
service multiple grade levels. Special education teachers and
teaching assistants work to ensure that all students are making
progress toward their academic and adaptive behavior goals as
stated in their IEPs.
The most appropriate school placement for elementary students
with ID continues to be debated among researchers, policy-
makers, administrators, and teachers. However, most agree that
some inclusion throughout the school day with general
education peers is beneficial for developing social and
behavioral skills and preparing students for secondary school
and adult interactions. Evidence-based research has shown that
while inclusion can be effective for students with severe
disabilities in increasing academic, social, and communication
skills, further work is needed to improve overall instructional
effectiveness for students with ID in the general education
setting (Alquraini & Gut, 2012).
Secondary School
Most students with ID will have been identified and will have
begun receiving services by the time they enter middle or high
school. As at elementary levels, secondary students with ID
receive instruction either in the general education class with
support, in a separate special education class, or some
combination of the two. Curriculum for secondary students with

ID will vary depending on their IEP goals and learning
environment.
Academic IEP goals for students with ID often include a
modified version of state standards. These modified state
standards often focus on academic skills critical for independent
living, such as word recognition, reading and listening
comprehension, addition and subtraction, understanding time,
and using money. Additionally, students with ID often have
behavior goals and social skills built into their curriculum.
Adaptive behavior instruction should be explicitly connected to
independent living and outside interests to keep secondary
students engaged in learning social skills.
Behavior and social skill instruction should be aimed at
empowering students to pursue a variety of post-secondary
options. This is often referred to as self-determination, or the
ability to make decisions and set goals. High self-determination
is associated with higher quality of life for individuals with ID,
and self-determination can increase through supportive
environments that promote choice (Nota, Ferrari, Soresi, &
Wehmeyer, 2007).
Teaching self-determination to students with ID is especially
important in middle and high school. After graduation, it is less
likely that students will have the opportunity to practice
decision-making and receive feedback in safe, supportive
environments. Facilitating student self-determination while
students are receiving school services may improve their quality
of life post-graduation.
Goals, curriculum, and instruction for students with ID are
highly tailored to each individual's strengths, interests, and
needs. Since instruction can differ drastically from the general
education curriculum, it is important to consider where students
with ID receive instruction. Secondary placement decisions are

based on several factors, including severity of disability, school
and district inclusion policies, and post-secondary plans.
Transition
Transition goals and post-secondary school plans are critical for
secondary students with ID and are included in the IEP to
ensure that students are prepared for their next stage of life. For
students with ID, post-secondary school options can range from
continuing their education at a community college or university,
entering the work force, moving to a residential home, or a
combination. This decision is made by the IEP team and should
include input from the student, family members, teachers,
administrators, and any other health or service providers.
Within all of these options, skills in communication and self-
care are vital for success.
Post-secondary opportunities are influenced by a student's
education, which is often measured by a high school diploma.
There is a great deal of controversy regarding the awarding of
high school diplomas to students with ID (see the feature box
titled "The High School Diploma Debate" for a discussion of
this). Students receiving instruction in secondary special
education classrooms may not take all classes typically required
for high school graduation. As a result, states have differing
policies on whether or not completion of a modified high school
curriculum warrants a traditional high school diploma. Some
states choose to provide an alternative certificate, while other
states make course allowances for students with ID and award
them the traditional diploma. This issue continues to be
debated, particularly since it is linked to the topics of school
accountability and school performance.
Some students with ID take advantage of an option called
Comprehensive Transition and Postsecondary Programs (CTPS),
in which they take classes at the college or vocational school
level (Kleinert, Jones, Sheppard-Jones, Harp, & Harrison,
2012). Students may take these classes while they are still in

high school or after graduating or completing high school.
Special grants and work-study monies are available for students
with ID to take classes that will help them in a future career.
For example, a student with an interest in working at a print
shop might take graphic design classes at a community college
(Kleinert et al., 2012). Students may take the college or
vocational courses for credit, or they may audit the courses. To
help students with ID gain access to coursework, colleges and
schools sometimes have different entrance requirements (e.g.,
not requiring a graduation diploma and not requiring the student
to take a college entrance exam). Some students graduate with a
college degree, while many others take only a few classes to
help them with a career.
8.7 How Do I Teach Students With ID?
As you have seen, students with ID vary tremendously in their
strengths and abilities. The optimal classroom placement also
varies from student to student. In the era of inclusion, some
students participate in the general classroom, so teachers must
use appropriate teaching strategies in reading, writing,
mathematics, and the content areas, while emphasizing social
skills.
Classroom Settings
As you learned in Chapter 1, a student's least restrictive
environment must be considered when the IEP team determines
the student's school placement. Since the reauthorization of
IDEA in 1997, all students have been required to have
meaningful access to the general curriculum (Cooper-Duffy,
Szedia, & Hyer, 2010). The IEP team needs to place students in
settings that allow the most access to the curriculum of the
school or district.
When students spend most or all of their day in the general
classroom, they may have a special education teacher who
comes into the general classroom to provide extra support. The

