Severe Intellectual Disability Research Articles

Losing a child with a severe developmental intellectual disability: Israeli mothers' accounts.

Caring for a child with a severe developmental intellectual disability is often extremely challenging. Consequently, if such a child passes away, the grieving process may be complex. In the present study, we sought to characterize Israeli mothers' meaning (re)construction in the face of such loss. Eight mothers who lost a child with severe developmental intellectual disability participated in in-depth semistructured interviews. Employing Interpretative Phenomenological Analysis, three primary meaning templates were identified from their narratives: regrieving the lost child, the duality of grief and relief, and continuous disenfranchisement. The findings revealed a distinctive rupture in the self-narratives of grieving mothers and depicted the intricately intertwined reality of living with and losing a severely disabled child. The interplay between personal and social aspects of this unique grief experience is highlighted, and practical implications are considered. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Using heart rate monitoring to discover pain and discomfort in non-verbal persons with severe intellectual disability: Caregivers’ experiences

Using heart rate monitoring to discover pain and discomfort in non-verbal persons with severe intellectual disability: Caregivers’ experiences

Exploring Concurrent Approach for Respiratory Epidemiological Surveillance and Symptom Screening (CARES): a new strategy for preventing respiratory infection outbreaks in long-term care facilities.

The Concurrent Approach for Respiratory Epidemiological Surveillance and Symptom Screening (CARES) combines symptom screening to prevent external respiratory infections by managing staff and visitor health and surveillance to monitor the infection rates within the facility and take timely decisions on activity programs based on outbreak prevalence. This study examines the efficacy of the CARES strategy in preventing respiratory infection outbreaks in long-term care facilities. Prospective cohort study utilizing historical controls including an intervention and control group. This study was conducted in two long-term care facility wards (total: 110 beds) in Japan. We enrolled patients aged 1-72 years from the target ward with severe intellectual and physical disabilities from October 1, 2018, to March 31, 2019, and from October 1, 2017, to March 31, 2018, for the intervention (n = 104) and control (n = 98) groups, respectively. The study included all admitted patients and excluded those hospitalized or discharged during the study period. The total number of days that activity programs, new admissions, and visitations were cancelled in the two groups was compared before and after the introduction of CARES. CARES reduced the duration of new admission cancellations and visitation cancellations by 16 and 23 days, respectively (α = 0.1, P value < 0.001). Additionally, the maximum duration of activity program cancellations was reduced by 2 days. Furthermore, five cases of presenteeism were prevented. CARES improves patients' quality of life by continuation of activity programs, new patient admission, and ongoing visitations.

Leveraging Artificial Intelligence to Enhance Implementation of Research-Based Practices for Teaching Students with Moderate to Severe Intellectual Disability

Artificial intelligence (AI) has transformative potential to support the education of students with moderate to severe intellectual disabilities (M/SID) and their teachers. Although research and evidence-based practices (EBPs) are integral to fostering positive student learning outcomes, educators face challenges in effectively implementing these strategies. In this article, we discuss how higher education faculty can prepare educators to harness the use of AI as a powerful tool to support the implementation of EBPs in the classroom, addressing teacher fluency and maintenance of application.

Microduplications of ARID1A and ARID1B cause a novel clinical and epigenetic distinct BAFopathy

BackgroundARID1A/ARID1B haploinsufficiency leads to Coffin-Siris syndrome, duplications of ARID1A lead to a distinct clinical syndrome, whilst ARID1B duplications have not yet been linked to a phenotype. MethodsWe collected patients with duplications encompassing ARID1A and ARID1B duplications. Results16 ARID1A and 13 ARID1B duplication cases were included with duplication sizes ranging from 0.1-1.2 Mb(1-44 genes) for ARID1A and 0.9-10.3 Mb(2-101 genes) for ARID1B. Both groups shared features, with ARID1A patients having more severe intellectual disability, growth delay and congenital anomalies. DNA methylation analysis showed that ARID1A patients had a specific methylation pattern in blood, which differed from controls and from patients with ARID1A or ARID1B loss-of-function variants. ARID1B patients appeared to have a distinct methylation pattern, similar to ARID1A duplication patients, but further research is needed to validate these results. Five cases with duplications including ARID1A or ARID1B initially annotated as duplications of uncertain significance were evaluated using PhenoScore and DNA methylation re-analysis, resulting in the reclassification of two ARID1A and two ARID1B duplications as pathogenic. ConclusionOur findings reveal that ARID1B duplications manifest a clinical phenotype and ARID1A duplications have a distinct episignature that overlaps with that of ARID1B duplications, providing further evidence for a distinct and emerging BAFopathy caused by whole gene duplication rather than haploinsufficiency.

