People with intellectual disability may have problems with learning, communication, thinking, solving problems and remembering. The way a person’s intellectual disability impacts on them may be mild, severe or profound. To receive a diagnoses of an intellectual disability, formal testing needs to occur, usually by a psychologist (Raising children network Australia, 2015). Usually if a child is under 6 years of age, the preferred term is ‘developmental delay’ and children will be diagnosed with an intellectual disability after the age of 6 years if they meet criteria, however not all children who have a developmental delay are diagnosed with an intellectual disability (The State of Queensland, 2015).
Although children develop at varying rates, the following signs may indicate that a child you are working with has a developmental delay or intellectual disability:
- They are slow to learn how to sit up, crawl or walk compared to other children their age.
- They are delayed in their language or have ongoing trouble talking
- They have difficulty solving problems.
- They have difficulty with self-care tasks such as getting dressed, toileting or feeding themselves, compared to their peers.
- They have difficulty adhering to social norms or rules.
- They have behavioural issues and have trouble seeing consequences of their behaviour (The State of Queensland, 2014; American Academy of Pediatrics, 2015).
Refer to the practice guide Physical and cognitive developmental milestones.
The following table provides an overview on ways to improve communication when engaging with a child or adult with intellectual disability. It’s important to remember that a person’s skills, communication ability and how they understand information will differ depending on the person, just like anyone.
|Use simple, everyday language.||
Don’t use acronyms, jargon, complex words or long sentences.
|Always allow for plenty of time when talking with a person who has an intellectual disability.||
Don’t rush or pressure a person who has an intellectual disability. If you don’t have enough time to go at the person’s pace, reschedule your time with the person to a more suitable time.
|Build rapport with the person and start the conversation with something easy and of interest to them.||
Don’t avoid building rapport and move straight into asking questions to the person.
|Look at the person and talk directly to the person.||
Don’t talk to the person through their companion or support person, unless the person has requested this.
|Let the person talk using their own words and own story. Wait to hear their story, then ask for clarifying information.||
Don’t ask multiple questions in the one sentence, ask leading questions, or intervene when the person is trying to tell their story.
|Invite the person to tell you if they don’t understand or aren’t sure of what you’re saying.||
Don’t assume that the person will tell you they aren’t understanding what you’re saying.
|Give the person time to process and respond to what you’re saying. Even if this feels uncomfortable for you, the person may need this time to think and respond.||Don’t continue talking or move to a new topic if a person hasn’t answered you immediately.|
Focus on one topic or piece of information at a time.
Don’t move quickly from topic to topic or talk rapidly about different things.
(Adapted from Intellectual Disability Rights Service, 2009; Surrey Place Centre, 2011).
Autism spectrum disorder
Autism Spectrum Disorder (ASD) is a cognitive and developmental disorder that affects a person’s cognition, communication and behaviour. People with ASD can have impairments that range from mild to severe, which is why it is called a spectrum disorder. No two people who have ASD are the same.
The following information from Autism Queensland (2019) and The Raising Children Network Australia (2019) provides some characteristics of a person diagnosed with ASD. A person diagnosed with ASD may exhibit some or many of these characteristics.
- They may experience difficulty with:
- Social interaction
- Communicating with others
- Understanding what others are feeling and thinking
- Maintaining eye contact
- Interpreting others’ body language
- Challenging behaviours in response to stress or environmental changes
- Preoccupation with specific topics, including outstanding skills in certain areas
- Getting upset or worried if routines change without warning
- Repetitive behaviours (body rocking, flapping hands)
- Intense interest or intense aversion to stimulus such as lights, noises or textures
- Taking something someone says literally.
ASD can become noticeable in infancy or early childhood, and can be diagnosed from two years of age. If you suspect a child has ASD, arrange diagnosis as soon as possible, as early intervention makes a significant difference to a child’s lifelong outcomes.
The Raising Children Network Australia provides key information on the early signs of Autism for children who are 0-3 years old.
Even if someone has ASD, it doesn’t mean that they don’t want people to be close to. People with ASD still have emotions and love to have friends, even if it can be difficult at times.
This animated video looks at the key characteristics of Autism and what it’s like living with Autism.
