4.1 Physiological Changes; Implication in Emotional and Social Development
Transitions occur throughout life and are faced by all young people as they progress, from childhood through puberty and adolescence to adulthood; from immaturity to maturity and from dependence to independence. In addition, some young people experience extra transitions as a result of other life events for example, bereavement, separation of parents, and being placed in care.
Transition marks a time where an individual gains greater choice and autonomy as they become independent. This can be a source of great anxiety for parents and carers when deciding how best to manage risk in the future. There is a marked discrepancy between the risk perceived by young people with intellectual disabilities and that perceived by their carers/parents. It is important to adopt an appropriate strategy to reduce risk for individuals in a way that does not restrict the individual's autonomy or access to opportunities that are available to their peers. A large part of the process is to provide the relevant life skills training during the transition period.
Psychosocial Development Issues
Adolescents with disabilities often lag behind their typically developing peers psychosocially. Adolescents with disabilities desire the same developmental milestones as their typically developing peers such as establishing friendships, developing an identity, and evaluating their familial relationships. Unfortunately, they routinely lack the cognitive, emotional, and behavioral ability/autonomy to do so. The limited research on psychosocial development of adolescents with disabilities has centered primarily on self-concept, positive parent and peer relationships, and optimism and depression.
Identity
The identity development was central to Erikson’s model of human development. During adolescence, individuals seek to develop a personal identity, independent of their parents and peers, while also ensuring that they are meeting societal norms. Extensive literature, exploring identity development in typically developing youth, abounds. However, the majority of the scant research on identity development in adolescents with disabilities focuses narrowly on the progression and development of sexual identity or the developmental process of social identity through social construction of what these youth observe from peers and siblings.
As adolescents with disabilities explore their identity, they recognize that everyone is different, redefining how they perceive themselves. Lingam et al. used qualitative interviews to gain an in-depth understanding of the experiences and aspirations of a group of young people with disabilities. They found that, for these youth, identity formation is a combination of their life experiences and how they perceived their disability, including the ensuing differences and difficulties. Furthermore, the adolescents’ self-perception was specifically influenced by their perception of how friendship groups saw them in school and their perception of their family’s attitude toward them at home. Finally, a positive sense of identity and self-worth stemmed from being part of a social network that provided a sense of belonging, preferably one that valued differences as well as similarities.
Attachment
Attachment relationships are of even greater importance to young people with disabilities, because of their reduced coping resources. However, forming these attachment relationships may be more difficult for individuals with disabilities because the methods of communication and behaviors they express may be more difficult for the caregiver to decipher, which in turn may decrease the caregivers’ sensitivity and responsiveness to the child. Parental factors, such as increased stress associated with caring for a child with disabilities and accepting the diagnosis of disability, may also negatively impact the development of attachment relationships.
Abubakar et al. extensively explored attachment patterns in individuals with disabilities. Adolescents with disabilities may become more strongly attached to their peers who are experiencing similar conditions. As a result, adolescents with disabilities often have higher scores in peer attachment measures compared with those without disabilities. Further, youth with disabilities generally have a similar quality of attachment with both mothers and peers, but they have significantly lower attachment with fathers. It is interesting to note that research focusing on young children indicates a positive relationship between paternal involvement in the child’s caretaking and the quality of father–child attachment. However, during adolescence, individuals with learning disabilities report less secure attachment relationships with both mothers and fathers compared to their typically developing peers. Moreover, there is growing evidence to suggest that youth with intellectual disabilities may be less likely to be classified as securely attached compared to their typically developing peers and peers with other types of disabilities.
