Stigma, public awareness about intellectual disability and attitudes to inclusion among different ethnic groups

Interplay between representations, practices, and stigma variables towards people with intellectual disabilities among healthcare professionals: A cross-sectional study

Disparities in healthcare are observed among people with intellectual disabilities. They generally face stigmatisation and negative attitudes from healthcare professionals. The aim of this study is to investigate the link of diagnostic label and social distance on inclusive health representations and practices towards people with intellectual disabilities among healthcare professionals. We conducted an online survey of 163 healthcare professionals living in French-speaking Belgium. The results highlighted that the diagnostic label and a lower social distance predict better representations and practices in inclusive health. In addition, an analysis of mediation showed the mediating effect of social distance on the link between being in contact with people with intellectual disabilities (through employment) and better representations and practices in inclusive health. This study enabled us to assess the interplay between stigma variables and healthcare professionals' representations and practices towards people with intellectual disabilities and to identify potential facilitators for promoting health equity.

Bias in assessment of co-occurring mental disorder in individuals with intellectual disabilities: Theoretical perspectives and implications for clinical practice

Influence from bias is unavoidable in clinical decision-making, and mental health assessment seems particularly vulnerable. Individuals with intellectual disabilities have increased risk of developing co-occurring mental disorder. Due to the inherent difficulties associated with intellectual disabilities, assessment of mental health in this population often relies on a different set of strategies, and it is unclear how these may affect risk of bias. In this theoretical paper, we apply recent conceptualisations of bias in clinical decision-making to the specific challenges and strategies in mental health assessment in intellectual disabilities. We suggest that clinical decision-making in these assessments is particularly vulnerable to bias, including sources of bias present in mental health assessment in the general population, as well as potential sources of bias which may be specific to assessments in this population. It follows that to manage potential bias, triangulating information from multi-informant, multi-method, interdisciplinary assessment strategies is likely to be necessary.

[Points de vue d'adultes vieillissants ayant une déficience intellectuelle à l'égard de leur participation sociale]

Au cours du vieillissement, les adultes ayant une déficience intellectuelle (DI) vivent de nombreux changements susceptibles d'influencer leurs possibilités d'exercer leurs activités quotidiennes et leurs rôles sociaux. Une bonne connaissance de leurs points de vue sur le sujet apparaît cruciale pour mieux adapter l'offre de services à leurs besoins. Cette recherche a pour but de mieux comprendre les points de vue des personnes ayant une DI à l'égard de leurs possibilités de participation sociale à travers l'avancée en âge. Des entrevues individuelles et un atelier participatif ont été réalisés avec des adultes âgés de 40 à 75 ans dans la ville de Québec. L'analyse de leurs propos a permis d'identifier leurs points de vue relatifs à trois thèmes, soit leurs capacités, les possibilités d'exercer leur participation sociale et les soutiens reçus. Pour conclure, des recommandations sont proposées afin que les pratiques soutiennent réellement leur participation sociale à travers l'avancée en âge.

The congenital birth defects burden in children younger than 14 years of age, 1990 - 2019: An age-period-cohort analysis of the global burden of disease study

Background

This study aims to delineate the burden of congenital birth defects (CBDs) in children under 14 years of age from 1990 to 2019, using an age-period-cohort framework to analyse data from the Global Burden of Disease Study (GBD).

Methods

Data on prevalence cases, age-standardised prevalence rates (ASPRs), death cases, and age-standardised death rates (ASDRs) of congenital birth defects (CBDs) from 1990 to 2019 were obtained from GBD 2019. Using this data set, we conducted an age-period-cohort (APC) analysis to examine patterns and trends in mortality, prevalence, and disability-adjusted life years (DALYs) associated with CBDs, while exploring correlations with age, time periods, and generational birth cohorts. Furthermore, to quantify the temporal trends, we calculated the estimated annual percentage changes (EAPCs) for these parameters.

Results

The global prevalence of CBDs decreased from 1404.22 to 1301.66 per 100 000 with an EAPC of -0.18% from 1990 to 2019. CBD mortality decreased by 42.52% between 1990 and 2019, with the global age-standardised death rate declining from 49.72 to 25.58 per 100 000. The age-standardised DALY rate decreased from 4529.16 to 2393.61 per 100 000. Prevalence declined most notably among older children. The risk of CBDs reached its lowest during adolescence (10-14 years) across all regions. The most recent period (2015-2019) showed a reduced risk of prevalence compared to 2000-2004. Earlier birth cohorts displayed declining tendencies followed by slight increases in risk.

