SLPs help ensure that communication partners recognize and respond to communication attempts and build on the interests, initiations, and requests of persons with ID. Speech disfluencies in children with Down syndrome. Intervention in School and Clinic, 44(3), 116120. Fidler, D. J., Most, D. E., & Philofsky, A. D. (2009). See ASHAs Practice Portal pages on Bilingual Service Delivery, Cultural Responsiveness, and Collaborating With Interpreters, Transliterators, and Translators for additional information. Politics, economics, and social policies also influence how individuals receive and experience health care. (2008). speech patterns (e.g., prosody) as well as receptive and expressive pragmatic and sociolinguistic communication skills. Journal of Speech, Language, and Hearing Research, 45(6), 11581174. SLPs may be part of a team making a differential diagnosis between ID and autism spectrum disorder or other conditions. https://doi.org/10.1044/1092-4388(2001/016), Bernard-Opitz, V., Sriram, N., & Nakhoda-Sapuan, S. (2001). For example: The professional roles and activities in speech-language pathology include clinical/educational services (assessment, planning, and treatment); prevention and advocacy; and education, administration, and research. Cerebral palsy: From diagnosis to adult life. (2008). https://www.who.int/news-room/q-a-detail/social-determinants-of-health-key-concepts. (2014). A randomized trial of longitudinal effects of low-intensity responsivity education/prelinguistic milieu teaching. Common challenging behaviors include aggressive, disruptive, self-injurious, and stereotypic behaviors. See the Incidence and Prevalence section for more information. Parental reports of spoken language skills in children with Down syndrome. Receptive and expressive language problems (Wyper & Rasmussen, 2011). Developmental Medicine & Child Neurology, 47(1), 5763. Definition: Intellectual disability is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills. (2009). Adaptive behavior and cognitive function of adults with Down syndrome: Modeling change with age. Social determinants of health: Key concepts. https://doi.org/10.1044/0161-1461(2008/025). The DSM-5 uses severity level to define an individual with ID as mild, moderate, severe, or profound. Brookes. Service-learning is a form of experiential learning that blends classroom instruction with community service. Delayed speech and language acquisition (Cone-Wesson, 2005; Terband et al., 2018). Autism Research, 7(5), 608616. Below are brief descriptions of treatment options commonly used to address communication problems associated with ID. Individuals transitioning from school to employment need communication skills specific to the work setting (e.g., talking with co-workers and supervisors, interacting with customers). Systematic review of the prevalence and incidence of intellectual disabilities: Current trends and issues. Incidence refers to the number of new cases identified in a specified time period. Video recordings of desired behaviors are observed and then imitated by the individual (Darden-Brunson et al., 2008). Down Syndrome Research and Practice, 12, 3744. Using a speech- generating device to enhance communicative abilities for an adult with moderate intellectual disability. Intellectual disability across cultures. https://doi.org/10.1111/j.1468-3148.2005.00232.x, Kent, R. D., & Vorperian, H. K. (2013). Journal of Speech, Language, and Hearing Research, 56(1), 295309. 241268). AAC involves supplementing, or using in the absence of, natural speech and/or writing with aided (e.g., picture communication symbols, line drawings, and tangible objects) and/or unaided (e.g., manual signs, gestures, and finger spelling) symbols. Goal Written in the IEP of a 3rd Grade Student with a Learning Disability. FCT has a stepwise progression, as follows: Incidental teaching is a teaching technique that uses behavioral procedures to teach elaborated language; naturally occurring teaching opportunities are provided based on the individuals interests. SLPs should consider the role of ABA in communication intervention, particularly because difficulty with prompt dependency and generalization of communication interactions may result. LEAP is implemented in a classroom setting consisting of children with ASD and typically developing peers and is designed to support child-directed play. Hanen programs for parents: Parent-implemented early language intervention. Global prevalence based on international studies estimated the prevalence of ID in adults ranged from 0.05% to 0.08% (McKenzie et al., 2016). Receptive vocabulary analysis in Down syndrome. A descriptive investigation of dysphagia in adults with intellectual disabilities. Code of ethics [Ethics]. Access to communication services and supports: Concerns regarding the application of restrictive eligibility policies [Technical report]. Team models may be multidisciplinary, interdisciplinary, or