Developmental Disabilities Research Articles

How youth of color with mental disabilities are excluded from school: A DisCrit and logistic regression analysis.

In the United States, youth of color, youth with a trauma history, and youth with disabilities are suspended and expelled at higher rates than their white peers without disabilities and trauma. Few researchers examine how this gap intersects to impact exclusionary discipline. DisCrit guides the article because it explains the pathways that lead to the overrepresentation of disabled youth of color in school exclusionary discipline through public policy. The purpose is to analyze the Minnesota Student Survey (2019) to examine how the impact of trauma on exclusionary discipline varies by race and disability. The main goal of this study was to examine the impact of ACEs on exclusionary discipline outcomes for youth of color with mental disabilities (MD). In the Minnesota Student Survey (2019), we use a representative sample (N=104,043) of students' self-reported data from all public school districts in Minnesota. We conducted a logistic regression analysis of students with ACEs on exclusionary discipline. ACEs (odds ratios [OR]=1.91) and youth with MD (OR=1.36) are strongly associated with exclusionary discipline among youth of color. Lastly, the odds of exclusionary discipline are higher for youth with ACEs and a known MD than those youth without an MD but with ACEs among youth of color (OR=0.74) and white youth (OR=0.75). The results confirmed youth of color with MD are at higher risk for exclusionary discipline with undersupported ACEs than their white peers without MD. Implications for social work collaboration are discussed for school mental health services.

Multiple developmental disabilities among American children: prevalence and secular trends 2016–2022

ObjectivesWe aimed to estimate the prevalence of multiple developmental disabilities, identify associated characteristics, and examine trends among American children from 2016 to 2022. Study designThis was a cross-sectional study. MethodsUsing the National Survey of Children's Health data from 2016 to 2022, we estimated the prevalence of multiple developmental disabilities among children aged 3–17 years. Multiple developmental disabilities were defined as two or more concurrent disabilities from 12 common disabilities. Trends were investigated using log-linear regression. Multivariate log-binominal regression was used to compare the prevalence prior to the COVID-19 pandemic (2016–2019) with prevalence during the COVID-19 pandemic (2020–2022). ResultsFrom 239,534 eligible children (mean age = 10.1 years; male = 51.7%), we found the overall prevalence of multiple developmental disabilities was 10.6%. The most predominant phenotype was attention-deficit/hyperactivity disorder concurrent with behavioural problems (2.1%). Higher prevalence was found among boys, non-Hispanic black children, those from low-household-income families and from families with lower education levels. Prevalence of multiple developmental disabilities increased from 9.8% in 2016 to 11.5% in 2022 (P = 0.014) with significantly higher prevalence during COVID-19 pandemic than before (11.2% vs 10.1%). These increases were found consistently across most sociodemographic groups. ConclusionsChildren from certain socio-disadvantaged groups were disproportionally affected by multiple developmental disabilities, highlighting the need for targeted strategies to improve health. The increasing prevalence during the pandemic suggests the need for ongoing monitoring of the trend and the impact of these conditions.

The effects of mosaicism on biological and clinical markers of Alzheimer's disease in adults with Down syndrome

Individuals with Down syndrome (DS) are at high risk of early-onset Alzheimer's disease (AD); yet, some 20 percent do not develop any signs of dementia until after 65 years or in their lifetime. Mosaicism could contribute to this phenotypic variation, where some disomic cells could lead to lower levels of gene products from chromosome21. We examined longitudinal neuropsychological and biomarker data from two large studies of DS: the Alzheimer Biomarker Consortium-Down syndrome study (ABC-DS) (n=357); and a legacy study (n=468). We assessed mosaicism using karyotyping or GWAS data. Participants had data on plasma AD biomarkers (Aβ40, Aβ42, tau, and NfL) and longitudinal cognitive measures. A subset had cerebrospinal fluid biomarkers (Aβ40, Aβ42, tau, ptau181, and NfL) and amyloid and tau PET data. For both cohorts, the prevalence of mosaicism was <10% (ABC-DS: 7.3%; Legacy: 9.6%), and those with mosaicism had lower plasma Aβ40 and Aβ42 concentrations. For the older legacy cohort, when compared to those with full trisomy, those with mosaicism had significantly smaller decline in total and annualized neurocognitive scores, and lower incidence and prevalence of dementia. Mosaicism in DS was associated with lower concentrations of plasma Aβ peptides, possibly leading to lower AD risk. However, its clinical impact was less clear in the younger ABC-DC cohort, and a follow-up study is warranted. National Institutes of Health (R01AG014673, P01HD035897, R56AG061837), NIA (U01AG051412, U19AG068054), NICHD, ADRC programs, the Eunice Kennedy Shriver Intellectual and Developmental Disabilities Research Centers Program, and NCATS (UL1TR001873).