Autonomy
Autonomy is not solely a function of behaviors one can do independently, but rather of accepting responsibility, and making decisions for oneself in a context of social connectedness. Self-determination is essentially a person’s ability to independently make meaningful life choices and encompasses activities such as problem solving, decision making, goal setting, self-observation and evaluation, self-management and reinforcement, acquiring an internal locus of control, experiencing positive attributions of efficacy and outcome expectancy, developing a realistic and positive self-image, and self-awareness. Obtaining a sense of autonomy constitutes a major goal for most individuals with disabilities, particularly in the transition from childhood to adolescence and adolescence to adulthood. Autonomy, for adolescents with disabilities, includes taking responsibility for their behavior, making decisions regarding their lives, and maintaining supportive social relationships. One area where adolescents with disabilities can begin to exercise autonomy with the support and influence of family members involves making medical decisions. Terrone et al. studied the relationship between adolescent autonomy and their perceptions of feelings and attitudes experienced within the family in adolescents with and without disabilities. While all family members influence the level of autonomy in typically developing adolescents, mothers, once again, had a significant influence on the level of autonomy of adolescents with disabilities.
Self-Esteem
There is evidence that for people with disabilities stigmatization can have a negative impact on their psychological well-being, lowering their self-esteem and negatively affecting their mood. Those who were most aware of being stigmatized had the lowest self-esteem scores. Disability has been associated with a lower sense of self-worth, greater anxiety, and less integrated view of self for some, while others have no differences in global self-esteem comparing groups of children and adolescents with and without disabilities.
Studies that involve people with disabilities have shown that negative social comparisons are related to lower self-esteem scores and higher levels of depression. Dagnan and Sandhu investigated the relationship between social comparison, depression and self-esteem in individuals with disabilities. They found that total social comparison scores positively associated with total self-esteem scores and negatively associated with reported levels of depression. Literature beyond the Dagnan and Sandhu study focused on self-esteem for those with physical disabilities.
Research into aspects of psychosocial development of adolescents with disabilities is markedly limited in comparison to other areas that are important to their growth. However, there have been some key findings that can be built upon to further develop research in the area. Being a part of a social network, along with friend and family perceptions, play an important role in identity development. Adolescents with disabilities tend to have high attachment levels to both peers and parents, particularly mothers. However, these attachments are often not secure. During the transition from childhood to adolescence and then from adolescence to adulthood, the need for autonomy increases. Families of adolescents with disabilities need to encourage, support, and assist in activities that encourage safe and secure autonomy development. Stigmatization can be a key contributor to low self-esteem in adolescents with disabilities, especially during this developmental period when they become more aware of the perceptions of others and comparison is increased.
4.2 Interpersonal relationship – Parents, Siblings, Extended family, Single child, Peer group
Family relationships play an important development role for adolescents with disabilities. As these young people seek to form an identity and explore relationships outside of the family, adolescents with disabilities rely heavily on their family. It is important to underscore the bi-directional impact of these relationship, especially with this subpopulation of adolescents; the individual with disabilities will impact the family while the family will impact the individual with disabilities. All family members play a role, but parental and sibling responsibilities differ noticeably in the life of the adolescent with disabilities.
Parents are also in a stage of transition as their child enters young adult life. There are major changes and challenges for parents as they adapt their role and promote their child’s growing independence and life choices. It can be difficult to find a good balance between the duty of a parent to protect their child and the own rights of young adults. Parents are usually very involved in child and adolescent mental health services however parents generally tend to be less involved in adult mental health services. This can be complicated for young people with intellectual disabilities as parents can have a much greater role in protecting their child from risks from others including exploitation or manipulation due to their vulnerability.
An individual with disabilities’ transitioning from childhood to adolescence poses new challenges for parents, particularly mothers. As the adolescent develops an independent sense of self, parents often explore how to best help their child with the transitions. This assistance can include ways to teach the adolescent with disabilities about potential limitations of their disability, ways to grant and limit freedom to their child, and ways to redefine their roles as parents. Even though extensive empirical literature on identity development and autonomy granting exists for typically developing adolescents, the same is not true for adolescents with disabilities. It seems unrealistic to assume that parents of adolescents with disabilities should look to the typically developing literature for guidance in raising a child with disabilities. Exploration in the role of the family in psychosocial development, specific to adolescents with disabilities, seems needed. Unfortunately, because of the difficulties associated with the psychosocial development process for young people with disabilities, most of the research on parent–child relationships with this population focuses on negative outcomes associated with it, such as stress, rather than on family’s role on the developmental process itself.
