Unit 4: Therapeutic Intervention for Children with ID

4.1.  Management of problem behaviours in students with intellectual disabilities

4.2.  Relevance, roleand techniques of physiotherapy for students with ID

4.3.  Role and techniques of occupational therapy and sensory integration for students with ID

4.4.  Techniques & strategies for Speech & Language intervention to students with Intellectual disability.

4.5.  Recreational Therapy for students with Intellectual Disability: Yoga, Music, Play & Movement therapy












4.1         Management of problem behaviours in students with intellectual disabilities


Behaviour disorders are frequent in children with an intellectual disability, regardless of the underlying etiology. They are often disabling, and can create problems in everyday life and can mask, or reveal, an organic or psychiatric illness. Such behaviours are often chronic and more than one may be present in the same individual. This is further complicated by the fact that parents often do not seek help for the problem, perhaps believing that it is due to the child’s disability and cannot be treated. 

Challenging behaviour is common in intellectual disability but it is difficult to diagnose and manage. It can adversely affect the quality of life of the individual and cause the breakdown of community placements, resulting in hospital admission. This article discusses the aetiology of challenging behaviour (including the complex relationship with mental illness), diagnostic problems, the current evidence base in relation to psychosocial and pharmacological treatments, and service delivery.

It is important to emphasise at the outset that there is no one method that should be prescribed for any one problem. The first essential is to study the individual concerned - his or her likes and dislikes, circumstances, idiosyncratic behaviour patterns, history, family set-up, and so on. Only following that study will a treatment programme, tailored to the characteristics of the individual and to his or her environment, be arrived at.

There are however certain procedures that will normally be considered.

·       Changing the Surroundings

·       Positive Reinforcement

·       Differential Reinforcement of Other Behaviours

·       Extinction

·       Time Out from Positive Reinforcement

·       Functional communication training

·       Stimulus Control

·       The Least Restrictive Alternative

·       Fading programmes


Problem, or challenging, behaviour, is defined as: 'behaviour of such intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit or deny access to and use of ordinary community facilities' (Emerson et al 1988). It is important to note that such behaviours are shown by only a minority of people with intellectual disabilities - 6.1% (Emerson 1995, p.24).

Changing the surroundings
It may be possible to lessen a challenging (problem) behaviour by altering the person's circumstances to make it less likely that the behaviour will occur. For example, a young man who could not tolerate noisy places and caused so much disruption that he was no longer taken out to shops and cafes, was given a headset and a portable cassette player with tapes of music that he liked. When he used these they screened out the other noises and he could then be taken out. (See Donnellan et al 1984). By itself this may not change the behaviour but it can help to allow other methods to be put into place and to take effect.

Positive Reinforcement
Many of the methods described here involve the use of positive reinforcement. This is defined as: anything which, when it follows a behaviour, increases the likelihood of that behaviour occurring again. So a preliminary to most programmes is the search for and identification of whatever is likely to have that effect for this individual. No assumptions are made as to what this will be - anything assumed to be a reinforcer 'for most people' will not do unless it is known, or can be shown to be, a reinforcer for this individual. The search for reinforcers should be wide-ranging, taking in sensory stimulation - lights, sounds, music, tastes, smells - preferred activities, favourite foods and drinks. Social reinforcers - attention, approval, praise, hugs - are powerful reinforcers for some people but ineffective for others, and for others still may actually be aversive, so cannot be invariably relied on. Whatever is finally selected, it is crucial that it is of great interest to the person concerned, and can be shown to increase any behaviour that it regularly follows. Used to increase appropriate and to teach new behaviours, it works best when given after every occurrence of the behaviour, at least at first.

In some cases the normal response to a behaviour, that would normally be thought of as unpleasant and leading to a decrease in any behaviour it follows, may have a contrary effect for a person with a Intellectual disability. One example of this is remonstrance, disapproval or anger. A person with a intellectual disability, if he or she enjoys attention, may relish the attention involved in the scolding; even angry attention may be better than none. If this is the case then the scolding will act as a reinforcer, and will result, not in a lessening but rather in an increase of the behaviour, as the person realises that this is a good way of ensuring that people attend to him or her.

Differential Reinforcement of Other Behaviours
One way of diminishing a challenging behaviour is to build up other behaviours, by deliberately reinforcing them, to compete with the target one. These other behaviours may be those that are incompatible with the problem one, ie, it is impossible for the person to do both behaviours simultaneously. So a girl who frequently poked her eyes with her fingers, damaging her sight, was provided with a piece of apparatus which produced sounds and noises that she loved when she pressed its switches with her fingers. While she pressed the switches and heard the sounds she could not at the same time poke her eyes, and the eye-poking diminished.

Sometimes it is not possible to identify a behaviour that is incompatible with the target behaviour. In this case all other behaviours may be reinforced, apart from the target one. Here it is the absence of the target behaviour that is reinforced: the person receives reinforcement for each period of time (five minutes, ten minutes, half an hour or more, depending on the person and on the behaviour) during which the target behaviour has not occurred. The person learns that he or she has a better time when not displaying the target behaviour, and so will display it less.

Next, two methods used to reduce problem or challenging behaviours by withholding reinforcement.

1. Extinction
Behaviours that are followed by a reinforcer are maintained or strengthened. This may happen also, inadvertently, with a challenging behaviour. If the reinforcer for this challenging behaviour can be identified it may be possible to determine that it will never again follow the behaviour. Without reinforcement, the behaviour should eventually die out (extinguish).

