DEAL works with people diagnosed as having an intellectual disability (or intellectual impairment, or mental retardation; many names, same problems).

I say ‘diagnosed as having an intellectual disability’ rather than ‘with an intellectual disability’ because I think the concept of intellectual disability is intellectually incoherent.

There’s no way to put a ruler against someone’s mind.  Everything we know about a person is based on their performance – their performance on IQ tests, their performance at school, their performance at speaking and walking and behaving. In particular, DEAL has found that virtually everybody who is regarded as intellectually disabled has severe language impairment.

When a person scores significantly below average on cognitive tests, most of which involve language, there are two ways of interpreting the results.

One is that the tests reflect the reality.  The person has a global mental deficit, a ‘blinkus in the thinkus’.

The other is that the test results are not measuring the underlying mind but are instead picking up interference from outside the mind – that they are
•    A social construct resulting from inappropriate testing, or
•    Evidence of one or more functional problems affecting performance, or
•    An example of the wide range of variation among humans, and not a deficit at all.

The global explanation is expressed in the term ‘intellectual disability’ – the person’s mind has an overall problem and just doesn’t have the neural capacity to allow them to think as well as other people.  A 1981 IBM PC simply doesn’t have the capacity of a 2006 desktop supercomputer.

The other sort of explanation suggests that there isn’t a general deficit, there are particular problems that are snarling things up – that we’re all running the same machines, but some of us have buggy software.

If there’s a general deficit, there’s not much that can be done about it.  If there are particular problems, we can see what can be done to fix them.

The only way to test which of these explanations is correct is to work on the basis that the second explanation is correct.  We try to identify and address whatever may be interfering with performance – ethnicity, environment, education or lack of it, sensory impairments, physical impairments and so on -- and see whether the person’s communication performance improves. 

Overwhelmingly, DEAL has found that almost everybody who presents to the Centre with a diagnosis of intellectual disability has been able to demonstrate immensely improved capacity.

In particular, we have found that in most cases it is possible to show that the person does in fact have functional language.  The difficulty is enabling them to use it. 

DEAL is a communication centre.  This is what we do.

People with diagnoses of intellectual impairment certainly have disabilities.  People who come to DEAL have behavioural problems, physical problems, and splinter deficits.  Their communication is complicated by factors such as impulsiveness, perseveration, dyspraxia, attention deficit, muscle tone, medication effects, and emotional lability.  They have often been socialised by their disempowerment into such attitudes as apathy, unwillingness to risk failure, or depression. 

Enabling them to access a means of communication can be difficult, timeconsuming, stressful, and complicated.  Working out a means of communication that will allow them to communicate in different situations with different people can be more difficult still and take still longer.  It’s worth it.  Developing communication changes a person’s life, offering them a chance to participate in all life has to offer.

That’s ‘all life has to offer’, not ‘all life has to offer to a person with an intellectual disability’ Many people with communication disabilities have a few words, or some yes/no gestures, or some repetitious phrases, and sometimes these people aren’t brought to a therapist because their attendants think that they’ve got enough communication for their modest needs.  If they can’t communicate as fluently as you or I, then they could do with a communication assessment.

Don’t make people jump through hoops, pass tests, score high on different scales, or show prelingual skills to show that they have the potential to communicate.  The way you find out whether someone has the capacity to communicate is to teach them to communicate and see whether they learn.  There are no exceptions to this rule.

These issues are discussed in more detail here, here and here.