general and special education teachers work together to develop
appropriate modifications for the student with ID. Other
students spend time in a resource room receiving individualized
or small-group instruction in reading or math, as well as time in
the general classroom for instruction related to science, art,
music, or physical education (Bouck, 2011).
Students with moderate or severe ID may be placed in one of
two settings. The first is a self-contained classroom where the
teacher concentrates on adaptive behavior skills and academic
skills that are appropriate for the student. The student might
participate in extracurricular activities with peers without
disabilities (i.e., recess, art, field trips), but most of the
student's time is spent in a classroom devoted to the education
of students with severe disabilities.
The second setting is a specialized school operated by the
school district or a private school for students with disabilities
that the district chooses for the student. At these schools, the
staff members are highly trained to provide appropriate training
and services to students with severe disabilities. Fewer than
20% of students with ID are placed in self-contained classrooms
or specialized schools. If the district makes the decision to
place a student in a setting other than the student's local school,
the cost is covered by the district.
Teaching Academic Skills
Many of the accommodations and modifications discussed in
Chapter 2 are appropriate for teaching academic skills, such as
reading, writing, and mathematics, to students with ID, but it is
important for teachers to receive appropriate training in
designing this instruction (Lee, Soukup, Little, & Wehmeyer,
2008). In the general classroom or resource room, students with
ID may benefit from working in small groups or in pairs
(Carter, Sisco, Chung, & Stanton-Chapman, 2010). When
pairing a student with ID and a typical student, the teacher

needs to ensure proper training and appropriate activities for the
pair; the teacher must train the students to work together in a
positive way and to provide appropriate feedback.
Students with ID may benefit from extended time to take tests
or complete assignments. Additionally, these students may need
assignments or assessments broken into smaller sections. The
IEP team makes many of these decisions, but the general and
special education teachers may recognize a further need to
break instruction into smaller segments.
Reading
Until recently, many students with ID did not receive reading
and literacy instruction (Allor, Champlin, Gifford, & Mathes,
2010). Many people thought that these students could not learn
to read, but recent evidence supports the idea that many
students with ID can and should learn basic reading skills
(Lemons, Mrachko, Kostewicz, & Paterra, 2012). Even students
with severe ID can potentially identify letters and read sight
words (Agran, 2011). Reading and literacy skills not only
improve the academic outcomes of students with ID but also can
improve their social skills by enabling the student with ID to be
more of a participant in the classroom and with peers (Forts &
Luckasson, 2011).
Some suggestions for reading instruction include the following:
Teach print concepts (Allor, Mathes, Roberts, Cheatham, &
Champlin, 2010). Teach students where to find the title and
author of a book and how to read a book by turning the pages
one by one.
Teach phonological awareness and phonics (Lemons et al.,
2012). Students should learn letter names and letter sounds.
They should also practice blending sounds into words.
Teach decoding skills (Lemons et al., 2012). Students should
learn how to "sound out" a word. For example, "cat" can be
broken into three sounds: /c/ /a/ /t/. By decoding, students use
their phonics skills to read a word.

Teach sight words (Allor, Champlin, et al., 2010). Students
should learn important words that they recognize when they see
them. Sight words include high-frequency words that are
difficult to "sound out" using phonics skills (e.g., "the,"
"about," and "and"). Students can practice sight words via flash
cards, games, reading, or puzzles (Allor, Mathes, Jones,
Champlin, & Cheatham, 2010; Ruwe, McLaughlin, Derby, &
Johnson, 2011).
Conduct read-alouds (Knight, Browder, Agnello, & Lee, 2010).
The teacher and student can read together or the teacher can
read aloud while the student follows along. The teacher pauses
frequently during the reading to ask comprehension or
prediction questions.
Teach vocabulary (Allor, Mathes, Roberts, et al., 2010).
Explicit instruction in vocabulary, where teachers teach
vocabulary words and their meaning (e.g., "This word is allow.
Allow means to let someone do something.") is important.
Providing cards with pictures that go along with key vocabulary
words (as shown in Figure 8.4) is a very helpful strategy for
students with ID (Cooper-Duffy et al., 2010).
Figure 8.4: Vocabulary Picture Cards
To help students understand vocabulary, teachers can create
cards with pictures to represent specific words. Students can use
the picture cards to understand the word, write the word, or
communicate the idea.
Focus on comprehension (Evmenova, Behrmann, Mastropieri,
Baker, & Graff, 2011). Teachers can help students understand
the main concepts in a text by highlighting important words or
phrases and using pictures to accompany the text. Teachers can
conduct read-alouds and sprinkle comprehension questions
throughout the reading.
Use graphic organizers (Morgan, Moni, & Jobling, 2006).
Graphic organizers (i.e., visuals that help organize information)
help students organize the main idea of a story, remember
vocabulary, or understand other types of information.