Foetal alcohol spectrum disorder
Foetal Alcohol Spectrum Disorder (FASD) is a lifelong condition that occurs in a person whose birth mother consumed alcohol during pregnancy. Children in care are a high risk group for FASD. The amount and frequency of the alcohol use during pregnancy can influence the level of damage done to the brain. A person with FASD may have difficulties with impulsivity, attention, physical activities, language, memory, learning and behaviour (FASD Hub Australia, 2019; No FASD Australia, 2018). For a list of difficulties faced by children and young people who have FASD, visit the FASD hub for further information.
“The effects of FASD vary considerably and it is sometimes referred to as the ‘invisible disability’ as it often goes undetected, whether it be overlooked, ignored, attributed to another known non-genetic condition or even simply blamed on ‘poor’ parenting or post birth environments. … FASD is often not noticed until the child reaches school age when behavioural and learning difficulties become more evident”.
(No FASD, 2018).
For a child to be diagnosed with FASD, there needs to be evidence of prenatal alcohol exposure and severe impairment in three or more domains of central nervous system structure or function (such as cognition, language, affect regulation, memory, and attention). The Australian Guide to the Diagnoses of FASD developed in 2016 for the Australian Government Department of Health provides a diagnostic instrument for clinicians to diagnose, refer and manage FASD. Refer to Appendix A4: Information on FASD diagnostic assessment for individuals and caregivers of this guide for useful information on obtaining a FASD diagnosis including what is involved in getting a diagnosis, what documents are required for a diagnosis, and why a diagnosis is important.
This short video provide a snapshot on FASD including the signs of FASD and the importance of diagnosis.
FASD is a disability that can be prevented. There is a broad scope of research that supports the viewpoint that there is no safe amount of alcohol a woman can consume during pregnancy, and that not drinking is the safest option. When working with parents who are planning or expecting a baby, educate them on the risks of FASD and support them to lead an alcohol free lifestyle.
The FASD Parent toolkit for parents, caregivers and families was developed by the National Organisation for Fetal Alcohol Spectrum Disorders (NOFASD). It includes information on FASD diagnoses, characteristics, interventions and strategies, and supports for children and adults who have FASD.
Attention deficit hyperactivity disorder
While most young children have a limited attention span or limited awareness of the consequence for their behaviours, Attention deficit hyperactivity disorder (ADHD) is a chronic disorder that can have a significant impact on child and family functioning if left undiagnosed and unsupported. Children who have ADHD exhibit hyperactive, inattentive and/or impulsive behaviours.
- Seems non-responsive when you talk to them or ask them to do something.
- Poor sense of time.
- Inability to follow instructions.
- Forgetfulness of everyday things and losing belongings.
- Getting distracted or bored before finishing a task or avoids tasks that require a lot of mental effort.
- Inability to pay attention.
- Fidgeting or inability to be still.
- Running away.
- Climbing on structures, even if deemed unsafe or asked not to do so.
- Inability to remain sitting in the classroom.
- Difficulty sleeping, staying asleep or getting to sleep at night.
- Difficulty engaging in quiet play or activities.
- Being disruptive in groups or classrooms.
- Rushing through tasks to get them done with little attention.
- Talking or acting impulsively without regard for the consequences.
- Quickly getting excited about something then quickly losing interest.
- Difficulty persisting with a task.
- High risk behaviours, particularly in adolescence, such as using drugs, impulsive sexual interactions, joyriding or shoplifting.
(The Royal Children’s Hospital Melbourne, 2018; Raising Children Network Australia, 2019).
If a child you are working with is suspected to have ADHD that has not been diagnosed, having them seen by a General Practitioner is a good place to start. They may then be referred onto a paediatrician, psychologist or psychiatrist. Early diagnosis is critical to support a child who has ADHD and their family. In addition to the pressure that ADHD can put on a child and their family, other difficulties may also develop in a child who has ADHD such as conduct disorder, oppositional defiant disorder, anxiety or depression (Raising children network, 2016). The factsheet ADHD-Ways to help a child at home and school is a useful resource for parents or caregivers on supporting a child who has ADHD. For more information and support on ADHD, refer to the Raising Children Network.
As with many other disabilities, the signs and symptoms of ADHD can be similar for children who are experiencing traumatic stress. The resource Is it ADHD or child traumatic stress? A guide for clinicians (2016) developed by the National Child Traumatic Stress Network explains how symptoms of child traumatic stress and ADHD differ and overlap, and how understanding these differences can help assess and treat children more effectively.
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