Alejandro delimits his space to write. When he wrote for first pair of words, the child drew a wide rectangle and he made an oval and several squares for the second pair of words. The child wrote some letters to fill those drawn spaces. It seems that Alejandro's rule is to fill the space and not only represent the word.

When Alejandro writes the words, we identified that he presents difficulty in the conventional directionality of writing. He wrote most of words from left to right (conventional directionality), but he wrote some words from right to left (no conventional). For example, the child started to write the second word on the left.

**157**

**Figure 7.**

(**Figure 8**).

following (**Figure 9**).

*Alejandro reads "caballo" (horse).*

*The Child with Learning Difficulties and His Writing: A Study of Case*

He wrote seven letters. He looked at the sheet for some seconds. After, he continued to write other letters on the right. He wrote and completed the space he had left,

Alejandro shows two ways to write: left–right (conventional) and right–left (no conventional). When he wrote the last word, the child wrote one letter under another. There was no limited space on the sheet. Alejandro wrote it there. The child

When we compared Alejandro's writings, we identified that the number of letters used by him does not correspond to the image size.  The six names of animals had three syllables in Spanish and Alejandro used nine letters for CABALLO (horse) and eleven for PÁJARO (bird). The letters used by him are similar to the conventional ones. However, these are in different positions. There are no phonetic correspondences with the words. The child shows a primitive writing. Alejandro has not started the level of relation between phoneme and grapheme yet. We can believe that the boy wrote some letters to cover the space on the sheet. Alejandro takes into account the card size instead of the image size. After writing a list of words, the interviewer asked Alejandro to read and point out every word he wrote. The purpose of this task is to observe how the child relates his writing to the sound length of the word. When Alejandro read CABALLO

Alejandro reads every word and points out what he reads. In this way, he justifies what he has written. In the previous example, Alejandro reads the first syllable and points out the first letter, second syllable with the second letter. At this moment, he gets in conflict when he tries to read the third syllable. It would correspond to the third letter. However, "there are more letters than he needs." When he reads the word, he shows the beginning of phoneticization: relation between one syllable with one letter. This is the syllabic writing principle [4]. Nevertheless, he has written more letters. Therefore, Alejandro says "o" in the other letters. In this way, we can point out that Alejandro justifies every letters and there is a correspondence

When Alejandro reads the second word, the child pointed out as follows

When interviewer showed the next pair of cards, Alejandro wrote as

Alejandro makes a different correspondence syllable-letter than the first word. Although his writing was in two ways, his reading is only one direction: from left to right. The first syllable is related to first three letters he wrote. The second syllable is related to the fourth letter. But, he faces the same problem as in the previous word: "there are many letters." So he justifies the other letters as follows. He reads the third syllable in relation to the sixth and seventh letter. And, reads "o" for the other letters.

*DOI: http://dx.doi.org/10.5772/intechopen.89194*

has not learned the writing directionality.

(horse), he pointed out as follows (**Figure 7**).

between what he reads and what he writes.

from right to left.

**Figure 6.** *Horse and bird writing.*

#### *The Child with Learning Difficulties and His Writing: A Study of Case DOI: http://dx.doi.org/10.5772/intechopen.89194*

*Learning Disabilities - Neurological Bases, Clinical Features and Strategies of Intervention*

several minutes, Alejandro wrote: E. The interviewer asked the child if he has finished. He denied with his head. After 1 min, he started to write. We observed

Alejandro used inverted letters in three words. They may be considered as pseudo-letters. However, if we observe carefully they are similar to conventional

We can identify that Alejandro shows a primitive writing [4]. He is still in writing system learning process. The phoneticization process is not present yet. The child has not achieved this level yet. He only uses letters without a conventional sound value.  It is identified if there is the same rules used by the child, number of letters, or if there is any change when he writes a new word. It may happen that the length of the words is related to the size of the image or the number of objects presented. In this way, we can identify the child's knowledge and difficul-

The first task is about observing how the child writes when he is in front of two different sized images. That is, we want to identify if the image size influences on his writings. Therefore, two pairs of cards were presented to Alejandro. Every pair of cards contained two animals, one small and one large. The interviewer asked

Based on the writing produced by Alejandro, we mentioned the following: Alejandro delimits his space to write. When he wrote for first pair of words, the child drew a wide rectangle and he made an oval and several squares for the second pair of words. The child wrote some letters to fill those drawn spaces. It seems that

When Alejandro writes the words, we identified that he presents difficulty in the conventional directionality of writing. He wrote most of words from left to right (conventional directionality), but he wrote some words from right to left (no conventional). For example, the child started to write the second word on the left.

Alejandro's rule is to fill the space and not only represent the word.

May be there is a writing rule by Alejandro. His words have a minimum of four letters and a maximum of six letters. This rule has been established by him. There is

that his writing contains six letters. Capital letters are predominated.

letters. The child has written them in different positions: inverted.

no relation to the length of orality or the object it represents.

pseudo-letters sometimes.

ties when he writes some words.

Alejandro to write the name on each one (**Figure 6**).

*6.3.1 The image size variable*

**6.3 To write for image**

**156**

**Figure 6.**

*Horse and bird writing.*

He wrote seven letters. He looked at the sheet for some seconds. After, he continued to write other letters on the right. He wrote and completed the space he had left, from right to left.

Alejandro shows two ways to write: left–right (conventional) and right–left (no conventional). When he wrote the last word, the child wrote one letter under another. There was no limited space on the sheet. Alejandro wrote it there. The child has not learned the writing directionality.

When we compared Alejandro's writings, we identified that the number of letters used by him does not correspond to the image size.  The six names of animals had three syllables in Spanish and Alejandro used nine letters for CABALLO (horse) and eleven for PÁJARO (bird). The letters used by him are similar to the conventional ones. However, these are in different positions. There are no phonetic correspondences with the words. The child shows a primitive writing. Alejandro has not started the level of relation between phoneme and grapheme yet. We can believe that the boy wrote some letters to cover the space on the sheet. Alejandro takes into account the card size instead of the image size.

After writing a list of words, the interviewer asked Alejandro to read and point out every word he wrote. The purpose of this task is to observe how the child relates his writing to the sound length of the word. When Alejandro read CABALLO (horse), he pointed out as follows (**Figure 7**).

Alejandro reads every word and points out what he reads. In this way, he justifies what he has written. In the previous example, Alejandro reads the first syllable and points out the first letter, second syllable with the second letter. At this moment, he gets in conflict when he tries to read the third syllable. It would correspond to the third letter. However, "there are more letters than he needs." When he reads the word, he shows the beginning of phoneticization: relation between one syllable with one letter. This is the syllabic writing principle [4]. Nevertheless, he has written more letters. Therefore, Alejandro says "o" in the other letters. In this way, we can point out that Alejandro justifies every letters and there is a correspondence between what he reads and what he writes.

When Alejandro reads the second word, the child pointed out as follows (**Figure 8**).

Alejandro makes a different correspondence syllable-letter than the first word. Although his writing was in two ways, his reading is only one direction: from left to right. The first syllable is related to first three letters he wrote. The second syllable is related to the fourth letter. But, he faces the same problem as in the previous word: "there are many letters." So he justifies the other letters as follows. He reads the third syllable in relation to the sixth and seventh letter. And, reads "o" for the other letters.

When interviewer showed the next pair of cards, Alejandro wrote as following (**Figure 9**).

**Figure 7.** *Alejandro reads "caballo" (horse).*

**Figure 8.**

*Alejandro reads "pájaro" (bird).*

**Figure 9.**

*Giraffe and worm writing by Alejandro.*

**Figure 10.** *Giraffe writing.*

When the interviewer shows the pair of cards to Alejandro, the child said "It's a zebra." So, the interviewer said "It's a giraffe and it's a worm" and pointed out every card. The interviewer asked Alejandro to write the name of every animal. First, the child draws a rectangle across the width of the sheet. Next, he started to write on the left side inside the rectangle. He said the first syllable "JI" while writing the first letter. After, he said "ra," he wrote a hyphen. Then, he said "e" and wrote another letter. At that moment, he looked at the sheet and filled the space he left with some letters (**Figure 10**).

Alejandro shows different rules of writing. These rules are not the same as previous. He delimited the space to write and filled the space with some letters. The child tries to relate the syllable with one letter, but he writes others. There is a limited repertoire of letters too. In this case, it seems that he used the same letters: C capital and lower letter, A capital and lower letter, and O. We believe that he uses hyphens to separate every letter. However, when he wrote the first hyphen, it reads the second syllable. We do not know why he reads there. Alejandro had tried to use conventional letters. He uses signs without sound value. In addition, there is no relation phoneme and grapheme.

When Alejandro wrote GUSANO (worm), he drew a rectangle and divided it into three small squares. Then, he drew other squares below the previous ones. After, he began to write some letters inside the squares, as seen in the following picture (**Figure 11**).

Alejandro used other rules to write. They are different than the previous. Alejandro has written one or two letters into every box. At the end, he writes some letters under the last box. There is no correspondence between what he reads and writes. There are also no fixed rules of writing for him. Rather, it is intuited that he draws the boxes to delimit his space to write.

**159**

direction).

**Figure 11.** *Worm writing.*

**Figure 12.**

**Figure 13.**

*Cards with one cat and four cats.*

objects in the card.

*The Child with Learning Difficulties and His Writing: A Study of Case*

*DOI: http://dx.doi.org/10.5772/intechopen.89194*

*6.3.2 Singular and plural writing*

*Alejandro writes GATO (cat).*

wrote the following (**Figure 13**).

showed Alejandro the following images (**Figure 12**).

if this influences the directionality of Alejandro's writing.

The next task consists to write singular and plural. For this, the interviewer

Alejandro drew an oval for first card. This oval is on the left half of the sheet. He

Next, the interviewer asked Alejandro to write for the second card, in plural. For this, Alejandro draws another oval from the middle of the sheet, on the right side. The child did not do anything for 1 h 30 min. After this time, he wrote some different letters inside the oval (**Figure 14**). He wrote from right to left (unconventional

Alejandro wrote in the opposite conventional direction: from right to left. He tried to cover the delimited space by him. His letters are similar to the conventional ones. Also, there are differences between the first and the second word. He used lesser letters for first word than the second. That is, there are lesser letters for singular and more letters for plural. Perhaps, the child took into account the number of

The writing directionality may have been influenced by the image of the animals: cats look at the left side. Alejandro could have thought he was going to write from right to left, as well as images of the cards. Therefore, it is necessary to research how he writes when objects look at the right side. In this way, we can know *The Child with Learning Difficulties and His Writing: A Study of Case DOI: http://dx.doi.org/10.5772/intechopen.89194*

**Figure 11.** *Worm writing.*

*Learning Disabilities - Neurological Bases, Clinical Features and Strategies of Intervention*

When the interviewer shows the pair of cards to Alejandro, the child said "It's a zebra." So, the interviewer said "It's a giraffe and it's a worm" and pointed out every card. The interviewer asked Alejandro to write the name of every animal. First, the child draws a rectangle across the width of the sheet. Next, he started to write on the left side inside the rectangle. He said the first syllable "JI" while writing the first letter. After, he said "ra," he wrote a hyphen. Then, he said "e" and wrote another letter. At that moment, he looked at the sheet and filled the space he left with some

Alejandro shows different rules of writing. These rules are not the same as previous. He delimited the space to write and filled the space with some letters. The child tries to relate the syllable with one letter, but he writes others. There is a limited repertoire of letters too. In this case, it seems that he used the same letters: C capital and lower letter, A capital and lower letter, and O. We believe that he uses hyphens to separate every letter. However, when he wrote the first hyphen, it reads the second syllable. We do not know why he reads there. Alejandro had tried to use conventional letters. He uses signs without sound value. In addition, there is no

When Alejandro wrote GUSANO (worm), he drew a rectangle and divided it into three small squares. Then, he drew other squares below the previous ones. After, he began to write some letters inside the squares, as seen in the following

Alejandro used other rules to write. They are different than the previous. Alejandro has written one or two letters into every box. At the end, he writes some letters under the last box. There is no correspondence between what he reads and writes. There are also no fixed rules of writing for him. Rather, it is intuited that he

**158**

**Figure 10.** *Giraffe writing.*

**Figure 9.**

**Figure 8.**

*Alejandro reads "pájaro" (bird).*

*Giraffe and worm writing by Alejandro.*

letters (**Figure 10**).

picture (**Figure 11**).

relation phoneme and grapheme.

draws the boxes to delimit his space to write.