There are two caveats. First, the reinforcer must be one that can be controlled. Second, the behaviour must be expected to increase initially (the 'extinction burst').

Regarding the first of these: if, for example, it were thought important to reduce a person's masturbation, extinction would not be a suitable method to choose because the reinforcement cannot be externally controlled; if the person masturbates the reinforcement will inevitably follow. Some other method must be looked for.

Secondly, if a reinforcer, which can be controlled, is prevented from following the behaviour, then initially this can result in an 'extinction burst'. The person finds that the expected reinforcement is not forthcoming, so tries a repeat of the behaviour. If still there is no reinforcement the person may raise the level of the behaviour (worsen it). If the reinforcement is rigorously withheld, no matter how much worse the behaviour becomes, the behaviour should then begin to lessen, slowly at first and then more rapidly.

As the behaviour worsens during the extinction burst it may be that the worker in charge of the programme cannot tolerate the increased level, gives in, and gives the reinforcement. In this case the person learns that, even if the original level of the behaviour will not be reinforced, an exacerbation of it will. From then on it is likely that the behaviour will be worse than it was originally. So it is of the utmost importance that, when the use of extinction is considered, the process is carefully thought through, including whether it could be kept up through an extinction burst. If there is any doubt about this it would be better not even to attempt extinction but to use another method.

2. Time Out from Positive Reinforcement
Often referred to as Time Out, but the full title is important. Time out from positive reinforcement is an option where the problem behaviour usually happens when the person is already in a reinforcing situation - eating favourite food, enjoying music, TV, a social situation. Whenever the behaviour occurs, the reinforcement is temporarily suspended. So if the person very much enjoys a social situation, time out could involve him or her being removed from the situation, perhaps to another room, for a short period (say, five minutes, or even less). But, if the person is not interested in social interaction, removing him or her to another room would not remove the reinforcer and would be pointless, even possibly reinforcing (in allowing the person to escape from a situation he or she dislikes). So time out essentially does not mean the invariable use of a time-out room. On the other hand it has been effective where, for example, the person is fond of music, which is playing, or of TV, and on the occurrence of the behaviour the music or TV is briefly turned off.

Functional communication training
Sometimes a challenging behaviour appears to function in people with a intellectual disability as a way of 'asking' for something. It may be a way of asking for attention, or for a tangible item, or for something to be stopped - a task perhaps, or an aversive situation. In such cases an effective treatment may be to teach the person to use a word or sign to ask appropriately for what they want. So if children are misbehaving in order to get the teacher's attention, teaching them to say or sign 'Come here please' can result in a reduction of the misbehaviour. Similarly if they were misbehaving in order to escape from a too-difficult task teaching 'Help please' can also bring about a lessening of the misbehaviour.

Stimulus control
Certain stimuli lead to certain kinds of behaviour - rain prompts us to put on a mackintosh, a red traffic light to stop the car. Without these stimuli, these behaviours might not occur. Similarly it is possible for a stimulus to become associated with a behaviour that is permitted - reinforced - while the absence of the stimulus indicates that the behaviour will not be reinforced. These conditions can be put to use to help to manage difficult behaviours.

A 13 year old boy was causing major problems in school, among them the relentless questioning of staff. Although this sounds a trivial problem, the tensions it produced led on to other difficulties including physical aggression. The boy was given a sticker to wear on his shirt, and was told that when it was on his shirt his questions would be answered. When it was not on his shirt his questions would not be answered; he should wait until the sticker was back on his shirt. At first the sticker was removed very briefly - for 15 seconds, four times in every hour. His questioning dropped off in frequency very rapidly, within three weeks, even when he was wearing the sticker, and the other associated problems declined too.

Stimulus control can be a useful method in some situations. However since, like extinction, it allows for some occurrence of the behaviour, it is not suitable for tackling behaviours that are dangerous either to the person or to others.

Deliberately programming reinforcement
Some of the methods described above involve the withholding or removal of reinforcement. It is then important to ensure that the person gets reinforcement at other times - our aim is to improve, not impoverish, the person's life. So for example, if the reinforcer were attention, which was withheld when the behaviour occurs, the person should receive plenty of attention at other times: not necessarily for any markedly virtuous but simply for acceptable behaviour. This precaution will also make it less likely that other problem behaviours will emerge to take the place of the original one.

The Least Restrictive Alternative
In work with people with Intellectual disabilities we have an ethical obligation to cause them as little distress as possible. Therefore in tackling a challenging behaviour we should at the outset select a method which, while having at least some prospect of being effective, is the least aversive option available (changing the surroundings, differential reinforcement of other behaviours, etc). Only if this is shown convincingly to fail will other, more stringent, methods, be tried.

Fading programmes
When a programme has been put into practice and has been effective, the question arises as to how to end it. This applies particularly to methods that involve giving reinforcement ( differential reinforcement of other behaviours, stimulus control). As a rule, the principle is that it should not be stopped abruptly but gradually tailed off. If the reinforcement is suddenly stopped the likelihood is that the behaviour, which had improved, would worsen. So instead the reinforcement can be given at gradually lengthening intervals; for gradually increasing standards of behaviour; or where appropriate, the reinforcement may be transferred to a new target behaviour. Another strategy is to give the reinforcement at irregular intervals - some short, some longer - so that the person cannot predict exactly when it will arrive. This can make it less problematic for the person when the intervals become generally longer, until eventually the reinforcement, for this behaviour, comes to an end.