De onbegrepen wereld van matig, ernstig en diep verstandelijk beperkte kinderen met autisme

Children with moderate, severe or profound intellectual disabilities form a small but significant subgroup within the autism spectrum with high and very specific needs. This article reviews their behavioural characteristics and the way they process sensory stimuli and information. Because these children are – unlike people with a normal intelligence – unable to articulate their needs, an attempt is made to give a sketch of their unique experiential world: how do they experience the world, other people and themselves?

Expanding the genetic and clinical spectrum of Tatton-Brown-Rahman syndrome in a series of 24 French patients

BackgroundTatton-Brown-Rahman syndrome (TBRS; OMIM 615879), also known as DNA methyltransferase 3 alpha (DNMT3A)-overgrowth syndrome (DOS), was first described by Tatton-Brown in 2014. This syndrome is characterised by overgrowth, intellectual disability...

Events of children responsible for the development of epilepsy in patients with cerebral palsy

Background: Cerebral palsy (CP) is characterized by abnormal muscle tone, ‘posture, and movement’, thereby limiting the activity of the affected person. Epilepsy is said to occur in 15-90% of children with CP. The aim of this study was to evaluate the events of children responsible for the development of epilepsy considering natal, postnatal characteristics and associated impairment in patients with CP. Methods: This was a case-control study and was conducted in the Department of Pediatric Neurology at the National Institute of Neurosciences and Hospital, Dhaka, Bangladesh during the period from January 2020 to December 2020. In total 150 children with cerebral palsy were enrolled in this study who were divided into two groups. In the ‘CP with epilepsy’ group, there were 50 patients, and in the CP without epilepsy group taken as a case group, there were 100 age-sex matched CP patients without epilepsy patients were taken as a control group. Informed written consent was taken from all the parents. Along with baseline characteristics, data regarding natal, postnatal events, general clinical findings, psychological assessment, computed tomography (CT) scan findings of the head, and electroencephalogram (EEG) findings in epilepsy cases were recorded in a predesigned questionnaire and analyzed. Results: In distributing the CP patients’ comparison regarding postnatal complications neonatal seizures were a strong predictor for epilepsy (p≤0.001). 1st seizure during 1st year of life and family history of epilepsy was also a significant event of epilepsy (p≤0.001). In the case of microcephaly, no significant difference was observed between groups (p=0.278). A significant difference was observed when the distribution of severity of intellectual disability of CP patients was compared between groups (p&lt;0.001). Abnormal CT scan findings of the head were significantly higher in CP with epilepsy 42 (84.0%) than in CP without epilepsy 46 (46.0%) (p≤0.001). The total mean age at the onset of epilepsy was 13.58±14.47 months. Epilepsy was most common in spastic quadriplegic CP (54%). 38.0% had focal epileptiform activity on EEG. Clinically focal epilepsy was found in 36.0% of cases. Conclusions: This study demonstrates the presence of a history of neonatal seizure, 1st seizure during 1st year of life, a family history of epilepsy, CT scan abnormalities, severe intellectual disability, and spastic quadriplegic CP were the events responsible for the development of epilepsy in children with CP.

Stigma toward individuals with intellectual disabilities and severe mental disorders: analysis of postgraduate university students’ perceptions