#### **Figure 12.** *Cards with one cat and four cats.*

**Figure 13.** *Alejandro writes GATO (cat).*

#### *6.3.2 Singular and plural writing*

The next task consists to write singular and plural. For this, the interviewer showed Alejandro the following images (**Figure 12**).

Alejandro drew an oval for first card. This oval is on the left half of the sheet. He wrote the following (**Figure 13**).

Next, the interviewer asked Alejandro to write for the second card, in plural. For this, Alejandro draws another oval from the middle of the sheet, on the right side. The child did not do anything for 1 h 30 min. After this time, he wrote some different letters inside the oval (**Figure 14**). He wrote from right to left (unconventional direction).

Alejandro wrote in the opposite conventional direction: from right to left. He tried to cover the delimited space by him. His letters are similar to the conventional ones. Also, there are differences between the first and the second word. He used lesser letters for first word than the second. That is, there are lesser letters for singular and more letters for plural. Perhaps, the child took into account the number of objects in the card.

The writing directionality may have been influenced by the image of the animals: cats look at the left side. Alejandro could have thought he was going to write from right to left, as well as images of the cards. Therefore, it is necessary to research how he writes when objects look at the right side. In this way, we can know if this influences the directionality of Alejandro's writing.

#### **Figure 14.**

*Alejandro writes GATOS (cats).*

#### **Figure 15.**

*Cards with one rabbit and three rabbits.*

#### **Figure 16.**

*Alejandro writes CONEJO (rabbit).*

#### **Figure 17.**

*Alejandro writes CONEJOS (rabbits).*

With the next pair of images (**Figure 15**), the interviewer asked Alejandro to write CONEJO (rabbit) and CONEJOS (rabbits).

Alejandro draws a rectangle in the middle of the sheet for the first card (rabbit). He said "cone" (rab-) and wrote the first letter on the left of the sheet. Then, he said "jo" (bit) and wrote the second letter. He said "jo" again and wrote the third letter. He was thoughtful for some seconds. He started to write other letters. His writing is as follows (**Figure 16**).

At the beginning, Alejandro tries to relate the syllables of the word with first two letters. However, he justifies the other letters when he read the word. There is no exact correspondence between the syllable and the letter. As well as his writing is to fill the space he delimited.

Alejandro takes into account other rules for plural writing. He drew a rectangle across the width of the sheet. Starting on the left, he said "CO" and wrote one letter. Then, he said "NE" and drew a vertical line. After, he said "JO" and wrote other letters. His writing is as follows (**Figure 17**).

Alejandro writes both words differently. He reads CONEJO (rabbit) for first word and CONEJOS (rabbits) for the second. Both words are different from each other. But, he wrote them with different rules. This is confusing for us because there

**161**

their learning needs.

*The Child with Learning Difficulties and His Writing: A Study of Case*

child tried to represent every object, although he did not explain it.

are vertical lines between every two letters in the second word. We believe that the

In summary, Alejandro shows different writings. He used pseudo-letters and conventional letter. These letters are in unconventional positions. There is no relationship between grapheme and phoneme yet; and, he uses different writing rules.

We described Alejandro's writing process. According to this description, we can

Alejandro is a student of an elementary regular school. He presents learning difficulties. He could not write "correctly." However, he did not have a full assessment by specialized teachers. His school is so far from urban areas and his parents could not take him to a special institution. Therefore, he has not received special support. Also, there is not a favorable literacy environment in his home. His teacher teaches him like his classmates. Usually, he has been marginalized and stigmatized because

We focused on Alejandro because he was a child who was always distracted in class. We did not want to show his writing mistakes as negative aspects, but as part of his learning process. Errors are indicators of a process [5]. They inform the person's skills. They allow to identify the knowledge that is being used [13]. In this

Alejandro showed some knowledge and also some difficulties to write. The child identifies and distinguishes letters and numbers. We do not know if he conceptualizes their use in every one. When he wrote, he shows his knowledge: letters are for

The writing directionality is a difficulty for Alejandro. He writes from left to right and also from right to left. We do not know why he did that. We did not research his reasons. But, it is important to know if there are any factors that influ-

The student does not establish a phoneme-grapheme relationship yet. He is still in an initial level to writing acquisition. He uses conventional letters and pseudoletters to write. There are no fixed rules to write: number and variety of letters. However, we observed student's thought about writing. He justifies his writings

There is still a limited repertoire of letters. He used a few letters of the alphabet. Therefore, Alejandro needs to interact with different texts, rather than teaching him letter by letter. Even if "he does not know those letters." In this way, he is going to

Time he takes to write is an important element for us. He refused to write for several minutes at the beginning. After, he wrote during 1 or 2 min every word. As we mentioned previously, we believe that Alejandro did not feel sure to do the task. Perhaps, he thought that the interviewer is going to penalize for his writing "incorrectly." He felt unable to write. Therefore, it is important that children's mistakes are not censored in the classroom. Mistakes let us to know the child's knowledge and

We considered that class work was not favorable for Alejandro. He painted letters, drawings, among others. These were to keep him busy. Therefore, it is important for the child to participate in reading and writing practices. In this way, he can be integrated into the scholar activities and is not segregated by his classmates. About children with learning difficulties, it is important that these children write as they believe. Do not censor their writings. They are not considered as

way, errors can be considered as elements with a didactic value.

when he reads them and invents letters to represent some words.

appropriate other elements and resources of the writing system.

reading, because he did not use any number in the words.

*DOI: http://dx.doi.org/10.5772/intechopen.89194*

**7. Conclusions**

note the following:

"he does not know or work in class."

ence the child to write like this.

#### *The Child with Learning Difficulties and His Writing: A Study of Case DOI: http://dx.doi.org/10.5772/intechopen.89194*

are vertical lines between every two letters in the second word. We believe that the child tried to represent every object, although he did not explain it.

In summary, Alejandro shows different writings. He used pseudo-letters and conventional letter. These letters are in unconventional positions. There is no relationship between grapheme and phoneme yet; and, he uses different writing rules.

#### **7. Conclusions**

*Learning Disabilities - Neurological Bases, Clinical Features and Strategies of Intervention*

With the next pair of images (**Figure 15**), the interviewer asked Alejandro to

Alejandro draws a rectangle in the middle of the sheet for the first card (rabbit). He said "cone" (rab-) and wrote the first letter on the left of the sheet. Then, he said "jo" (bit) and wrote the second letter. He said "jo" again and wrote the third letter. He was thoughtful for some seconds. He started to write other letters. His writing is

At the beginning, Alejandro tries to relate the syllables of the word with first two letters. However, he justifies the other letters when he read the word. There is no exact correspondence between the syllable and the letter. As well as his writing is to

Alejandro takes into account other rules for plural writing. He drew a rectangle across the width of the sheet. Starting on the left, he said "CO" and wrote one letter. Then, he said "NE" and drew a vertical line. After, he said "JO" and wrote other

Alejandro writes both words differently. He reads CONEJO (rabbit) for first word and CONEJOS (rabbits) for the second. Both words are different from each other. But, he wrote them with different rules. This is confusing for us because there

write CONEJO (rabbit) and CONEJOS (rabbits).

letters. His writing is as follows (**Figure 17**).

as follows (**Figure 16**).

**Figure 14.**

**Figure 15.**

**Figure 16.**

**Figure 17.**

*Alejandro writes GATOS (cats).*

*Cards with one rabbit and three rabbits.*

*Alejandro writes CONEJO (rabbit).*

*Alejandro writes CONEJOS (rabbits).*

fill the space he delimited.

**160**

We described Alejandro's writing process. According to this description, we can note the following:

Alejandro is a student of an elementary regular school. He presents learning difficulties. He could not write "correctly." However, he did not have a full assessment by specialized teachers. His school is so far from urban areas and his parents could not take him to a special institution. Therefore, he has not received special support. Also, there is not a favorable literacy environment in his home. His teacher teaches him like his classmates. Usually, he has been marginalized and stigmatized because "he does not know or work in class."

We focused on Alejandro because he was a child who was always distracted in class. We did not want to show his writing mistakes as negative aspects, but as part of his learning process. Errors are indicators of a process [5]. They inform the person's skills. They allow to identify the knowledge that is being used [13]. In this way, errors can be considered as elements with a didactic value.

Alejandro showed some knowledge and also some difficulties to write. The child identifies and distinguishes letters and numbers. We do not know if he conceptualizes their use in every one. When he wrote, he shows his knowledge: letters are for reading, because he did not use any number in the words.

The writing directionality is a difficulty for Alejandro. He writes from left to right and also from right to left. We do not know why he did that. We did not research his reasons. But, it is important to know if there are any factors that influence the child to write like this.

The student does not establish a phoneme-grapheme relationship yet. He is still in an initial level to writing acquisition. He uses conventional letters and pseudoletters to write. There are no fixed rules to write: number and variety of letters. However, we observed student's thought about writing. He justifies his writings when he reads them and invents letters to represent some words.

There is still a limited repertoire of letters. He used a few letters of the alphabet. Therefore, Alejandro needs to interact with different texts, rather than teaching him letter by letter. Even if "he does not know those letters." In this way, he is going to appropriate other elements and resources of the writing system.

Time he takes to write is an important element for us. He refused to write for several minutes at the beginning. After, he wrote during 1 or 2 min every word. As we mentioned previously, we believe that Alejandro did not feel sure to do the task. Perhaps, he thought that the interviewer is going to penalize for his writing "incorrectly." He felt unable to write. Therefore, it is important that children's mistakes are not censored in the classroom. Mistakes let us to know the child's knowledge and their learning needs.

We considered that class work was not favorable for Alejandro. He painted letters, drawings, among others. These were to keep him busy. Therefore, it is important for the child to participate in reading and writing practices. In this way, he can be integrated into the scholar activities and is not segregated by his classmates.

About children with learning difficulties, it is important that these children write as they believe. Do not censor their writings. They are not considered as

people incapable. It is necessary to consider that learning is a slow process. Those children will require more time than their classmates.

Special education plays an important role in Mexico. However, rather than attending to the student with learning difficulties in isolation, it is necessary that the teacher should be provided with information and the presence of specialized teachers in the classroom. In this way, the student with learning difficulties can be integrated into class, scholar activities, and reading and writing practices.