Conclusions

This study demonstrates encouraging global reductions in the burden of CBDs among children over the past three decades. Prevalence, mortality, and DALYs attributable to CBDs have exhibited downward trajectories, although regional disparities remain. APC analysis provides valuable insights to inform prevention and management strategies for pediatric CBDs.

Psychosocial development measures modification for adolescents with intellectual and developmental disabilities

BACKGROUND

Although diagnosis and identification of IDD is improving, adolescents with IDD receive limited attention in research, particularly concerning their psychosocial development. Measures developed and normed with typically developing populations may not be appropriate for IDD populations and may result in biased assessment.

AIM

This study aimed to develop and validate modified psychosocial development assessments for adolescents with intellectual and developmental disabilities (IDD), addressing the absence of such assessments.

METHOD

It involved two phases: modifying existing instruments and validating the revised versions. Four stakeholder groups participated: adolescents with IDD, parents, and scholars in adolescent developmental and disabilities. Validation included two groups: neurotypical adolescents completing both measures and IDD adolescents completing modified measures.

RESULTS

Confirmatory factor analyses identified the need to adjust or eliminate scales for better understanding by individuals with IDD. The modified instruments provided suitable measures for assessing psychosocial development in adolescents with IDD.

DISCUSSION

All the scales allowed for accommodation toward comprehension for those with IDD except for identity formation. Further work is needed to understand the challenges associated with assessing identity formation in adolescents with IDD. The active involvement of and participation from adolescents with IDD and their parents in this research was paramount to understanding their comprehension and needs.

CONCLUSION

This study highlights the importance of tailored assessments for accurate measurement of IDD individuals' development, benefiting the assessment of all adolescents.

A Google Trends Analysis of Interest in Nonbinary Identities

Emerging research on stigma suggests that society's mistreatment of nonbinary individuals can, in part, be attributed to public uncertainty and a lack of knowledge about nonbinary identities. In response to this, this study drew upon the theoretical framework of uncertainty management to explore research questions related to nonbinary identity and information behaviors by investigating uncertainty management as evidenced by longitudinal Google Trends data related to nonbinary gender identities. If individuals were found to be engaging in information seeking, the result of this behavior may be that they become less likely to hold stigmatizing attitudes toward nonbinary people, and ultimately be less likely to engage in discrimination toward them. Results indicated that indeed there has been an increase in search volume interest related to nonbinary identities in the past decade. The study concludes by presenting the need for further research to clarify the nature of the relationship between stigma and information seeking, as well as presenting a quandary for researchers regarding the desire for more detailed demographic data, as balanced with concerns for privacy.

Applying the mixed-blessings model and labeling theory to stigma in inclusive education: An experimental study of student and trainee teachers’ perceptions of pupils with ADHD, DLD, and intellectual disability

Institutional and individual stigmatization represent major barriers that prevent children with disabilities from accessing education. It can be presumed that children with disabilities are labeled as such even in inclusive educational settings and that teachers’ attitudes toward inclusive education and children with disabilities play a crucial role in this context. Against this background, the present study aims to (a) apply and conceptualize the mixed-blessings model in the context of stigma-related reactions to children’s disability labels in inclusive education and (b) shed light on the causal attributions of teachers that underlie stigma-related attitudes toward children with various disabilities. A 3 × 2 × 2 × 2 × 2 online experiment examined the ways in which disability-specific causes and symptoms, the type of disability in question, the children’s sex, and efficacy cues regarding educational efforts affect future teachers’ attitudes toward and expectations of inclusive education as well as their social distance toward children with disabilities. The participants in this experiment were N = 605 German student and trainee teachers representing different types of teaching professions. A multivariate analysis of variance (MANOVA) revealed that, in particular, the cause attributed to the disability, the depicted type of disability and the probability of learning success led to changes in attitudes. Respondents’ teaching self-efficacy and their status as students or trainees emerged as moderators of the effect of pupils’ type of disability. As a result, teacher education and training as well as communication regarding pupils with disabilities require a high degree of sensitivity to disability-specific and efficacy-related cues to prevent (accidental) professional or institutional stigmatization.