Use technology (Machalicek et al., 2010). Augmentative and
alternative communication (AAC) devices can be used to read
text to students, allow students to respond to questions, or help
students understand and use vocabulary (Ruppar, Dymond, &
Gaffney, 2011). These devices—for example, an electronic
reader—can highlight sentences or words for students or
provide illustrations of stories or concepts.
Read, read, read (Schnorr, 2011). Teachers should read as much
as possible with their students, especially students with ID.
Many students like knowing a story and reading it again and
again, and they can begin making connections with the known
story and the printed text. Teachers can also echo read with
students. In echo reading, the teacher reads a phrase or sentence
and then the student reads the same phrase or sentence.
Instruction on reading and literacy should be intensive and
explicit (Taylor, Ahlgrim-Delzell, & Flowers, 2010). That is,
teachers model and demonstrate activities and skills and provide
students with multiple practice opportunities. Students need
daily, intensive teaching sessions that occur over an entire
school year or several school years (Allor, Champlin, et al.,
2010). Instructional sessions should last 30–60 minutes. They
should be fast-paced and include brief activities that are
repeated each day (Allor, Mathes, et al., 2010). Student
progress must be monitored so that instruction is provided at the
appropriate level, and teachers should use progress monitoring
data to determine whether current instruction is adequate.
Teachers should explicitly connect instruction with the student's
vocabulary and speech (i.e., teach using words the student
knows and understands). Teachers should use a motivational
system, such as a token economy, to keep students engaged and
on task (Allor, Champlin, et al., 2010).
Coyne, Pisha, Dalton, Zeph, and Smith (2010) suggest
incorporating the principles of Universal Design for Learning
(UDL) into reading instruction. For example, students with ID
can use multiple representations by having text highlighted,

having hyperlinks embedded within text, and having
illustrations that accompany written text. Multiple modes of
action and expression can be provided through the use of
prompts, questions, and think-alouds, as well as by allowing
students to use different response options (e.g., multiple choice,
open ended, true or false). Teachers can employ multiple modes
of engagement by using popular books or by having students
listen to recordings of text.
Writing
Many students with ID can learn to write. Writing has two
major aspects: (1) the action of writing letters to make words
and (2) the putting together of ideas into sentences and
paragraphs.
Some students with ID, especially severe ID, may not possess
the fine motor skills required to grasp a marker or pen in a way
that allows them to form letters on paper. AAC devices can help
these students communicate. Speech-to-text applications and
software are readily available, and students can speak while a
technology translates their speech into a written form. Other
students can learn to write letters with practice. Using a variety
of mediums (e.g., sand and rice), students can learn the action
of writing the letter "p" or the word "car."
Strategy instruction has emerged as one of the better approaches
for teaching students with ID how to put ideas together into
sentences and paragraphs (Joseph & Konrad, 2009). Teachers
provide explicit instruction on a specific writing strategy and
allow ample practice opportunities for students to apply the
formula. One example is POW: Pick my idea, Organize my
notes, Write and say more (Sandmel et al., 2009). Figure 8.5
illustrates some of these writing strategies. If students struggle
with the physical action of writing as they use any of the
strategies, they may use scribes (i.e., a teacher or adult who
does the writing for the student) or the speech-to-text

