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short term. Continuing input in the school years may help maintain
these gains in the long term. Just as there is no one critical period after
which environmental damage is irreversible, so there is no one therapeutic
window after which environmental enrichment is no longer necessary. It
is important, though, not to overestimate the likely effect of environmental
interventions. One adoption study found that there was a 12-point IQ
difference according to whether children were raised by adoptive parents
from the highest and lowest socio-economic groups. A lasting effect of
this size is well beyond anything that specific stimulation or educational
intervention projects have yet achieved.
Provision of services for children
with intellectual disability
Service provision is increasingly influenced by the desire for ‘normali-
sation’, that is, the promotion of as ordinary a life as possible in the
community.
Social provision
Children and adolescents develop best if they grow up as part of a family.
Nowadays, most children and adolescents with intellectual disability live
with their biological family. This can be a very positive experience for
parents and siblings, but there is often a substantial burden of care too,
particularly with marked intellectual disability. However, this burden can
be eased by extra assistance and support, for example, mobility allowances
or respite care (usually arranged by social services). If the family’s capacity
to cope is overwhelmed even with maximum respite care, placement in an
alternative family setting is highly desirable, either by adoption or long-
term fostering. A specialist residential placement should only rarely be
required.
Educational provision
The law in many countries insists that all children and adolescents are en-
titled to an appropriate education, no matter how severe their intellectual
disability. No individual should be denied all schooling on the grounds
that they are ‘ineducable’. It is increasingly recognised that children and
adolescents with mild intellectual disability can generally receive the extra
help they need within mainstream schools. Those with marked intellectual
disability are more likely to need to attend special schools, or special
units within mainstream schools. Reports from doctors and other health
professionals can help education authorities identify special needs and
provide for them accordingly.
Medical provision
Appropriate medical care generally involves family doctors and paediatric
teams. Contact with child and adolescent mental health services is not