We presented Alejandro's writing process in this paper. Although he was considered as a child with learning difficulties, we identified he shows some difficulties, but he knows some elements of the writing system too.

### **Acknowledgements**

I thank Alejandro, his parents, and his teacher for the information they provided to me about him.

### **Conflict of interest**

The authors declare no conflict of interest.

### **Author details**

Edgardo Domitilo Gerardo Morales Faculty of Philosophy and Letters, National Autonomous University of Mexico, México City, México

\*Address all correspondence to<EMAIL_ADDRESS>
© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**163**

*The Child with Learning Difficulties and His Writing: A Study of Case*

Severas de Aprendizaje, Conducta o Comunicación. México, DF: Secretaria

de Educación Pública; 2018

ISBN 968-9082-33-7

[10] Durán M. Las Adecuaciones Curriculares Individuales: Hacia la Equidad en Educación Especial. México: Secretaría de Educación Pública; 2016.

[11] CONAFE. Discapacidad Intelectual. Guía Didáctica Para la Inclusión en Educación Inicial y Básica. México: Secretaria de Educación Pública; 2010

[12] Ferreiro E, Gómez M. Análisis de las Perturbaciones en el Proceso de Aprendizaje de la Lecto-Escritura. Fascículo 1. México: SEP-DGEE; 1982

[13] Vaca J. Así Leen (Textos) los Niños. Textos Universitarios. México: Universidad Veracruzana; 2006. ISBN:

968-834-753-1

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[2] SEP. Propuesta Educativa Multigrado 2005. México: Secretaria de Educación

[3] García-Cedillo E, Escalante I, Escandón M, Fernández L, Mustre A, Puga I. La Integración Educativa en el Aula Regular. Principios, Finalidades y Estrategias. México: Secretaría de Educación Pública; 2000. ISBN:

[4] Ferreiro E, Teberosky A. Los Sistemas de Escritura en el Desarrollo del Niño. México, D.F.: Editorial Siglo XXI; 1979. ISBN 968-23-1578-6

[5] Dolz J, Gagnon R, Vuillet Y. Production écrite et Difficultés D'apprentisage. Genève: Carnets des Sciences de L'education. Université de Genéve; 2011. ISBN: 2-940195-44-7

[6] INEE. Panorama Educativo de México. Indicadores del Sistema Educativo Nacional 2017. Educación Básica y Media Superior. México: Instituto Nacional para la Evaluación de

[7] SEP. Modelo Educativo: Equidad e Inclusión. México: Secretaria de Educación Pública; 2017. ISBN:

[8] SEP. Orientaciones Generales Para el Funcionamiento de los Servicios de Educación Especial. México: Secretaria de Educación Pública; 2016. ISBN:

[9] SEP. Estrategia de Equidad e Inclusión en la Educación Básica: Para Alumnos con Discapacidad, Aptitudes Sobresalientes y Dificultades

[1] SEP. Aprendizajes Clave Para la Educación Integral. Plan y Programas de Estudio Para la Educación Básica. México, D.F.: Secretaria de Educación Pública; 2017. ISBN: 970-57-0000-1

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*The Child with Learning Difficulties and His Writing: A Study of Case DOI: http://dx.doi.org/10.5772/intechopen.89194*

#### **References**

*Learning Disabilities - Neurological Bases, Clinical Features and Strategies of Intervention*

integrated into class, scholar activities, and reading and writing practices.

children will require more time than their classmates.

but he knows some elements of the writing system too.

The authors declare no conflict of interest.

**Acknowledgements**

**Conflict of interest**

to me about him.

**Author details**

México City, México

Edgardo Domitilo Gerardo Morales

provided the original work is properly cited.

\*Address all correspondence to<EMAIL_ADDRESS>
people incapable. It is necessary to consider that learning is a slow process. Those

Special education plays an important role in Mexico. However, rather than attending to the student with learning difficulties in isolation, it is necessary that the teacher should be provided with information and the presence of specialized teachers in the classroom. In this way, the student with learning difficulties can be

We presented Alejandro's writing process in this paper. Although he was considered as a child with learning difficulties, we identified he shows some difficulties,

I thank Alejandro, his parents, and his teacher for the information they provided

Faculty of Philosophy and Letters, National Autonomous University of Mexico,

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

**162**

[1] SEP. Aprendizajes Clave Para la Educación Integral. Plan y Programas de Estudio Para la Educación Básica. México, D.F.: Secretaria de Educación Pública; 2017. ISBN: 970-57-0000-1

[2] SEP. Propuesta Educativa Multigrado 2005. México: Secretaria de Educación Pública; 2005

[3] García-Cedillo E, Escalante I, Escandón M, Fernández L, Mustre A, Puga I. La Integración Educativa en el Aula Regular. Principios, Finalidades y Estrategias. México: Secretaría de Educación Pública; 2000. ISBN:<PHONE_NUMBER>-18-0

[4] Ferreiro E, Teberosky A. Los Sistemas de Escritura en el Desarrollo del Niño. México, D.F.: Editorial Siglo XXI; 1979. ISBN 968-23-1578-6

[5] Dolz J, Gagnon R, Vuillet Y. Production écrite et Difficultés D'apprentisage. Genève: Carnets des Sciences de L'education. Université de Genéve; 2011. ISBN: 2-940195-44-7

[6] INEE. Panorama Educativo de México. Indicadores del Sistema Educativo Nacional 2017. Educación Básica y Media Superior. México: Instituto Nacional para la Evaluación de la Educación; 2018

[7] SEP. Modelo Educativo: Equidad e Inclusión. México: Secretaria de Educación Pública; 2017. ISBN:<PHONE_NUMBER>4-4-9

[8] SEP. Orientaciones Generales Para el Funcionamiento de los Servicios de Educación Especial. México: Secretaria de Educación Pública; 2016. ISBN: 970-57-0016-8

[9] SEP. Estrategia de Equidad e Inclusión en la Educación Básica: Para Alumnos con Discapacidad, Aptitudes Sobresalientes y Dificultades Severas de Aprendizaje, Conducta o Comunicación. México, DF: Secretaria de Educación Pública; 2018

[10] Durán M. Las Adecuaciones Curriculares Individuales: Hacia la Equidad en Educación Especial. México: Secretaría de Educación Pública; 2016. ISBN 968-9082-33-7

[11] CONAFE. Discapacidad Intelectual. Guía Didáctica Para la Inclusión en Educación Inicial y Básica. México: Secretaria de Educación Pública; 2010

[12] Ferreiro E, Gómez M. Análisis de las Perturbaciones en el Proceso de Aprendizaje de la Lecto-Escritura. Fascículo 1. México: SEP-DGEE; 1982

[13] Vaca J. Así Leen (Textos) los Niños. Textos Universitarios. México: Universidad Veracruzana; 2006. ISBN: 968-834-753-1

**165**

Section 5

Strategy of Interventions

in Learning Disabilities

### Section 5

## Strategy of Interventions in Learning Disabilities

**167**

communities.

**Chapter 12**

**Abstract**

**1. Introduction**

*Rakgadi Grace Malapela*

*and Gloria Thupayagale-Tshweneagae*

Transition Possibilities for

Disabilities into Adulthood

Adolescents with Intellectual

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, nonhealthcare 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.

**Keywords:** adolescents, adulthood, intellectual disabilities, transition and possibility

Adolescence is a time of transition, involving multidimensional changes, namely biological, psychological and social [1]. These changes occur simultaneously and at different paces for each adolescent. Extant literature reports that the world is home to 1.2 billion adolescents aged between 10 and 19 years. Transition for adolescents is not only biological, but it also includes emotional transition [2]. The United Nations statistics has reported that there are more than 600 million people with disability and that 80 million live in Africa. There is also an estimation that more than 300,000 adolescents have intellectual disabilities. Majority of adolescents with intellectual disabilities (IDs) adolescents would be excluded from acquiring some education and employment opportunities, as well as to suffer discrimination Nyangweso [3]. In addition, Meleis, Sawyer, Im, Messias, Schumacher [4] transition is perceived to be complicated. Adolescents with IDs will grow into adulthood as a result of improved healthcare and related technologies. Pandey and Agarwal [5] wrote that even though transitions are almost normal as they happen often, it is, however, very challenging for adolescents moving into adulthood especially for those with intellectual disabilities who may remain wholly dependent on their parents for emotional wellbeing. This chapter provides a clear and detailed definition of the concept of transition, transition of adolescents with intellectual disabilities (IDs), followed by governmental intervention. Transition possibilities for adolescents with ID are discussed under various roles of the government, healthcare workers and

#### **Chapter 12**

## Transition Possibilities for Adolescents with Intellectual Disabilities into Adulthood

*Rakgadi Grace Malapela and Gloria Thupayagale-Tshweneagae*

#### **Abstract**

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, nonhealthcare 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.

**Keywords:** adolescents, adulthood, intellectual disabilities, transition and possibility

#### **1. Introduction**

Adolescence is a time of transition, involving multidimensional changes, namely biological, psychological and social [1]. These changes occur simultaneously and at different paces for each adolescent. Extant literature reports that the world is home to 1.2 billion adolescents aged between 10 and 19 years. Transition for adolescents is not only biological, but it also includes emotional transition [2]. The United Nations statistics has reported that there are more than 600 million people with disability and that 80 million live in Africa. There is also an estimation that more than 300,000 adolescents have intellectual disabilities. Majority of adolescents with intellectual disabilities (IDs) adolescents would be excluded from acquiring some education and employment opportunities, as well as to suffer discrimination Nyangweso [3]. In addition, Meleis, Sawyer, Im, Messias, Schumacher [4] transition is perceived to be complicated. Adolescents with IDs will grow into adulthood as a result of improved healthcare and related technologies. Pandey and Agarwal [5] wrote that even though transitions are almost normal as they happen often, it is, however, very challenging for adolescents moving into adulthood especially for those with intellectual disabilities who may remain wholly dependent on their parents for emotional wellbeing.

This chapter provides a clear and detailed definition of the concept of transition, transition of adolescents with intellectual disabilities (IDs), followed by governmental intervention. Transition possibilities for adolescents with ID are discussed under various roles of the government, healthcare workers and communities.

#### **2. Transition as a concept**

The concept of 'transition' has been in existence for more than three decades. It is among the concepts that are debated on its meaning and uses in literature. Transitions occur throughout life and are the processes faced by all humans, from birth, to adolescence and to adulthood, from being immature to mature and from being dependent to independent [6]. Transition is often associated with movement from a more shielded environment to a more self-directed environment. It is characterised by the ability to make decisions and to take care of oneself [7]. Transition also includes many adjustments that have to occur in life. Such events include leaving parents to boarding school, leaving home after parental death to an orphanage and all other life events that may render one to transit from one area to another [8]. Chick and Meleis [9] summarises transition by defining it as 'a passage or movement from one state, condition or place to another' (p239). Ally et al. [10] are of the opinion that transitions are aimed at improving one's quality of life. It is a movement from one area of dependency to one area of independence, where one can do activities of daily living with minimal assistance. The authors further noted that it is about the cognitive and adaptive functioning of the individual. The process of transitioning is very difficult for most adolescents and could be particularly difficult for those adolescents with intellectual disabilities [11]. Shaw and DeLaet [12] define transition as a process, a point in time and a perception. As a process, transition needs people with ID their families, caregivers and the healthcare system to work together towards a common goal. The authors argue that transition entails the period starting from the anticipation of transition until the new status and change have been achieved. Lastly, the authors are of the view that transition depends on the individuals' interpretations of what transition mean to them rather than being an event. Furthermore, this depends upon the setting in which the transition process takes place. Eighteen years is globally believed to be an age of maturity, and hence adolescents when they turn 18 are expected to have reached a certain level of independence and are able to make life decisions such as employment and career. In accordance with Patterson and Pegg [13] past history reflects that adolescents with IDs were devalued and not allowed to live independently. These assumptions and beliefs pose challenges for those who are intellectually disabled.

