Intellectual Disabilities In China Research Articles

Feasibility and Effectiveness of a Computer-Assisted Instructional System Implemented by Teachers for Students on the Autism Spectrum With Intellectual Disabilities in China

The purpose of this study was to evaluate the feasibility and effectiveness of computer-assisted instruction (CAI) implemented by special education teachers in a school setting in China. Feasibility was evaluated by procedural fidelity of teacher implementation and a social validity questionnaire. Effectiveness was measured by the acquisition of bidirectional naming through multiple exemplar instruction implemented in CAI for students on the autism spectrum with intellectual disabilities. Bidirectional naming is a key ability in early language development that allows children to expand their knowledge through incidental learning (Greer et al., 2011). Three students on the autism spectrum with intellectual disabilities (7 years of age; 1 female, 2 males) and their teachers (27–29 years of age; female) participated in this study. Using a single-case design--multiple probes across participants with pre- and post-assessments, all three students demonstrated improvements at post-instruction bidirectional naming assessments. Teachers implemented CAI with a high level of fidelity; they gave it high ratings for acceptability and feasibility. They were satisfied with CAI and student learning outcomes. All three students reported that they enjoyed learning with CAI. The implications and potential utilities of incorporating CAI in special education classrooms in China are discussed.

The Effect of a Family Member–Assisted Online Early Reading Intervention Program for Students With Intellectual Disability in China

Early reading skills are a prerequisite for children to acquire subsequent reading skills. Many online programs have been reported to be effective in improving students’ reading skills. However, there is limited evidence demonstrating the effectiveness of online early reading programs for students with intellectual disability (ID). Using a single-case multiple-probe across-participant design, the study examined whether a family member–assisted online early reading program could improve the early Chinese reading skills of students with ID. All three participants demonstrated significant treatment effects on early reading skills in response to the program. These acquired effects were generalized across settings and maintained in follow-up conditions for all participants. As such, this study extends the limited literature on the effectiveness of online programs to develop early reading skills in students with ID.

Teaching Individuals with Intellectual Disabilities in China: Strategies and Challenges

Teaching Individuals with Intellectual Disabilities in China: Strategies and Challenges

The economic burden of autism spectrum disorder with and without intellectual disability in China: A nationwide cost-of-illness study

ObjectiveThe economic burden of autism spectrum disorder (ASD) on individuals, their families and society as a whole is poorly understood. Accurate figures are crucial for economic estimates and service planning. MethodsThe total lifetime individual costs and annual societal costs of ASD in China were estimated with a prevalence-based, gross cost of illness approach and data from multiple sources. The direct medical costs in outpatient and inpatient settings from the electronic health records (EHRs) of hospitals, and direct nonmedical costs from a national survey were included. The indirect costs were from both the national survey and the estimation using human capital methods. Age-specific lifetime incremental societal costs were measured. Comorbidity-related and unrelated costs were analyzed separately. ResultsThe discounted lifetime cost for an individual with ASD in China was $2.65 million (at 2020 prices, $) for those without intellectual disability (ID) and $4.61 million (at 2020 prices, $) for those with ID. The total cost of ASD amounted to $41.8 billion in 2020. Productivity loss were major cost drivers for ASD individuals without ID. Direct nonmedical costs (rehabilitation or adult care costs etc.) were major drivers for ASD individuals with ID. In a lifetime course, the total annual costs for middle aged and elderly (>42 years) were highest, followed by transitional adults (18–29 years) and preschoolers, both for individuals with or without ID. The distribution of costs over the lifespan varied by the cost category. ConclusionsASD imposes a substantial economic burden on families and health care systems. Sectors and services coordination should be given policy considerations.

Modeling the relationships among home literacy environment, reading interest, self-regulation, and reading ability of children with intellectual disabilities in China

Background Understanding of reading skills of children with intellectual disabilities can help implement appropriate educational strategies. This study aimed to explore the relationship between home literacy environment and reading ability of children with intellectual disabilities and possible mediating roles of reading interest and self-regulation in this relationship. Method 297 Chinese children with intellectual disabilities were surveyed for home literacy environment, reading interest, self-regulation and reading ability questionnaires. Data entry, correlation and structural equation modeling were performed using the Statistical Package for Social Science software package. Results Home literacy environment impacted reading ability of children with intellectual disabilities via mediation by reading interest and self-regulation. Conclusions These results revealed the influencing pathways of home literacy environment on reading ability of children with intellectual disabilities and ascertained the positive roles of reading interest and self-regulation in their reading development.