The contribution of yoga to children with mental health disabilities: A scoping review

Background: Children with mental health difficulties often experience challenges in motor and physical skills, stress, anxiety and emotional difficulties. Yoga can help these children in engaging in social environments providing physical and motor improvements, emotional regulation, cognitive and behavioural control. Aim: Yoga is an approach that can help children with any occupational challenges and diagnosis. The aim of this scoping review is to explore the contribution of yoga for children with mental health disabilities, to inspire healthcare professionals to determine whether to promote yoga as a beneficial intervention for children with special needs and highlight a beneficial outcome in implementing yoga that can help the parents, caregivers and the children to fulfill their needs. Methodology: A scoping review of the existing literature was conducted based on databases such as AMED, CINAHL, Academic Search Complete and Google scholar. The studies focusing on the contribution of yoga for children with mental health disabilities were selected by taking into account the inclusion and exclusion criteria, as well as the use of PRISMA guidelines. Results: The review of the literature retrieved 11 studies for a time period from 2005 to 2024. The studies reviewed provide convincing evidence that yoga is an accessible and effective intervention for populations that have physical, emotional and cognitive difficulties. Significant improvements were highlighted in motor skills, emotional regulation, cognitive and behavioural control. It is also underlined that yoga can be an essential part of therapeutic programs for children with intellectual disabilities. However, the variety in physical outcomes, specifically for children with cerebral palsy that have physical challenges, highlights the need for additional supporting interventions. Conclusions: The 11 articles reviewed had generally showed that yoga is an effective intervention for children with mental health difficulties. The combination of physical movements, mindfulness and breathing are perfectly suited for multidimensional challenges for children with mental health disabilities. Yoga’s effectiveness in a diversity of populations for children with autism, ADHD, children with psychiatric issues show that yoga can be acceptable and has a broad potential as therapy for these children.

Impact of Inclusive Schooling in the Management of the Children with Downs Syndrome

Abstract: Education is Human right. Every children irrespective of their caste,culture,society and intellectual ability have equal right to education .The same is for children with mental disabilities like Down’s syndrome .Inclusive schooling can reduce discrimination and provide them normal learning environment.

A Multilevel Analysis of Attitudes towards Inclusive Education among Teachers of Students with Developmental Disabilities in China: School Factors Matter.

Teachers' attitudes towards inclusive education (ATIE) are crucial for educating students with developmental disabilities. The school environment plays an important role in shaping teachers' ATIE. This study aimed to examine the effects of three school factors (i.e., perceived school support, perceived principals' leadership, and in-service training) on teachers' ATIE and the mediating effect of self-efficacy in the relationships. A total of 972 teachers who taught students with developmental disabilities in 49 inclusive elementary schools in Beijing, China, participated in this study. Multilevel analysis was performed to analyze the data. After controlling for demographics, at the school level, administrative support (one dimension of perceived school support) positively predicted teachers' ATIE. At the individual level, teachers' ATIE were positively predicted by emotional support (one dimension of perceived school support) and in-service training, but negatively predicted by transactional leadership (one dimension of perceived principals' leadership). Self-efficacy mediated the positive effects of transformational leadership (one dimension of perceived principals' leadership), emotional support, and in-service training on ATIE. Administrative support, emotional support, transformational leadership, and in-service training are conducive to fostering positive ATIE among teachers of students with developmental disabilities, and the underlying mechanism is explained by the mediating role of self-efficacy.

Maternal insulinemic and inflammatory dietary patterns and risk of child neurodevelopmental delay.

