Exceptionalities

Intellectual Disability and Giftedness

The results of studies assessing the measurement of intelligence show that IQ is distributed in the population in the form of a Normal Distribution (or bell curve), which is the pattern of scores usually observed in a variable that clusters around its average. In a normal distribution, the bulk of the scores fall toward the middle, with many fewer scores falling at the extremes. The normal distribution of intelligence shows that on IQ tests, as well as on most other measures, the majority of people cluster around the average (in this case, where IQ = 100), and fewer are either very smart or very dull (see Figure 5.13). Because the standard deviation of an IQ test is about 15, this means that about 2% of people score above an IQ of 130, often considered the threshold for giftedness, and about the same percentage score below an IQ of 70, often being considered the threshold for an intellectual disability.

Although Figure 5.13 presents a single distribution, the actual IQ distribution varies by sex such that the distribution for men is more spread out than is the distribution for women. These sex differences mean that about 20% more men than women fall in the extreme (very smart or very dull) ends of the distribution.^[1] Boys are about five times more likely to be diagnosed with the reading disability dyslexia than are girls, and are also more likely to be classified as having an intellectual disability.^[2] However, boys are also about 20% more highly represented in the upper end of the IQ distribution.

One end of the distribution of intelligence scores is defined by people with very low IQ. Intellectual disability (or intellectual developmental disorder) is assessed based on cognitive capacity (IQ) and adaptive functioning. The severity of the disability is based on adaptive functioning, or how well the person handles everyday life tasks. About 1% of the United States population, most of them males, fulfill the criteria for intellectual developmental disorder, but some children who are given this diagnosis lose the classification as they get older and better learn to function in society. A particular vulnerability of people who have a low IQ is that they may be taken advantage of by others, and this is an important aspect of the definition of intellectual developmental disorder.^[3]

One cause of intellectual developmental disorder is Down syndrome, a chromosomal disorder caused by the presence of all or part of an extra 21st chromosome. The incidence of Down syndrome is estimated at approximately 1 per 700 births, and the prevalence increases as the mother’s age increases.^[4] People with Down syndrome typically exhibit a distinctive pattern of physical features, including a flat nose, upwardly slanted eyes, a protruding tongue, and a short neck.

Fortunately, societal attitudes toward individuals with intellectual disabilities have changed over the past decades. We no longer use terms such as “retarded,” “moron,” “idiot,” or “imbecile” to describe people with intellectual deficits, although these were the official psychological terms used to describe degrees of what was referred to as mental retardation in the past. Laws such as the Americans with Disabilities Act (ADA) have made it illegal to discriminate on the basis of mental and physical disability, and there has been a trend to bring people with mental disabilities out of institutions and into our workplaces and schools.

Giftedness refers to children who have an IQ of 130 or higher.^[5] Having extremely high IQ is clearly less of a problem than having extremely low IQ, but there may also be challenges to being particularly smart. It is often assumed that schoolchildren who are labeled as “gifted” may have adjustment problems that make it more difficult for them to create social relationships. To study gifted children, Lewis Terman and his colleagues selected about 1,500 high school students who scored in the top 1% on the Stanford-Binet and similar IQ tests (i.e., who had IQs of about 135 or higher), and tracked them for more than seven decades (the children became known as the “termites” and are still being studied today).^[6] This study found that these students were not unhealthy or poorly adjusted, but rather were above average in physical health and were taller and heavier than individuals in the general population. The students also had above-average social relationships and were less likely to divorce than the average person.^[7]

Terman’s study also found that many of these students went on to achieve high levels of education and entered prestigious professions, including medicine, law, and science.^[8] Of the sample, 7% earned doctoral degrees, 4% earned medical degrees, and 6% earned law degrees. These numbers are all considerably higher than what would have been expected from a more general population. Another study of young adolescents who had even higher IQs found that these students ended up attending graduate school at a rate more than 50 times higher than that in the general population.^[9]