An experimental study on the categorization ability of children with moderate intellectual disabilities in China

Background Little is known about the categorization ability of children with intellectual disabilities (ID) in China, which is critical in guiding teaching practice and learning support strategies for those students. The study has aimed to explore the characteristics of categorization ability of children with ID. Method This study used an experimental method to compare the classification ability of children with moderate ID (n = 40, average age of 10.6, average IQ = 47.03), typically developing children of the same age (n = 40, average age of 10.5), and kindergarten middle-class children (n = 20, average age of 6.2) to find differences in categorization abilities, including selecting items in the same category, excluding items from a different category, and direct classification. Findings We found that the classification capacity of 10-year-old children with moderate ID was significantly lower than that of typically developing children of the same age. There was no significant difference in the total classification score between 10-year-old children with moderate ID and 6-year-old typically developing children, while there were differences in the task of direct classification. Besides, there was a significant positive correlation between IQ and classification capability in children with moderate ID. Conclusion Educators should develop corresponding educational programs based on the cognitive level and categorization ability characteristics of children with moderate ID.

Barriers and facilitators to participation in everyday activities for children with intellectual disabilities in China.

Children with intellectual disabilities (IDs) are vulnerable and participate less in everyday activities compared to their peers with typical development. This study aimed to identify barriers and facilitators related to the participation in everyday activities of children with IDs in China. Twenty semi-structured interviews were conducted with primary caregivers of children with IDs from special schools in Tianjin, China. The data were transcribed and analysed using inductive qualitative content analysis. Four categories of barriers to participation in everyday activities for children with IDs were identified: insufficient knowledge, attitudes and skills in primary caregivers; ID-related characteristics of children; stigma and Chinese culture; and lack of support from society. Four categories describing facilitators of participation in everyday activities for children with IDs were also identified: the optimistic attitude of the primary caregiver; adequate family support; active environment in school and policy; and attractive characteristics of children with IDs. The findings in this study add knowledge on important barriers and facilitators affecting the participation of children with IDs in everyday activities in China. The primary caregivers' voices need to be heard by government and society. Appropriate and effective changes in family-oriented services and the legal, social, political and economic context of the child welfare management system for the scale-up of improving participation should be implemented for children with IDs.

Trends of the disease burden of intellectual disability among children and adolescents from 1990 to 2019 in China

Objective: This study aims to analyze the disease burden of intellectual disability among Chinese children and adolescents aged 0-19 years in 2019 and its trends from 1990 to 2019. Methods: Data were gathered from the Global Burden of Disease study. The prevalence and years lived with disability (YLDs) of intellectual disability among Chinese children and adolescents were compared with the global average by gender, age group, and severity of disability in 2019. Joinpoint regression model was used to analyze the trends in the prevalence and YLDs of intellectual disability among Chinese children and adolescents from 1990 to 2019. Results: The prevalence and YLDs of intellectual disability among Chinese children and adolescents in 2019 were 1 522.65 per 100 000 (95%UI: 1 228.62 per 100 000-1 817.55 per 100 000) and 109.81 per 100 000 (95%UI: 72.15 per 100 000-158.09 per 100 000), respectively, which were lower than the global average. The prevalence and YLDs of severe intellectual disability in China were slightly higher than the global average. The average annual percent changes in the prevalence and YLDs of intellectual disability among Chinese children and adolescents were -0.23% (95%CI: -0.26%--0.21%, P<0.001) and 0.74% (95%CI: 0.66%-0.81%, P<0.001) from 1990 to 2019, respectively. The prevalence and YLDs of severe intellectual disability showed continuously increasing trends over the past 30 years. Conclusions: The disease burden of intellectual disability among Chinese children and adolescents was lower than the global average in 2019, but severe intellectual disability was higher than the global average. The prevalence of intellectual disability among Chinese children and adolescents showed an overall decrease, while YLDs showed an increasing trend from 1990 to 2019.

The Rule of Law for the Exercise of Marriage and Reproductive Rights for Women with Intellectual Disabilities in China.

Women with intellectual disabilities (WIDs) are entitled to the rights to marriage and reproduction under Chinese law. However, Chinese marriage and reproduction regimes have imposed restrictions on their right to marry that limit the exercise of their reproductive rights. Marrying WIDs has become a popular choice for men in rural areas. Although in China’s Civil Code, the legislature has repealed the prior requirement of a medical examination for marriage registration, the exercise of rights to marriage and reproduction by WIDs is still restricted. China has not fully implemented equal rights for persons with disabilities under the United Nations Convention on the Rights of Persons with Disabilities. China needs to set legal procedural requirements for the exercise of these rights for different types of WIDs, systematically constructing them at three levels: legal basis, legislative implementation, and institutional support.