Our aim was to assess the risk of higher insulinemic, inflammatory, and hyperglycemia potential in the diet during pregnancy with child neurodevelopmental delay. We enrolled 7,438 pregnant women participating in a prospective cohort study. The food frequency questionnaire was used to evaluate the empirical dietary index for hyperinsulinemia (EDIH), empirical dietary inflammatory pattern (EDIP), glycemic index (GI), and glycemic load (GL) during mid-pregnancy. Child neurodevelopmental assessment was conducted at 6-36 months postpartum using the Denver Developmental Screening Test-II (DDST-II) scale, and the Gesell Developmental Diagnosis Scale (GDDS) was administered to assess children who did not meet the criteria for passing the DDST-II screening. We documented 540 incident child neurodevelopmental delay cases over 7,438 pregnant women (median follow-up: 2 years). Pregnant women exhibiting the high levels of hyperinsulinemic or proinflammatory components, or GI encountered an elevated risk of child neurodevelopmental delay; HRs (95% CI) comparing highest to lowest dietary index quintiles were EDIH 1.48 (1.07,2.04; P trend = 0.017), EDIP 1.39 (1.05,1.84; P trend = 0.019) and GI 1.36 (1.02,1.81; P trend = 0.038). In sex-stratified analyses, these results remained significant only in boys (P trend = 0.018 for EDIH, P trend = 0.028 for EDIP, P trend = 0.029 for GI). The performance of combined model of EDIH and EDIP for boys is comparable to that of the combined model of EDIH, EDIP, and GI to assess the risk of neurodevelopmental delay (AUC [area under curve] 0.801 vs. AUC 0.830). Both values are higher than the AUC values achieved by models using either set of indicators individually. Our findings suggest that maternal consumption of diets with high insulinemic, inflammatory, or glycemic index properties may be associated with neurodevelopmental delays in children, particularly in boys. Higher insulinemic and inflammatory potentials in maternal diet may forecast neurodevelopmental delay in boys.

Homozygous PGAP2 mutation cause hyperphosphatasia with mental retardation syndrome-3 (HPMRS3): Genetic and clinical evaluation of the ultra rare inherited glycosylphosphatidylinositol (GPI) biosynthesis defect

Introduction: Inherited glycosylphosphatidylinositol biosynthesis defect is considered a subset of the congenital glycosylation disorder that result from mutations in the genes encoding proteins participating in glycosylphosphatidylinositol biosynthesis and modification. Glycosylphosphatidylinositol anchor proteins play important roles in numerous cellular processes including neurogenesis, cell adhesion, immune response and signalling. Hyperphosphatasia with mental retardation syndrome-3 is one of the Glycosylphosphatidylinositol anchor defects, characterized by moderate to severe intellectual disability, dysmorphic features, hypotonia, seizures and persistent hyperphosphatasia. The aim of this study was to investigating the clinical implications of the PGAP2 gene and identifying the severe phenotype. Case Presentation: A male patient with dysmorphic features, neurodevelopmental delay, seizures, hearing loss, Hirschsprung disease, central fever and elevated alkaline phosphatase was included in the study. The magnetic resonance imaging showed cerebral atrophy, corpus callosum hypoplasia. The whole exome sequencing analysis of the individual, and Sanger sequencing were performed for segregation. Additionally, next generation sequencing, whole transcriptome sequencing and homology modelling and analysis were performed. Whole exome sequencing revealed a homozygous c.651C&gt;G (p.His217Gln) in the PGAP2 gene. The Sanger sequencing confirmed the parents were heterozygous. There is no splicing variant was detected by whole transcriptome sequencing. The AlphaFold model was interpreted hypothetically. It was observed the substitution of histidine, with glutamine and may affect the stability of protein. Discussion: Homozygous PGAP2 mutations in the patient we reported in our study resulted in a severe clinic including, severe developmental delay and intellectual disability, severe epilepsia, dysmorphic features, central fever, biochemical, hormonal and immunological abnormalities. This patient would be the youngest case published in the literatur. We showed that, the instability of mutant PGAP2 protein that cause Hyperphosphatasia with mental retardation syndrome-3 lead to more severe phenotypes.

About Whom Are We Talking When We Use Intellectual and Developmental Disabilities?