PurposeThe purpose of this study is to delve into societal stigma surrounding severe mental disorders and intellectual disabilities, emphasizing gender differences and students’ proximity influence.Design/methodology/approachInvolving 572 Spanish master’s students, this nonexperimental study categorizes participants based on contact frequency, using Goratu and CAEE questionnaires to measure stigma.FindingsGender-based stigma differences are absent; however, increased contact correlates with lower stigma levels. Notably, greater closeness is associated with more positive attitudes toward intellectual disability, resulting in diminished stigma toward severe mental disorders.Practical implicationsThis research sheds light on the pervasive stigma faced by individuals with intellectual disabilities and severe mental disorders among postgraduate university students. Notably, the recognition of widespread stigma among individuals with higher education highlights a more significant societal problem. The findings underscore the urgent need for targeted interventions, especially in higher education contexts, to enhance understanding and reduce societal bias.Social implicationsBy identifying factors influencing stigma and emphasizing the importance of contact in fostering empathy, the study lays the groundwork for informed socioeducational strategies. These strategies have the potential to promote inclusivity, challenge stereotypes and contribute to the well-being and social integration of those affected by intellectual disabilities and severe mental disorders.Originality/valueThe findings highlight the efficacy of direct contact in reducing stigma and underscore the necessity for nuanced understanding. The study suggests fostering positive attitudes through increased contact can combat prejudice and promote social inclusion. Nevertheless, further research is crucial to explore factors influencing stigma reduction and design comprehensive socioeducational interventions addressing diverse cultural proficiencies. This study contributes valuable insights for mitigating stigma, fostering inclusivity and informing future interventions.

Children and adolescents with severe motor and intellectual disabilities who underwent kidney transplantation.

Kidney transplantation (KT) in children and adolescents with severe motor and intellectual disabilities (SMID) has been a topic of controversy. A multicenter study in Japan showed that KT was not contraindicated for children with multiple handicaps, but no consensus has been reached on KT for patients with SMID. This study aimed to determine whether KT is a viable treatment option for children and adolescents with SMID. A single-center, retrospective study was conducted on children and adolescents with SMID who underwent KT. SMID was defined based on Oshima's classification. Clinical information was collected through a review of medical records. Of 453 children and adolescents who underwent KT between 1983 and 2023 in our institution, six (1.3%) patients with SMID were identified. One patient received KT twice. All patients underwent living KT. Five patients used medical devices, including gastrostomy and a ventriculoperitoneal shunt, prior to KT. Perioperative complications, including hemothorax related to central venous catheter insertion, ventilator-associated pneumonia, and common iliac artery thrombosis requiring graftectomy, occurred in three patients. One patient required vesicostomy owing to refractory urinary tract infection. There was no significant difference in the graft survival rate between patients with SMID and those without SMID. One patient developed graft failure and died after selecting conservative kidney management. Our study showed a favorable graft survival in children and adolescents with SMID who underwent KT. Although careful perioperative management and continued medical care are required, KT may be a viable option for these patients.

Health economic impact of patients with phenylketonuria (PKU) in France – A nationwide study of health insurance claims data

BackgroundPhenylketonuria (PKU) is an inherited metabolic disease. If left untreated, it can lead to severe irreversible intellectual disability and can cause seizures, behavior disturbance, and white matter disease. This study aimed at evaluating the health economic impact of patients with PKU in France. MethodsThis retrospective observational study used health insurance claims data from the French SNDS (Système National des Données de Santé) database, which contains data from over 66 million French inhabitants. Patients with PKU were identified by ICD-10 diagnosis codes E70.0 (PKU) and E70.1 (Other hyperphenylalaninemia) documented as a chronic condition (affection de longue durée – ALD) or in the inpatient setting in the SNDS database between 2006 and 2018. Patients with PKU were matched to controls without PKU by age, sex, and region. Patients with early- and late-diagnosed PKU were defined as patients born after and before the implementation of nationwide newborn screening in France in 1972, respectively. Outcomes were analyzed for the year 2018. ResultsOverall, 3549 patients with PKU were identified in the database on January 1st, 2018. Of those, 3158 patients versus 15,703 controls with at least one healthcare consumption in 2018 were available for outcome analyses. Patients with PKU had 7.7 times higher healthcare costs than non-PKU controls in 2018 (€11,144 versus 1456 mean costs; p < 0.0001). Pharmaceutical costs including dietary amino acid supplements were the cost driver and contributed 80.0% of the overall mean difference (MD) between patients with PKU and matched non-PKU controls. More than half (52.4%) of the mean pharmaceutical costs per patient with PKU was attributable to medical foods including dietary amino acid supplements.Of the 3158 patients with PKU, 2548 (80.7%) were classified as early-diagnosed and 610 (19.7%) as late-diagnosed. Increased healthcare costs, in comparison to non-PKU controls, were more evident in early-diagnosed patients (€11,263 versus €855 mean costs; 13.2-fold increase; p < 0.0001). For patients with late-diagnosed PKU, healthcare costs were 2.7-fold higher compared to matched non-PKU controls (€10,644 versus €3951 mean costs; p < 0.0001). Outpatient pharmaceutical costs accounted for 89.1% of the MD between early-diagnosed patients and controls. Among late-diagnosed patients, 55.5% of the MD were attributable to costs for inpatient care, followed by costs for outpatient care (23.9%) and outpatient pharmaceutical costs (20.6%). ConclusionThe results indicate that PKU is associated with substantially increased health care costs compared to non-PKU controls in France. The health economic impact was most evident in patients with early-diagnosed PKU due to increased outpatient pharmaceutical costs, especially for medical foods including dietary amino acid supplements. For late-diagnosed and by definition older patients with PKU, the excess costs compared with matched controls were mostly driven by costs for inpatient care.