Parents of adolescents with intellectual disabilities also experience high levels of stress and/or mental health problems, which can be related to subjective factors such as feeling social isolation and life dissatisfaction. Additionally, they may experience disappointment, embarrassment, shame, and guilt as they recognize that their child may never reach the goals they had envisioned for them. These negative feelings result from both logical and illogical beliefs that they caused their child to have disabilities. Communication issues for parents of adolescents with intellectual disabilities are frequently linked to this stress. Jones et al. found that talking to an adolescent about difference and disability is a difficult task for parents. Many struggle to grasp the level of content and optimal timing of interactions with their child with intellectual disabilities. As a result, much of the communication within the parent–child dyad ends up being reactive instead of proactive, often occurring after the adolescent was bullied, or as an explanation for why the child could not participate in an activity with their typically developing peers.
An individual with disabilities’ transition into adolescence relates to sibling relationships as well. Similar to typically developing sibling dyads, several factors play into the sibling relationship quality and the closeness that adolescents with disabilities have with their siblings. Typically developing siblings’ understanding of their sibling’s disability and its implications impacts the level and quality of relationship. As the individual with disabilities gets older, the siblings, those younger and older, often take on a parent/caretaker role and begin to realize that it might 1 day be their responsibility to care for their brother/sister.
Researchers posited that there may be more similarities than difference between typically developing sibling dyads and dyads that include a sibling with an intellectual disability. It is important to acknowledge the similarities between typically developing sibling dyads and those dyads with an adolescent with disabilities. However, the complexities of the relationship within a typically developing-disability dyad is related to the type and severity of the disability as well as added dimensions such as behavioral and health concerns.
Begum and Blacher concluded that relationships between siblings, particularly same-sex dyads, are important to adolescents with intellectual disabilities. Social opportunities are less prevalent for youth with disabilities than for typically developing youth. Given the limited social sphere, sibling relationships provide an opportunity for adolescents with intellectual disabilities to learn requisite skills and appropriate behaviors through observation and experience. Sibling relationships also socialize and prepare adolescents with intellectual disabilities for social functioning in other peer contexts, as the sibling provides opportunities to experiment with behaviors and learn from observed interactions between the typically developing sibling and others. Further, the older sibling, without intellectual disabilities, is likely to assume a caretaking role, particularly if the older sibling is female. As a result, the sibling is more likely to report feeling greater levels of warmth/closeness and lower levels of conflict compared to a typically developing adolescent sibling dyad.
Many young people with disabilities may either not see difference between themselves and their typically developing peers, or they may choose to look beyond their disabilities seeking normalcy. Often, adolescents with disabilities do not perceive themselves as different from their peers. However, their peers frequently perceive and treat them differently. Similar to their typically developing peers, adolescents with disabilities value the importance of friendship. Regrettably, lower levels of social skills connected with their disability lead adolescents with disabilities to struggle establishing meaningful connections with their typically developing peers, hindering the development of meaningful friendships. Middle childhood and adolescence are periods when youth become increasingly aware of individual differences, which can lead to rejection and stigmatizing of individuals with disabilities.
Paradoxically, the actual disability has little baring on how individuals with disabilities conceptualize themselves, but it is a determining factor for how others conceptualize them. Skär interviewed twelve adolescents with disabilities multiple times at the participant’s home seeking to better understand how adolescents with disabilities perceived social roles and relationships to peers and adults. Adolescent with disabilities gave a description of themselves as regular members of the adolescent group, even though they were fully cognizant of their disability. At the same time, however, the adolescents felt that others, both their typically developing peers and adults, saw them as drastically distinctive because of their disability. The relationships to friends of the same age were either markedly defective or non-existent, while relationships to adults were often characterized as ambivalent or asymmetric, conceivably as a result of these beliefs held by the adolescent with disabilities. Diamond et al. illuminate another potential reason for challenges in establishing and maintaining friendships for adolescents with disabilities. They report that these youths often feel powerless and alienated, more than their typically developing peers.