The Pedagogical Value of Creating Accessible Games: A Case Study with Higher Education Students

The potential of games in empowering underrepresented groups is a central theme in the field of media studies. However, to ensure that everyone can benefit from them, it is necessary to ensure that they are inclusive and accessible. In the present work, we have implemented a Participatory Action Research (PAR) approach to target this problem, right at the stage of training new game designers and game developers. Thus, through a game-design-based or experimental game design pedagogical approach, we intended to promote inclusive and accessibility-driven game design and development skills in students, while decreasing their negative attitudes towards people with Intellectual Disability (pwID). A protocol with a Non-Governmental Organization in the field was established and, during two semesters, students were challenged to develop 10 accessible games and physical interfaces for pwID and motor disabilities, through participatory processes. Pre and post assessment was conducted, through a mixed-method approach. After participating in this process, students reported satisfaction and increased knowledge of cognitive and motor accessibility, and inclusive game design in general. Moreover, the attitudinal assessment showed significantly lower levels of prejudiced beliefs towards pwID (p < 0.05).

Perceived community disability stigma in multicultural, low-income populations: Measure development and validation

BACKGROUND

Stigma and knowledge about disabilities differ across groups, impacting care. No validated measures of perceived community disability stigma exist for families in multicultural communities, at risk for disparities.

AIMS

Develop and validate a brief bilingual (i.e., English/Spanish) perceived disability stigma measure, compare perceived disability and autism stigma, and examine perceived disability stigma by parent sociodemographic characteristics and disability familiarity.

METHODS AND PROCEDURES

Secondary data from 522 parents with children ages 2-5 years were recruited from Oregon WIC Special Supplemental Nutrition Program agencies for a child development and disability survey in 2015. The study sample included items regarding disability familiarity and stigma, among the survey population, which was 50 % Latino. Internal consistency, reliability and structural validity were examined. Secondary data on perceived disability and similar autism stigma items were compared. Nested multivariable linear regression assessed associations of perceived disability stigma with sociodemographic characteristics and disability familiarity.

OUTCOMES AND RESULTS

Five perceived disability stigma items had reasonable internal consistency and performed well in the confirmatory factor analysis. Perceived autism stigma was greater than perceived disability stigma. Latino parents reported less perceived disability stigma than white parents. Parents who knew 1+ individual(s) with a disability reported greater perceived disability stigma.

CONCLUSIONS AND IMPLICATIONS

The perceived disability stigma scale demonstrated sound psychometric properties. Results suggest differences in how stigma is perceived across sociodemographic characteristics and disability familiarity.

An international study of public contact with people who have an intellectual disability

BACKGROUND

People with intellectual disability (ID) are often socially isolated, and many experience stigma and discrimination. Increased contact with the general public is thought to overcome prejudices. This large-scale international study had three main aims: to determine the type and frequency of contact that the general public has with people with ID; to identify the personal characteristics of those who have greater contact; and to examine the public's level of comfort at the prospect of having contact with people with ID.

METHOD

Self-completed online questionnaires were administered to nationally representative panels of respondents in 17 countries; totally 24 504 persons. Multivariate analyses were used to identify respondents more likely to have had frequent personal contact with persons with ID from those with infrequent or no contact and those respondents who were most comfortable at meeting a person with ID.

RESULTS

Internationally around one in four of the general population reports having frequent personal contact with people who have an ID although this varied from 7% in Japan to 46% in Panama. The principal forms of contact were through friendships, neighbours or extended family members. Over all countries, volunteering and engagement with Special Olympics were the two main predictors of frequent personal contact followed by employment in the education, health or social care field, being a parent of children under 18 years, playing sports and being employed. People who reported frequent personal contact were also more comfortable at meeting a person with ID.

CONCLUSIONS

This international dataset provides a baseline against which public contact can be compared across countries and changes monitored over time. The findings suggest ways in which greater contact can be promoted and making the public more comfortable at meeting people with ID.

'I Waited for It until Forever': Community Barriers to Accessing Intellectual Disability Services for Children and Their Families in Cape Town, South Africa

BACKGROUND

Intellectual disability is more common in low- and middle-income countries than in high-income countries. Stigma and discrimination have contributed to barriers to people with intellectual disability accessing healthcare. As part of a larger study on caregiving of children with intellectual disability in urban Cape Town, South Africa, we interviewed a sub-group of families who had never used the intellectual disability services available to them, or who had stopped using them.