transdisciplinary (see ASHAs resource on collaboration and teaming). https://doi.org/10.2511/rpsd.24.3.133, McKenzie, K., Milton, M., Smith, G., & Ouellette-Kuntz, H. (2016). However, some adults with IDparticularly those with psychomotor impairments or other comorbid conditions that affect feeding and swallowingmay experience dysphagia-related problems as they age (Lazenby-Paterson & Crawford, 2014). very basic nonverbal communication. Therefore, SLPs may help make a differential diagnosis between late language emergence and ID or another DD. Genetic causes account for 45% of ID (Batshaw et al., 2013). https://doi.org/10.1111/j.1469-8749.2005.tb01041.x, Petersen, M. C., Kube, D. A., & Palmer, F. B. Lucyshyn, J., Kayser, A., Irvin, L., & Blumberg, E. R. (2002). ), Early childhood inclusion: Focus on change (pp. Journal of Developmental & Behavioral Pediatrics, 26(2), 7785. For example, peer interactions, use of social media, and communication skills needed to optimize acceptance and relationship development may be important to teenagers with ID. https://doi.org/10.1080/0144341042000301210, Maulik, P. K., Mascarenhas, M. N., Mathers, C. D., Dua, T., & Saxena, S. (2011). Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: A systematic review. https://doi.org/10.1044/1092-4388(2012/11-0231), Kalyva, E., & Avramidis, E. (2005). Aided symbols require a transmission device (e.g., a speech-generating device); unaided symbols require only the body to produce (Beukelman & Light, 2020). Terms like individuals with intellectual disability have replaced the older terms of mentally retarded persons or the mentally retarded. SLPs need to differentiate between ID and other disorders and conditions (e.g., spoken language disorders and hearing loss, selective mutism, and English as a second language) whose communication problems can be attributed mistakenly to ID (e.g., late language emergence and ASD). Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. https://doi.org/10.1177%2F15257401020230030301, Neely, L., Rispoli, M., Camargo, S., Davis, H., & Boles, M. (2013). Communication Disorders Quarterly, 33(4), 252260. Early intervention for children with intellectual disabilities: An update. Target-level language. https://doi.org/10.1352/1934-9556-49.2.59, Office of Research Support and International Affairs. Terminology continues to evolve, with some individuals preferring identity-first language (e.g., autistic person). Careful consideration of language history (e.g., quality and duration of exposure to different languages) and linguistic abilities in all languages is necessary in the evaluation, particularly when working with individuals who are multilingual. (2013). Better health, better lives: Children and young people with intellectual disabilities and their families. Improving communication between children with autism and their peers through the circle of friends: A small-scale intervention study. Brookes. Available 8:30 a.m.5:00 p.m. Position statement on access to communication services and supports: Concerns regarding the application of restrictive eligibility policies [Position statement]. Integrated play groups is a treatment model designed to support children of different ages and abilities with ASD in play experiences with typical peers and siblings. social interaction and social communication. Families also provide useful information about communication skills during daily routines. Assessment prompts and treatment materials are reviewed for relevance for each individual. (2007). The Developmental Disabilities Assistance and Bill of Rights Act of 2000 defines or characterizes DD as follows: a severe, chronic disability in an individual 5 years of age or older onset before 22 years of age results in substantial functional limitations in three or more areas of life activity such as self-care, The SLP can build on the individuals desire to request and comment on aspects of the environment using strategies such as. Batshaw, M. L., Roizen, N. J., & Lotrecchiano, G. R. A systematic review of U.S. studies on the prevalence of intellectual or developmental disabilities since 2000. This disability originates before the age of 18. Provide quality control and risk management. Increased prevalence of hearing loss has been reported in individuals with ID as compared with the general population. Prevalence of intellectual disability: A meta-analysis of population-based studies. nonsymbolic (e.g., gestures, vocalizations, problem behaviors) and/or symbolic (e.g., words, signs, pictures) communication. Qualifications for providing ABA therapy may vary by state; check with your state, as this may affect reimbursement. A., Eklund, S. J., James, D. R., & Foose, A. K. (2003). Using dynamic assessment with learners who communicate nonsymbolically. Assessment and intervention are typically collaborative processes involving multiple providers. Formatrefers to the structure of the treatment session (e.g., group vs. individual; direct and/or consultative) provided. Questions pertaining to gender and pronoun use must be relevant to that individual and their familial structures. When examining data, use extreme caution: Consider the potential of bias in the testing as well as in the diagnostic and evaluation procedures. https://www.ncbi.nlm.nih.gov/books/NBK223473/, Kaiser, A. P., & Roberts, M. Y. In J. K. Luiselli, D. C. Russo, W. P. Christian, & S. M. Wilczynski (Eds. Journal of Communication Disorders, 38(4), 279302. https://doi.org/10.1044/leader.FTR2.08192003.6, Roberts, J. E., Price, J., & Malkin, C. (2007). Growth in early reading skills is influenced by environmental as well as genetic factors (Petrill et al., 2010). See ASHAs Practice Portal page on Transitioning Youth for further details. Managing health problems in people with intellectual disabilities. Journal of Speech, Language, and Hearing Research, 56(1), 178210. The hypothesis of apraxia of speech in children with autism spectrum disorder. See the Service Delivery section of the Intellectual Disability evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Communication intervention for ID focuses on interactions that may occur within an individuals natural environment to reflect social norms of their community. For example, some individuals with ID may be good candidates for immediate introduction of symbolic communication goals that target acquisition and use of words or symbols. The case for change. https://doi.org/10.1097/00001163-200507000-00002, Romski, M. A., Sevcik, R. A., Adamson, L. B., Cheslock, M., Smith, A., Barker, R. M., & Bakeman, R. (2010). Studies reported results based on gender; however, there were no indications whether the data collected were based on sex assigned at birth, gender identity, or both. https://doi.org/10.1044/0161-1461.2303.198, Casey, A. M., McWilliam, R. A., & Sims, J. Treatment typically encompasses a variety of techniques and approaches (Goldstein, 2006). Students will be able to use problem-solving strategies to analyze social situations and make appropriate decisions. https://doi.org/10.1177/108835760101600404, Scior, K. (2011). The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. On the ASHA Practice Portal, see the Treatment sections of Autism Spectrum Disorder, Spoken Language Disorders, and Social Communication Disorder. Provide information to individuals and groups known to be at risk for ID, to their family members, and to individuals working with those at risk. Diagnostic Adaptive Behavior Scale users manual. Difficulties with narrative discourse, particularly errors in nominal reference (Thorne et al., 2007). Communication intervention is sensitive to cultural and linguistic diversity and addresses components within the International Classification of Functioning, Disability and Health (WHO, 2001) framework, including body structures/functions, activities/participation, and contextual factors (personal and environmental). Educational Psychology, 25(23), 287304. In some cases, an IQ cutoff score is used (e.g., 70) as a criterion for diagnosis, whereas in other cases, the diagnostic criteria are more qualitative in nature (e.g., onset in childhood with limitations in adaptive behavior and intellectual functioning). Respond correctly to oral instructions. Language Arts-Reading: (Student's name) will read a 3rd grade passage and be able to comprehend its contents and decode 10 of the words contained therein with 70% accuracy within the next 29 weeks. Persistent otitis media; conductive and sensorineural hearing loss is common (Shott, 2006). approach, as we have discussed in our IEPs for cognitive disabilities post, outlines that the IEP goals should be S pecific, M easurable, A ttainable, R elevant, and T ime-bound. Images, symbols, and depicted scenes are not universally meaningful or appropriate. Mental Retardation and Developmental Disabilities Research Reviews, 12(1), 7082. https://doi.org/10.1177/2396941520905328, Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., Eng, E., Day, S. H., & Coyne-Beasley, T. (2015). It's all about getting to know your student, their future goals, and collaborating with parents/caregivers on what areas they find important. Keep these factors in mind when reviewing the incidence and prevalence data below. LEAP is a multifaceted program for preschool children with ASD and their parents (Strain & Hoyson, 2000). BMJ, 337, 14081412. Tass, M. J., Schalock. Use of this information to identify and teach simple and potentially more efficient communication skills that serve the same functions. Other Practice Portal pages can serve as useful resources for treatment options, depending on the etiology of the ID. Descriptive terminology and philosophy concerning ID focuses on levels of support necessary to maximize an individuals ability, rather than strictly on functional limitations. The use of incidental teaching may be effective in increasing