Adolescents with disabilities have friendships that are characterized by less warmth/closeness and less positive reciprocity than the friendships of their typically developing peers. Likewise, adolescents with disabilities spent less time with friends outside of school and were less likely to have a cohesive group of friends. For adolescents with disabilities, internalizing behaviors may actually prevent the social interaction needed to develop friendships. As a result, youth with disabilities are often perceived as less socially competent and of lower social status than their typically developing peers, and they struggle to resolve social conflict with peers.
4.3 Employment, Sexuality, Marriage, Alternative options, Pre- marital counselling
Most people with intellectual disabilities (ID, formerly mental retardation) are able to work. This may be part-time or full-time employment. IDs encompass a broad range of functional limitations, and a diverse set of abilities. Fortunately, employment opportunities are just as diverse.
Employers of people with IDs report they are pleased with these employees' performance. They are punctual, reliable, and dependable. People with IDs fulfill job responsibilities in a great variety of vocations. The key to successful employment is to match people's interests, skills and abilities with the job requirements. People with IDs are just like everyone else. They are motivated and perform well when they enjoy their work.
Historically, people with disabilities were trained to perform jobs specifically created for people with disabilities. These non-competitive jobs were artificially created. Today, people with disabilities are encouraged to choose work that appeals to them. They are no longer limited to work that was created for them. With additional supports, many people with IDs can work alongside people without disabilities. They also can successfully compete for these jobs.
There are different levels of support for employment. This is called support intensity. Some people with IDs may require occupational, physical, or speech therapies along with job training programs. Other employment supports include vocational rehabilitation program (voc-rehab). Children usually receive voc-rehab while enrolled in school. Adults might have a job coach using a supportive strategy called supported employment. Often social skills training is also provided. This is because successful employment usually requires some degree of social skill. Social skills and rehabilitative therapies are discussed in other sections
Voc-rehab programs teach important job skills. These training programs may be offered in a variety of locations. Some may be conducted at a regular job site. Others may be offered in a classroom. The classroom simulates an employment setting, such as a factory. Vocational programs also include job-seeking skills. Students learn how to complete an employment application. They practice employment interviews. State and federally funded community service programs may provide assistance with job placement. These jobs are reserved for the disabled. Therefore, they are considered non-competitive jobs. The disadvantage of these jobs is that they continue to separate disabled workers from workers without disabilities.
Recently, a new support strategy had gained acceptance. It is called supported employment. Supported employment is an evidence-based practice. An evidence-based practice means there is a large body of research that demonstrates its effectiveness. Supported employment has three key features. These features distinguish it from traditional vocational rehabilitation programs:
1. Employment is paid, competitive employment. This means the same work performance is expected of disabled and non-disabled workers. Therefore, work is compensated in the same manner. This includes all forms of compensation such as pay, healthcare, vacation, etc.
2. Work sites are integrated. Workers with disabilities work alongside workers without disabilities. They perform the same tasks. They eat lunch together and take breaks together.
3. Workers with disabilities are provided ongoing support. This enables them to achieve success and satisfaction. This support includes natural supports such as supervisors and co-workers.
Section-47(1) & 47(2), 48(c), 67(1) & 67(2) of PWD Act’1995 have following provisions to safeguard the rights of disabled Government employees and to ensure equal rights/participation.
Section-47(1): No establishment shall dispense with, or reduce in rank, an employee, who acquires a disability during his service.
Provided that, if an employee, after acquiring disability is not suitable for
the post he was holding, could be shifted to some other post with same pay
scale and service benefits.
Provided further that if it is not possible to adjust the employee against any
post, he may be kept on a supernumerary post until a suitable post is available
or he attains the age of superannuation, whichever is earlier.
Section-47(2) : No promotion shall be denied to a person merely on the ground of his disability. Provided that the appropriate Government may, having regard to the type of work carried on in any establishment, by notification and subject to such conditions, if any, as may be specified in such notification, exempt any establishment from the provision of this section.