applications mentioned above.
Figure 8.5: Writing Strategies
These two posters highlight common writing strategies for
students. When teaching students with ID, it can be helpful to
further simplify the strategies and provide picture prompts for
each step.
Mathematics
Teaching mathematics to students with ID can involve many of
the teaching strategies employed for students with LD. Students
should learn to recognize numbers and understand what they
represent. Students can use the concrete-representational-
abstract sequence to learn many different mathematics concepts.
By using manipulatives at the concrete stage, students have the
opportunity to understand how math works both conceptually
and in practical terms.
One popular method for helping students understand the concept
of small amounts is TouchMath (Fletcher, Boon, & Cihak,
2010), shown in Figure 8.6. Each number is "drawn" with the
appropriate number of dots on the printed number to show the
students the quantity. For example, "3" has 3 dots; the student
can count and touch "1, 2, 3" dots to understand what "3"
represents.
Figure 8.6: TouchMath Numbers
In TouchMath, dots represent the quantity indicated by each
written numeral. Students use these aids to understand quantity
and to add and subtract single-digit amounts.
Students can also use TouchMath to learn the steps in solving
addition, subtraction, multiplication, and division problems.
Solving specific problem types can be taught by using task
analysis, which describes each step necessary for solving a
problem. (See Figure 8.7 for an addition example.)

Figure 8.7: Task Analysis of Addition without Regrouping
This task analysis breaks a double-digit plus double-digit
problem (without regrouping) into manageable steps. By
breaking down and teaching each step, students can learn to
successfully solve this type of problem.
Pegword mnemonics have proven to help students memorize
answers to basic facts, such as math tables (Zisimopoulos,
2010). In using pegwords for math, students first use rhymes
that are similar to numbers; for example, 6 times 7 is "six sticks
and seven heaven." Then, the students create a picture that puts
sticks and heaven with the rhyming answer, "forty-two warty-
shoe." The student might draw sticks in a warty shoe in heaven.
It may sound complicated, but students who are familiar with
pegwords find it very easy to use this system to remember facts.
Many students with ID need explicit instruction on identifying
and using money, as well as on telling and managing time. It is
best to let students practice with real money or manipulative
coins. They should also practice using money in real-life
situations (e.g., grocery shopping, eating at a restaurant).
Time management can be learned using tools—for example, an
elapsed time calculator or a vibrating watch (Green, Hughes, &
Ryan, 2011). To use an elapsed time calculator, the student
types in two dates or times, and the calculator computes the
time between the two events. A vibrating watch can keep
students on task by vibrating at set intervals to remind students
to complete a task or pay attention.
To solve word problems in math, students should use cognitive
strategies (Chung & Tam, 2005). Cognitive strategies help
students break down an otherwise overwhelming task into
manageable parts. For example, students might use the
following strategy when solving a word problem:

Read the problem.
Find key words.
Draw a picture.
Write an equation and compute.
Check your work.
See Figure 8.8 for an example of student work that uses this
cognitive strategy.
Figure 8.8: Solving a Word Problem Using Cognitive Strategies
A student used the strategy Read, Find key words, Draw a
picture, Write an equation and compute, and Check your work
to solve this word problem.
Just as when they are learning to read and write, students
learning math can use AAC to understand mathematical
concepts and solve problems (Knight et al., 2010). They may
use AAC to practice basic facts or computation problems or to
learn to manage money.
Content Areas
Many of the strategies discussed here to teach reading, writing,
and math are also helpful in teaching students with ID in the
content areas, such as science and history. For example, it is
important to highlight important vocabulary and allow students
to practice concepts with hands-on materials.
One approach commonly used for science instruction in the
general classroom—the use of inquiry-based activities, in which
students explore topics with teacher facilitation—is not
typically the most effective teaching strategy for students with
ID (Stavroussi, Paplexopouloes, & Vavougios, 2010), who
require explicit instruction and hands-on modeling. For
example, when learning about the life cycle of plants, a teacher
should model with videos or hands-on materials how a seed
turns into a plant. The teacher explains what happens to the

seed by explaining each stage of the plant's life cycle. Students
should have opportunities to plant seeds, document the life
cycle of the plant, and engage in discussion with the teacher and
class.
Peer tutoring may also be useful in the content areas. Jimenez,
Browder, Spooner, and Dibiase (2012) put students with ID in
pairs with general education students. The pairs learned how to
use the KWHL strategy to work through problems:
K: What do you know?
W: What do you want to know?
H: How will you find out?
L: What did you learn?
For example, when learning about Pearl Harbor, the pair might
say:
K: We know that Pearl Harbor is in Hawaii. We know that
Japanese bombed Pearl Harbor.
W: We want to know why Pearl Harbor was bombed. We want
to know about the damage of the bombing. We want to know
when this happened.
H: We will read our history book section about Pearl Harbor.
We will research Pearl Harbor online. We will look at
newspaper articles from the time of the bombing.
L: We learned that Pearl Harbor was bombed in 1941. The
Japanese bombed Pearl Harbor because the United States had
sided with China (and China and Japan were at war). At least 18
ships sank and over 2300 people died.
The KWHL strategy is helpful because it can be applied across
subject areas and across grade levels.