#### **3. Transition of adolescents with intellectual disabilities**

Intellectual disability is characterised by several limitations in mental, emotional, cognitive and physical functioning. People with intellectual disabilities display very problematic behaviours that require attention at all times [14]. The definition of intellectual disability is also wrought with many controversies. To date there is no single definition that is acceptable for all. For instance, it is believed that people with intellectual disability's social and practical skills differ significantly from what is accepted as normal by his or her society (American Association of Intellectual and Developmental Disabilities (2011 cited in Aldersey [15])). On the contrary, Werner [16] and Lancaster et al. [17] define ID as characterised by significant limitations in intellectual functioning with an IQ below 75 which originates before the age of 18 years. To this end, intellectual disability has been defined by limitations in intellectual functioning and adaptive behaviours. They need more attention and assistance to cope with activities of daily living Shogren and Plotner [18].

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.

**169**

**disabilities**

*Transition Possibilities for Adolescents with Intellectual Disabilities into Adulthood*

programmes and policies suited for addressing their needs.

larger society are still rife in some parts of Africa [24].

because they have differing conceptions of friendships [25].

However, in most countries, especially developing countries, they do not have structures in place to assist them achieve this milestone [8]. Most often, there are no

Disability is a developing concept in Africa as it is entrenched within the culture [19]. In the African context, disability is associated with supernatural causes that affect the way family members would treat the individual with ID [20]. Aldersey [15] posits that disability in Africa is a formation of one's culture. Etiyiebo and Omiegbe [20] also support this view that culture defines an individual with intellectual disability as less than human. The two studies quoted above gave examples of other studies in Africa, such as Botswana, Zimbabwe and Cameroon, that define intellectual disability according to norms of the society they live in. These negative stereotypes in most of the African countries have led to the exclusion of individuals with ID from the mainstream society [21]. This has even led to some families to hide their adolescents allowing them to grow in isolation with no proper transition. It is therefore not surprising that in most of Africa, there is lack of relevant policies for individuals with ID, and this poses many challenges for them and their families. Most of these challenges relate to social, occupational and parental issues.

**3.1 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 [2, 22, 23] 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. Incidences of individuals with ID being locked in the houses and hidden from the

Adolescents with ID may not even have the opportunity to volunteer for some activities in their communities. Friendships and peer interactions are limited mostly because other peers with no ID may react negatively towards those with ID, and it is

**3.2 Occupational challenges with transition of adolescents with intellectual**

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. In a study by Malapela [26], she found that out of the 25 adolescents admitted in two special schools in South Africa, only one of them was given a vocational job after completion. In other countries, there are social grants with which these individuals and their families depend on, whereas in other countries where there are no disability grants, their livelihood is dependent on their parents and families. Pandey and Agarwal [5] reported that adolescents with ID are most likely not to be employed and less likely to complete secondary education.

**3.3 Leisure challenges with transition of adolescents with intellectual disabilities**

It is generally believed that leisure promotes emotional and psychological wellbeing for individuals with ID [27]. Leisure activities develop general skills and adaptive behaviours. However, in most countries leisure activities for individuals with ID are limited or non-existent Majoko [28]. Lack of leisure or recreational

*DOI: http://dx.doi.org/10.5772/intechopen.89174*

#### *Transition Possibilities for Adolescents with Intellectual Disabilities into Adulthood DOI: http://dx.doi.org/10.5772/intechopen.89174*

However, in most countries, especially developing countries, they do not have structures in place to assist them achieve this milestone [8]. Most often, there are no programmes and policies suited for addressing their needs.

Disability is a developing concept in Africa as it is entrenched within the culture [19]. In the African context, disability is associated with supernatural causes that affect the way family members would treat the individual with ID [20]. Aldersey [15] posits that disability in Africa is a formation of one's culture. Etiyiebo and Omiegbe [20] also support this view that culture defines an individual with intellectual disability as less than human. The two studies quoted above gave examples of other studies in Africa, such as Botswana, Zimbabwe and Cameroon, that define intellectual disability according to norms of the society they live in. These negative stereotypes in most of the African countries have led to the exclusion of individuals with ID from the mainstream society [21]. This has even led to some families to hide their adolescents allowing them to grow in isolation with no proper transition. It is therefore not surprising that in most of Africa, there is lack of relevant policies for individuals with ID, and this poses many challenges for them and their families. Most of these challenges relate to social, occupational and parental issues.

#### **3.1 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 [2, 22, 23] 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. Incidences of individuals with ID being locked in the houses and hidden from the larger society are still rife in some parts of Africa [24].

Adolescents with ID may not even have the opportunity to volunteer for some activities in their communities. Friendships and peer interactions are limited mostly because other peers with no ID may react negatively towards those with ID, and it is because they have differing conceptions of friendships [25].

#### **3.2 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. In a study by Malapela [26], she found that out of the 25 adolescents admitted in two special schools in South Africa, only one of them was given a vocational job after completion. In other countries, there are social grants with which these individuals and their families depend on, whereas in other countries where there are no disability grants, their livelihood is dependent on their parents and families. Pandey and Agarwal [5] reported that adolescents with ID are most likely not to be employed and less likely to complete secondary education.

#### **3.3 Leisure challenges with transition of adolescents with intellectual disabilities**

It is generally believed that leisure promotes emotional and psychological wellbeing for individuals with ID [27]. Leisure activities develop general skills and adaptive behaviours. However, in most countries leisure activities for individuals with ID are limited or non-existent Majoko [28]. Lack of leisure or recreational

*Learning Disabilities - Neurological Bases, Clinical Features and Strategies of Intervention*

**3. Transition of adolescents with intellectual disabilities**

assistance to cope with activities of daily living Shogren and Plotner [18].

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.

Intellectual disability is characterised by several limitations in mental, emotional, cognitive and physical functioning. People with intellectual disabilities display very problematic behaviours that require attention at all times [14]. The definition of intellectual disability is also wrought with many controversies. To date there is no single definition that is acceptable for all. For instance, it is believed that people with intellectual disability's social and practical skills differ significantly from what is accepted as normal by his or her society (American Association of Intellectual and Developmental Disabilities (2011 cited in Aldersey [15])). On the contrary, Werner [16] and Lancaster et al. [17] define ID as characterised by significant limitations in intellectual functioning with an IQ below 75 which originates before the age of 18 years. To this end, intellectual disability has been defined by limitations in intellectual functioning and adaptive behaviours. They need more attention and

The concept of 'transition' has been in existence for more than three decades. It is among the concepts that are debated on its meaning and uses in literature. Transitions occur throughout life and are the processes faced by all humans, from birth, to adolescence and to adulthood, from being immature to mature and from being dependent to independent [6]. Transition is often associated with movement from a more shielded environment to a more self-directed environment. It is characterised by the ability to make decisions and to take care of oneself [7]. Transition also includes many adjustments that have to occur in life. Such events include leaving parents to boarding school, leaving home after parental death to an orphanage and all other life events that may render one to transit from one area to another [8]. Chick and Meleis [9] summarises transition by defining it as 'a passage or movement from one state, condition or place to another' (p239). Ally et al. [10] are of the opinion that transitions are aimed at improving one's quality of life. It is a movement from one area of dependency to one area of independence, where one can do activities of daily living with minimal assistance. The authors further noted that it is about the cognitive and adaptive functioning of the individual. The process of transitioning is very difficult for most adolescents and could be particularly difficult for those adolescents with intellectual disabilities [11]. Shaw and DeLaet [12] define transition as a process, a point in time and a perception. As a process, transition needs people with ID their families, caregivers and the healthcare system to work together towards a common goal. The authors argue that transition entails the period starting from the anticipation of transition until the new status and change have been achieved. Lastly, the authors are of the view that transition depends on the individuals' interpretations of what transition mean to them rather than being an event. Furthermore, this depends upon the setting in which the transition process takes place. Eighteen years is globally believed to be an age of maturity, and hence adolescents when they turn 18 are expected to have reached a certain level of independence and are able to make life decisions such as employment and career. In accordance with Patterson and Pegg [13] past history reflects that adolescents with IDs were devalued and not allowed to live independently. These assumptions and beliefs pose challenges for those who are intellectually disabled.

**2. Transition as a concept**

**168**

activities leave the individual with ID to have television as an only option. For some who do not have television, they spend most of the time in the house watching movements of their people depending on the degree of their disability. For some, parents may not allow their adolescents with ID to play with others for fear that they would be hurt, mocked or ridiculed. Jerome, Frantino and Sturmey [29] see this as being overprotective, which does not benefit the individual with ID as taking risks of being hurt is part of growing up. All these are daily challenges faced by these individuals.

#### **3.4 Parental challenges**

Literature has reported stress and depression for parents of adolescents with ID. Parents experience caregiver burden because in most cases they are left alone to care for their adolescents with no external assistance. In most instances, the parents are responsible for attending to all the activities of daily living for their adolescents with ID. A study conducted in United Kingdom by Rogers [30] reported that parenting an individual with intellectual disability incapacitates the whole family. It puts more pressure and burden on the family as more attention is needed from parents and mothers of these individuals to assist them to achieve activities of daily living including bathing, feeding, mobility, toilet training, socialising and others. The caregiver burden is aggravated by lack of professional support and unavailability of services. The American Psychological Association (2016) is of the view that where there is support and services the caregiver burden would be lessened. In other countries, where there is absence of such facilities or the lack of knowledge about their existence, then parental stress can be exacerbated [26].

#### **4. Governmental interventions**

Transition of adolescents with ID into adulthood has been a concern not just for researchers but for national governments as well. Most governments encourage the principle of inclusion in schools and employment [7]. In some instances, policies have been developed that encourage inclusion and provide more opportunities for adolescents with ID aiming at maximising their interaction with the wider community.

In South Africa, for instance, a number of legislative regulations and policy framework have been developed to protect individuals with intellectual disabilities from exploitation, vulnerability and discrimination. However, numerous concerns and challenges have been reported regarding their care, treatment and rehabilitation that are detrimental to their general wellbeing and their future prospects. According to the policy guidelines on child and adolescent mental health and reconstruction and development programme (RDP), adolescents with ID are still faced by many challenges in their transition to adulthood. It is for this reason that transition possibilities need to be prioritised.

The Mental Health Care Act No.17 of 2002 that directs care, treatment and rehabilitation of adolescents with intellectual disabilities states that individuals with ID have the right to a sheltered employment and fair treatment. However, the demands of this act have not been realised fully, and this impacts negatively on their transition.