Communicating clearly about who is included in a population group is a critical element to effective dissemination and knowledge transfer. This narrative review highlights the inconsistency as it relates to communicating about individuals with intellectual disability (ID) and developmental disability (DD). There is enormous variability in the use of definitions and abbreviations in the field of intellectual disability and developmental disabilities. The lack of consistency has resulted in widely varying reported rates of prevalence and has contributed to confusion around the interpretation of research and clinical findings, population statistics, and policy decisions. The reported rates of prevalence for developmental disabilities published by different US federal agencies have ranged widely from 3% to 17%. This represents a 5-fold difference. Equally confusing is the inconsistent and ambiguous adoption of initialisms. These initialisms include ID/DD, IDD, and I/DD for which it is not always clear if these initialisms reference separate and independent populations (eg, ID or DD) or populations with co-occurring conditions (eg, persons with ID and DD). This Narrative Review discusses these issues and proposed a number of recommendations that would contribute to enhanced consistency and clarity of understanding for stakeholders, administrators, practitioners, researchers, and policy makers. Authors of scholarly works, clinical publications, policies, and position papers are encouraged to provide a clear operational definition as well as the choice of initialisms used (eg, ID/DD, IDD, I/DD, etc) when it is first used.

Establishing an Advocacy Activities Scale for Parents of Individuals With Intellectual and Developmental Disabilities.

Advocacy has long been heralded as a way to create change for individuals with intellectual and developmental disabilities (IDD) and their families. However, without an established measure, it is difficult to accurately characterize advocacy activities. Drawing from extant research, the Advocacy Activities Scale was developed to assess three domains of parent advocacy: advocacy for one's own children, advocacy for other families, and advocacy for systemic change. Factor analyses were conducted using data from two projects reflecting 382 parents of individuals with IDD from seven states and the District of Columbia. The scale confirmed the three moderately correlated domains of parent advocacy and demonstrated that the scale has high: reliability, validity, test-retest reliability, and moderate correlations with related measures.

Racial/Ethnicity Disparities in COVID-19 Worry for Caregivers of Adults With Intellectual and Developmental Disabilities.

This study investigated the racial/ethnic differences in COVID-19-related worry amongst family caregivers of adults with intellectual and developmental disabilities (IDD) living in Texas using the COVID-Related Thoughts and Behavioral Symptoms-Adult Version (COV-TaBS-A) questionnaire. Two hundred and six caregivers completed the survey. Compared to White caregivers, Latino caregivers were more likely to be very concerned about having enough food and supplies (adj OR 3.41, 95% CI [1.50, 7.74]) when adjusting for being that sole caregiver and using provider services. In free text questions, caregivers described feeling overwhelmed by additional responsibilities, disruptions in home health services, and concerns about their loved ones' wellness. Study findings can be used to strategize support for caregivers of adults with IDD during pandemic/emergency situations.

Access and Barriers to Mental Health Resources for College Students in an Inclusive Postsecondary Education (IPSE) Program: A Qualitative Inquiry

ABSTRACT Introduction This study sought to explore the lived experiences of college students with intellectual and developmental disabilities (IDD) and their understanding and access of mental health resources, as well as potential barriers to accessing these resources. Method Fourteen college students with IDD enrolled in an inclusive postsecondary education (IPSE) program completed a semi-structured interview about their experiences with mental health resources. The research team utilized interpretative phenomenological analysis (IPA) and generated group experiential themes from exploratory notes and individual experiential statements. Results Following data analysis, six themes emerged that describe the participants’ experience with the phenomena (i.e. understanding, accessing, and barriers to mental health resources). The themes are: (a) using resources and services provided by an IPSE program; (b) using resources and services provided by their Institute of Higher Education (IHE); (c) satisfaction with current IHE resources available; (d) family and friends as a mental health resource; (e) recognizing importance of and attuning to emotions; and (f) navigating barriers to mental health resources. Conclusion These themes highlight potential practices and policies that the Institutes of Higher Education (IHE) and IPSE programs may consider as they strive to make higher education and mental health resources more accessible to individuals with IDD. Limitations and future research suggestions are also provided.

The possible association of two novel heterozygous GNB1 variants with obesity and metabolic disorders.