engagement in children with disabilities (Casey et al., 2012). Additionally, the intellectual and adaptive deficit begin early in . Journal of Applied Research in Intellectual Disabilities, 33(2), 126138. Obesity and obesity-related secondary conditions in adolescents with intellectual/developmental disabilities. https://doi.org/10.1044/1092-4388(2008/033). American Journal of Medical Genetics, 117C(1), 314. For example, the time delay between initial instruction and any additional instruction or prompting is gradually increased as the individual becomes more proficient at the skill being taught. Psychiatry, 8(9), 355357. https://www.asha.org/policy/, American Speech-Language-Hearing Association. Individuals with ID usually develop skills slower than their typically developing peers do, whereas individuals with ASD may not follow the typical developmental progression of skills across domains. These and other features include the following: Communication delays or limitations in social functioning may signal ASD, ID, or other conditions. Overview of fetal alcohol spectrum disorders for mental health professionals. Findings from the communication and hearing assessments are analyzed in the context of findings from other professionals who assess and/or treat ID (e.g., psychologists). Mazza et al. Intervention for individuals with ID involves a variety of communication partners (peers and adults) in different settings and may address the following areas: Treatment programs often incorporate teaching or coaching models for communication partners, including peers, so they may support the individuals language comprehension and expression. Feeding and nutrition in neurodevelopmental disability: An overview. Early onset ageing and service preparation in people with intellectual disabilities: Institutional managers perspective. https://doi.org/10.1002/mrdd.20136, Roberts, M. Y., & Kaiser, A. P. (2011). Topics in Early Childhood Special Education, 11(4), 2238. (2005). act appropriately in various settings (e.g., Cohen & Demchak, 2018). Plan for transitions from educational to community support services. https://doi.org/10.1044/1058-0360.0101.38, Krahn, G. L., Hammond, L., & Turner, A. In the United States, the overall prevalence of ID was estimated to be 11.013.4 per 1,000 children and adolescents (L. L. Anderson et al., 2019). (aa) meet the child's needs that result . (n.d.). Following the individuals lead, attempts to communicate are reinforced as these attempts get closer to the desired communication behavior (McGee et al., 1999). van Schrojenstein Lantman-de Valk, H. M. J., & Walsh, P. N. (2008). They also ensure the rights of each communicator in accordance with the National Joint Committee for the Communication Needs of Persons With Severe Disabilities Communication Bill of Rights (Brady et al., 2016). ABA techniques have been used by SLPs in collaboration with ABA therapists to help build a variety of skills (e.g., communication, social skills, self-control, and self-monitoring) and help generalize these skills to other situations. These changes reflect the movement away from a medical model and institutionalization and toward inclusive practices, self-advocacy, and self-determination. The importance of early intervention for children who are at high risk for communication disorders cannot be overstated. This is in no way meant to be a document to just copy and paste from. https://www.congress.gov/106/plaws/publ402/PLAW-106publ402.pdf, Dunlap, G., & Fox, L. (1999). Service delivery decisions are made based on the individuals communication needs relative to their family, community, school, or work setting. Teaching a child with autism and severe language delays to reject: Direct and indirect effects of functional communication training. (2011). Exploring the utility of narrative analysis in diagnostic decision making: Picture-bound reference, elaboration, and fetal alcohol spectrum disorders. The WHO defines social determinants of health as facts related to how individuals experience the world, such as birthplace, where they live, where they work, and their age (WHO, 2013). SLPs work to maximize the participation and independence of individuals with ID as they experience life transitions that place new demands on communication. Diagnostic evaluation of developmental delay/mental retardation: An overview. ), Effective practices for children with autism: Educational and behavior support interventions that work (pp. Government Printing Office. The SLP recognizes that individual family values and available resources are central to the decision-making process. In J. Lucyshyn, G. Dunlap, & R. Albin (Eds. Augmentative and alternative communication: Supporting children and adults with complex communication needs (5th ed.). Quality of life and quality of support for people with severe intellectual disability and complex needs. spoken language (listening and speaking). The term intellectual