Given all the limitations that affect the transition possibilities, proper understanding of transition possibilities in the context of intellectual disabilities needs urgent attention. There must be a change that would have positive impact in the

**171**

*Transition Possibilities for Adolescents with Intellectual Disabilities into Adulthood*

educating different players such as parents, families and communities.

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 [5]. 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 [31] suggest that inclusive education has more enhanced academic results for students

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 [7] 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

Governments can also expand employment opportunities for adolescents with ID. These they could do through collaborating with employment agencies. A study done by Plotner and Mashall [32] in the United States found that 28.4% of adults with ID were in formal employment compared to 71% of those adults without ID. However, in developing countries the statistics would even be lower. Adolescents with ID should be taught courses that would link them with particular employment

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. [33] argued that transition partnerships and collaboration are key factors in the facilitation and fostering of the transition

lives of individuals with ID. These changes must take cognisance of their level of

There are numerous transition possibilities that could be done to assist adolescents with ID. Most of these possibilities centre on what governments and healthcare workers can do to mitigate the many challenges associated with their transitions. The possibilities for governments are on policy development and involvement of other stakeholders. For healthcare workers, the main theme is on

*DOI: http://dx.doi.org/10.5772/intechopen.89174*

**5. Transition possibilities**

**6. The role of governments**

with disabilities.

inclusive.

opportunities.

mental, physical, social and emotional functioning.

lives of individuals with ID. These changes must take cognisance of their level of mental, physical, social and emotional functioning.

#### **5. Transition possibilities**

*Learning Disabilities - Neurological Bases, Clinical Features and Strategies of Intervention*

activities leave the individual with ID to have television as an only option. For some who do not have television, they spend most of the time in the house watching movements of their people depending on the degree of their disability. For some, parents may not allow their adolescents with ID to play with others for fear that they would be hurt, mocked or ridiculed. Jerome, Frantino and Sturmey [29] see this as being overprotective, which does not benefit the individual with ID as taking risks of being hurt is part of growing up. All these are daily challenges faced by

Literature has reported stress and depression for parents of adolescents with ID. Parents experience caregiver burden because in most cases they are left alone to care for their adolescents with no external assistance. In most instances, the parents are responsible for attending to all the activities of daily living for their adolescents with ID. A study conducted in United Kingdom by Rogers [30] reported that parenting an individual with intellectual disability incapacitates the whole family. It puts more pressure and burden on the family as more attention is needed from parents and mothers of these individuals to assist them to achieve activities of daily living including bathing, feeding, mobility, toilet training, socialising and others. The caregiver burden is aggravated by lack of professional support and unavailability of services. The American Psychological Association (2016) is of the view that where there is support and services the caregiver burden would be lessened. In other countries, where there is absence of such facilities or the lack of knowledge

Transition of adolescents with ID into adulthood has been a concern not just for researchers but for national governments as well. Most governments encourage the principle of inclusion in schools and employment [7]. In some instances, policies have been developed that encourage inclusion and provide more opportunities for adolescents with ID aiming at maximising their interaction with the wider

In South Africa, for instance, a number of legislative regulations and policy framework have been developed to protect individuals with intellectual disabilities from exploitation, vulnerability and discrimination. However, numerous concerns and challenges have been reported regarding their care, treatment and rehabilitation that are detrimental to their general wellbeing and their future prospects. According to the policy guidelines on child and adolescent mental health and reconstruction and development programme (RDP), adolescents with ID are still faced by many challenges in their transition to adulthood. It is for this reason that

The Mental Health Care Act No.17 of 2002 that directs care, treatment and rehabilitation of adolescents with intellectual disabilities states that individuals with ID have the right to a sheltered employment and fair treatment. However, the demands of this act have not been realised fully, and this impacts negatively on their

Given all the limitations that affect the transition possibilities, proper understanding of transition possibilities in the context of intellectual disabilities needs urgent attention. There must be a change that would have positive impact in the

about their existence, then parental stress can be exacerbated [26].

**170**

transition.

these individuals.

**3.4 Parental challenges**

**4. Governmental interventions**

transition possibilities need to be prioritised.

community.

There are numerous transition possibilities that could be done to assist adolescents with ID. Most of these possibilities centre on what governments and healthcare workers can do to mitigate the many challenges associated with their transitions. The possibilities for governments are on policy development and involvement of other stakeholders. For healthcare workers, the main theme is on educating different players such as parents, families and communities.

### **6. 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 [5]. 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 [31] 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 [7] 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. A study done by Plotner and Mashall [32] in the United States found that 28.4% of adults with ID were in formal employment compared to 71% of those adults without ID. However, in developing countries the statistics would even be lower. Adolescents with ID should be taught courses that would link them with particular employment opportunities.

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. [33] 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.

#### **7. 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. Ramalhal et al. [34] assert that nurses have the responsibility to assist individuals and their families to deal with the transition process. On the contrary, Shaw and DeLaet [12] argue that the physicians should take the first critical step to improve the transition process to adult-oriented healthcare. According to Meleis' Transition Theory, nurses are the partners of individuals and their families as they will be able to follow changes and outcomes regarding the transition process.

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.

Families should also be educated on the importance of a friendly, safe and stimulating environment to enable adolescents with ID to maximise their potentials and to cushion emotional and behavioural challenges [26]. Internet should be used where possible, and computer skills should be developed. Seal [35] and Seal and Pockney [36] hold a strong view that the use of the Internet allows individuals with ID to express themselves.

Provision of counselling is another viable transition possibility [26]. Individuals with ID should be counselled if they get frustrated in their inability to solve problems and be encouraged if they are able to solve problems on their own. Healthcare in most countries is very fragmented; healthcare workers should support their integration so that counselling is offered with other services. This would ensure that individuals with ID receive total quality care when is needed.

In a study by Malapela [26], it was found that the majority of parents lacked the knowledge and skill to care for their adolescents with ID. The study recommended that educating caregivers on the care of their adolescents and knowledge about their limitations would promote positive transition outcomes.

#### **8. 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

**173**

*Transition Possibilities for Adolescents with Intellectual Disabilities into Adulthood*

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

More community resources should be available and accessible to support these

Positive transition of adolescents with ID would ensure improvement of quality of life for individuals with ID. Governments and other stakeholders need to further develop the policy framework needed to assist individuals with ID and related interventions. Education, employment and leisure are key to a fruitful integration of individuals with ID in the mainstream society. Studies quoted in this chapter support those individuals with ID to have the same opportunities as for all individuals without ID. Prioritisation of provision and development of working skills are the determining factors for facilitating transition of adolescents with IDs into adulthood. The need for further research is necessary to ensure that adolescent with ID

individuals and their families during the transition experience and process.

Rakgadi Grace Malapela\* and Gloria Thupayagale-Tshweneagae\*

\*Address all correspondence to<EMAIL_ADDRESS>and<EMAIL_ADDRESS>
© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

University of South Africa, Pretoria, South Africa

provided the original work is properly cited.

*DOI: http://dx.doi.org/10.5772/intechopen.89174*

experiences.

**9. Conclusion**

can live an independent life.

**Author details**

#### *Transition Possibilities for Adolescents with Intellectual Disabilities into Adulthood DOI: http://dx.doi.org/10.5772/intechopen.89174*

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.

More community resources should be available and accessible to support these individuals and their families during the transition experience and process.

#### **9. Conclusion**

*Learning Disabilities - Neurological Bases, Clinical Features and Strategies of Intervention*

or services throughout the transition process.

**7. The role of healthcare workers**

families can support and encourage each other.

individuals with ID receive total quality care when is needed.

limitations would promote positive transition outcomes.

ID to express themselves.

**8. The role of communities**

process. This means an inclusion of a wide range of professionals, agencies, centres

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.

In order to ensure successful healthy transitions in healthcare, partnership work with families, communities, societies, education and other relevant stakeholders is needed. Ramalhal et al. [34] assert that nurses have the responsibility to assist individuals and their families to deal with the transition process. On the contrary, Shaw and DeLaet [12] argue that the physicians should take the first critical step to improve the transition process to adult-oriented healthcare. According to Meleis' Transition Theory, nurses are the partners of individuals and their families as they will be able to follow changes and outcomes regarding the transition process.

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 should also be educated on the importance of a friendly, safe and stimulating environment to enable adolescents with ID to maximise their potentials and to cushion emotional and behavioural challenges [26]. Internet should be used where possible, and computer skills should be developed. Seal [35] and Seal and Pockney [36] hold a strong view that the use of the Internet allows individuals with

Provision of counselling is another viable transition possibility [26]. Individuals with ID should be counselled if they get frustrated in their inability to solve problems and be encouraged if they are able to solve problems on their own. Healthcare in most countries is very fragmented; healthcare workers should support their integration so that counselling is offered with other services. This would ensure that

In a study by Malapela [26], it was found that the majority of parents lacked the knowledge and skill to care for their adolescents with ID. The study recommended that educating caregivers on the care of their adolescents and knowledge about their

Teaching communities and socialisation of the intellectually disabled children into the community are the key factors that form the basis for assisting adolescents with

**172**

Positive transition of adolescents with ID would ensure improvement of quality of life for individuals with ID. Governments and other stakeholders need to further develop the policy framework needed to assist individuals with ID and related interventions. Education, employment and leisure are key to a fruitful integration of individuals with ID in the mainstream society. Studies quoted in this chapter support those individuals with ID to have the same opportunities as for all individuals without ID. Prioritisation of provision and development of working skills are the determining factors for facilitating transition of adolescents with IDs into adulthood. The need for further research is necessary to ensure that adolescent with ID can live an independent life.

#### **Author details**

Rakgadi Grace Malapela\* and Gloria Thupayagale-Tshweneagae\* University of South Africa, Pretoria, South Africa

\*Address all correspondence to<EMAIL_ADDRESS>and<EMAIL_ADDRESS>
© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

#### **References**

[1] Steinberg L. Age of Opportunity: Lessons from the New Science of Adolescence. Boston, MA: Houghton Mifflin Harcourt; 2014

[2] Mudhovozi P, Maphula A, Mashamba T. Caring for children with mental retardation: The experiences of Vhavenda mothers. *African*. Journal for Physical. Health Education. Recreation and Dance (AJPHERD). 2012;**2**:148-159

[3] Nyangweso M. Disability in Africa: A cultural/religious perspective. East Carolina University. ResearchGate.net; 2018

[4] Meleis AI, Sawyer LM, Im EO, Messias DKH, Schumacher K. Experiencing transitions: An emerging middle range theory. Advances in Nursing Science. 2000;**23**(1):12-28

[5] Pandey S, Agarwal S. Transition to adulthood for youth with disability: Issues for the disabled child and family. JOSR Journal of Humanities and Social Science (IOSR-JHSS). 2013;**17**(3):41-45

[6] Foley KR, Dyke P, Bourke J, Leonard H. Young adults with intellectual disability transitioning from school to post-school: A literature review framed within the ICF. Disability and Rehabilitation. 2012;**34**(20):1747-1764

[7] Maxey M, Beckett TE. Adolescents and disabilities. Adolescent Research Review. 2017;**2**:59-75

[8] Malapela G, Mfidi F, Sibanda S, Thupayagale-Tshweneagae G. Caring for mental health care users with profound intellectual disabilities: Approaches and opportunities. Africa Journal of Nursing and Midwifery. 2017;**19**:1-10

