sample case study of a child with intellectual disability

Case Study of a Child with Intellectual Disability

In this intellectual disability case study, the author looks at designing an education curriculum for Meagan, a 14-year-old student.

Introduction

There are numerous interventions that have been designed to enable students with intellectual disability better cope with their condition. Most of these interventions have been hinged on the principle that respective educational programs should be tailored to complement the students’ strengths, and to supplement their weaknesses.

This is the same principle underlying the functioning of the K12 educational principle because it is centered on meeting individual student needs (K12 Inc. 2011, p. 1). The K12 educational paradigm mostly works through online communication but it has been seen to offer a lot of advantages to students with unique disabilities.

For instance, the educational methodology is known to provide rich, challenging and engaging content; an individualized learning plan; a learning coach; and cutting-edge technology in the provision of the best learning outcomes for intellectually disabled students (K12 Inc. 2011, p. 1).

When educating students with intellectual disabilities, it should be understood that, students are bound to have trouble in learning, retaining information and understanding information (Pearson Education Inc. 2011, p. 2).

Educators have often experienced such challenges, but comprehensively, there is a consensus among most stakeholders that it is vital to make accommodations for certain groups of students, and it is also crucial to make curriculum modifications for other students. In this regard, there seems to be a lack of consensus in coming up with one formula for handling students with intellectual disability.

This is the main framework for the advancement of this paper because this paper focuses on developing curriculum adjustments for a young man, Meagan. Meagan is 14 years old and has had a history of intellectual disability. This paper analyzes various dynamics of Meagan’s life, with the intention of making curriculum adjustments to provide an effective framework for learning.

To provide a good backdrop for the development of a good framework for learning, several aspects of Meagan’s life will be analyzed. These aspects include his family background, personal history, personal skills and personal abilities.

These factors will be analyzed systematically. Comprehensively, this analysis will be done with the aim of identifying one long-term aim or objective of the learning outcome and two short-term aims or objectives of the learning outcome.

Family Background

Meagan is the eldest child in a family of three children. His younger sibling is a girl, Sophia, aged nine years old. The youngest child is also a girl and she is three years old. Among his siblings, Meagan is deemed to be the child who has experienced most difficulty in learning. Meagan’s family hails from a middle-class society in Melbourne, Australia. His father works as a retired engineer in a local factory.

The mother works as a librarian in a local university. There has been no vivid or confirmed reports of intellectual disability among any of Meagan’s family members, though there have been unconfirmed reports of mental illness among some of Meagan’s relatives hailing from his father’s side of the family.

His aunt is said to experience occasional episodes of mental instability. However, there have been no confirmed reports of mental illnesses or cognitive disability from any of the family members of Megan’s mother.

Megan’s family professes the Christian faith, though they are not committed in their religion. However, Christianity has had an influence on Meagan’s life because he strongly identifies with his Christian faith. In the past couple of months, Meagan was baptized and currently devotes most of his time to his religious duties. None of Meagan’s family members pay much attention to religion.

His family also hails from a background of child neglect, with many of Meagan’s relatives having been abandoned by their parents at an early age. Meagan’s parents are no exception. The degree of attention they give Meagan is inadequate because little attention is paid to Meagan’s slow intellectual development. This has been going on since his parents confirmed that he was suffering from intellectual disability.

There is also an almost non-existent family support structure for Meagan to cope with his condition. Moreover, there is very little evidence of family cohesion among Megan’s family members, starting from his parents to his siblings. In this regard, Meagan is left to live with his condition, alone.

Personal History

Meagan hails from the aboriginal community of Australia. He was prematurely born because he was birthed at only seven months into his mother’s pregnancy. During his infant life, Meagan was abandoned by his mother, even before he was completely weaned from her. This forced his father to look for a baby sitter.

Nonetheless, despite these challenges, Meagan lived to have a vibrant childhood, with no signs of failing to cope with his playmates or friends. To a large extent, Meagan has been deemed a “normal” child. In his teen years, he used to participate in church activities (for the young) and also took part in school activities including extracurricular games.

He was a vibrant member of the school choir and an active member of the school soccer club. However, Meagan’s repeated the seventh grade level (twice) because he failed to meet the minimum threshold for admission into the eighth grade.