‘Does the loss outweigh the gain?’: inclusive teachers’ belief systems about teaching students with intellectual disabilities in Chinese elementary classrooms

ABSTRACT Little is known about inclusive teachers’ belief systems about teaching students with mild, moderate, or severe intellectual disabilities across different subjects (e.g. language arts, math, science, PE, art, and music) in less developed countries. To address this gap, this study aims to understand inclusive teachers’ belief systems about teaching students with intellectual disabilities in China. Semi-structured interviews were conducted with 32 elementary teachers who taught students with intellectual disabilities. The analysis yielded three categories of Chinese inclusive teachers’ beliefs, including beliefs about students with intellectual disabilities, beliefs about themselves, and beliefs about teaching practice, which varied from limiting orientation, representing the medical model, to constructive orientation, representing the social model. Furthermore, these beliefs interacted with each other and formed either nested belief systems, with three beliefs closely connected and coherent in orientation, or divergent belief systems, with three beliefs partially unconnected and conflicting in orientation. Findings highlight the need to move beyond focusing on a particular belief and pay attention to the structural features and orientation coherence within inclusive teachers’ belief systems.

The effects of incorporating extended conversations into video-based story retelling instruction on oral narrative skills in adolescents with intellectual disability in China

Background/aimsOral narrative language is a persistent area of language difficulty for individuals with intellectual disability (ID). This study aims to explore the effectiveness of a comprehensive intervention program that incorporates extended conversations into video-based story retelling instruction with a novel visual support strategy, Story Hand, to develop oral narrative skills in adolescents with ID in China. MethodsUsing a single-case multiple-probe across participants design, the researchers examined whether the comprehensive intervention program could improve participants’ oral narrative skills both microstructurally and macrostructurally. ResultsAll three participants demonstrated moderate to high treatment effects in the microstructural narrative outcomes (i.e., the mean length of utterance in morphemes [MLU-M] and the number of different words [NDW]) and one of the macrostructural narrative outcomes (i.e., the complexity of story grammar [SG-complexity]) in response to the comprehensive intervention program, and these acquired effects were maintained at a high level for up to one month. However, all three participants demonstrated limited treatment effects in one of the macrostructural narrative outcomes (i.e., cohesion) in response to the comprehensive intervention program. Conclusions/implicationsThe comprehensive intervention program that incorporates extended conversations into visually supported video-based story retelling instruction offers an option for teachers to develop oral narrative skills in adolescents with ID. However, the relative effectiveness of the different components of the intervention needs to be further explored.

A study of the use of virtual reality headsets in Chinese adolescents with intellectual disability

Background: Virtual reality technologies (VRTs) present many characteristics that can facilitate learning, especially in individuals with intellectual disabilities (ID). The VRT head-mounted display (HMD) has recently shown significant technological improvement. This study aims to prove the suitability of the newer commercially available VRT HMDs used in interventions for adolescents with ID in China. To this end, we explored the acceptance, immersion, and negative effects for adolescents with ID in a series of virtual environments. Methods: Forty-nine adolescents with ID (33 boys and 16 girls, IQ < 70), aged 11 to 21, from three special schools participated in this study. Questionnaires, observations, and interviews were used to investigate their views while using a VR HMD. Results: Our analysis found that most participants narrated a pleasant experience using HMD and a series of VR experiences and experienced a high level of immersion accompanied by low negative effects. In addition, our study found that the gender variable was independent of the acceptance of HMDs and the immersion experience. Conclusions: Overall, this study suggests that the HMD is accepted by most Chinese adolescents with ID; thus, its application has great potential in China.

Prevalence of overweight and obesity in children and adolescents with intellectual disabilities in China

Overweight and obesity in children and adolescents has become a worldwide epidemic. There are several studies that have concentrated on the prevalence rate of children and adolescents with intellectual disabilities (ID), whereas data on such a population on the mainland of China remain unclear. The purpose of this study was to investigate the prevalence rate of overweight and obesity among school-aged children and adolescents with ID on China's mainland. This study employed a cross-sectional design to examine the body weight status of 1873 children and adolescents (ages 6-18years old) with ID in 35 special education schools. Body mass index was calculated, and the concepts of overweight and obesity were defined according to the standard of the Working Group for Obesity in China. Data indicated that 18.2% (95% CI: 16.5%-20.0%) of children and adolescents with ID were overweight and 14.4% (95% CI: 12.8%-16.0%) were obese. Boys with ID were more likely to be overweight than girls with ID (OR=1.48[95% CI: 1.13-1.94], P<0.05). Children and adolescents with Down syndrome or autism spectrum disorder had a trend to be classified as overweight (OR=1.76[95% CI: 1.22-2.54], P<0.05; OR=1.57[95% CI: 1.17-2.09], P<0.05, respectively) or obesity (OR=1.82[95% CI: 1.23-2.69], P<0.05; OR=1.40 [95% CI: 1.02-1.93], P<0.05, respectively) compared with those with ID without these conditions. Moreover, children and teenagers with ID living in urban areas had a predisposition to be overweight (OR=2.16[95% CI: 1.14-4.09], P<0.05) or obese (OR=3.25[95% CI: 1.41-7.50], P<0.05) relative to those who lived in rural areas. Results indicated that in China, the prevalence rate of overweight and obesity among school-aged children and adolescents with ID was remarkably high. Therefore, future research should make every effort to focus on reducing and preventing overweight and obesity of this population in China.