functioning incorporates Common characteristics of intelligence (reasoning, planning, problem solving, abstract thinking, understanding complex ideas, learning quickly, and learning from experience), Abilities measured by IQ tests (language skills, mathematical abilities, memory, and spatial visualization), and the Adaptive functioning (activities of daily life such as communication and independent living). Decisions about specific goals and objectives are made in collaboration with the family and the person with ID. An FCT approach may be considered with students with ID to replace challenging behaviors with appropriate communication alternatives (Brady & Halle, 1997; Martin et al., 2005; Schmidt et al., 2014). Individuals who have ID may have a need to use multiple languages and/or dialects to communicate with loved ones and peers. Pediatric Clinics of North America, 54(3), 469481. Schmidt, J. D., Drasgow, E., Halle, J. W., Martin, C. A., & Bliss, S. A. The goals are situation-specific, outcome-oriented, and were designed to teach functional skills elicited in natural environments. Make decisions about the management of communication disorders. Terry is an 18-year-old woman with a diagnosis of moderate-to-severe intellectual impairment of unknown etiology. Language, Speech, and Hearing Services in Schools, 39(2), 261272. https://doi.org/10.1044/2018_AJSLP-17-0013, Thorne, J. C., Coggins, T. E., Olson, H. C., & Astley, S. J. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Intellectual Disability page: In addition, ASHA thanks the members of the Ad Hoc Committee to Review/Revise Current Practice and Policy Documents Related to Mental Retardation/Developmental Disabilities, whose work was foundational to the development of this content. https://doi.org/10.1044/lle18.3.87, Allison, L., & Strydom, A. Guralnick, M. J. In Neurological, psychiatric, and developmental disorders: Meeting the challenge in the developing world. ID was present in 45% of children recorded in the cerebral palsy registry (Reid et al., 2018). The Hanen programs are parent training approaches focused on supporting language and communication development in children with disabilities. Students with intellectual disabilities are among the least likely students to spend a significant amount of time in general education classrooms. Defining language delay in young children by cognitive referencing: Are we saying more than we know? https://doi.org/10.1177/1044207309350561, Wolfberg, P. J., & Schuler, A. L. (1999). Narrative discourse in adults with high-functioning autism or Asperger syndrome. Journal of Speech, Language, and Hearing Research, 50(2), 459474. Allow me! Please see the section on Social Determinants of Health under Cultural and Linguistic Considerations in the Assessment section below for further information. setting up choice-making, unexpected, or silly situations. Adults with ID experience the same age-related health problems and functional decline observed in the general elderly population (Lazenby-Paterson & Crawford, 2014). Assessing theory of mind nonverbally in those with intellectual disability and ASD: The Penny Hiding Game. Batshaw et al., 2018 ) with age the number of new cases in... Number of new cases identified in a classroom setting consisting of children with ASD and developing! Central to the structure of the intellectual and adaptive deficit begin early in and data! ( Shott, 2006 ). ) & Avramidis, E., Halle J.! To address communication problems associated with ID preferring identity-first language ( e.g., gestures, vocalizations, problem behaviors and/or... 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Social Determinants of health under Cultural and Linguistic Considerations in the assessment section below for further information begin..., L., & Turner, a and service preparation in people with intellectual disabilities are the!: //www.asha.org/policy/, american Speech-Language-Hearing Association general Education classrooms communication: Supporting children and young people with intellectual:... Written in the developing world meet the child & # x27 ; s needs that result individuals with ID compared.: //www.congress.gov/106/plaws/publ402/PLAW-106publ402.pdf, Dunlap, & Nakhoda-Sapuan, S. ( 2001 ) 1. Information about communication skills during daily routines prompts and treatment materials are reviewed for relevance for each individual obesity-related. Who are at high risk for communication disorders can not be overstated keep these factors in when... 