If the programme has been devised with an appropriate goal - that of improving the person's life - then when it succeeds the person should experience the improvement, finding new sources of pleasure and enjoyment. This too should help to make deliberate reinforcement less necessary.




4.2         Relevance, role and techniques of physiotherapy for students with ID



Physiotherapy is a health care profession that aims to promote mobility, functional ability, quality of life and movement potential for people throughout their lives.

People of all ages are referred to Physiotherapy, from newborns to elderly, who have health-related conditions that limit their ability to move and perform functional tasks as well as they would like in their daily lives. Physiotherapy involves personal interaction with the people requiring services, families, relevant personnel, and communities. Physiotherapists assess and diagnose movement potential and agree goals for the person receiving a service.

Physiotherapists working in the area of intellectual disability require an ability to merge specialist skills and experience, including specialist areas such as neurology, orthopaedics, respiratory care, paediatrics, care of the elderly, orthotics, postural management, prescription of equipment, and relevant treatment techniques.

Physical therapy services may be sought for various reasons across the lifespan of people with IDD. Many individuals have impairment-related needs that fall within the scope of physical therapist practice and may seek a physical therapist to assist with issues such as pain management, functional mobility or activity training, postural and respiratory support, secondary impairment prevention, assistive technology provision, and environmental modification. Physical therapy may also be useful in managing the impacts of aging with IDD. In complement with skilled physical therapy services, people with IDD have also increasingly sought out lay recreation and fitness opportunities to improve their health, wellness, and participation. The benefits of physical therapist intervention for individuals with IDD have been broadly reported. For example, improvements in cardiovascular parameters, functional activity performance, cognitive performance, strength, and dynamic balance have been demonstrated in individuals with Down syndrome, cognitive impairments, and cerebral palsy who participated in aerobic, resistance, or combined training interventions. Additional studies have examined the psychosocial benefits of physical therapist interventions for individuals with IDD, identifying significant post-treatment changes in life satisfaction, exercise self-efficacy, positive attitudes toward exercise, and depression risk factors. Despite these benefits, it appears that people with IDD may not routinely access physical therapy services, with reported physical therapy service utilization rates between 14.6% and 24% in certain populations.

For children with physical disabilities they can often spend their day in the same position or positions that can have a variety ways that can affect their health even more that it is already. From higher risks for illnesses to the effects of a sedentary life, disabled children can benefit from the use of physiotherapy and other disabled services like massage therapy and acupuncture from qualified medical professionals. You might ask why that is, well we’ve put together a short list of the ways that physiotherapy disabled services are so important to the continued health and mobility of disabled children.

It Keeps Them Fit
When the body isn’t as mobile and in action as it would be at full capacity, that sedentary lifestyle can affect the weight and overall health of a disabled child. Because of this it is important to make full use of the body even when it has physical limitations and with trained physiotherapist disabled services, a child will be able to stretch their body and strengthen muscles that are rarely if ever used. This will help them manage their weight, their overall health and help to give them more mobility and control of their body.

It helps to Relax the Body and Reduce Pain
Physiotherapy disabled services not only help to keep the body fit and trim, but help to release tension, pain and stress from it that can oftentimes build up in a mobility challenged child. Physiotherapy massage is far from a luxury, it is actually one of the most effective ways in allowing disabled children to properly manage their pain from problems such as spasms and spasticity that might otherwise be hard to manage. Physiotherapy works to manipulate the body into a better state of health and it could be a very helpful way to relaxing the body and relieving stress as well.

It Helps to Promote Overall Health in the Body
Disabled services such as physiotherapy are just one of the many ways to help promote better overall health is disabled children. Sadly disabled children often have a multitude of medical issues that can affect their health far beyond the initial physical disability such as higher risks for colds, chest infections, viruses, etc. By utilizing physiotherapy to manipulate the body to function better it can instill a better sense of health and well-being in disabled children.

Therapeutic Interventions

Passive Stretching

It is a manual application for spastic muscles to relieve soft tissue tightness. Manual stretching may increase range of movements, reduce spasticity, or improve walking efficiency in children with spasticity.  Stretch may be applied in a number of ways during neurological rehabilitation to achieve different effects. The types of stretching used include;

1.    Fast / Quick

2.    Prolonged

3.    Maintained

When we look at the use of a stretch for facilitation, we employ a fast/quick stretch. The fast/quick stretch produces a relatively short-lived contraction of the agonist's muscle and short-lived inhibition of the antagonist muscle which facilitates a muscle contraction. It achieves its effect via stimulation of the muscle spindle primary endings which results in reflex facilitation of the muscle via the monosynaptic reflex arc.

The presence of increased tone can ultimately lead to joint contracture and changes in muscle length. When we look at the use of stretch to normalise tone and maintain soft tissue length we employ a slow, prolonged stretch to maintain or prevent loss of range of motion. While the effects are not entirely clear the prolonged stretch produces inhibition of muscle responses which may help in reducing hypertonus, e.g. Bobath's neuro-developmental technique, inhibitory splinting and casting technique. It appears to have an influence on both the neural components of muscle, via the Golgi Tendon Organs and Muscle Spindles, and the structural components in the long term, via the number and length of sarcomeres.