Technology and scaling up: Evidence from an NGO for adolescents with intellectual disabilities in China

This paper takes the innovative practices of a Chinese NGO serving adolescents with intellectual disabilities (ID) as a case to analyze whether technology can effectively promote the impact scaling of NGOs providing services for intellectually disabled adolescents. It was found that the use of technology can have positive effects on expanding service areas and population range in terms of improving professional skills and knowledge, reducing scaling costs, increasing flexibility, and enhancing government and social trust. Challenges faced by the program included user retainment, digital literacy of target users, difficulty teaching practical skills virtually, and the loss of specificity through standardization. Based on the case study, this paper has summarized a “COATE influencing factor model,” composed of a series of considerations that NGOs serving adolescents with ID should make prior to deciding which technological means to implement in their service model.

Rehabilitation service utilisation among adults with intellectual disabilities: Trends and socioeconomic disparities in China.

Intellectual disabilities (IDs) have become a public health concern worldwide, but few studies on rehabilitation service utilisation in this population were conducted in developing countries. We aimed to examine trends and socioeconomic disparities in the utilisation of rehabilitation services among adults with IDs in China. We obtained data from a population-based survey by using a multistage, randomised, cluster sampling process to ascertain adults with IDs in 2006 and a selected subsample for follow-up surveys during 2007-2013. Psychiatrists ascertained individuals with IDs ascertained by intelligence quotient score under 70, deficits in two or more adaptive behaviours and age of onset under 18years. Overall, the utilisation rate of rehabilitation services significantly increased from 10.1% in 2007 to 33.7% in 2013, with an annual average percentage growth of 34.3% when adjusting for multiple confounders. The mounting trends remained significant in all socioeconomic groups. The growth rates among lower socioeconomic participants were much higher than those among higher socioeconomic participants, and the strength in the association between socioeconomic position (education and region) and rehabilitation service utilisation declined in 2007-2013. This study found an upward trend in rehabilitation service utilisation in Chinese adults with IDs during 2007-2013, and socioeconomic disparities in rehabilitation service use in this population showed a downward trend over time.

Adults with intellectual disabilities in China: comorbid psychiatric disorder and its association with health service utilisation.

Adults with intellectual disabilities (ID) often have multiple comorbidities. Psychiatric disorders in this population have been poorly studied in developing countries. We aimed to investigate the prevalence of psychiatric disorders in adults with ID and whether comorbid psychiatric disorders were associated with health service utilisation. We obtained data from the Second National Sample Survey on Disability, conducted in 31 provinces of China and selected a subsample of 13631 adults aged 18years and above with ID. ID were defined by intelligence quotient score under 70, deficits in two or more adaptive behaviours and age of onset under 18years. Psychiatric disorders were identified according to the International Statistical Classification of Diseases, Tenth Revision. Logistic regressions were used for data analyses. The prevalence of psychiatric disorders in adults with ID was 16.7%. The most prevalent type of psychiatric disorder was dementia. Older adults, females, being minorities, urban residents, being literate, low-income groups and having severe ID, were associated with elevated risk of psychiatric disorder among adults with ID. Compared with individuals without psychiatric disorders, those with comorbid psychiatric disorders were more likely to use medical service and less likely to use rehabilitation service. The prevalence of psychiatric disorder in adults with ID was strikingly higher than that in the general population. Health service utilisation among Chinese adults with ID remained a big challenge. There is a possibility of diagnostic overshadowing by local clinicians, which may have resulted in overdiagnosis of dementia and underdiagnosis of common mental disorders. This study informs further investigations regarding common mental disorders among people with ID and has implications for public health strategies and health policies to meet health service need for this population.

