Intellectual Disability Peter Mittler

18 World Health • 48th Year, No . 5, September-October 1995 Intellectual disability Peter Mittler

ment and the support that is needed the learning and development of The needs of people with to do so. their children. Home-visiting People with a mild intellectual schemes have been used in many intellectual disabilities have disability may be accepted in developing countries. The essence schools and in the local community, of this approach is that the parent often been overlooked in though the threshold of acceptance and a home vi sitor jointly assess the programmes designed to will vary with social and economic developmental level of the child and circumstances and also with local on that basis plan a programme of reach disabled people in attitudes. Most people with more teaching which the parent carries out general. They themselves are significant degrees of intellectual at home. disability will require support from Inclusive education involves calling for their needs to be their families and from social service schooling for all children and ensur- ·agencies. met. It is estimated that one in ten of all disabled people has a significant Ideally, people with an in tellec­ intellectual disability- over 50 tual disabil ity: he term intellectual disability is million in the world at the present • have the same basic rig hts, increasingly accepted as appro­ time or up to l % of the population. needs and responsibilities as a ll priate by the main international T Mild forms will affect up to 3%. By oth er ci tizens to be fully included professional and scientific associa­ 2025, three-quarters of them will in society and social instituti ons; tions. Mental retardation is still the live in developing countries, mainly • can contribute to and enrich official terminology of WHO, as as a result of much more rapid popu­ society; well as of the United States; other lation growth and al so because many • can learn , provided th ey are countries use terms such as mental children who would previously have properly taught and are g iven handicap, learning disability, intel­ died at an early age are now surviv­ time to do so; lectual impairment. Mental defi­ ing and needing services. • will be supported by persons ciency or mental subnormality are and services within the commu­ no longer in use and language which nity; appears to encourage stereotypes Stimulating learning and • should be able to make their and generalizations is discouraged, own choices and decisions; such as references to the "retarded". development • should be abl e to li ve with According to the American The families of infants identified at their families or in the commu­ Association on Mental Retardation an early age as having an intellectual nity with appropriate support, (AAMR), "Mental retardation disability will need practical advice and shou ld not be segregated refers to substantial deficits in cer­ and personal support in stimulating or placed in ins ti tu tional setti ngs. tain aspects of personal competence. It is manifested as significantly sub­ average abilities in cognitive func­ tioning, accompanied by deficits in adaptive skills". For an individual to be regarded as having an intel­ lectual disability, both cognitive functions and ability to function in society must be impaired; neither is sufficient on its own. The AAMR definition also emphasizes the nature and intensity of the supports that an individual may need to function in society. In other words, the current approach to mental health is not limited to identifying deficits in the individual; it underlines the impor­ tance of interaction with the environ- Plans can be developed to enable teaching to be carried out at home. World Health • 48th Year, No. 5, September October 1995 19

themselves are calling more clearly and with greater persistence for their needs to be met. Their representa­ tives have addressed the UN General Assembly. Human rights organiza­ tions such as Inclusion International (formerly the International League of Societies for Persons with Mental Handicap) are disseminating exam­ ples of good practice and protesting at examples of discrimination and abuse. Family members throughout the world are insisting on better support and better community understanding. Many local and national voluntary organizations Efforts should be made to educate children with in tellectual disabilities in their neighbourhood schools. are insisting on the rights of all citizens with an intellectual dis­ ing that the teaching and the activi­ health, education and vocational ability to contribute to society and ties of the school are accessible to all training. People with intellectual to live in a more inclusive society. children in the community. Surveys disabilities are now beginning to gain Here are some practical steps that by UNESCO suggest that although access to rehabilitation programmes can be taken by health workers most children with intellectual di s­ from which they were previously at field level and also by those abilities in developing countries are excluded. In future, this approach involved in policy and planning. excluded from any form of school­ will need to be much more closely • Offer to meet and work with ing, an increasing number of children integrated, with access to local edu­ local voluntary organizations and are being successfully educated in cational and work opportunities. parents' groups concerned with their local schools. this problem. If these do not The United Nations' goal of a exist, offer to support parents and Society for All by the year 2010 Better community volunteers who may be prepared applies not only to education but also understanding to start a small group. to health, housing, employment, • Help to ensure that families are recreation and leisure, public trans­ The needs of people with intellectual supported when a child is identi­ port- in fact to all social amenities disabilities have often been over­ fied as likely to have an intellec­ and institutions. In many countries, looked in programmes designed to tual disability. This can be done progress is being achieved through a reach disabled people in general. But by ensuring that guidelines are new approach to community-based we now have enough knowledge and available on initial communica­ rehabilitation, one that involves skill to ensure that their needs are tion with parents (such as the much closer collaboration between more fully met in the future. They WHO behavioural science learn­ ing module entitled Introducing parents to their abnormal baby), or by providing accurate and reliable information to parents, in written or pictorial form, which includes guidance and sugges­ tions on what the family can do to stimulate and support the child's development. • Work with other professionals - especially teachers, social work­ ers and staff of day centres - to develop a joint, multidisciplinary approach, using WHO's guide­ lines on community-based rehabilitation. •

Professor Peter Mitt/er is with the School of Education, University of Manchester, Oxford People with intellectual disabilities are able to learn, provided they are properly taught and given Road, Manchester M I 3 9PL, England, and a sufficient time. former President of Inclusion International.