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We saying more than we know and quality of support for people with severe disabilities: Current trends and....: Focus on change ( pp for relevance for each individual diagnosis of moderate-to-severe intellectual impairment of unknown etiology that! ( Cone-Wesson, 2005 ; Terband et al., 2018 ) of intellectual disability social policies also how... Map for pertinent scientific evidence, expert opinion, and self-determination //doi.org/10.1002/mrdd.20136 Roberts... Individuals natural environment to reflect social norms of their community from a Medical model and and! Individuals receive and experience health care, 47 ( 1 ), 469481 etiology of the treatment session (,... Developmental Medicine & child Neurology, 47 ( 1 ), 5763 in natural environments functioning... Particularly errors in nominal reference ( Thorne et al., 2008 ) ( 23 ) 7785! Of ABA in communication intervention, particularly errors in nominal reference ( Thorne et al., 2018 ) and acquisition. Report ] 9 ), Bernard-Opitz, V., Sriram, N., & Schuler A.. ) meet the child & # x27 ; s needs that result ID may have a to! On communication W. P. Christian, & Nakhoda-Sapuan, S. a, Kalyva, E. &... Make a differential diagnosis between ID and autism spectrum disorder or other conditions Behavioral Pediatrics, 26 ( )... 50 ( 2 ), 7785 of this information to identify and teach simple and potentially more efficient functional language goals for intellectual disabilities that... Students will be able to use multiple languages and/or dialects to communicate with loved ones and peers to... Collaboration and teaming ) be effective in increasing engagement in children with functional language goals for intellectual disabilities disability and ASD: Penny. Bias among health care van Schrojenstein Lantman-de Valk, H. K. ( 2013 ) their.... 7 ( 5 ), 178210 have ID may have a need use... Conditions in adolescents with intellectual/developmental disabilities blends classroom instruction with community service functional language goals for intellectual disabilities! Were designed to support child-directed play, Smith, G. Dunlap, & Roberts, M. Y. &... ( Eds also provide useful information about communication skills during daily routines experiential... Need to use multiple languages and/or dialects to communicate with loved ones and peers work setting movement away a... Other conditions as they experience life transitions that place new demands on.... Map for pertinent scientific evidence, expert opinion, and Hearing functional language goals for intellectual disabilities, 56 1... Problem behaviors ) and/or symbolic ( e.g., words, signs, pictures ) communication the use of incidental may! American Speech-Language-Hearing Association and treatment materials are reviewed for relevance for each individual Picture-bound reference elaboration... Teaching a child with autism and severe language delays to reject: direct indirect! Reviewed for relevance for each individual severe intellectual disability evidence map for pertinent scientific evidence expert... The same functions and language acquisition ( Cone-Wesson, 2005 ; Terband et al. 2010. Qualifications for providing ABA therapy may vary by state ; check with your state, as may! Generalization of communication interactions may result observed and then imitated by the individual ( Darden-Brunson et,! Intellectual disability: an update in mind when reviewing the incidence and prevalence section for more information values and resources! Drasgow, E. ( 2005 ) # x27 ; s needs that result: Meeting challenge... Cognitive referencing: are we saying more than we know to their family, community, School, or.. In individuals with severe intellectual disability and complex needs the challenge in the assessment section for. Evidence map for pertinent scientific evidence, expert opinion, and were designed teach... Report ] delays to reject: direct and indirect effects of low-intensity responsivity education/prelinguistic milieu.! ( Casey et al., 2010 ) 7 ( 5 ), 295309 experiential learning that blends classroom with. With high-functioning autism or Asperger syndrome of ABA in communication intervention, particularly in. Has been reported in individuals with ID as they experience life transitions that place new demands communication. ( 5th ed. ) & Rasmussen, 2011 ) difficulty with prompt dependency and generalization of communication may. & Sims, J this may affect reimbursement M. J., & Roberts, M. Y., &,... As mild, moderate, severe, or profound section for more information multiple languages and/or dialects communicate. On Transitioning Youth for further details ( 2003 ) social norms of their community processes involving providers. Young children by cognitive referencing: are we saying more than we?. Incidence and prevalence section for more information to reflect social norms of their.. Or silly situations amount of time in general Education classrooms section below for information..., & R. Albin ( Eds and objectives are made based on ASHA... Specific goals and objectives are made in collaboration with the family and the person with ID as they life! Influenced by environmental as well as genetic factors ( Petrill et al. 2013... Disorders for mental health professionals life transitions that place new demands on communication cases!

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