For a long time, he experienced a lot of difficulty trying to meet the minimum threshold for admission into sequential class grades because he always trailed among the last five candidates in any class. This was witnessed from his admission into the first grade.

However, Meagan’s academic background was characterized by exemplary performance in various academic writing competitions. His teachers termed him as a very creative writer and he never disappointed in his English creative writing assignments.

However, this was as far as his academic excellence stretched. Currently, Meagan undertakes blue collar jobs on minimum wage but there is increasing pressure among his peers for him to continue with his studies.

Personal Skills and Abilities

Meagan has a creative mind. He has shown interest in creative writing from his younger years but as he grew older, his interest changed. However, as explained in earlier sections of this study, in his young years, Meagan used to write exemplary creative works. His interest however shifted into music when he grew a little older.

So far, he has been able to record music in a local music company but his talents have never been fully exploited because of the lack of adequate finances to bankroll his musical ambitions. Moreover, there has been limited support from most of his family members in his quest to pursue music. However, due to his strong religious background, Meagan hopes to produce music for his local church.

The main aim of undertaking a curriculum adjustment for Meagan is to enable him to earnest his abilities and use them to the optimum benefit of his talents.

To enable Meagan to be independent and able to communicate his needs in effective and acceptable ways.

To assist Meagan to excel in personal growth and compete with other students in varying levels of excellence.

Curriculum Adjustments

Making the best curriculum adjustments for Meagan entirely depends on the nature of his disability. From previous sections of this paper, we have affirmed that Meagan suffers from a slow comprehension of academic disciplines, but he has a stronger grasp on creative works.

Here, there are several curriculum adjustments that can be done to ensure Meagan lives to his full potential. In this regard, this paper proposes several curriculum adjustments, based on the K12 teaching model which aims to provide individualized learning for students with intellectual disability. They are outlined below:

Interest and Student Ability

To ensure Meagan lives to his full potential, it is crucial to make curriculum adjustments to suit individual needs, abilities and preferences. A uniform curriculum which is meant to work for the majority student population is bound to fail for Meagan because it will not be specific to Meagan’s abilities and potential.

In this regard, it is therefore crucial for the curriculum to be designed to emphasize on creative works, as opposed to academic excellence, to enable Meagan to succeed in arts (Queensland Government 2011). Emphasis should be further made to ensure the school grading criteria focuses the same level of attention it gives to sciences (and other disciplines) as it does with art subjects.

Such a grading criterion would ensure students are assessed on all fronts, and not just academic. When adjusting the learning curriculum, it is also crucial for teachers to structure the curriculum in a manner that guarantees the grouping of students into different ability groups.

Not all students have the same type of abilities and therefore, it would be beneficial for teachers to group Meagan into the “creative works” group, so that he can share his creative ideas with his peers (Foreman 2009, p. 170).

Adjusting the Learning Outcomes

Adjusting the learning outcomes is an important adjustment to the learning curriculum if the school grading process is to be fair. Here, “fair” means to accommodate intellectually disabled students (Snowman 2011).

Accommodation of Diverse learning Styles

Intellectually disabled students are normally faced with the challenge of failing to comprehend learning instructions as fast as other students do. However, research studies affirm that some of these students prefer certain learning styles in place of others (Queensland Government 2011). Moreover, educationists have shown that certain learning styles are more effective for intellectually disabled students, while others are not.

Such dynamics withstanding, it is crucial to make curriculum adjustments that allow for the accommodation of diverse learning styles for improved efficacy in learning. For instance, conventional or online lessons can be administered using various learning materials such as DVDs, CDs, Books, videos and such materials (Browder 2011, p. 332).

The inclusion of such diverse strategies is set to improve the level of interaction between the students and the teachers because an appropriate learning style would motivate the students to pay more interest in the learning process. This improves the students’ level of engagement. Moreover, such curriculum changes ensure the learning process is rich in its contents.

Integrating a Learning Coach (Parent Involvement)

It is crucial to integrate the input of a learning coach into the school curriculum to encourage the participation of Meagan’s parents in his educational endeavors. The parents will be the learning support team.