Section-48(c) : The appropriate
Government and local authorities shall promote and sponsor research, inter alia
in the area of … development of assistive devices including their psycho-social
aspects;…
Sexuality:
Sexuality is an important component in people’s lives, however forgotten in people with intellectual disabilities. Faced with this situation, people with intellectual disabilities tend to be in a situation of vulnerability with greater risk of sexual abuse and altered sexual behavior that give them difficulties to have a lasting relationship. Included studies must mention the perception of people with intellectual disabilities about their sexuality in relation to: education, difficulties, strengths, gender identification, the role of the family and their close circle.
Being evident the importance of sexuality in people with intellectual disability, this topic should be addressed from a personal level and their close circle (family and support networks) through sex education about: sexuality, anatomy and functioning of the body, sexual abuse, use of contraceptives, and sentimental relationships. Sexuality in people with intellectual disability should be approached in a multidimensional way. An overarching theme is to teach family and educators not to diminish the value that represents sexuality in people and to assist when needed to address the process of sexual development and sexuality.
Existing sex education programmes have failed in involving people with intellectual disabilities in the development of these programmes. Not involving the target population decreases the likelihood that the sex education programme will be effective. Their knowledge regarding sex education is mainly limited to topics such as safe sex, contraception and STI’s and tends to be superficial. Additionally, knowledge on safe sex does not always translate to safe sex behaviour. Finally, relationships are important for most participants; mainly because they don’t want to be alone.
People with intellectual disabilities and developmental disabilities (IDD)*, like all people, have inherent sexual rights. These rights and needs must be affirmed, defended, and respected.
Issue
For decades, people with IDD have been thought to be asexual, having no need for loving and fulfilling relationships with others. Individual rights to sexuality, which is essential to human health and well-being, have been denied. This loss has negatively affected people with intellectual disabilities in gender identity, friendships, self-esteem, body image and awareness, emotional growth, and social behavior. People with IDD frequently lack access to appropriate sex education in schools and other settings. At the same time, some individuals may engage in sexual activity as a result of poor options, manipulation, loneliness or physical force rather than as an expression of their sexuality.
Position
Every person has the right to exercise choices regarding sexual expression and social relationships. The presence of IDD, regardless of severity, does not, in itself, justify loss of rights related to sexuality.
All people have the right within interpersonal relationships to:
With respect to sexuality, individuals have a responsibility to consider the values, rights, and feelings of others.
With respect to the potential for having and raising children, individuals with IDD have the right to:
Marriage:
It is a well know fact that in India marriage between disabled and able-bodied persons is not encouraged. Disabled persons are expected to marry other disabled persons. Arranged marriages are quite prevalent in India. And often matches for disabled people are often made only with a person with disability. This trend is a huge hurdle in the path of inclusion of disabled people in the mainstream.
To get around this problem, the Government of India and various state governments provide monetary incentive to the couple — if one of whom is a disabled person. The idea is to encourage able-bodied people to get into wedlock with persons with disabilities.
Premarital counseling is a type of therapy that helps couples prepare for marriage. Premarital counseling can help ensure that you and your partner have a strong, healthy relationship — giving you a better chance for a stable and satisfying marriage. This kind of counseling can also help you identify weaknesses that could become problems during marriage.
Premarital counseling is often provided by licensed therapists known as marriage and family therapists
4.4 Ethical Issues
The effective provision of psychotherapy services to individuals with intellectual disability requires consideration of ethical issues related to clinical competence, access to services, obligations to multiple parties, guardianship, and appropriate assessment practices. This article provides an overview of major ethical considerations with guidance for clarifying and resolving common ethical concerns. Psychologists are encouraged to expand access to psychotherapy services for this population while maintaining awareness of potential modifications, training needs, and boundaries of professional competence. The authors provide recommendations and resources for effective and ethical treatment of psychotherapy clients with intellectual disabilities.
Person-centered planning is a philosophy and a set of strategies aimed at promoting self-determination on the part of persons with intellectual and developmental disabilities. It involves understanding each person’s specific context, dreams, and aspirations and responding by creating the conditions that will promote and support the person’s own view of a positive future.