Muscle Immobilised Shortened Position = Loss of Sarcomeres and Increased Stiffness related to increase in connective tissue

Muscle Immobilised Lengthened Position = Increase Sarcomeres

Studies in Mice show that a stretch of 30 mins daily will prevent the loss of sarcomeres in the connective tissue of an immobilised muscle, although the timescale in humans may not relate directly. The study by Johannes M N Enslin et al. discusses the current literature on possible stretching interventions in children with Cerebral Palsy and highlights additional research that has the potential to improve non-invasive treatment outcomes[7].

Passive stretching may be achieved through a number of methods which include;

Manual Stretching 

Prolonged manual stretch may be applied manually, using the effect of body weight and gravity or mechanically, using machine or splints. Stretch should provide sufficient force to overcome hypertonicity and passively lengthen the muscle. Unlikely to provide sufficient stretch to cause change in a joint that already has contracture.

Weight Bearing

Weight bearing has been reported to reduce contracture in the lower limb through use of Tilt-tables, and standing frames through a prolonged stretch. Angles are key to ensure the knees remain extend during the prolonged stretch as the force exerted on the knee can be quite high. Some research also challenges the assumption of the benefits of prolonged standing.


Splints and casts are external devices “Splints and casts are external devices designed to apply, distribute or remove forces to or from the body in a controlled manner to perform one or both basic functions of control of body motion and alteration or prevention in the shape of body tissue.” Splinting can be used to produce low-force, long duration stretching although there is a dearth of evidence to support this. A wide range of splint have been used to influence swelling ,resting posture, spasticity, active and passive ROM. A systematic review suggested that Lower Limb Serial Casting improved ankle dorsiflexion passive range of motion, reduced hypertonocity and improved gait in children with Cerebral Palsy.

Serial Casting 

Serial casting is a common technique that is used and most effective in managing spasticity related contracture. Serial casting is a specialized technique to provide an increased range of joint motion. The process involves a joint or joints that are tight, which are immobilized with a semi-rigid, well-padded cast. Serial casting involves repeated applications of casts, typically every one to two weeks as range of motion is restored. 

Static Weight-bearing Exercises

Stimulation of antigravity muscle strength, prevention of hip dislocation, reduction in spasticity and improvements in bone mineral density, self-confidence and motor function have all been achieved through the use of Static Weight-Bearing exercises such as Tilt-Table and Standing Frame. 

Muscle Strengthening Exercises

It aims to increase the power of weak antagonist muscles and of the corresponding spastic agonists and to provide the functional benefits of strengthening in children with CP. 

Functional Exercises

Training related to specific functional activities combining aerobic and anaerobic capacity and strength training in ambulatory children, has been shown to significantly improve overall physical fitness, the intensity of activities, and quality of life. Training programs on static bicycles or treadmill have been shown to be beneficial for gait and gross motor development but have not shown to have any impact on spasticity or abnormal movement patterns.  A study suggests the application of plyometric exercises to the physical rehabilitation programs of children with unilateral CP could achieve more significant improvement in muscle strength and walking performance.

Body Weight Supported Treadmill Training

Stepping movements from Reflex Stepping Reactions are normally present in newborns and infants, before the infant starts to bear weight, stand and walk. Body Weight Supported Treadmill Training, is achieved through supporting the child in a harness on the treadmill in an upright posture limiting overall weight bearing, on a slow moving treadmill, eliciting the stepping movements. Treadmill training, thus allows the development of stepping movements needed for ambulation. Studies using 3-4 sessions per week lasting for 3-4 months have shown improvement in lower extremity movements and gait patterns in children with cerebral palsy. 

Electrical Stimulation

The goal of the electrical stimulation is to increase muscle strength and motor function. Electrical stimulation is provided by Transcutaneous Electrical Nerve Stimulation (TENS) Unit which is portable, non-invasive and can be used in the home-setting by parents or the patient. Neuromuscular Electrical Stimulation (NMES) involves application of transcutaneous electrical current that results in muscle contraction. NMES has been postulated to increase muscle strength by increasing the cross-sectional area of the muscle and by increased recruitment of type 2 muscle fibers. Functional Electrical Stimulation (FES) refers to the application of electrical stimulation during a given task or activity when a specific muscle is expected to be contracting. Patel (2005) has shown there is some evidence to support the use and effectiveness of NMES in children with Cerebral Palsy but found that many of the studies are limited by confounding variables including concomitant use of other therapies, wide variation in methods of application, heterogeneity of subjects, difficulty in measuring functional outcomes and lack of control subjects. Mintaze (2009) proposes that neuromuscular and threshold electrical stimulation as a modality in Cerebral Palsy is used for strengthening the quadriceps muscles in ambulatory diplegic children with Cerebral Palsy, who have difficulty with specific resistive strength training.


Gross Motor Function including Muscle tone, Range of Movement, BalanceCoordination and Postural Control in children with CP have been shown to improve with Hippotherapy - Therapeutic horse-back riding which may reduce the degree of motor disability. Many none physical benefits may also be developed through enjoyment and providing a setting for increased social interaction, cognitive and psychosocial development. Sharan et al (2005) have noted satisfactory results with Hippotherapy in Bangalore, especially in post-surgical rehabilitation. There is limited evidence available with two lower-quality trials on saddle riding on a horse found no between-group differences in muscle symmetry or in any of the seven different outcome measures, except on a sub-item of grasping. 