A Review of Reading Interventions for Students With Moderate and Severe Intellectual Disabilities

A Review of Reading Interventions for Students With Moderate and Severe Intellectual Disabilities

Successful Electroconvulsive Therapy in Aicardi-Goutières Syndrome Presenting Psychiatric Symptoms: An Unprecedented Clinical Case.

Aicardi-Goutières syndrome (AGS) is a rare genetic disorder that primarily affects the central nervous system and is characterized by severe intellectual and physical disabilities. Although AGS traditionally exhibits nonpsychiatric symptoms, our case challenges this norm by presenting an 18-year-old male with AGS who developed distinctive psychiatric manifestations that required hospital admission.The patient, diagnosed with spastic cerebral palsy and thrombotic vasculopathy, displayed abrupt behavioral disturbances, insomnia, and food aversion. Standard assessments revealed basal ganglia calcifications and chilblain-like lesions, and AGS was confirmed via genetic studies that showed a mutation in the SAMHD1 gene. Despite initial treatment with aripiprazole and diazepam, psychiatric symptoms persisted. This led to the initiation of electroconvulsive therapy (ECT) with substantial success, marking its first documented use in AGS.In conclusion, this unique case broadens the comprehension of AGS, introducing psychiatric symptoms and pioneering the successful application of ECT. The intricate interplay of neurovascular involvement, genetic nuances, and innovative treatments underscores the complexity of AGS, encouraging further exploration of its diverse clinical spectrum and evolving therapeutic strategies.

Potentially avoidable mortality among adults with intellectual disability.

Persons with intellectual disabilities (ID) face pronounced health disparities. The aim of this study was to describe premature mortality by causes of death and avoidable mortality among persons with ID compared to the general Danish population. This study is based on a Danish nationwide cohort of adults (aged 18-74 years) with ID (n = 57663) and an age- and sex-matched reference cohort (n = 607 097) which was established by linkage between several registers. The cohorts were followed in the Register of Causes of Death between 2000 and 2020. Causes of death were categorized into preventable, treatable, or unavoidable deaths using the OECD/Eurostat classification and furthermore categorized into specific interventions. We compared the observed and expected number of deaths by calculating standardized mortality ratio (SMR). Among persons with ID the number of deaths was 9400 whereof 5437 (58%) were avoidable. SMR for preventable deaths, e.g. by reducing smoking and alcohol intake or by vaccination, was 2.62 (95% CI, 2.51-2.73), and SMR for treatable deaths, e.g. by earlier diagnosis and treatment, was 6.00 (5.72-6.29). Unavoidable mortality was also six-fold increased (SMR = 6.03; 5.84-6.22). Preventable deaths were higher for persons with mild ID compared to severe ID, while treatable and unavoidable mortality were highest for persons with severe ID. The study confirmed that persons with ID have an amplified risk of mortality across all categories. There is a need for competence development of social care and healthcare personnel and reasonable adjustment of health promotion programs and healthcare services for people with ID.