Teaching Adaptive Skills
Instruction to help improve adaptive skills is crucial for
students with ID to function as members of society (Bouck,
2010). The IEP team will decide which adaptive behaviors
should be included in the student's instructional program.
Adaptive skills may be taught alone or in conjunction with
conceptual (academic) skills (Miller, 2012).
Social Skills
Teachers should provide instruction on communication, such as
engaging in a conversation, taking turns when talking, and
interacting in social situations (Boden, Ennis, & Jolivette, 2012;
Solish, Perry, & Minnes, 2010). Students with ID may
participate in lunch or some classes with general classroom
students, but neither the general education students nor students
with ID may always understand how to engage in appropriate
conversations. Students without disabilities are sometimes
afraid to talk to students with ID or unsure of how to respond to
students who have different speech patterns (Hughes et al.,
2011). Teachers can help bridge the gap between these groups
of students with meaningful instruction and practice.
It can be helpful to teach students with ID how to solve
problems that arise with friends, at work, or at home (Cote et
al., 2010). A general problem-solving approach may be the most
helpful, because students can use it in a variety of situations.
The following example shows how a general approach can help
students think through their choices when presented with a
challenging situation:
What's the problem?
How can you fix it?
Why would it work?
Life Skills
Teachers may need to teach students how to take care of their
personal needs (Bouck & Flanagan, 2010). They may guide

students in practicing how to pick out clothes and get dressed.
They may teach students how to brush their teeth, take a
shower, or go to the bathroom. If preparing to live on their own,
students may need to learn how to shop for groceries, do their
laundry, and cook simple meals. Some students need to learn
how to navigate a bus system in the city where they will live.
Many of the skills that other students pick up indirectly by
observing adults need to be explicitly taught to students with
ID.
Task analysis, which was introduced in the discussion of
teaching math, is a good way to teach many life skills. Figure
8.9 illustrates a task analysis related to brushing teeth.
Figure 8.9: Brushing Teeth Task Analysis
In task analysis, each part of a process is described as a
separate step. A student who learns all the steps in the
process—here, brushing teeth—will learn to be successful at the
task!
Another way to teach life skills is through video modeling
(Hammond, Whatley, Ayres, & Gast, 2010). With video
modeling, a student watches a video instructing how to do
something. By watching the visual presentation multiple times,
the student learns how to do a task. This method has proven
successful for teaching students with ID how to cook a meal and
get around the community via bus (Mechling & O'Brien, 2010;
Stock, Davies, Wehmeyer, & Lachapelle, 2011; Taber-Doughty
et al., 2011).
Task analysis and video modeling might be used to teach
students and adults with ID to perform tasks, such as watering a
plant, delivering the mail, or changing paper towels (Mechling
& Ortega-Hurndon, 2007). Checklists generated from a task
analysis can provide reminders of how to do tasks, such as
preparing food. It is often helpful for these checklists to be

accompanied by pictures showing each step (Lancioni &
O'Reilly, 2002; Minarovic & Bambara, 2007).
Students with ID also need to receive training on safety skills
(Agran, Krupp, Spooner, & Zakas, 2012), which can be
provided via explicit instruction or, when feasible, with video
modeling. Students should learn how to change batteries in a
smoke detector and what to do in case of a fire or crime.
Working adults with ID must be trained on appropriate work
safety skills (e.g., not walking through an area with a "wet
floor" sign).
People with ID should also receive education on relationships
that could involve sex. They are at greater risk of sexual abuse
(Swango-Wilson, 2011), and appropriate education and training
can decrease this risk. For example, teachers may teach students
about inappropriate touching and what to do when someone
makes you feel uncomfortable.
Students and adults with ID also need to learn of the dangers of
drug and alcohol abuse and how to avoid improper use of
medication (Agran et al., 2012). While many safety topics may
be more useful for adults, students should also receive training
and education at appropriate times during their school career.
This is especially important with teenage students, who may be
influenced by the actions of their peers.
References
Powell, S. R., & Driver, M. K. (2013). Working with
exceptional students: An introduction to special education
[Electronic version]. Retrieved from https://content.ashford.edu/

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