Task-oriented approach

This treatment is based on the requirements of the child. Today the child is given the possibility to be more of an active problem solver (instead of, as previously, a passive recipient of treatment) in the context of the day-to-day environment. The aim of this therapy for children with CP, as for most children with developmental disabilities, is to facilitate the child’s participation in everyday life situations, e.g., to communicate with parents, siblings, and peers; to move from one place to another; to dress and undress; to eat; and to play. The choice of goals for therapy is dependent on many factors: the child’s likings and the family’s preferences, the society and environment in which the family lives, and the child’s degree of disability. Thus, it is important to integrate principles of motor learning in the treatment concept and adapt the principles to the prerequisites of each specific child. The set goals should be specific, measurable, attainable, relevant, and timed (SMART).

Conductive Exercise

Conductive education (CE) is a combined educational and task-oriented approach for children with CP. Specially trained ‘conductors’ give education to homogeneous groups of children with motor disorders. This approach has its origins in learning theory. The conductor who is trained in all aspects of motor and cognitive development structures the activities, especially the self-care activities.. The emphasis of intervention is on independence in attaining goals rather than on quality of movement. 

Bimanual Training

Bimanual training (BIT) provides bimanual training activities, which focus on improving the coordination of both arms using structured tasks in bimanual play and functional activities with intensive practice. Recently has an intensive bimanual training program, the hand-arm bimanual intensive training (HABIT) been published to substantiate its effectiveness. This approach is based on motor learning theory (practice specificity, types of practice, and feedback), neuroplasticity (i.e., the potential of the brain to change by repetition, increasing movement complexity, motivation, and reward), and focuses on the equal use of both arms in bimanual tasks. Intensive BIT (e.g., HABIT), was developed with recognition that increased functional independence in the child’s environment requires the combined use of both hands. It also focuses on improving coordination of the two hands using structured task practice embedded in bimanual play and functional activities. Hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) combines upper and lower bilateral extremity training. Frequently used bilateral lower extremity tasks are ball sitting, standing, balance board standing, virtual reality (wii-fit, kinect), walking/running, jumping, cycling, and making scooter. Bimanual activities that require trunk and LE postural adaptations are performed at a table of appropriate height (50% of the time) on unstable supports: sitting on fitness balls or standing on balance boards. Furthermore, 30% of the time is devoted to activities of daily living where standing and/or walking is required (dressing, brushing teeth, doing one’s hair, transporting objects such as a tray, and household chores such as sweeping and washing dishes). Finally, the remaining time (20%) is spent in gross motor physical activities/play, such as bowling, ball playing, jumping rope, street hockey, use of wii-fit, balance bike (without pedals), scooter use, and wall climbing. These are performed in standing, walking, and running (or jumping) with the LE and simultaneously involving bimanual coordination. These activities are graded toward more demanding tasks for the LE.

Robot-assistive therapy

Robot-assisted therapy (RAT) is conducted using robotic devices that enable the patients to perform specific limb movements. The main interest in using robots is to allow the patients to achieve a large amount of movement in a limited time. Additionally, the attractive human-machine interface has the capacity to motivate the child to perform his or her therapy through playful games, such as car races, or to perform exercises that mimic ADLs. Moreover, robotic devices allow the patient to receive visual, auditory, or sensory feedbacks. A device specifically developed for the locomotion training is the Lokomat (Hocoma, CH), made of two active orthoses, a weight-bearing system and a treadmill. This robotic rehabilitation has been proposed to improve walking and physical fitness



4.3         Role and techniques of occupational therapy and sensory integration for students with ID


An Occupational Therapist is often the first professional to work with a child that is delayed in a typical milestone, or who behaves in an unusual or unruly way. An OT will assess the child and his or her environment and make modifications to help the child complete specific tasks. The goal is to help improve the child’s participation and performance in daily activities, and to promote overall independence.

An OT can help address a wide range of difficulties experienced by a child with disabilities, including:

·       Attention span and arousal level

·       Sensory and processing skills

·       Fine and gross motor skills

·       Activities of Daily Living (ADLs), also known as self-help skills, such as brushing teeth

·       Visual-perceptual skills

Role of Occupational Therapy for Intellectual Disability

Occupational Therapy focuses on the life skills each individual needs for their life, across the environments where they spend time. Barriers to accessing typical experiences are overcome by modifying the task or environment, or teaching new skills, step by step. When working with people with intellectual disabilities or cognitive impairment, the OT brings knowledge of activity analysis to break down tasks into component parts, and to identify what underlying skills and/or adaptations are needed for greater independence and inclusion.

Improved fine motor skills: Children who struggle with fine motor skills could benefit through performing activities with their occupational therapist which develop this skill so that they can learn to play with toys, grasp pencils and scissors, and improve their handwriting ability.

Improved coordination: Sound coordination is important for doing things like eating and drinking, using a computer, and playing sports. Therapy can help to improve hand-eye coordination so that the child is better equipped to play with friends and perform tasks at school.

Improved behaviour: Children with behavioural disorders can learn to become better at maintaining positive behaviours across a range of environments, from the classroom to the home. Their therapist can help them practice positive techniques for dealing with anger or frustration, such as expressing their feelings in writing or going for a run.

Improved development: Children with a disability who undergo occupational therapy before the age of six years may benefit from improved mental and physical development, thanks to the wide range of communication, motor, cognitive, play and sensory processing skills they can learn.

Learn basic tasks: Occupational therapists can help children who have severe developmental delays become competent at performing basic day-to-day tasks, such as tying their shoelaces, feeding themselves, bathing, and brushing their teeth.

Improved social skills and relationships: Children who struggle to develop or maintain good relationships such as friendships may benefit from occupational therapy. There are many reasons why socialising may be challenging, and a therapist will develop a unique solution for each child. They will be able to learn interpersonal and communication skills, as well as techniques for improving focus.