The practices that devolve from self-determination and person-centered planning have important ethical implications for professionals. In this article, we re-examine assumptions about basic concepts relevant to supporting persons with intellectual and developmental disabilities. In doing so, we focus on decisions with momentous implications, such as planning transition from school to adult life, changing living environments, and managing health issues.
To create a fresh vantage point from which professionals can reflect on their assumptions and practice, we begin with an analysis of the ethical principle of respect for autonomy. This is one of a number of ethical principles found in the ‘‘helping’’ professions but is often misunderstood as giving priority to whatever an individual chooses for him-/ herself. We develop our analysis by drawing attention to additional important concepts that are less often addressed: empowerment, participation in decision making, asymmetrical power, outer-directedness, and respect for persons. Ultimately, we propose that professionals adopt a moral principle of respect for persons as an overarching guiding principle in their work with adults with intellectual and developmental disabilities. The values of the construct of self determination and person-centered planning processes are not diminished by our analysis but are explicitly placed in a larger scope of ethical practice. We discuss the relationships among the moral principle of respect for persons, self-determination, and person-centered planning. To help apply our results, we offer a set of practical considerations that encourage respect for these individuals by involving them in the decision-making process in situations that have a large impact on them.
The concept of autonomy originated in Greek political philosophy to refer to a state’s capacity to govern itself: An autonomous state could act independently of governments or powers from outside its borders. The concept was later applied to individual persons, recognizing that persons have a certain capacity to govern themselves, to make and follow moral rules that they personally commit to. For some, the concept merged in meaning with the concept of self-determinism found in the philosophy–psychology literature in a distinction between free-will and determinism. At least in this early use, self-determinism referred more simply to making choices that influence an outcome. Where most actions in the world have external causes (e.g., gravity causes the apple to fall from the tree to the ground), many human actions originate, or are caused by, the human will. In other words, we have the capacity to choose which action to take. Rather than being determined from the outside, we are selfd etermined. Therefore, in this context, self-determinism does not necessarily have an ethical or moral dimension.
4.5 Challenges and Implications
Adolescents with disabilities face many challenges common to their typically developing peers. However, the ways that they resolve them may differ.
Adolescence is a time of marked biological changes, cognitive adjustments, and social transitions. While not all youth experience these transformations equally, disproportionately more young people with disabilities are prone to challenges than their typically developing peers. Understandably, most adolescents with disabilities desire to have developmental experiences and social opportunities similar to their typically developing peers. However, when struggles related to their disabilities make it more difficult, or impossible, to participate in social activities at the same rate and level as their peers, negative psychosocial outcomes like stress and loneliness can result.
Transition possibilities for adolescents with intellectual disabilities into adulthood remain a complex issue and often neglected by the healthcare system and non-healthcare system. Given the responsibilities and roles that the healthcare system, non-healthcare system and families have to fulfil to address the transition possibility issue, the lack of knowledge, skills and resources negatively impacts on the transition possibility. In favour of situating adolescents with intellectual disabilities into adulthood, the provision and development of working skills need to be prioritised. Transition possibilities are to be considered to all adolescents with intellectual disabilities.
The transition of adolescents with ID into adulthood is challenging in that they are expected to go through psychological and social maturation just like their able counterparts. There is a range of issues associated with transition of adolescents with ID into adulthood. They include rehabilitation and special education issues. However, in most countries, especially developing countries, they do not have structures in place to assist them achieve this milestone. Most often, there are no programmes and policies suited for addressing their needs.
Social challenges with transition of adolescents with intellectual disability
Lack of support and labelling of individuals with ID by communities are some of the challenges that affect adolescents with ID. These lead to isolation and loneliness. Other studies also reported that individuals with ID are ridiculed, not supported and unaccepted by the society they live in. Stigma and discrimination, especially in African countries where disability is associated with witchcraft and other supernatural causes, influence the way the individuals with ID are treated.
Occupational challenges with transition of adolescents with intellectual disabilities
Adolescents with ID face many challenges, especially in developing countries. There are very few schools open to adolescents with ID. The majority of them end at the seventh grade. This is especially true if they come from poor families who may not afford few private schools.