Variants in the GNB1 gene, which encodes for the beta-1 subunit of G proteins, have been associated with intellectual development disorder (OMIM: 616973), characterized by developmental delay, infantile hypotonia, seizures, and psychiatric problems. GNB1 variants may also cause a multisystem disorder, with symptoms such as hearing and vision impairment, gastrointestinal disorders, genitourinary abnormalities, and growth delay. We present two pediatric patients with two novel GNB1 variants. The first patient is a 12-year old Caucasian European female with a history of neonatal hypotonia, feeding difficulties, and failure to thrive for the first 2 years of life. Subsequently, she developed grade 3 obesity, hyperphagia, and autoimmune thyroiditis. Whole Exome Sequencing (WES) revealed a novel likely pathogenic variant in the GNB1 gene (NM_002074.5:c.93_94del, p.Gln32AspfsTer46), which is predicted to result in a loss or disruption of normal protein function through nonsense-mediated decay (NMD) or protein truncation. The second patient is a 2-year old Roma female with severe failure to thrive during infancy, congenital hypothyroidism, and transient hyperoxaluria. No developmental delay was identified. Genetic testing excluded primary hyperoxaluria and WES revealed to be a novel likely pathogenic variant {NM_002074.5:c.183G > T (NP_002065.1:p.Met61Ile), which is predicted to have a damaging effect on the gene or gene product. We present two rare pediatric cases with novel GNB1 variants which highlight the phenotypic variability associated with disrupted GNB1 expression. GNB1 may serve as a candidate gene for severe early onset obesity, hyperphagia, neurodevelopmental delay, and other metabolic and endocrine disorders.

Teachers’ Perceptions of Barriers to Implementing School-Based Sexual Health Education for Students with Intellectual and Developmental Disabilities

Students with intellectual and developmental disabilities (IDD) are often excluded from school-based sexual health education despite the need and benefits. This qualitative study explored teacher-identified barriers to implementing school-based sexual health education for students with IDD. Thematic analysis of focus groups (n = 19 special education teachers) and interviews (n = 7 health education teachers) revealed four themes: (1) misbeliefs and stigma; (2) parent/caregiver and school administrator support; (3) teacher preparedness; and (4) lack of evidence-based curricula/materials for the population. Recommendations are provided at the student-, interpersonal-, community-, institutional-, and policy-/system-level to support increased implementation of school-based sexual health education for students with IDD.

Sex Trafficking Prevention for Youth with Intellectual and Developmental Disabilities: Service Provider Perspectives

ABSTRACT Given the paucity of research on sex-trafficking prevention education for youth with intellectual and developmental disabilities (IDD), this qualitative study aimed to determine service providers’ (N = 22) perspectives regarding (a) topics and delivery methods to include in this programming, (b) factors that promote accessibility, and (c) challenges and recommendations associated with implementation. Individual interviews and focus groups were conducted using Zoom. For programming acceptability, participants identified challenges (e.g. misconception that individuals with IDD are asexual) and recommendations (e.g. teaching developmentally appropriate concepts in early childhood). For content and delivery, topics included consent, safety, and context/social rules. Tactical activities for self-care and sensory processing, and non-infantilizing, realistic visuals were recommended to improve accessibility. For systems involvement in disclosures and referrals, participants noted challenges (i.e. confusion about agency responsibility and information sharing) and recommendations (i.e. ensuring a clear and predictable disclosure process for youth). Findings can contribute to policy development, particularly in service provider training for responding to disclosures and clarifying funding allocation for school and community sex trafficking prevention.

Repeated use of hospital-based services and delayed hospital discharges in a population-based cohort of autistic adults in Canada.

We know that autistic people have more health problems and are more likely to go to the emergency department and get hospitalized than other people, but we know less about the problems they have once they get to the hospital. In this study, we looked at all autistic adults in Ontario and compared them to adults who were not autistic and to adults who had other kinds of developmental disabilities to see who came back to the emergency department in the month after an emergency department visit, who got re-hospitalized in the month after being sent home from hospital, and who stayed in the hospital longer than they needed to because there was no place appropriate for them to go to. We found that both autistic males and females were more likely to have these things happen to them than the same age- and sex-matched adults who did not have developmental disabilities. We also found that adults with other kinds of developmental disabilities had similar problems to autistic people. This makes us think that we need to work harder to improve health care for autistic adults and adults with other developmental disabilities when they come to hospital. We also need to make community services work better, and work more closely with hospital services, so that people only come to hospital when they need to and that they can go home when they are ready.

15q24 Duplication: A Case Report of Neurodevelopmental Delay.