Improve independence: Developing these skills can help children become more independent and self-confident, which may set them up for independent living when they become adults.

Obtain specialised equipment: An occupational therapist can also help by evaluating a child’s need for aids and specialised equipment, such as splints, communication aids, bathing equipment or wheelchairs.



Many different techniques and equipment can be used as part of occupational therapy, depending on the difficulties you are having.

Some of these techniques are explained below.

Thinking about activities differently

A key aim of occupational therapy is to help you develop or maintain a satisfying routine of meaningful everyday activities that can give you a sense of direction and purpose.

This can include help with budgeting, domestic or personal care routines, leisure activities, and involvement in work or voluntary activities.

An occupational therapist will look at the activity you are finding difficult and see if there is another way it can be completed.

For example, if you are finding it difficult to:

An occupational therapist will also help find new ways to carry out an activity by breaking it down into small individual movements, and will then practise thestages with you.

For example, if you cannot get up from a chair without assistance, an occupational therapist will go through each stage of the movement with you until you can confidently get up on your own.

If appropriate, the occupational therapist may suggest a special chair.

For children, an occupational therapist may develop a game or activity that they can complete each day.

This could be aimed at improving your child's:

Focusing on a small goal, such as improved hand strength, may eventually help your child to hold a spoon, a pencil or dress themselves.

Adapting your environment

Part of occupational therapy may involve making an environment suitable for your needs.

This could be your home, workplace or where you are studying, and may involve changes such as:

Using special equipment

Occupational therapists can also advise about what special tools or pieces of equipment you may find helpful. For example:

You should mention any difficulties to your occupational therapist, no matter how small they seem, as there may be all kinds of adapted equipment that can help.

For example, you could have a special comb to style your hair more easily, or a device to turn the pages of a book.

Sensory Integration Training

Sensory integration therapy is based on the idea that some kids experience “sensory overload” and are oversensitive to certain types of stimulation. When children have sensory overload, their brains have trouble processing or filtering many sensations at once. Meanwhile, other children are undersensitive to some kinds of stimulation. Children who are undersensitive do not process sensory messages quickly or efficiently. These children may seem disconnected from their environment. In either case, children with sensory integration issues struggle to organize, understand, and respond to the information they take in from their surroundings. Sensory integration therapy exposes children to sensory stimulation in a structured, repetitive manner. The theory behind this treatment approach is that, over time, the brain will adapt and allow them to process and react to sensations more efficiently. In this concept, difficulties in planning and organizing behavior are attributed to problems of processing sensory inputs within the CNS, including vestibular, proprioceptive, tactile, visual, and auditory. Children with sensory integration dysfunction frequently use different sensory combination strategies. Treatment focuses on integration of neurological processing by facilitating the individual to process the type, quality, and intensity of sensation. 

A child’s sensory processing is problematic if they are:

·       Over-responsive – avoidance, caution and fearful

·       Sensory seeking – impulsive and takes risks

·       Under-responsive – withdrawn, passive or difficult to engage

The goals of sensory integration therapy are:

·       Assist children with perception issues in sorting out mixed messages

·       Create a physical environment that fosters participation in activities that depend on the senses

·       Determine how a child’s specific sensory perceptions affect their overall physical, social and human development

·       Encourage activities that allow children to explore their environment, learn and develop their senses

·       Identify and eliminate barriers caused by disordered perception

·       Implement new sensory processing approaches that organize multiple sensations, filter out background stimuli, and compensate for deficits in perception

·       Restore a child’s sense of body position and function (also known as vestibular and proprioception)

·       Restore motor planning (praxis) capabilities, so a child can focus on his or her senses to plan movement, respond to other’s movements, and understand the body’s relationship to space

Some signs that a child might be struggling with his or her sensory perception include:

·       Discomfort sitting or standing

·       Feeling too hot or too cold

·       High, or low, physical activity levels

·       Inability to link a task with the necessary physical function

·       Inappropriate physical responses

·       Lack or physical coordination

·       Little reaction to external events

·       Low self-esteem

·       Over-sensitivity, or under-sensitivity, to touch

·       Restlessness and behavior issues

·       Reclusiveness

·       Speech delays

·       Strong reactions to textures, food and sound

Benefits to sensory integration therapy include:

·       Anticipate action and outcome

·       Correctly interpret sensory input

·       Create physical equilibrium and sense of space

·       Develop positive behavior patterns

·       Eliminate fear

·       Encourage play and socialization

·       Lessen sensory defensiveness

·       Minimize input intolerance

·       Reduce negative physical reactions

Parents and caregivers also benefit from sensory integration therapy because they learn how to productively interact with their child, greatly enhancing the relationship.



4.4         Techniques & strategies for Speech & Language intervention to students with Intellectual disability.


One of the most common and evident effects of an intellectual disability is that on the person’s speech and communication, with many children progressing poorly with speech and language skills. A speech therapist (or speech pathologist) is a trained allied health professional who works with people with communication disorders and difficulties. Speech therapists help individuals attain their communication potential and improve overall speech and language skills.
Individuals with an intellectual disability may have a speech and/or language disorder and it is important to recognize the distinction between the two. A
 speech disorder is where the person has difficulty producing the sounds of speech necessary to communicate effectively with others. This can include difficulties with articulation, fluency, voice or phonological disorders. On the other hand, people with language disorders do not usually have struggles with producing speech sounds or pronouncing words, but have difficulty comprehending language and its rules and processes. This often includes problems with utilizing correct grammar and developing adequately constructed sentences. Language disorders are generally categorized into expressive (problems with explaining or expressing their needs) or receptive (difficulties with understanding language and its meaning) language disorder.