Autistic features in patients with intellectual disability attending the psychiatry outpatient department of a tertiary healthcare center

Background: Meta-syndromic groups with cognitive and relational impairment include both autism spectrum disorder (ASD) and intellectual disability (ID). When it comes to individuals with intellectual difficulties, autistic traits are often unexplored unless they reach the level of the syndrome. The presence of both autism and ID increases disability percentage. Aim: To study the presence of autistic symptoms in individuals with ID. Materials and Methods: This was a cross-sectional, observational study in which after informed consent from caretakers of patients with ID, clinical history and sociodemographic details were recorded. Further Indian Scale for Assessment of Autism (ISAA) was administered for evaluation of autistic features. Statistical analysis of the data was done using the Chi-square test and Spearman’s correlation. Results: Out of 150 subjects with ID, 18% (n = 27) were diagnosed with comorbid ASD. A statistically significant (P value = &lt;0.001) association was found between the severity of ID (intelligence quotient, [IQ]) and the severity of autism in patients. Various domains of autism like social relation and reciprocity, speech, language, communication, emotional responsiveness, etc., showed a statistically significant correlation with IQ. Conclusion: This study finding also highlights that lower IQ scores, i.e., severe ID have higher incidence and severity of autistic features. Improving assessment both clinically and on objective testing can help in planning rehabilitation for these patients.

Effectiveness of deep brain stimulation on refractory aggression in pediatric patients with autism and severe intellectual disability: meta-analytic review

Some patients with autism and severe intellectual disability may experience uncontrolled aggression, causing serious injury or harm to others, and the therapeutic ineffectiveness of traditional pharmacological and behavioral treatment may aggravate symptoms. Deep brain stimulation (DBS) has been tested in patients with little evidence in children and adolescents. Therefore, we analyzed the efficacy and safety of DBS in refractory aggression in pediatric subjects with autism (ASD) and severe intelligence deficit (ID).Methods A meta-analytic review of Web of Science (WOS) and Scopus articles, following Prisma criteria. A total of 555 articles were identified, but after applying the inclusion criteria, only 18 were analyzed. The review of the registries and the extraction of information was performed by 2 independent groups, to reduce the evaluator’s bias. For the description of the results, pediatric patients with ASD or ID present in each registry, with an application of specialized scales (Overt aggression scale, OAS, and THE modified version of the OAS, MOAS) pre and post-DBS, with a clinical follow-up of at least 12 months, were considered valid. Clinical improvement was calculated using tests of aggressiveness. In each registry with available data and then pooling the means of all patients in the OAS and MOAS, the effect size of DBS (overall and per study) was estimated. Finally, the adapted NOS scale was applied to rate the studies’ quality and level of bias.Results In the studies analyzed, 65/100 were pediatric patients, with a mean age of 16.8 years. Most of the studies were conducted in South America and Europe. In all teams, aggressive behavior was intractable, but only 9 groups (53/65) applied specialized scales to measure aggressiveness, and of these, only 51 subjects had a follow-up of at least 12 months. Thus, in 48/51 a clinical improvement of patients was estimated (94.2%), with a considerable overall effect size (OAS: d = 4.32; MOAS: d = 1.46). However, adverse effects and complications were found in 13/65 subjects undergoing DBS. The brain target with the most evidence and the fewest side effects was the posteromedial hypothalamic nuclei (pHypN). Finally, applying the adapted NOS scale, quality, and bias, only 9 studies show the best indicators.Conclusion An optimal level of efficacy was found in only half of the publications. This is mainly due to design errors and irrelevant information in the reports. We believe that DBS in intractable aggressiveness in children and adolescents with ASD and severe ID can be safe and effective if working groups apply rigorous criteria for patient selection, interdisciplinary assessments, objective scales for aggressiveness, and known surgical targets.

Behavioural interventions to treat anxiety in adults with autism and moderate to severe intellectual disabilities: The BEAMS-ID feasibility study.

The aim of this feasibility study was to adapt and model a behavioural intervention for anxiety with autistic adults with moderate to severe intellectual disabilities. Twenty-eight autistic adults with moderate or severe intellectual disabilities, 37 carers, and 40 therapists took part in this single-group non-randomised feasibility study designed to test intervention feasibility and acceptability, outcome measures, and research processes. The intervention was judged as feasible and acceptable by autistic adults with intellectual disabilities, carers, and therapists. Minor intervention revisions were suggested. Carers completed 100% of outcome measures and the missing data rate was low. Complying with legislation governing the inclusion of participants who lack capacity to decide whether they wanted to take part in this study led to an average 5-week enrolment delay. The intervention and associated study processes were judged to be feasible and acceptable and should now be tested within a larger randomised trial.