As you might expect based on our discussion of intelligence, kids who are gifted have higher scores on general intelligence “g”, but there are also different types of giftedness. Some children are particularly good at math or science, some at automobile repair or carpentry, some at music or art, some at sports or leadership, and so on. There is a lively debate among scholars about whether it is appropriate or beneficial to label some children as “gifted and talented” in school and to provide them with accelerated special classes and other programs that are not available to everyone. Although doing so may help the gifted kids, it also may isolate them from their peers and make such provisions unavailable to those who are not classified as “gifted.”^[10]

Children with Disabilities

A Learning Disability (or LD) is a specific impairment of academic learning that interferes with a specific aspect of schoolwork and that reduces a student’s academic performance significantly. An LD shows itself as a major discrepancy between a student’s ability and some feature of achievement: The student may be delayed in reading, writing, listening, speaking, or doing mathematics, but not in all of these at once. A learning problem is not considered a learning disability if it stems from physical, sensory, or motor handicaps, or from generalized intellectual impairment. It is also not an LD if the learning problem really reflects the challenges of learning English as a second language. Genuine LDs are the learning problems left over after these other possibilities are accounted for or excluded. Typically, a student with an LD has not been helped by teachers’ ordinary efforts to assist the student when he or she falls behind academically, though what counts as an “ordinary effort”, of course, differs among teachers, schools, and students. Most importantly, though, an LD relates to a fairly specific area of academic learning. A student may be able to read and compute well enough, for example, but not be able to write. LDs are by far the most common form of special educational need, accounting for half of all students with special needs in the United States and anywhere from 5 to 20 percent of all students, depending on how the numbers are estimated.^{[11] [12]} Students with LDs are so common, in fact, that most teachers regularly encounter at least one per class in any given school year, regardless of the grade level they teach.

These difficulties are identified in school because this is when children’s academic abilities are being tested, compared, and measured. Consequently, once academic testing is no longer essential in that person’s life (as when they are working rather than going to school) these disabilities may no longer be noticed or relevant, depending on the person’s job and the extent of the disability.

Dyslexia is one of the most commonly diagnosed disabilities and involves having difficulty in the area of reading. This diagnosis is used for a number of reading difficulties. Common characteristics are difficulty with phonological processing, which includes the manipulation of sounds, spelling, and rapid visual/verbal processing. Additionally, the child may reverse letters, have difficulty reading from left to right, or may have problems associating letters with sounds. It appears to be rooted in neurological problems involving the parts of the brain active in recognizing letters, verbally responding, or being able to manipulate sounds. Recent studies have identified a number of genes that are linked to developing dyslexia.^[13] Treatment typically involves altering teaching methods to accommodate the person’s particular problematic area.

ADHD

A child with Attention Deficit Hyperactivity Disorder (ADHD) shows a constant pattern of inattention and/or hyperactive and impulsive behavior that interferes with normal functioning. ^[14] Some of the signs of inattention include great difficulty with, and avoidance of, tasks that require sustained attention (such as conversations or reading), failure to follow instructions (often resulting in failure to complete schoolwork and other duties), disorganization (difficulty keeping things in order, poor time management, sloppy and messy work), lack of attention to detail, becoming easily distracted, and forgetfulness. Hyperactivity is characterized by excessive movement, and includes fidgeting or squirming, leaving one’s seat in situations when remaining seated is expected, having trouble sitting still (e.g., in a restaurant), running about and climbing on things, blurting out responses before another person’s question or statement has been completed, difficulty waiting for one’s turn for something, and interrupting and intruding on others. Frequently, the hyperactive child comes across as noisy and boisterous. The child’s behavior is hasty, impulsive, and seems to occur without much forethought; these characteristics may explain why adolescents and young adults diagnosed with ADHD receive more traffic tickets and have more automobile accidents than do others their age.^[15]

ADHD occurs in about 5% of children.^[16] On average, boys are 3 times more likely to have ADHD than are girls; however, such findings might reflect the greater propensity of boys to engage in aggressive and antisocial behavior and thus incur a greater likelihood of being referred to psychological clinics.^[17] Children with ADHD face severe academic and social challenges. Compared to their non-ADHD counterparts, children with ADHD have lower grades and standardized test scores and higher rates of expulsion, grade retention, and dropping out.^[18] They also are less well-liked and more often rejected by their peers.^[19]