METHODS

We employed a qualitative research design and conducted semi-structured interviews to explore the views and perspectives of parents and caregivers of children with intellectual disability who are not using specialised hospital services. We developed an interview guide to help explore caregivers' and parents' views.

RESULTS

Results revealed that caregivers and parents of children with intellectual disability did not use the intellectual disability service due to financial difficulties, fragile care networks and opportunity costs, community stigma and lack of safety, lack of faith in services and powerlessness at effecting changes and self-stigmatisation.

CONCLUSION

Current findings highlight a need for increased intervention at community level and collaboration with community-based projects to facilitate access to services, and engagement with broader issues of social exclusion.

Perceptions of the rights and capabilities of people with intellectual disability in the United States

BACKGROUND

The United States has yet to ratify the UN Convention on the Rights of Persons with Disabilities. The extent of public support in the United States for the rights of persons with intellectual disability is not known.

METHODS

Online public opinion polls were conducted nationally and in eight selected cities in 2017 and repeated in 2018 with 26,876 respondents in total.

RESULTS

Support for rights was high: notably in accessing healthcare, schooling, playing sports and getting married. However, less support was evident for the rights of people who were perceived as less capable. Respondents with prior frequent personal contact and who had an engagement with Special Olympics were those most likely to support the rights and capabilities of persons with intellectual disability.

CONCLUSIONS

Public support for the ratification of the UN Convention seems likely. Further longitudinal research could identify successful strategies for implementing the rights of disabled persons locally and nationally.

"We have been magnified for years - Now you are under the microscope!": Co-researchers with Learning Disabilities Created an Online Survey to Challenge Public Understanding of Learning Disabilities

Public attitudes towards learning disabilities (LDs) are generally reported as positive, inclusive and empathetic. However, these findings do not reflect the lived experiences of people with LDs. To shed light on this disparity, a team of co-researchers with LDs created the first online survey to challenge public understanding of LDs, asking questions in ways that are important to them and represent how they see themselves. Here, we describe and evaluate the process of creating an accessible survey platform and an online survey in a research team consisting of academic and non-academic professionals with and without LDs or autism. Through this inclusive research process, the co-designed survey met the expectations of the co-researchers and was well-received by the initial survey respondents. We reflect on the co-researchers' perspectives following the study completion, and consider the difficulties and advantages we encountered deploying such approaches and their potential implications on future survey data analysis.

Stigma, Acceptance and Belonging for People with IDD Across Cultures

Purpose of Review

This review explores recent literature (from 2017 onwards) to identify current developments related to reducing stigma and increasing acceptance for people with Intellectual and Developmental Disabilities (IDD) in their communities across diverse cultures.

Recent Findings

We identified literature related to experiences of stigma for people with IDD and their families across diverse cultures, as well as current and potential interventions and approaches for promoting acceptance.

Summary

Although the literature confirms that stigma is still a major barrier to acceptance and inclusion for people with IDD regardless of culture, there appears to be progress in terms of using diverse approaches to support acceptance and belonging. Researchers are also increasingly acknowledging the importance of culture and context in the experience and mitigation of stigma. There remains a need for researchers and practitioners to include people with IDD in identifying and prioritising interventions that promote belonging within their communities.

Rasch Validation of the Arabic Version of the Chedoke-McMaster Attitudes Toward Children With Handicaps (CATCH-AR) Scale

Students' attitudes toward peers with disabilities are crucial for the social inclusion of the latter. Therefore, understanding such attitudes can help improve the social inclusion of students with disabilities. This study aimed to examine the psychometric properties of the Arabic version of the Chedoke-McMaster Attitudes toward Children with Handicaps scale. Data were collected from 415 elementary school students, including 232 (56%) girls and 183 (44%) boys, in grades three to six in Saudi Arabia. The psychometric properties of the scale were examined using the Rasch analysis procedures. The results did not support the unidimensionality of the 36-item scale. Dividing items based on whether they are negatively or positively phrased improved the scale fit. Both the 15-item (positive phrasing) and the 18-item (negative phrasing) scales were supported by the Rasch analysis as unidimensional scales.

Lay people's psychological reactions and helping intention after friends' cancer disclosure: An exploratory analysis using vignettes

OBJECTIVES

Stigma, anticipated responses from others, and their relationships may affect patients' decision-making of cancer disclosure. However, little research has explored responses to cancer disclosure and the outcome from receivers' perspectives who had stereotypic views of cancer. This vignette study aimed to explore how lay people with negative attitude to cancer would react to the friend's cancer disclosure.