Development and psychometric properties of the Clinical Anxiety Scale for People with Intellectual Disabilities (ClASP-ID)

BackgroundThere is a critical need for the development of dependable and valid anxiety assessment tools suitable for people with moderate to severe intellectual disabilities, particularly those who speak few or no words. Distinguishing anxiety from distress caused by physical discomfort (pain) or characteristics associated with autism, prevalent in this population, necessitates specialised assessment tools. This study (a) developed a parent-report anxiety questionnaire tailored for individuals with severe to moderate intellectual disabilities, potentially with a co-diagnosis of autism, and (b) evaluated the psychometric attributes of this novel measure.MethodsA comprehensive approach involving literature reviews, inspection of existing tools, and interviews with clinicians and parents guided the creation of the Clinical Anxiety Scale for People with Intellectual Disabilities. The tool was completed by parents or caregivers (N = 311) reporting on individuals aged 4 or older with intellectual disabilities.ResultsExploratory factor analysis indicated a four-factor structure encompassing anxiety, pain, low energy/withdrawal, and consolability. The anxiety factor explained the most variance in scores (26.3%). The anxiety, pain, low energy/withdrawal subscales demonstrated robust internal consistency (α = 0.81-0.92), and convergent, divergent, and discriminant validity. Robustness of these subscales was further evidenced by test-retest reliability (ICC = 0.79-0.88) and inter-rater reliability (ICC = 0.64-0.71). Subgroup analyses consistently demonstrated strong psychometric properties among individuals diagnosed with non-syndromic autism (N = 98), children (N = 135), adults (N = 175), and across diverse communication abilities within the sample. Moreover, individuals diagnosed with both autism and anxiety exhibited significantly higher scores on the anxiety subscale compared to those without an anxiety diagnosis, while showing no difference in autism characteristic scores.ConclusionsThe findings indicate that the Clinical Anxiety Scale for People with Intellectual Disabilities is a promising measure for use across diverse diagnostic groups, varying communication abilities, and with people with moderate to severe intellectual disabilities.

Process evaluation of a parenting intervention for pre-schoolers with intellectual disabilities who display behaviours that challenge in the UK.

Stepping Stones Triple P (SSTP) is a complex parent-mediated intervention aimed to reduce behaviours that challenge in children with moderate to severe intellectual disabilities, aged 30-59 months. To formulate a comprehensive understanding of SSTP implementation in the UK, we conducted a process evaluation collecting stakeholder views and considering intervention fidelity, dose, reach, delivery adaptations, and acceptability. Fidelity and quality of delivery ratings were high. Parents perceived SSTP as valuable, reporting increased parental confidence and understanding of the child's behaviours. However, only 30% of families received an adequate dose of the intervention. Parents who only received treatment as usual described feeling abandoned by current services. Service managers emphasised the importance of availability of resources and therapist training for successful intervention delivery. SSTP supports effective management of early-onset behaviours that challenge. Further work is needed to ensure equitable access to the intervention across health and social care services. NCT03086876 - https://www. gov/ct2/show/NCT03086876?term=Hassiotis+Angela&draw=1&rank=1.

Dynamic testing of learning potential of children with moderate to severe intellectual disabilities: A Delphi study

AbstractEducation of children with moderate to severe intellectual disabilities requires adequate assessment of their educational needs and potential to learn. Dynamic testing using analogical reasoning tasks may be a promising way to perform such an assessment. However, it remains unclear how dynamic testing with these children may be done in practice. Therefore, we sought expert opinions on operationalizing learning potential and dynamic testing. We performed a three‐round online Delphi study (N = 37) with experts in psychological educational assessment of children with moderate to severe intellectual disabilities in special schools and specialized day‐care centres in the Netherlands. Consensus was found on a conceptual and an operational definition of learning potential, describing step‐by‐step how learning potential could be measured in daily practice. This included a pre‐test, training, post‐test design with the inclusion of a graduated prompts protocol for mediation and an observation checklist focussing on response to mediation. Based on examples from the Analogical Reasoning Learning Test, we assessed consensus on adapted design requirements for dynamic testing using analogical reasoning. Experts agreed that dynamic testing using analogical reasoning tasks might be suitable for children with moderate intellectual disabilities. A key concern was whether performance on analogical reasoning task was within reach of children with severe intellectual disabilities. The panel recommended research into the type of mediation needed to support the learning of analogical reasoning tasks. Further development and evaluation of dynamic testing for children with moderate to severe intellectual disabilities may build on the recommendations of this panel of experts.