[9] Chick N, Meleis AI. Transitions: A nursing concern. In: P.L. Chinn

editor. Nursing Research Methodology. Boulder, CO: Aspen; 1986. pp. 237-257

[10] Ally s, Boyd K, Abells D, Amaria K, Hamdani Y, Lo A, et al. Improving transition to adulthood for adolescents with intellectual and developmental disabilities. Canadian Family Physcian. 2018;**64**(2):S37-S43

[11] Ferraioli S, Harris S. The impact of autism on siblings. Social Work in Mental Health. 2010;**8**:41-53

[12] Shaw TM, DeLaet DE. Transition of adolescents to young adulthood for vulnerable populations. Pediatrics in Review. 2010;**31**(12):1-4

[13] Patterson I, Pegg S. Serious leisure and people with intellectual disabilities: Benefits and opportunities. Leisure Studies. 2009;**28**(4):387-402

[14] Foley KR, Taffe J, Bourke J, Einfeld SL, Tonge JT, Leonard H. Young people with intellectual disability transitioning into adulthood: Do behaviour trajectories differ in those with and without down syndrome. PLoS One. 2016;**11**(7):1-9

[15] Aldersey HM. Family perception of intellectual disability: Understanding and support in Dar es Salaam. African Journal of Disability. 2012;**1**(1):32. DOI: 10.4102/ajod.v1i1.32

[16] Werner S. Individuals with intellectual disabilities: A review of the literature on decision-making since the convention on the rights of people with disabilities (CRPD). Public Health Reviews. 2012;**34**(2):1-27

[17] Lancaster RL, Balling K, Hastings R, Lloyd TJ. Attributions, criticism and warmth in mothers of children with intellectual disability and challenging behaviour: A pilot study. Journal of Intellectual Disability Research. 2014;**58**:1060-1071

**175**

*Transition Possibilities for Adolescents with Intellectual Disabilities into Adulthood*

2018

2005;**9**(1):25-42

Open. 2019;**8**:1-16

2007;**40**(1):185-189

2010;**44**:146-160

2016;**59**(4):195-202

2014;**3**(4):333-341

[33] Pallisera M, Vila M,

Fullana J. Transition to adulthood for young people with intellectual disability: Exploring transition partnerships from the point of view of professionals in school and post school services. Journal of Intellectual

and Developmental Disability.

disabilities into adulthood (thesis). Pretoria, SA: University of South Africa;

[27] Buttimer J, Tiery E. Patterns of leisure participation among adolescents

[28] Majoko T. Inclusion of children with disabilities in physical education in Zimbabwean primary schools. SAGE

[29] Jerome J, Frantino EP, Sturmey P. The effects of errorless learning and backward chaining on the acquisition

of Internet skills in adult with developmental disabilities. Journal of Applied Behaviour Analysis.

[30] Rogers C. Mothering and intellectual disability: Partnership rhetoric? British Journal of Sociology of Education. 2011;**32**(4):563-581

[31] Kurth JA, Mastergeorge AM. Individual education plan goals and services for adolescents with autism: Impact of age and educational setting. Journal of Special Education.

[32] Plotner AJ, Marshall KJ.

Supporting post-secondary education programs for individuals with an intellectual disability: Role of the vocational rehabilitation counselor. Institute on Disabilities Hammill.

with mild intellectual disability. Journal of Intellectual Disabilities.

*DOI: http://dx.doi.org/10.5772/intechopen.89174*

[18] Shogren KA, Plotner AJ. Transition planning for students with intellectual disability autism or other disabilities: Data from the National Longitudinal. Intellectual and Developmental Disabilities. 2012;**50**(1):16-30

[19] Mckenzie JA, McConkey R, Adnams C. Intellectual disability in Africa: Implications for research and service development. Disability and Rehabilitation. 2013;**35**(20):1750-1755

[20] Etiyiebo E, Omiegbe O. Religion, culture, and discrimination against persons with disabilities in Nigeria. African Journal of Disability.

2016;**5**(1):1-6. DOI: 1o.4102/ajod.v5i1.192

[22] Tugli AK, Zungu LI, Ramakuela NJ, Goon DT, FC A. Perceived challenges of serving students with disabilities in a historically disadvantaged tertiary institution, South Africa. African Journal for Physical Health Education. Recreation and Dance (AJPHERD) (Supplement). 2013;**1**(2):346-355

[21] Koszela K. The Stigmatization of Disabilities in Africa and the Development Effects, Independent Study project Collection 1639. 2013. Available from: http://digitalcollections.

sit.edu/ISP-collection/1639

[23] Vermeer A, Magyarszeky Z. Disability Care in Africa Community Based Rehabilitation in Rural Regions. 1st ed. Netherlands, Amsterdam: VU

[24] Acker J. Inequality regimes: Gender, class, and race in organisations. Gender and Society. 2006;**20**(4):441-464

[25] Rossetti Z. Descriptors of friendship between secondary students with and without autism or intellectual and developmental disability. Remedial and Special Education. 2015;**36**(3):181-192

[26] Malapela RG. Strategy for transition

of adolescents with intellectual

University Press; 2014

*Transition Possibilities for Adolescents with Intellectual Disabilities into Adulthood DOI: http://dx.doi.org/10.5772/intechopen.89174*

[18] Shogren KA, Plotner AJ. Transition planning for students with intellectual disability autism or other disabilities: Data from the National Longitudinal. Intellectual and Developmental Disabilities. 2012;**50**(1):16-30

[19] Mckenzie JA, McConkey R, Adnams C. Intellectual disability in Africa: Implications for research and service development. Disability and Rehabilitation. 2013;**35**(20):1750-1755

[20] Etiyiebo E, Omiegbe O. Religion, culture, and discrimination against persons with disabilities in Nigeria. African Journal of Disability. 2016;**5**(1):1-6. DOI: 1o.4102/ajod.v5i1.192

[21] Koszela K. The Stigmatization of Disabilities in Africa and the Development Effects, Independent Study project Collection 1639. 2013. Available from: http://digitalcollections. sit.edu/ISP-collection/1639

[22] Tugli AK, Zungu LI, Ramakuela NJ, Goon DT, FC A. Perceived challenges of serving students with disabilities in a historically disadvantaged tertiary institution, South Africa. African Journal for Physical Health Education. Recreation and Dance (AJPHERD) (Supplement). 2013;**1**(2):346-355

[23] Vermeer A, Magyarszeky Z. Disability Care in Africa Community Based Rehabilitation in Rural Regions. 1st ed. Netherlands, Amsterdam: VU University Press; 2014

[24] Acker J. Inequality regimes: Gender, class, and race in organisations. Gender and Society. 2006;**20**(4):441-464

[25] Rossetti Z. Descriptors of friendship between secondary students with and without autism or intellectual and developmental disability. Remedial and Special Education. 2015;**36**(3):181-192

[26] Malapela RG. Strategy for transition of adolescents with intellectual

disabilities into adulthood (thesis). Pretoria, SA: University of South Africa; 2018

[27] Buttimer J, Tiery E. Patterns of leisure participation among adolescents with mild intellectual disability. Journal of Intellectual Disabilities. 2005;**9**(1):25-42

[28] Majoko T. Inclusion of children with disabilities in physical education in Zimbabwean primary schools. SAGE Open. 2019;**8**:1-16

[29] Jerome J, Frantino EP, Sturmey P. The effects of errorless learning and backward chaining on the acquisition of Internet skills in adult with developmental disabilities. Journal of Applied Behaviour Analysis. 2007;**40**(1):185-189

[30] Rogers C. Mothering and intellectual disability: Partnership rhetoric? British Journal of Sociology of Education. 2011;**32**(4):563-581

[31] Kurth JA, Mastergeorge AM. Individual education plan goals and services for adolescents with autism: Impact of age and educational setting. Journal of Special Education. 2010;**44**:146-160

[32] Plotner AJ, Marshall KJ. Supporting post-secondary education programs for individuals with an intellectual disability: Role of the vocational rehabilitation counselor. Institute on Disabilities Hammill. 2016;**59**(4):195-202

[33] Pallisera M, Vila M,

Fullana J. Transition to adulthood for young people with intellectual disability: Exploring transition partnerships from the point of view of professionals in school and post school services. Journal of Intellectual and Developmental Disability. 2014;**3**(4):333-341

**174**

*Learning Disabilities - Neurological Bases, Clinical Features and Strategies of Intervention*

editor. Nursing Research Methodology. Boulder, CO: Aspen; 1986. pp. 237-257

[10] Ally s, Boyd K, Abells D, Amaria K, Hamdani Y, Lo A, et al. Improving transition to adulthood for adolescents with intellectual and developmental disabilities. Canadian Family Physcian.

[11] Ferraioli S, Harris S. The impact of autism on siblings. Social Work in

[12] Shaw TM, DeLaet DE. Transition of adolescents to young adulthood for vulnerable populations. Pediatrics in

[13] Patterson I, Pegg S. Serious leisure and people with intellectual disabilities: Benefits and opportunities. Leisure Studies. 2009;**28**(4):387-402

disability transitioning into adulthood: Do behaviour trajectories differ in those with and without down syndrome. PLoS One. 2016;**11**(7):1-9

[15] Aldersey HM. Family perception of intellectual disability: Understanding and support in Dar es Salaam. African Journal of Disability. 2012;**1**(1):32. DOI:

[17] Lancaster RL, Balling K, Hastings R, Lloyd TJ. Attributions, criticism and warmth in mothers of children with intellectual disability and challenging behaviour: A pilot study. Journal of Intellectual Disability Research.

10.4102/ajod.v1i1.32

[16] Werner S. Individuals with intellectual disabilities: A review of the literature on decision-making since the convention on the rights of people with disabilities (CRPD). Public Health

Reviews. 2012;**34**(2):1-27

2014;**58**:1060-1071

[14] Foley KR, Taffe J, Bourke J, Einfeld SL, Tonge JT, Leonard H. Young people with intellectual

Mental Health. 2010;**8**:41-53

Review. 2010;**31**(12):1-4

2018;**64**(2):S37-S43

[1] Steinberg L. Age of Opportunity: Lessons from the New Science of Adolescence. Boston, MA: Houghton

[3] Nyangweso M. Disability in Africa: A cultural/religious perspective. East Carolina University. ResearchGate.net;

Im EO, Messias DKH, Schumacher K. Experiencing transitions: An emerging middle range theory. Advances in Nursing Science. 2000;**23**(1):12-28

[5] Pandey S, Agarwal S. Transition to adulthood for youth with disability: Issues for the disabled child and family. JOSR Journal of Humanities and Social Science (IOSR-JHSS). 2013;**17**(3):41-45

[7] Maxey M, Beckett TE. Adolescents and disabilities. Adolescent Research

[8] Malapela G, Mfidi F, Sibanda S, Thupayagale-Tshweneagae G. Caring for mental health care users with profound intellectual disabilities: Approaches and opportunities. Africa Journal of Nursing

[9] Chick N, Meleis AI. Transitions: A nursing concern. In: P.L. Chinn

and Midwifery. 2017;**19**:1-10

[6] Foley KR, Dyke P, Bourke J, Leonard H. Young adults with intellectual disability transitioning from school to post-school: A literature review framed within the ICF. Disability and Rehabilitation.