METHODS

A cross-sectional survey study was conducted in community organisations. Of 161 recruited, 91 participants returned their questionnaires (56.5% of response rate). A total of 88 responses to open-ended questions were qualitatively analysed.

RESULTS

Thematic analysis extracted four themes: 'Initial emotional reactions and the acceptance of the friend's cancer diagnosis'; 'Empathy, trust and helping intention'; 'Sharing informational and emotional support provision'; and 'Offering help, but waiting and seeing the friend's request.' As a result of comparison to these themes by the participants' familiarity of cancer patients in their real life, it was found that participants, who had not known any cancer patients, did not report the acceptance of the friends' cancer diagnosis and informational support provision to share.

CONCLUSION

Intervention for lay people who felt difficulty with accepting friends' cancer diagnosis may be helpful to reduce the impact of friends' cancer diagnosis.

Ghanaian traditional and faith healers' explanatory models of intellectual disability

BACKGROUND

The use of traditional/alternative medicine for health care in Africa has been examined for various conditions. However, there is limited research about traditional/alternative health care for intellectual disability. The present authors explored the explanatory models (EMs) of intellectual disability held by traditional/faith healers in Ghana.

METHODS

Using a case vignette, the present authors conducted semi-structured interviews with 36 traditional/faith healers in Accra, Ghana. Using the EMs of illness framework as a guide, participants were asked questions to examine their beliefs about the nature, causes, course and recommended treatment of intellectual disability.

RESULTS

The healers' causal explanations included maternal negligence during pregnancy and spiritual factors. They also believed that intellectual disability was a congenital, lifelong condition which could not be cured.

CONCLUSIONS

Unlike other conditions which traditional healers claimed to cure, participants admitted that intellectual disability was not curable. The present authors suggest that the findings highlight opportunities that exist for collaboration between biomedicine and traditional medicine.

Disability and workplace harassment and discrimination among Canadian federal public service employees

OBJECTIVES

Policy and legislation that prohibits workplace harassment and discrimination, including that which is disability related, has been in place in Canada for many years. The study objective was to examine associations between disability and workplace harassment and discrimination in the current Canadian context, as well as the intersection of disability with age, gender, and ethnicity.

METHODS

Cross-sectional data from the 2014 Canadian Public Service Employee Survey was analyzed (n = 175,742) using logistic regression to investigate the relationship between self-reported disability and workplace harassment and discrimination in the last 2 years. Age, gender, and ethnicity were included as potential confounders and effect modifiers. Additive and multiplicative effect modifications were examined using linear binomial and logistic regression, respectively.

RESULTS

Overall, 18 and 8% of the sample of Canadian public service employees reported workplace harassment and discrimination, respectively. The prevalence was higher for workers with disability (37 and 26%). Disability was significantly associated with an increased odds of harassment (odds ratio (OR) = 2.80; 95% confidence interval (CI), 2.68-2.92) and discrimination (OR = 4.97; 95% CI, 4.72-5.23) in models adjusted for confounders. Significant positive additive effect modification was observed for (1) age in the harassment and discrimination models and (2) ethnicity in the discrimination model.

CONCLUSION

Findings from a 2014 census of the Canadian federal public service suggest that additional efforts are needed to address workplace harassment and discrimination beyond those already in place. Consideration should be given to workers with disability, as well as the intersectional impacts for older workers, visible minorities, and Aboriginal peoples.

Attitudes Towards Prenatal Genetic Counseling, Prenatal Genetic Testing, and Termination of Pregnancy among Southeast and East Asian Women in the United States