Already, we have established that Meagan hails from a family that pays little attention to his educational needs. Here, there is a strong need to integrate the parents’ input into Meagan’s educational projects to ensure he enjoys a support structure, aside from the traditional teacher-student framework.

Though an integration of the role of the learning coach into the school curriculum may not necessarily be confined in the parent-student framework, it is crucial for this integration to be developed in this framework, if Meagan has to develop better learning skills (National Parent Teacher Association 2009, p. 1 ) .

This is because a great degree of the deterioration of his intellectual ability comes from a lack of effective support structure that enables him to improve his learning skills (Queensland Government 2011).

For long, this need has been ignored, and as a result, Meagan has continually performed poorly in his academic endeavors. Nonetheless, the learning coach framework can be designed in various ways. For instance, the school curriculum can be designed to include the participation of parents in the student’s projects, at least once or twice a semester.

Parents may be required to give consent, provide counsel or similar activities on the student’s tasks, thereby encouraging him to better develop with his learning activities. The inclusion of this principle into the school curriculum may be indirectly beneficial to Meagan because it is bound to have a motivating effect on him. This is the first strategy that can be adopted in encouraging parent participation.

The second strategy that can be adopted by the school is implementing a family-school partnership policy where parents and teachers agree on a common framework where parental involvement is assessed, and the parents’ progress is measured (Westwood 2011, p. 15).

This recommendation emanates from research studies which have shown that schools which have an efficient family-school partnership perform better than schools which lack this policy (Queensland Government 2011).

Finally, the school should make adjustments to the curriculum to ensure that parents take part in the decision making process of activities affecting student achievement. Here, parents should be allowed to be part of advisory committees which affect student achievement.

This paper proposes that, adjustments in the school curriculum which have to be made to accommodate Meagan’s skills and abilities have to be done within the confines of earnesting his skills and abilities (to use them for the benefit of his personal growth). In this regard, this paper proposes that the school curriculum should be tailored to accommodate Meagan’s artistic skills.

Moreover, the learning outcome should be adjusted to accommodate the same skills and abilities. From a holistic perspective, this paper also proposes that diverse learning styles should be accommodated into the learning curriculum to ensure students with intellectual disability learn in an efficient way.

These recommendations are carved from the K12program. Nonetheless, this paper also puts a lot of emphasis on the importance of incorporating parent input in the school curriculum. Integrating these principles will go a long way in enabling Meagan to earnest his strengths and use them to the optimum benefit of his talents.

Browder, D. (2011) Teaching Students with Moderate and Severe Disabilities . New York, Guilford Press.

Foreman, P. (2009) Education of Students with an Intellectual Disability: Research and Practice (PB). New York, IAP.

K12 Inc. (2011) How a K12 Education Works . Web.

National Parent Teacher Association. (2009 ) Enhancing Parent Involvement. Web.

Pearson Education Inc. (2011) Teaching Students with Special Needs . Web.

Queensland Government. (2011) Intellectual Impairment – Educational Adjustments. Web.

Snowman, J. (2011) Psychology Applied to Teaching . London, Cengage Learning.

Westwood, P. (2011) Commonsense Methods for Children with Special Educational Needs . London, Taylor & Francis.

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Case 2: An 11-year-old girl with aggressive behaviour and intellectual impairment

An 11-year-old Caucasian girl was referred for evaluation of aggressive behaviour that had worsened over the past two years. She experienced frequent outbursts of anger and would scream or bite when she became upset. She was cognitively delayed and could not independently perform activities of daily living such as bathing and eating. Attempts at toilet training were unsuccessful. She exhibited repetitive mannerisms such as hand flapping, eye blinking, repeated hand washing and running in circles. Socialization skills were restricted and eye contact was poor. Family history was significant for four brothers with developmental delay, a maternal aunt with premature menopause, and history of gait instability and tremors in her maternal grandfather since 40 years of age. There was no history of consanguinity. No complications were reported during pregnancy or birth. Her motor milestones were normal. Although she exhibited language delay, she could engage in a conversation with diminished vocabulary.

On physical examination, vital signs were normal. Subtle facial dysmorphism was present ( Figure 1 ). Her head was normocephalic, and cardiac and pulmonary examinations were unremarkable. The patient was noted to be intellectually impaired, hyperactive, had poor eye contact and displayed repetitive behaviour. The remainder of the neurological examination (cranial nerves, motor, sensory and reflexes) was normal.