Chromosomal rearrangements are structural anomalies that affect chromosomal architecture and can impact gene expression, genomic imprinting, or even generate de novo gene fusions, as seen in hematological chromosomal aberrations. Chromosomal rearrangements can be associated with syndromes causing neurodevelopmental delay, autism spectrum disorder, and variable dysmorphic features. This article presents the clinical and molecular characteristics of a 2-year-old male child with neurodevelopmental delay who was diagnosed with a chromosomal rearrangement due to a 15q24 duplication (dup15q24). The 15q24 locus presents controversy between the phenotype associated with duplication and deletion, thus posing a challenge in differential diagnosis for both. The phenotypes of autism spectrum disorder and pediatric patients with language delay should be evaluated by a multidisciplinary team comprising genetics, pediatrics, and pediatric neurology to shorten the diagnostic odyssey for patients with rare diseases and to impact the quality of life of the patient and their family.

Association between parents’ perceived social support and children’s psychological adjustment: a cross-sectional study

BackgroundThis study examined the relationship between parents’ perceived social support and their children’s psychological adjustment.MethodsThis cross-sectional survey study was conducted in 52 kindergartens and 78 preschools in Nagoya, Aichi, a major metropolitan area in Japan. Parents of eighth-grade children aged 13–14 years (N = 1,195) completed a questionnaire. A total of 602 valid responses were received. To accurately assess the relationship between parents’ perceived social support and behavioral characteristics, respondents diagnosed with a developmental disability or who failed to answer the required questionnaire items were excluded from the analysis. Consequently, 536 (89.0%) of the 602 participants met the eligibility criteria.ResultsThe results indicated that the stronger the social support for parents, the lower the scores for externalizing and internalizing problems, and the higher the scores for prosociality. Conversely, insufficient social support may pose a risk to parental mental health and lead to suboptimal parenting practices. Issues in parental mental health adversely affect parenting, leading to fewer positive interactions with young children, increased rates of negative interactions and hostility, diminished communication, and delayed responses to children’s behaviors.ConclusionsThese results underscore the significant influence of parents’ perceptions of social support on their parenting beliefs and behaviors, which may, in turn, affect the development of their children’s mental health. Therefore, parents’ perceptions of social support are likely positively associated with children’s mental health.

Executive Function in Children Born Moderate-to-Late Preterm: A Meta-Analysis.

The risk of early neurodevelopmental delay is increasingly recognized in children born moderate-to-late preterm (MLP; 32-36 weeks' gestation), but school-aged cognitive outcomes are unclear, particularly for domains such as executive function (EF). To evaluate EF outcomes (attentional control, cognitive flexibility, and goal setting) in school-aged children born MLP compared with children born at term. Medline, Embase, PsycInfo, and Scopus. Studies assessing EF outcomes (overall EF, attentional control, cognitive flexibility, and goal setting) in children born MLP aged between 6 and 17 years, which included a term-born control group. Two reviewers screened for eligibility and completed the risk of bias assessment using the Newcastle-Ottawa Scale, and 1 reviewer extracted data. Random effects meta-analyses were performed. Twelve studies were eligible for inclusion in the meta-analyses (2348 MLP children and 20 322 controls). Children born MLP had poorer overall EF compared with children born at term (standardized mean difference, -0.15, 95% confidence interval, -0.21 to -0.09; P < .0001; I2 = 47.59%). Similar conclusions were noted across the subdomains of attentional control, cognitive flexibility, and goal setting. Study methodologies and EF measures varied. Only a small number of studies met eligibility criteria and were from developed countries. School-aged children born MLP may experience greater challenges in EF compared with term-born children. Further research is needed to investigate the potential impact these challenges have on functional outcomes such as academic achievement and social-emotional functioning.

Examining Axiological and Ethical Assumptions in Physical Activity Intervention Research involving Individuals With Intellectual Impairments: A Review.

Adapted physical activity has been critiqued for its lack of attention to assumptions underlying both research and practice. In response to these critiques, the purpose of this paper was to perform a secondary analysis of a recent systematic literature review to examine the axiological and ethical assumptions of physical activity intervention research involving adults with Down syndrome since 1990 in light of the possibilities of critical disability studies. Findings revealed the dominance of normative movement ideologies and a focus on physical activity performance. Participants were not afforded research roles beyond that of subjects, and there was no evidence of results being communicated to them. In future, we hope scholars will consider the use of emancipatory frameworks where power is situated within the community involved and more inquiry that expands our understanding of the benefits of physical activity for individuals with intellectual impairment that decenters the focus on normative ways of being.