2012;**34**(20):1747-1764

Review. 2017;**2**:59-75

Mifflin Harcourt; 2014

**References**

2018

[2] Mudhovozi P, Maphula A, Mashamba T. Caring for children with mental retardation: The experiences of Vhavenda mothers. *African*. Journal for Physical. Health Education. Recreation and Dance (AJPHERD). 2012;**2**:148-159

[4] Meleis AI, Sawyer LM,

**177**

**Chapter 13**

**Abstract**

**1. Introduction**

Speech Therapy Work with

Language Impairment: Algorithms

The concept of "personalization" is rather strengthened in pedagogy. At the same time, in Russia in the field of special pedagogy and, in particular, in speech therapy, there is an urgent need for personalized influence with specific language impairments. A review of Russian classical and modern data on the comorbidity of speech, language, motor skills, and other processes in children with specific language disorders is presented. The rationale for personifying speech therapy work in children with specific language impairments was justified. The scientific positions of the authors with respect to personalization in the field of differential evaluation, developmental effects, and prevention of systemic consequences of specific language impairments in children are indicated. The groups of personalized means and aids of influence of a speech therapist for specific language impairments in children are indicated. The directions of further development of the indicated problem of

**Keywords:** personalization, children of preschool age, personalized means and aids of speech therapy work, specific language impairment in children, personalized

In world science, and in Russian speech therapy, in particular, the issues of differential evaluation and in-depth study of specific language disorders in children are dynamically developing [1–3]. The manifestations and symptoms revealed by the authors determine the understanding of the underlying mechanisms of such a state as "specific language impairment." This allows to study in detail the structure of impaired development, to determine strategies and directions of developmental effects of speech therapy. Therefore, in Russian science, the search for further ways of a transdisciplinary study of the problem of helping children with SLI remains very relevant in special pedagogy in general, and speech therapy, in particular. It can be stated that in modern speech therapy, as a science, it is defined as a number of contradictions. On the one hand, there is a need to find new and improving

diagnostic profile, comorbidity of speech, language and motor disorders

Children Having Specific

and Personalization

*Tatiana Volodarovna Tumanova*

*and Tatiana Borisovna Filicheva*

personalization of speech therapy work are determined.

[34] Ramalhal T, Lagarto A, Matos A, Cruz H, Ribeiro H. Transition to parenthood: Nursing intervention to promote paternal competences. NERP. 2013;**5**:164-169

[35] Seale JK. The same but different: The use of the personal home page by adults with down syndrome as a tool for self-presentation. British Journal of Educational Technology. 2001;**32**: 343-352. DOI: 10.1111/1467-8535.00203

[36] Seale JK, Pockney R. The use of the personal home page by adults with down syndrome as a tool for managing identity and friendship. British Journal of Learning Disabilities. 2002;**30**:142-148. DOI: 10.1046/j.1468-3156.2002.00195.x

### **Chapter 13**

*Learning Disabilities - Neurological Bases, Clinical Features and Strategies of Intervention*

[34] Ramalhal T, Lagarto A,

2013;**5**:164-169

Matos A, Cruz H, Ribeiro H. Transition to parenthood: Nursing intervention to promote paternal competences. NERP.

[35] Seale JK. The same but different: The use of the personal home page by adults with down syndrome as a tool for self-presentation. British Journal of Educational Technology. 2001;**32**: 343-352. DOI: 10.1111/1467-8535.00203

[36] Seale JK, Pockney R. The use of the personal home page by adults with down syndrome as a tool for managing identity and friendship. British Journal of Learning Disabilities. 2002;**30**:142-148. DOI: 10.1046/j.1468-3156.2002.00195.x

**176**

## Speech Therapy Work with Children Having Specific Language Impairment: Algorithms and Personalization

*Tatiana Volodarovna Tumanova and Tatiana Borisovna Filicheva*

### **Abstract**

The concept of "personalization" is rather strengthened in pedagogy. At the same time, in Russia in the field of special pedagogy and, in particular, in speech therapy, there is an urgent need for personalized influence with specific language impairments. A review of Russian classical and modern data on the comorbidity of speech, language, motor skills, and other processes in children with specific language disorders is presented. The rationale for personifying speech therapy work in children with specific language impairments was justified. The scientific positions of the authors with respect to personalization in the field of differential evaluation, developmental effects, and prevention of systemic consequences of specific language impairments in children are indicated. The groups of personalized means and aids of influence of a speech therapist for specific language impairments in children are indicated. The directions of further development of the indicated problem of personalization of speech therapy work are determined.

**Keywords:** personalization, children of preschool age, personalized means and aids of speech therapy work, specific language impairment in children, personalized diagnostic profile, comorbidity of speech, language and motor disorders

#### **1. Introduction**

In world science, and in Russian speech therapy, in particular, the issues of differential evaluation and in-depth study of specific language disorders in children are dynamically developing [1–3]. The manifestations and symptoms revealed by the authors determine the understanding of the underlying mechanisms of such a state as "specific language impairment." This allows to study in detail the structure of impaired development, to determine strategies and directions of developmental effects of speech therapy. Therefore, in Russian science, the search for further ways of a transdisciplinary study of the problem of helping children with SLI remains very relevant in special pedagogy in general, and speech therapy, in particular. It can be stated that in modern speech therapy, as a science, it is defined as a number of contradictions. On the one hand, there is a need to find new and improving

existing approaches to the speech therapy work with children with SLI. On the other hand methodological, substantive, organizational, and other aspects of new and modernized approaches to solving the designated problem are insufficiently developed. The resolution of the existing contradictions, of course, occurs, and will continue to take place in scientific research of several generations. However, today, we can say that a personalized approach in speech therapy work with SLI children meets the abovementioned social challenges and contributes to effectively overcoming pressing contradictions in general, inclusive, and special education.

In Russian pedagogy, interest in the development of a personalized approach can be traced in the writings of scientists starting last century [1]. There are different interpretations of personalization in education, which allows interpreting this phenomenon in different ways. Personalization can be explained as the process of gaining by a subject universal human, socially significant, individually unique properties and qualities that allow him to fulfill a certain social role in an original way, creatively build communication with other people, and actively influence their perception and assessment of their own personality and activities [2]. At the same time, the term "personalization in education" is often used in Russian scientific research, interpreted extremely variably as: a special form of organization of the educational process, taking into account the peculiarities of personal differences of students [3]; one of the directions of modernization of the system of continuous education; a process aimed at the development of students' abilities and interests [4]; a factor of development of cognitive activity of trainees; and a means of building a personal educational route [5]. The personalization of education is also considered as a didactic principle, according to which the content and all other elements of the educational process should be determined and built on the basis of the interests, needs, and aspirations of persons involved in educational activities [6].

The variability of interpretations, however, reflects the general focus of educational processes in Russia on the dynamic development of such pedagogical paradigms that put the student's personality and his multidirectional interests and needs at the center of pedagogical processes.

Moreover, the relevance of a personalized approach in the field of evaluation and development work of a speech therapist with SLI children seems logical.

#### **2. Speech therapy impact at SLI in Russia: algorithms or personalization?**

For many decades, Russia has developed stable algorithms for speech therapists: how to work with children with specific language impairments. Those algorithms are based on the classic Russian level approach to assessing the linguistic and speech status of such children [7]. For many decades (since the 60s of the last century), Russian speech therapy has developed an understanding of the essence of SLI as a developmental speech\language disorder that has signs of systemic underdevelopment of all language components and embraces all speech processes [8]. In this regard, in Russia, national models for evaluation of children with SLI have been identified and are successfully operating to date. These models bring together an interdisciplinary team of specialists, which conducts a comprehensive examination of children, evaluates the state of various functions, and formulates a conclusion and recommendations for working with a particular child (psychologist, pediatrician, neurologist, speech therapist, teacher-representative of the school, and if necessary, other specialists). The speech therapist as part of this team conducts his assessment. It can be variable in technology and didactic materials, but always includes: collecting data on the development of language and speech of the child and the speech environment in his

**179**

*Speech Therapy Work with Children Having Specific Language Impairment: Algorithms…*

of language and speech in children with SLI, starting from the age of three:

not understand the tasks aimed at distinguishing the verbal sounds.

characterized by multiple violations.

• *The second level*—the beginning of the sentence development: children begin to combine two or three words into a simple sentence. However, these sentences are characterized by violations of structure and content. Understanding of speech lags significantly behind these normotypic children. Children skip or distort prepositions, as well as morphemic parts of words, which allow differentially denoting the number, size, gender of objects, objects actions and signs, and other categorical qualities. The initial attempts to form words with significant structural and substantive errors may manifest. Children enter into a dialogue, but do not initiate it, rather respond in one or two words. There is still a tendency to use nonverbal means of communication. Children cannot talk about events, retell the text, etc. Tasks related to distinguishing the verbal sounds are not feasible. The pronunciation of different groups of sounds is

• *The third level* characterizes using a simple sentence with multiple lexical and grammatical errors. For children at the third level, it becomes possible to draw up simple and even some types of complicated sentences. Nevertheless, in these sentences, there are obvious errors: omissions and rearrangement of the order of the sentence parts, replacement of the end of words, replacement of

• *The first level* characterizes practically nonspeaking children who understand the extremely limited volume of words. They use single simple words, amorphous root words, sound complexes, and parts of words, sounds associated with what is named, not combining them into a phrase. There are no word endings, understanding and use of prepositions is not observed. Word formation is not available. A child cannot compose a story on his own. Monological speech is practically absent. A dialogue with such a child shows his active use of nonverbal means of communication. The phonetic side of speech is significantly disturbed; sounds from different phonetic groups are not formed. Children do

family, understanding of speech and language structures, the state of vocabulary, grammar, phonetics, dialogical and monologue utterances (in relation to the age indicators of normative development). The diagnostic program also includes examination of the state of operations of language analysis and synthesis (starting from 3 to 4 years of age), the state of the basics of literacy (from 6 years old), and later (from 7 to 8 years) an examination is added to the above writing, reading, counting operations, and other educational skills. For many decades, scientific research data, covering various regions of Russia, confirmed the idea of professor R.E. Levina, and, later, professor T.B. Filicheva that the speech-language status of children with SLI can be understood as very different, varying within different levels: from the first level (lowest) to the fourth level (somewhat close to the lower limits of the age norm) [7–9]. The national practice of speech therapy allows detecting a delay in the development of speech/language in children from 2 to 3 years of age with a normative state of intelligence and hearing, in order to subsequently consider these children as a risk group for detecting SLI in them, starting from 3 years. Accordingly, it is from this age in Russia that it is customary to designate a condition revealed in a child not as delayed, but as a disordered development of language and speech. The context of this approach is reflected in the national psycho-pedagogical classification of speech\ language disorders [9]. In Russian speech therapy, a hierarchy of short level characteristics has been established that testifies to the underdevelopment of the processes

*DOI: http://dx.doi.org/10.5772/intechopen.91185*

#### *Speech Therapy Work with Children Having Specific Language Impairment: Algorithms… DOI: http://dx.doi.org/10.5772/intechopen.91185*

family, understanding of speech and language structures, the state of vocabulary, grammar, phonetics, dialogical and monologue utterances (in relation to the age indicators of normative development). The diagnostic program also includes examination of the state of operations of language analysis and synthesis (starting from 3 to 4 years of age), the state of the basics of literacy (from 6 years old), and later (from 7 to 8 years) an examination is added to the above writing, reading, counting operations, and other educational skills. For many decades, scientific research data, covering various regions of Russia, confirmed the idea of professor R.E. Levina, and, later, professor T.B. Filicheva that the speech-language status of children with SLI can be understood as very different, varying within different levels: from the first level (lowest) to the fourth level (somewhat close to the lower limits of the age norm) [7–9]. The national practice of speech therapy allows detecting a delay in the development of speech/language in children from 2 to 3 years of age with a normative state of intelligence and hearing, in order to subsequently consider these children as a risk group for detecting SLI in them, starting from 3 years. Accordingly, it is from this age in Russia that it is customary to designate a condition revealed in a child not as delayed, but as a disordered development of language and speech. The context of this approach is reflected in the national psycho-pedagogical classification of speech\ language disorders [9]. In Russian speech therapy, a hierarchy of short level characteristics has been established that testifies to the underdevelopment of the processes of language and speech in children with SLI, starting from the age of three:

*Learning Disabilities - Neurological Bases, Clinical Features and Strategies of Intervention*

ing pressing contradictions in general, inclusive, and special education.

at the center of pedagogical processes.