Patient’s photograph demonstrating subtle dysmorphic features including a long face, thin upper lip and long philtrum

CASE 2 DIAGNOSIS: FRAGILE X SYNDROME

This case is a classic presentation of fragile X syndrome (FXS). FXS is caused by a mutation of the fragile X mental retardation 1 ( FMR1 ) gene on Xq27.3. The vast majority of cases occur as a result of unstable expansion of the CGG repeat in the FMR1 gene. The presence of >200 repeats is associated with hypermethylation, leading to transcriptional silencing and a decrease or absence of the gene product, fragile X mental retardation protein ( 1 ). The diagnosis of FXS is made by assessing the number of CGG repeats using polymerase chain reaction analysis, usually in conjunction with Southern blot analysis, which evaluates the methylation status of the gene. The patient in the present case was genetically confirmed to have the full mutation (667 repeats of CGG), along with four of her brothers.

FXS is the most common cause of inherited intellectual disability and is strongly associated with autism ( 1 ). It may present with features of pervasive developmental disorder including language delay, stereotypic behaviours and social impairment. Children with FXS often experience scholastic problems due to autism in addition to the underlying intellectual disability, and are frequently placed in special education classes or are homeschooled. Other features include attention deficit hyperactivity disorder, hyperextensible joints, mitral valve prolapse, flat feet, hypersensitivity to sensory stimuli and hypotonia ( 1 ). Many patients with FXS, particularly boys, develop seizures in early childhood ( 1 ). Individuals with FXS often have a characteristic physical appearance including macrocephaly, a long face with a prominent forehead and large ears. Postpubertal males can develop macro-orchidism. Similar to our patient, females affected with FXS may exhibit subtle dysmorphic features. As a result of random X inactivation and presence of FMR1 from the normal X chromosome, females with FXS may develop an attenuated phenotype ( 1 ). It may, thus, be challenging to suspect FXS in a girl solely based on clinical presentation.

Family history may provide important clues to the diagnosis of FXS. While the presence of >200 CGG repeats leads to FXS, patients with 55 to 200 repeats (‘premutation’) have a different clinical phenotype. Premutation carrier males often have mild cognitive deficits and may develop fragile X-associated tremor/ataxia syndrome (FXTAS), which is a Parkinson’s-like condition that presents with gait instability and postural tremors. Premutation carrier females may develop premature ovarian failure, anxiety and depression ( 2 ). The symptoms reported in the patient’s maternal grandfather and aunt were suspicious for FXTAS and premature ovarian failure, respectively. Taking a thorough history is vital to obtain these important clues, which may assist in evaluation and diagnosis.

Interventions, such as early developmental stimulation, physical therapy, occupational therapy, and speech and language therapy, are key to the management of children with FXS. Stimulants and anti-depressants can be prescribed for behavioural symptoms including hyperactivity, inattention and mood disturbances. Children with seizures should be treated with anticonvulsants. Targeted therapeutic options are currently being evaluated, including R-baclofen, which may have a role in decreasing seizures, improving autistic behaviours and decreasing social impairment ( 2 ). Families should be offered genetic counselling to determine the extent of the mutation and risk of transmission because there are implications for the diagnosis on seemingly unaffected family members.

In summary, FXS remains the most common cause of inherited intellectual disability and should be a part of the evaluation of any child with unexplained developmental delay. Our patient exhibited some of the physical characteristics of FXS, but the presence of pervasive features along with the intellectual disability and a strong family history favoured a diagnosis of FXS. It is important to consider FXS in girls presenting with intellectual disability because the clinical features may be more subtle compared with boys.

CLINICAL PEARLS

• FXS is the most common inherited cause of intellectual disability.
• Characteristic features of FXS include physical characteristics such as a long face, large ears and macro-orchidism (in postpubertal males), as well as autism, seizures and attention deficit hyperactivity disorder. Premutation carriers can present with FXTAS (males) and premature ovarian failure (females).
• FXS should be considered as a potential diagnosis in girls presenting with unexplained intellectual disability because other features of the disease may be less conspicuous.