Leisure challenges with transition of adolescents with intellectual disabilities
It is generally believed that leisure promotes emotional and psychological wellbeing for individuals with ID . Leisure activities develop general skills and adaptive behaviours. However, in most countries leisure activities for individuals with ID are limited or non-existent
The role of governments
Poor outcomes for adolescents with ID on employment, education and social activities call for an active path for changing the post high school scenery. Governments can strive to make transition easier by ensuring structures that accommodate adolescents with ID are in place. Firstly, governments should ensure that all the schools from primary to secondary have facilities for special education. Such an arrangement will ensure that adolescents with ID and those without ID are taught in the same schools. Arrangements could be made that in such schools there will exist common courses that are taken together such as physical education. This will have multiple benefits for all. Adolescents with no ID will be able to accept those with ID and can understand their shortcomings and be able to assist them.
Firm friendships can be built at this stage, and this would ensure that adolescents with IDs leisure time are well taken care of The authors reported that adolescents with ID believe that they are just like others and consider themselves able to interact with peers with no ID. Research by Kurth and Mastergeorge suggest that inclusive education has more enhanced academic results for students with disabilities.
The use of technology in such schools will also improve the academic outcomes for students with ID. Therefore, governments should strive to make all this available for adolescents with ID. Maxey and Beckett posit that special education which is in the same environment with the mainstream education plays a vital role on how adolescents with ID are perceived by both the teachers and their peers. Currently in most countries, especially in developing countries, there are very few special schools, hence governments should be encouraged to build some and make them inclusive.
Governments can also expand employment opportunities for adolescents with ID. These they could do through collaborating with employment agencies.
Community centres that are open for adolescents with ID need to be in place. The government can achieve this by forming partnerships with community agencies. The benefit of this would be that it would allow for integration of adolescents with ID into the community. Pallisera et al argued that transition partnerships and collaboration are key factors in the facilitation and fostering of the transition process. This means an inclusion of a wide range of professionals, agencies, centres or services throughout the transition process.
Healthcare services are fragmented in most countries. For adolescents with ID, this would compound the problem of caregivers; hence, the governments need to bring them together. In most countries there are no services tailored for adolescents. There are health services for children and for adults, and there are very few for adolescents such as youth centres. This gap in service provision should be attended to, and youth-friendly services and skill centres should be made available even for adolescents with ID.
The role of healthcare workers
In order to ensure successful healthy transitions in healthcare, partnership work with families, communities, societies, education and other relevant stakeholders is needed.
Healthcare workers are also responsible for educating parents on the adolescent’s condition and what parents should expect. This would lessen the stress and ensure that parents know what to do with their adolescents. Education should focus on the adolescent behaviour. This would help parents to develop healthy relationships with their adolescent. This education should involve not just primary caregivers but extended family such as siblings, grandparents, aunts and other significant parties.
Healthcare workers are also charged with explaining to families about the level and scope of healthcare services that are available for such individuals. In most cases, families get confused because they are not aware of services that are available to adolescents with ID. Healthcare workers can facilitate their formation so that families can support and encourage each other.
The role of communities
Teaching communities and socialisation of the intellectually disabled children into the community are the key factors that form the basis for assisting adolescents with IDs transition into adulthood. If communities understand the abilities and limitations of adolescents with ID, they would have a nondiscriminatory attitude that would assist in the transition outcomes for individuals with ID. A non-judgemental and nondiscriminatory attitude is key towards achieving healthy transition experience.
Community partnerships with parents and professionals would relieve parents from being alone in the care of their intellectually disabled. Therefore, working together as a team would ensure a healthy transition of individuals with ID. For transition to bring about change and difference, individuals, their families and health and non-healthcare professionals should make necessary efforts and changes that enable these individuals and their families to adapt to their new roles and expectations. A community approach is necessary to assist these individuals, their families and their caregivers adapt to new changes and routines. Therefore, community education is essential to ensure that transition process promote positive experiences.