Validating Kohler's Taxonomy of Transition Programming for adolescents with intellectual disability in the Chinese context

BackgroundSchool-to-work transition programmes play a crucial role in the achievement of post-secondary outcomes for young adults with intellectual disability (ID). Although special education in China has progressed in the last two decades, systematically planned transition education and services are not usually available for Chinese school leavers. AimsThe present study aimed to validate Kohler's Taxonomy of Transition Programming (KTTP) in the Chinese context for adolescents with ID. Methods and proceduresFive Chinese transition experts reviewed KTTP items, 14 Chinese transition teachers and 14 parents of adolescents with ID who would transition from school in the next 12 months were interviewed, and 329 transition teachers were surveyed. Outcome and resultsMost items in KTTP were found to be important and relevant to the Chinese context. Based on KTTP, a modified transition framework appropriate to the Chinese context was generated. Conclusions and implicationsThe Chinese transition framework may assist parents and professionals to better support adolescents with ID in China. Future validation checks of the framework will add confidence that the framework captures the essential components of effective transition practices appropriate in the Chinese context.

Examination of a Scale Assessing Attitudes towards Individuals with Intellectual Disability in China

This study examined the applicability of the four-factor structure of the short form of the Community Living Attitudes Scale-Intellectual Disability11 We chose to use the term “intellectual disability” to replace the term “mental retardation” in the original CLAS-MR scale to conform with the terminology in current usage. (CLAS-ID) in China, using a sample of 325 Chinese community members. Confirmatory factor analysis revealed that the original structure of the short form of the CLAS-ID did not adequately fit the data from the current sample. Most items of the Exclusion and Similarity subscales were retained while items on the Empowerment and Sheltering subscales were removed. Chinese community members held generally positive attitudes towards people with intellectual disability. However, a measurement tool originating from the Chinese context is needed to provide a better understanding of attitudes towards individuals with intellectual disability in mainland China.

Caring for a child with severe intellectual disability in China: The example of Rett syndrome

Purpose: Rett syndrome is one of several genetic disorders known to cause severe intellectual and physical disability, mostly in girls. Girls affected by Rett syndrome appear to develop normally in the first 6 months of life, after which the usual clinical presentation comprises regression of communication and hand skills, the appearance of hand stereotypies and impaired gait. Intellectual disability affects more than 1.5% of the population of children in developing countries yet we know little about the daily lives and support services available for them and their caregivers. Method: This qualitative study explored the daily experiences of 14 mothers and one grandmother caring for a child with Rett syndrome in China via telephone interviews. Results: Participants reported a lack of education, rehabilitation and support services available to them. Limited access to information reduced families’ capacity to adequately meet the needs of their child. These gaps were further exacerbated by discrimination and perceived stigma from some members of the community. Conclusions: Additional support services and educational programs at the governmental level can improve the quality of life of persons with an intellectual disability and their families and programs involving community participation in the care of people with disabilities may help to address discrimination.Implications for RehabilitationLittle is known about the lives of girls with Rett syndrome in China, a genetic condition associated with severe disability.Most girls experienced home-based care with limited access to appropriate equipment, education and rehabilitation.Limited information and discrimination and stigma from some community members reduced families’ abilities to meet their child’s needs.Greater access to health, education and information services in China should be supported.

Socioeconomic status and children with intellectual disability in China

Intellectual disability (ID) accounts for 70% of all disabilities among children in China's Second National Sampling Survey on Disability. Although studies have shown a relationship between social class and ID in children, none have investigated the association of socioeconomic variables in Chinese children with mild or severe ID. Data for children aged 0-6 years with and without ID were abstracted from the Second National Sampling Survey on Disability in China, conducted in 2006. Crude odds ratios showed the effect of sociodemographic factors on mild and severe ID. Adjusted odds ratios (OR(a) ) (95% confidence intervals) estimated the independent effects of these factors. For both mild and severe ID, risk of having ID increased with male sex, birth to a woman aged 35 years and older, lower maternal education, mother's older age at delivery, lower income and rural residence. After age, gender and parent disability were controlled, mothers aged 35 years and older were more likely to have a child with ID: mild ID, OR(a) 1.47 (1.15-1.88); severe ID, OR(a) 1.32 (1.00-1.73). There was an approximate increasing monotonic risk of severe ID with increasing socioeconomic disadvantage: lowest income, OR(a) 3.00 (2.19-4.12); low income, OR(a) 2.28 (1.63-3.19); lower middle income, OR(a) 1.72 (1.27-2.33); middle income, OR(a) 1.73 (1.28-2.36). There is a significant relationship between sociodemographic factors and ID. Similar patterns were found for both mild and severe ID. Recommendations are given for preventing ID in Chinese children.