How can speech therapy help an individual with intellectual disability?

People with an intellectual disability often have difficulties with processing and learning new information, following directions, understanding and utilizing written and spoken language (e.g. unable to follow conversation or verbally communicate their thoughts to others), comprehending detailed information and completing tasks. A person with an intellectual disability and communication deficits may also struggle with social skills and understanding non-verbal communication, such as understanding facial expression, gestures or social etiquette. In people who are non-verbal or have limited verbal abilities, they can help to develop alternative communication methods, such as using assistive technology.

What does speech therapy usually involve?

As with most therapeutic interventions, the first step generally involves the therapist obtaining a complete background of the person’s social, education and medical history, as well as their current level of functioning in regard to speech and communication. Using a standardized assessment tool is often useful to gain a formal assessment of the person’s baseline communication functioning and needs, which can then be used to formulate therapy goals. Speech therapy also often works better with the involvement of the person’s parents or carers, so they too can improve how they communicate with the person.
Below is a description of how speech therapy can enhance communication skills of specific disorders or difficulties:




4.5         Recreational Therapy for students with Intellectual Disability: Yoga, Music, Play & Movement therapy


Recreation therapy makes use of activity-based interventions that are rooted in functional performance, communication, behavior, adaptation and modification to physical conditions and cognitive processes.

Plans of treatment are highly-individualized; techniques that work on one child may not easily translate to another. Recreation therapists must systematically identify any physical and emotional roadblocks; they explore adaptations and, when required, modifications. Adaptations are distinctly different from modifications in that adaptations may require the assistance of orthotics, adaptive equipment or assistive technologies, while modifications are alternate methods for a child to perform an activity. The desired result can render a limitation manageable or nonexistent, thus allowing full participation and successful inclusion opportunities.

Taking the step into recreational activities can be stressful for children with Intellectual disability; many of the techniques used by therapists are designed to motivate children; it’s the therapist’s job to instill confidence in the child. It can be frustrating for the child to learn new ways to perform or overcome obstacles. However, when the child experiences the benefit of being accepted and included into areas of their own interest, children often quickly accept and learn, especially if the learning environment is positive and supportive.

Interventions that are used include:

·       Specific physical training in activities

·       Cognitive retraining

·       Wellness training

·       Stress management strategies

·       Behavior counseling

·       Play skills

·       Socialization and one-on-one conversation role play

·       Small group interactions and activities

·       Community integration

·       Guided imagery and meditation

·       Relaxation and biofeedback


The goals of recreation therapy include:

·       Determining a child’s capacity for recreational performance

·       Minimizing a child’s disability by teaching him or her adaptive strategies

·       Motivating a child to take part in activities with encouragement and support

·       Modifying process and procedures to enhance inclusion

·       Expanding a child’s ability to socialize and make friends

·       Enhancing a child’s self-concept and self-confidence

·       Helping a child develop interests

Physical benefits of recreation therapy include:

·       Improved physical adeptness

·       Increased strength and flexibility

·       Improved physical fitness and health

·       Improved athletic prowess

·       Improved coordination

Psychological benefits of recreation therapy include:

·       Acceptance of disability

·       Increased social skills

·       Increased ability to manage stress and depression

·       Decreased anger and anxiety

·       Diminished social isolation

·       Improved body image

·       Improved well-being and relaxation

Cognitive benefits of recreation therapy include:

·       Improved behavior

·       Increased analytical and decision-making skills

·       Improved confidence

·       Increased organization

·       Increased perception

Physical Activities for Adults with Disabilities

Physical activities and exercise can help adults with disabilities achieve their mental and physical potential. Bowling, exercise classes, gardening, team sports, dancing, and swimming are all activities that can be used to promote good holistic health while having fun.

As a matter of fact, a study published in the “Therapeutic Recreation Journal” in Fall of 2005 reported improved family life, improved social life, enhanced quality of life, and better health for participants with intellectual/developmental disabilities who participated in adaptive and organized recreational activities, such as horseback riding and alpine skiing.

According to the guidelines published in “Frontiers in Public Health” in April of 2014, older adults with intellectual and developmental disabilities are encouraged to participate in a minimum of 150 minutes per week of age-appropriate moderate-to-low intensity exercise. This report suggests that when group activities are combined with exercise and social interaction, it could enhance your loved one’s enjoyment and motivation.

Art Activities for Adults with Disabilities

Art is a viable way of expressing emotions and feelings, especially when someone isn’t able to do so through traditional means. As a result, many people with intellectual and developmental disabilities respond well to therapy involving arts and crafts.

Art therapy inspires creativity and can be used to encourage adults of all ages. Whether it’s creating with canvas, educational coloring books, making jewelry, scrap booking, or any other type of art therapy; you and your loved one will spend hours creating. A few of the most popular art activities for adults with disabilities include:

·       Developing origami

·       Beading activities

·       Crafting with clay

·       Creating paper mache

·       Reusing and recreating

·       Creative toys

·       Decorating with paint

·       Creating with fabric

Music Therapy Activities for Adults with Disabilities

Adults with intellectual and developmental disabilities typically respond well to music activities because it motivates action, captivates attention, brings joy, and offers success. In particular, music can be helpful because it is processed in both the right and left hemispheres of the brain. Music is a multi-sensory activity that incorporates auditory, visual, tactical systems, and kinesthetic systems.