ADHD can persist into adolescence and adulthood.^[20] A recent study found that 29.3% of adults who had been diagnosed with ADHD decades earlier still showed symptoms.^[21] Somewhat troubling, this study also reported that nearly 81% of those whose ADHD persisted into adulthood had experienced at least one other comorbid disorder, compared to 47% of those whose ADHD did not persist. Additional concerns when an adult has ADHD include Worse educational attainment, lower socioeconomic status, less likely to be employed, more likely to be divorced, and more likely to have non-alcohol-related substance abuse problems.^[22]

Causes of ADHD

Family and twin studies indicate that genetics play a significant role in the development of ADHD. Burt (2009), in a review of 26 studies, reported that the median rate of concordance for identical twins was .66, whereas the median concordance rate for fraternal twins was .20.^[23] The specific genes involved in ADHD are thought to include at least two that are important in the regulation of the neurotransmitter dopamine,^[24] suggesting that dopamine may be important in ADHD. Indeed, medications used in the treatment of ADHD, such as methylphenidate (Ritalin) and amphetamine with dextroamphetamine (Adderall), have stimulant qualities and elevate dopamine activity. People with ADHD show less dopamine activity in key regions of the brain, especially those associated with motivation and reward,^[25] which provides support to the theory that dopamine deficits may be a vital factor in the development of this disorder.^[26]

Brain imaging studies have shown that children with ADHD exhibit abnormalities in their frontal lobes, an area in which dopamine is in abundance. Compared to children without ADHD, those with ADHD appear to have smaller frontal lobe volume, and they show less frontal lobe activation when performing mental tasks. Recall that one of the functions of the frontal lobes is to inhibit our behavior. Thus, abnormalities in this region may go a long way toward explaining the hyperactive, uncontrolled behavior of ADHD.

Although some food additives have been shown to increase hyperactivity in non-ADHD children, the effect is rather small.^[27] Numerous studies, however, have shown a significant relationship between exposure to nicotine in cigarette smoke during the prenatal period and ADHD.^[28] Maternal smoking during pregnancy is associated with the development of more severe symptoms of the disorder.^[29]

Treatment for ADHD

Recommended treatment for ADHD includes behavioral interventions, cognitive behavioral therapy, parent and teacher education, recreational programs, and lifestyle changes, such as getting more sleep.^[30] For some children medication is prescribed. For an overview of treatments options for a variety of ages, please visit this link to the the CDC website. Also visit this site to learn about evidence-based treatment options.

Is the prevalence rate of ADHD increasing?

Many people believe that the rates of ADHD have increased in recent years, and there is evidence to support this contention. ADHD may be over-diagnosed by doctors who are too quick to medicate children as a behavior treatment. There is also greater awareness of ADHD now than in the past. Nearly everyone has heard of ADHD, and most parents and teachers are aware of its key symptoms. Thus, parents may be quick to take their children to a doctor if they believe their child possesses these symptoms, or teachers may be more likely now than in the past to notice the symptoms and refer the child for evaluation. Further, the use of computers, video games, iPhones, and other electronic devices has become pervasive among children in the early 21st century, and these devices could potentially shorten children’s attention spans. Thus, what might seem like inattention to some parents and teachers could simply reflect exposure to too much technology.

Legislation for Learning Disabilities

Since the 1970s political and social attitudes have moved increasingly toward including people with disabilities into a wide variety of “regular” activities. In the United States, the shift is illustrated clearly in the Federal legislation that was enacted during this time. Three major laws were passed that guaranteed the rights of persons with disabilities, and of children and students with disabilities in particular. The third law has had the biggest impact on education.

Rehabilitation Act of 1973, Section 504

This law, the first of its kind, required that individuals with disabilities be accommodated in any program or activity that receives Federal funding.^[31] Although this law was not intended specifically for education, in practice it has protected students’ rights in some extra-curricular activities (for older students) and in some child care or after-school care programs (for younger students). If those programs receive Federal funding of any kind, the programs are not allowed to exclude children or youths with disabilities, and they have to find reasonable ways to accommodate the individuals’ disabilities.