In Russian pedagogy, interest in the development of a personalized approach can be traced in the writings of scientists starting last century [1]. There are different interpretations of personalization in education, which allows interpreting this phenomenon in different ways. Personalization can be explained as the process of gaining by a subject universal human, socially significant, individually unique properties and qualities that allow him to fulfill a certain social role in an original way, creatively build communication with other people, and actively influence their perception and assessment of their own personality and activities [2]. At the same time, the term "personalization in education" is often used in Russian scientific research, interpreted extremely variably as: a special form of organization of the educational process, taking into account the peculiarities of personal differences of students [3]; one of the directions of modernization of the system of continuous education; a process aimed at the development of students' abilities and interests [4]; a factor of development of cognitive activity of trainees; and a means of building a personal educational route [5]. The personalization of education is also considered as a didactic principle, according to which the content and all other elements of the educational process should be determined and built on the basis of the interests, needs, and aspirations of persons involved in educational activities [6]. The variability of interpretations, however, reflects the general focus of educational processes in Russia on the dynamic development of such pedagogical paradigms that put the student's personality and his multidirectional interests and needs

Moreover, the relevance of a personalized approach in the field of evaluation and development work of a speech therapist with SLI children seems logical.

**2. Speech therapy impact at SLI in Russia: algorithms or personalization?**

For many decades, Russia has developed stable algorithms for speech therapists: how to work with children with specific language impairments. Those algorithms are based on the classic Russian level approach to assessing the linguistic and speech status of such children [7]. For many decades (since the 60s of the last century), Russian speech therapy has developed an understanding of the essence of SLI as a developmental speech\language disorder that has signs of systemic underdevelopment of all language components and embraces all speech processes [8]. In this regard, in Russia, national models for evaluation of children with SLI have been identified and are successfully operating to date. These models bring together an interdisciplinary team of specialists, which conducts a comprehensive examination of children, evaluates the state of various functions, and formulates a conclusion and recommendations for working with a particular child (psychologist, pediatrician, neurologist, speech therapist, teacher-representative of the school, and if necessary, other specialists). The speech therapist as part of this team conducts his assessment. It can be variable in technology and didactic materials, but always includes: collecting data on the development of language and speech of the child and the speech environment in his

existing approaches to the speech therapy work with children with SLI. On the other hand methodological, substantive, organizational, and other aspects of new and modernized approaches to solving the designated problem are insufficiently developed. The resolution of the existing contradictions, of course, occurs, and will continue to take place in scientific research of several generations. However, today, we can say that a personalized approach in speech therapy work with SLI children meets the abovementioned social challenges and contributes to effectively overcom-

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prepositions, multiple lexical changes and errors (e.g., according to the genusspecific characteristics of words). Children can actively engage in dialogue, but there is a steady tendency toward a passive role. Self-compilation of the story, retelling of the text, becomes possible. At the same time, expressed errors are allowed in the transmission of the text, its composition, cause and effect, logical and temporal relationships. Word formation and change of words by grammatical categories is characterized by persistent, constant errors (choice of morpheme, choice of grammatical model, word design, etc.). The ability to distinguish some sounds of the native language appears. However, sounding phonemes do not differentiate as should be in accordance with the age of children. They found disturbed pronunciation of sounds from different phonetic groups.

• *The fourth level* characterizes residual manifestations of mildly expressed underdevelopment of vocabulary, grammar, phonetics, and storytelling. Single, but persistent manifestations of impaired development of language and speech are noted in almost all areas, but as minimal manifestations. Such micro-manifestations in the underdevelopment of speech and language, however, are systemic. They show the need for further continuation of the work of the speech therapist [8, 10].

These characteristics of the level assessment of the state of speech and language in children, on the one hand, represent an algorithmized understanding of the fact that underdevelopment of the studied processes of varying severity can be observed in SLI. However, on the other hand, this approach already determines personalization in assessing the language and speech of a child with SLI (if there are common characteristics of underdevelopment inherent in one or another level). The speech-language data of each child are compared with indicators of the age norm. At the same time, indicators of insufficient development of language and speech inherent in each specific child are revealed. In accordance with such a layered approach, confirmed by hundreds of scientific studies and many decades of scientific and practical work, speech therapists in Russia successfully perfect effective algorithms for optimal care for children with SLI. These algorithms are based on determining the level of development of language and speech capabilities that correspond to the current state of the child, and the level that is promising and achievable for him in the course of development work, taking into account the social needs of the child [8, 10, 11].

Currently, these speech therapist work algorithms are reflected in training programs for children with SLI (e.g., programs for overcoming SLI in preschool children) [12].

Such training programs for children offer speech therapists a simple and transparent algorithm of work. It includes a plan for working with a child (with first, second, third, or fourth level of underdevelopment of speech-language processes), the content of the work, the main guidelines for the formation of the lexical, grammatical, phonetic, and syntactic possibilities of children, as well as the potential results that the speech therapist seeks in his work.

So, in working with children whose level of speech and language capabilities is assessed as the minimum (*first level*), the speech therapy is aimed at:

• development of understanding of speech: to teach according to the instructions of a speech therapist to recognize and show objects, actions, signs, understand the generalizing meaning of a word, differentially perceive who and where, and understand appeal to one or more persons, grammatical categories of the

**181**

ings, suffixes, etc.).

*Speech Therapy Work with Children Having Specific Language Impairment: Algorithms…*

number of nouns, verbs, guess objects according to their description, deter-

• the development of active speech activity: in any phonetic design, to name parents, close relatives, imitate the cries of animals and birds, sounds of the world, musical instruments; give orders—go, sit, give; make up the first sentences from amorphous root words (*mama pi*—mama, go to sleep), convert imperative verbs into singular verbs of the present tense, make sentences according to the model: (a) Who? what does? (b) Who? what does? what? (e.g., Katia (mom, dad) is sleeping; Anna drinks milk). Simultaneously, exercises are conducted to develop memory, attention, logical thinking (remembering 2–4 objects, guessing the removed or added object, remembering and selecting

As a result of speech therapy work at this stage of the formation of speech\language development, children learn to correlate objects and actions with their verbal designation, to understand the general meaning of words. An active and passive dictionary should consist of the names of objects that the child often sees; actions performed by himself or others, of some of his states (cold, warm). Children need to communicate with the help of elementary two-three-word sentences. Verbal activity

Teaching children with a *second level* of speech/language development involves

• development of understanding of speech: includes the formation of the ability to listen to the converted speech, to highlight the names of objects, actions, and some signs; the formation of understanding the generalized meaning of words; and preparation for the perception of dialogical and monological speech.

• activation of speech activity and the development of lexical and grammatical means of the language: learn to name words made up of one to three syllables (cat, bed, coat, puppy), teach initial inflection skills, then derivation (number of nouns, mood and number of verbs, possessive pronouns "my—mine," nouns

• development of active phrase: construction and use models of simple sentences—noun plus a coordinated verb in the indicative mood of the singular present tense, noun plus a coordinated verb in the indicative mood of the singular present tense plus a noun in the indirect case (of type "Misha, sleep," "Misha is sleeping," "Lilia drinks milk"); assimilation of simple prepositions—on, at, in; combining simple sentences into short stories; strengthen the skills of drawing up proposals for demonstrating actions based on questions; memorization of short couplets and nursery rhymes. Moreover, any phonetic design of independent expressions available to the child is allowed, while attention is paid to the correct grammatically significant elements (end-

• development of the pronunciation: to learn to distinguish between speech and nonspeech sounds to determine the source, strength, and direction of sound; to clarify the correct pronunciation of the sounds available to the child; develop the sounds at the level of the syllables, of the sentence, words, form the correct sound-syllabic structure of the word; to learn to distinguish and

with diminutive suffixes, categories of case of nouns).

can be manifested in any phrases without correction of their phonetic design.

*DOI: http://dx.doi.org/10.5772/intechopen.91185*

pictures of 2–4 parts).

several areas:

mine elementary cause-effect relationships;

number of nouns, verbs, guess objects according to their description, determine elementary cause-effect relationships;

• the development of active speech activity: in any phonetic design, to name parents, close relatives, imitate the cries of animals and birds, sounds of the world, musical instruments; give orders—go, sit, give; make up the first sentences from amorphous root words (*mama pi*—mama, go to sleep), convert imperative verbs into singular verbs of the present tense, make sentences according to the model: (a) Who? what does? (b) Who? what does? what? (e.g., Katia (mom, dad) is sleeping; Anna drinks milk). Simultaneously, exercises are conducted to develop memory, attention, logical thinking (remembering 2–4 objects, guessing the removed or added object, remembering and selecting pictures of 2–4 parts).

As a result of speech therapy work at this stage of the formation of speech\language development, children learn to correlate objects and actions with their verbal designation, to understand the general meaning of words. An active and passive dictionary should consist of the names of objects that the child often sees; actions performed by himself or others, of some of his states (cold, warm). Children need to communicate with the help of elementary two-three-word sentences. Verbal activity can be manifested in any phrases without correction of their phonetic design.

Teaching children with a *second level* of speech/language development involves several areas:

*Learning Disabilities - Neurological Bases, Clinical Features and Strategies of Intervention*

phonetic groups.

the speech therapist [8, 10].

results that the speech therapist seeks in his work.

prepositions, multiple lexical changes and errors (e.g., according to the genusspecific characteristics of words). Children can actively engage in dialogue, but there is a steady tendency toward a passive role. Self-compilation of the story, retelling of the text, becomes possible. At the same time, expressed errors are allowed in the transmission of the text, its composition, cause and effect, logical and temporal relationships. Word formation and change of words by grammatical categories is characterized by persistent, constant errors (choice of morpheme, choice of grammatical model, word design, etc.). The ability to distinguish some sounds of the native language appears. However, sounding phonemes do not differentiate as should be in accordance with the age of children. They found disturbed pronunciation of sounds from different

• *The fourth level* characterizes residual manifestations of mildly expressed underdevelopment of vocabulary, grammar, phonetics, and storytelling. Single, but persistent manifestations of impaired development of language and speech are noted in almost all areas, but as minimal manifestations. Such micro-manifestations in the underdevelopment of speech and language, however, are systemic. They show the need for further continuation of the work of