At the same time, music is a wonderful way to connect and express oneself, which can be especially helpful for those who struggle with language or are nonverbal. Whether it’s singing along or playing an instrument like the tambourines, music activities accomplish the following goals:

·       Academics – You can translate virtually anything into a song to improve recall.

·       Communication and speech – Creating custom songs can help increase repetition without monotony while isolating sounds.  

·       Gross and fine motor skills – Implementing adaptive and traditional percussion instruments (such as hand drums) can help address gross and fine motor skills.

·       Behavioral – You can create musical stories and songs to reinforce appropriate behavior.

·       Emotional-Social – Songs can be used to help adults with disabilities identify feelings and utilize coping strategies anytime they’re feel overwhelmed.

·       Quality of Life and Self Esteem – Successful and positive experiences can be commemorated through song and musical experiences.

Contact Community Mainstreaming

The activities you do at home with your loved one with intellectual/developmental disabilities can significantly help them throughout every facet of their lives. When choosing different activities for adults with disabilities, we find it most effective to focus on what they can do — not on what they can’t.


For Yoga Therapists interested in specialising in this field it may help to be very clear about your own definition of yoga and your intentions – what are you teaching and why? These questions should form the foundation of your work, and keep you aligned with teaching what is right for your client/students.

It also helps to be able to use your imagination to develop practices that are readily accessible for those with an intellectual disability:


Working with people with disabilities can be a wonderfully rewarding area for specialisation for Yoga Therapists/Teachers, and you may well learn more from your students/clients than they learn from you, particularly in the area of ‘practicing without expectations’. Striving and effort are often hallmarks of yoga practitioners. No matter how much you try and guide your students or even yourself into a different direction, competitiveness and attainment are difficult to control. People with an intellectual disability often have no such issues – there is often no sense that their experience has to be anything other than what it is. They may also be more in touch with their intuitive mind and their sense of feel with no intellectualising or judgement. 

As defined in “Adapted Physical Education and Recreation” by Sherrill, play refers to the spontaneous, pleasurable behaviours through which children interact with their environment. In non-disabled children, play is inborn and instinctive, and they progress through easily observable stages right from exploring and manipulating the environment during infancy to grasping complex rules, strategies and regulation as in competitive games, when they grow older.

Most children utilize their time outside school in unorganized or structured play activities. They are attempting to use play as a constructive activity and an outlet for excess energy. Earlier theorists proposed four major explanations of play. The first was the surplus energy theory (Schiller et al, 1875). According to this, the reservoir of energy left over after the basic needs of the body such as food are spent on play.

The second is the relaxation and recreation theory of play, proposed by philosophers Lazarus (1883) and Patrick (1916). In contrast to the first, this theory proposed that after engaging in physically and mentally exhausting work, the body is drained of energy and needs sleep. However, in order to achieve full restoration, it first needs to engage in play activities, that help one relax and release pressure.

The third is the practice or pre-exercise theory of play (Gross, 1898, 1901). The purpose of play according to this theory is to practice skills necessary for adulthood.

Importance of learning through play include:

·      Creativity: Open-ended play lets kids be creative with how they interact with things.

·      Vocabulary: Kids expand vocabulary as they interact with new things. They may learn new words from their peers as they play. Teachers can expand vocabulary by talking with kids about what they’re doing and offering them words for different things. Introduce new words related to what the child is playing or ask questions that encourage the kids to talk.

·      Problem-solving: Play often presents situations that call for problem-solving skills. They might need to figure out how to do something or how to work together with peers. During dramatic play, they have to decide which roles to take and how those roles interact, for example.

·      Concentration: When kids get to choose what they do, they’re more likely to show interest and stick with the activity. They get more out of the activity because they’re actively engaged and focused.

·      Social skills: The free play format encourages kids to interact with one another, which helps build social skills. They learn to communicate ideas and cooperate. Social skills are so important not only in the classroom but life in general.

·      Emotional development: Play opportunities help kids develop empathy and explore feelings. Dramatic play is particularly helpful. Kids play different roles and explore how others might feel. They can also learn how to keep their emotions under control while interacting with their peers.

·      Stress relief: Traditional classroom learning can put a lot of pressure on kids — especially those who may be behind developmentally. Play is something that kids enjoy. They might feel calmer while they play. They’re learning, but they don’t feel the same pressures that they might during traditional learning.

·      Decision-making: Since kids get to pick what they do, play-based learning can help them develop decision-making skills. They decide not only what to play with but also how to interact with those items.

·      Independence: Kids are responsible for their own actions. Instead of relying on a teacher to tell them exactly what to do, kids act independently as they explore the play options.

·      Confidence: All kids can play regardless of their background knowledge or ability level. They find success in the classroom with play-based learning. That success can help build confidence that may make school seem less intimidating.

·      Physical development: Play requires movement. Kids use fine motor skills to manipulate small toys and gross motor skills when they run around and play actively. The more they practice both types of motor skills, the faster they develop those abilities.

·      Active learning: When kids play, they’re actively engaged. Being mentally active helps kids learn better than they do when they’re learning passively.

·      Real-world connections: Play helps kids connect ideas to their lives. When they play in a store-themed dramatic play area, they might connect it to trips to the store they take with their parents.