Americans with Disabilities Act of 1990 (or ADA)

This legislation also prohibited discrimination on the basis of disability, just as Section 504 of the Rehabilitation Act had done.^[32] Although the ADA also applies to all people (not just to students), its provisions are more specific and “stronger” than those of Section 504. In particular, ADA extends to all employment and jobs, not just those receiving Federal funding. It also specifically requires accommodations to be made in public facilities such as with buses, restrooms, and telephones. ADA legislation is therefore responsible for some of the “minor” renovations in schools that you may have noticed in recent years, like wheelchair-accessible doors, ramps, and restrooms, and public telephones with volume controls.

Individuals with Disabilities Education Act (or IDEA)

As its name implied this legislation was more focused on education than either Section 504 or ADA. It was first passed in 1975 and has been amended several times since, including most recently in 2004.^[33] In its current form, the law guarantees the following rights related to education for anyone with a disability from birth to age 21. The first two influence schooling in general, but the last three affect the work of classroom teachers rather directly:

• Free, appropriate education: An individual or an individual’s family should not have to pay for education simply because the individual has a disability, and the educational program should be truly educational; i.e., not merely care-taking or babysitting the person.
• Due process: In case of disagreements between an individual with a disability and the schools or other professionals, there must be procedures for resolving the disagreements that are fair and accessible to all parties, including the person himself or herself or the person’s representative.
• Fair evaluation of performance in spite of disability: Tests or other evaluations should not assume test-taking skills that a person with a disability cannot reasonably be expected to have, such as holding a pencil, hearing or seeing questions, working quickly, or understanding and speaking orally. Evaluation procedures should be modified to allow for these differences. This provision of the law applies both to evaluations made by teachers and to school-wide or “high-stakes” testing programs.
• Education in the “least restrictive environment”: Education for someone with a disability should provide as many educational opportunities and options for the person as possible, both in the short term and in the long term. In practice, this requirement has meant including students in regular classrooms and school activities as much as possible, though often not totally.
• An individualized educational program: Given that every disability is unique, instructional planning for a person with a disability should be unique or individualized as well. In practice, this provision has led to classroom teachers planning individualized programs jointly with other professionals (like reading specialists, psychologists, or medical personnel) as part of a team.

Evaluation and diagnosis can be the first step in helping provide children with disabilities the type of instruction and resources that will benefit them educationally, but diagnosis and labeling also have social implications. It is important to consider that children can be misdiagnosed and that once a child has received a diagnostic label, the child, teachers, and family members may tend to interpret actions of the child through that label. The label can also influence the child’s self-concept. Consider, for example, a child who is misdiagnosed as learning disabled. That child may expect to have difficulties in school, lack confidence, and because of these expectations experience trouble. This self-fulfilling prophecy calls our attention to the power that labels can have whether or not they are accurately applied. It is also important to consider that children’s difficulties can change over time; a child who has problems in school may improve later or may live under circumstances as an adult where the problem (such as a delay in math skills or reading skills) is no longer relevant. That person, however, will still have a label as learning disabled. It should be recognized that the distinction between abnormal and normal behavior is not always clear; some abnormal behavior in children is fairly common.

Resources for Children who have Exceptionalities

• The Office for Civil Rights provides this article on protecting children who have special needs.
• Information on the Individuals with Disabilities Education Act can be found in government websites and independent publications.
• Learn about children who are academically-gifted, by reading this article on academically gifted children and giftedness more generally.
  • Parent resources are provided by the National Association for Gifted Children (NAGC).
  • The NAGC also offers tip sheets for parents of gifted children.
  • Download Gifted 101 [pdf]
• Children who have developmental variations: 1 in 6 children in the U.S. have one or more developmental disabilities or delays [pdf]
• The CDC has information about children who have birth defects, children diagnosed with Autism Spectrum Disorder, and children with Attention Deficit/Hyperactivity Disorder (ADHD).
• For a more general overview of children’s mental health, visit this children’s mental health webpage from the CDC.

Prevention and Interventions

• Targeted Interventions Supporting Parents of Children with Special Needs, Parents Facing Special Adversities, and Parents Involved with Child Welfare Services; Click here for a link to the full book on interventions.
• Helping families that have special needs.