Recognizing the heterogeneity of the Asian population with regards to acculturation, education, health awareness, and cultural values is vital for tailoring culturally sensitive and appropriate care. Prior studies show that cultural values influence perceptions of genetics within Asian populations. The reputation of the family unit factors into decisions such as pregnancy termination and disclosure of family medical history, and the nondirective model of American genetic counseling may conflict with the historical Asian model of paternalistic health care. Previous studies also provide conflicting evidence regarding correlations between education, acculturation, age, and awareness and perceptions of genetic testing. The aims of this study were to describe attitudes towards prenatal genetics among Southeast and East Asian women living in the United States for varying amounts of time and to explore sociocultural factors influencing those attitudes. Twenty-three Asian women who were members of Asian cultural organizations in the United States were interviewed via telephone about their attitudes towards prenatal genetic counseling, prenatal genetic testing, and termination of pregnancy. Responses were transcribed and coded for common themes using a thematic analysis approach. Four major themes emerged. In general, participants: (1) had diverse expectations for genetic counselors; (2) tended to weigh risks and benefits with regards to genetic testing decisions; (3) had mixed views on termination for lethal and non-lethal genetic conditions; and (4) identified cultural factors which influenced testing and termination such as lack of available resources, societal shame and stigma, and family pressure. These findings may allow prenatal genetic counselors to gain a richer, more nuanced understanding of their Asian patients and to offer culturally tailored prenatal genetic counseling.

Public stigma in intellectual disability: do direct versus indirect questions make a difference?

BACKGROUND

Stigma may negatively impact individuals with intellectual disabilities (ID). However, most studies in the field have been based on the use of direct measurement methods for assessing stigma. This study examined public stigma towards individuals with ID within a representative sample of the Israeli public by comparing direct versus indirect questioning.

METHODS

Vignette methodology was utilised with two questionnaire versions. In the direct questionnaire (n = 306), the participants were asked how they would think, feel and behave if a man with ID asked them a question in a public place. In the indirect questionnaire (n = 301), the participants were asked to report how a hypothetical 'other man' would think, feel and behave in the same situation.

RESULTS

Higher levels of stigma were reported among participants that answered the indirect questionnaire version. Furthermore, among those participants that answered the indirect questionnaire version, subjective knowledge of ID was a less important correlate of stigma than for those participants that answered the direct questionnaire.

CONCLUSION

Several explanations are suggested for the finding that indirect questioning elicits more negative stigmatic attitudes. Among others, indirect questioning may be a more appropriate methodology for eliciting immediate beliefs. Furthermore, the results call for implementing a comprehensive, multi-level programme to change stigma.

Implicit Attitudes towards People with Intellectual Disabilities: Their Relationship with Explicit Attitudes, Social Distance, Emotions and Contact

Implicit attitude research has expanded rapidly over the last decade and is seen as very promising as it counters biases present in much attitude research such as social desirability. However, most research in the area of intellectual disabilities has focused on explicit attitudes alone. This study examined implicit attitudes to this population and also examined their association with emotional reactions and contact, which have previously been found to have a significant influence on attitudes and stigma. A web based survey consisting of a single target Implicit Association Test, measures of explicit attitudes, social distance, and emotional reactions towards and contact with individuals with intellectual disabilities was completed by 326 adult UK residents. Implicit attitudes were not significantly associated with explicit attitudes, social distance or emotional reactions. Instead there were small to moderate associations between emotional reactions and explicit attitudes and social distance. Implicit attitudes did not vary according to participants’ level of contact with individuals with intellectual disabilities, type of the contact relationship (voluntary versus involuntary), gender or educational attainment. In contrast, these participant characteristics did affect explicit attitudes and social distance. Implicit attitudes towards individuals with intellectual disabilities were somewhat negative and, unlike explicit attitudes and stigma, did not vary according to participant demographics or contact. As they may have a negative impact on the lives of people with intellectual disabilities, implicit attitudes merit increased attention in research and interventions in the intellectual disabilities field.

New innovations: therapeutic opportunities for intellectual disabilities

Intellectual disability is common and is associated with significant morbidity. Until the latter half of the 20th century, there were no efficacious treatments. Following initial breakthroughs associated with newborn screening and metabolic corrections, little progress was made until recently. With improved understanding of genetic and cellular mechanisms, novel treatment options are beginning to appear for a number of specific conditions. Fragile X and tuberous sclerosis offer paradigms for the development of targeted therapeutics, but advances in understanding of other disorders such as Down syndrome and Rett syndrome, for example, are also resulting in promising treatment directions. In addition, better understanding of the underlying neurobiology is leading to novel developments in enzyme replacement for storage disorders and adjunctive therapies for metabolic disorders, as well as potentially more generalizable approaches that target dysfunctional cell regulation via RNA and chromatin. Physiologic therapies, including deep brain stimulation and transcranial magnetic stimulation, offer yet another direction to enhance cognitive functioning. Current options and evolving opportunities for the intellectually disabled are reviewed and exemplified.