Integrating Persons with Developmental Disabilities into Virtual Environments: A Life Course Model

The interconnectedness between the life course development and the environmental structures has to be considered to effectively improve the health outcomes of individuals with developmental disabilities.

Understanding the Life Course Approach

The life course model (Figure 1) integrates developmental and structural perspectives that shape health (Jones et al., 2019). Developmental perspectives consider the genetics, the psychological adaptations to early life adversity, and the biological cost of such adaptations. Structural perspectives, on the other hand, consider how race or ethnicity, disability, religion, sexual orientation, socioeconomic status, and so on, influence individual and population level health outcomes (Jones et al., 2019). The health of persons with developmental disabilities (DD) can be significantly improved by understanding how physical, environmental, and socioeconomic exposures shape health (Jones et al., 2019). To understand and improve the overall health of persons with DD, the person-environment fit must be considered (Palisano et al., 2017). Persons with DD face various challenges influencing their health directly or indirectly especially in communication, education, employment, mobility and more (Manzoor & Vimarlund, 2018). Evaluating the impact of the environment beyond the biological aspects of DD is critical to improve the health of individuals with DD (Palisano et al., 2017; Jones et al., 2019).

Figure 1. Multilevel approach to epidemiology. SOURCE: Institute of Medicine (2000).

The interconnectedness between the life course development and the environmental structures has to be considered to effectively improve the health outcomes of individuals with DD. Cognition of persons with DD tend to be lower than their peers without DD (Khayatzadeh-Mahani et al., 2020). Influences on cognitive and emotional development includes genetics, uterine environment and early childhood development (Richards & Hatch, 2011). Beyond biological factors, other factors that influence health of individuals with DD include social relationships, living conditions, neighbourhood environment, institutions and socioeconomic policies. All these factors are interrelated. Cognition affects self-regulation, which involves self-generated thoughts, feelings, and actions that are targeted towards the attainment of individual goals (Richards & Hatch, 2011). Self-regulation equips an individual in the development of skills for life. However, this neuropsychological construct of self-regulation can be limited by DD (Richards & Hatch, 2011). Education can enhance cognitive skills, just as cognition is a determinant of educational attainment (Richards & Hatch, 2011). Hence, educational institutions providing educational opportunities for persons with DD need to exist. Education of persons with DD can augment the cognition of these individuals, as well as equip these individuals with practical skills that may make them functional in the labour market (Richards & Hatch, 2011; Khayatzadeh-Mahani et al., 2020). Improving educational and employment outcomes for persons with DD can empower these individuals and enhance their mental wellbeing through self-actualization (Gilson et al., 2018; Khayatzadeh-Mahani et al., 2020). Unfortunately, young adults with DD have lower educational attainment statuses, lower employment rates, lower recreational and social participation than peers without DD (Palisano et al., 2017; Khayatzadeh-Mahani et al., 2020). Individuals with DD miss out on the non-monetary benefits of employment such as community involvement, social inclusion, sense of identity (Khayatzadeh-Mahani et al., 2020). Inclusive and interactive workplaces with jobs that appeal to the interests of individuals with DD are a stronger preference for these individuals over other job features like high pay, more hours, or advancement opportunities (Gilson et al., 2018). Other concerns regarding employment include ability to find a job, communication, social skills, and transportation (Gilson et al., 2018). Virtual solutions may mitigate some of these challenges faced by persons with DD.

The Adoption of Virtual Solutions

Figure 2. COVID-19: A virus that made the world go virtual.

COVID-19 has led to a greater adoption of virtual services of e-health, online education and training (McMahon et al., 2020). Such virtual services are offered through phone calls, apps, video conferencing, virtual reality and so on (McMahon et al., 2020; Rosenbaum et al., 2020). Access to and use of digital technologies promise improved social and economic integration of persons with DD, by supporting their autonomy, and facilitating their inclusion into society (Khanlou et al., 2020). Variations of virtual solutions have been applied and proposed to various problems of education, employment participation, physical health, social participation, medical visits, and adapting in the COVID-19 pandemic (Manzoor & Vimarlund, 2018; Rosenbaum et al., 2020). Virtual solutions have the potential of facilitating social inclusion and integration for individuals with DD (Manzoor & Vimarlund, 2018). Virtual solutions can enhance daily living, education, employment readiness, and community living among individuals with DD, thus improving health outcomes and quality of life (Manzoor & Vimarlund, 2018; Jones et al., 2019). Integrating virtual solutions in the daily routine of persons with DD can improve fitness, function, fun, and the natural support of family and friends (Rosenbaum et al., 2020). Other reported benefits of already implemented virtual services include convenience, increased ease of access, empowerment of families to be more involved with care of family members with DD (Rosenbaum et al., 2020). The adoption of virtual services can benefit individuals with DD immensely, however, there are recognizable limitations.

Health Inequalities with Virtual Solutions

Figure 3. A virtual environment

Health disparities can lead to worsened health outcomes for the disadvantaged population (Jones et al., 2019). Identified barriers include training, affordability, availability, infrastructure, design, lack of fit with needs, access to community activities, literacy, and accommodations (Khanlou et al., 2020). Challenges with the adoption of virtual services include inequities associated with internet and technology access, navigating the technology if available (Rosenbaum et al., 2020). Disadvantaged populations may lack the financial resources to purchase laptops, good functioning phones, or subscription services to the internet. Others who have these resources may lack the technical know-how or the cognitive capacity to operate in certain virtual environments. The technical literacy of users, level of developmental disability, economic limitations of purchasing or renting these technologies need to be assessed for more effective implementation of these technologies. Certain individuals benefit from the decreased over-stimulation from the environment with the social distancing and isolation, however, physical proximity generally enhances communication and intellectual abilities of persons with DD (Constantino et al., 2020). Special education of persons with DD typically requires subtle physical contact and redirection, interpersonal prompting, and attention to motivating factors in the environment, making the integration into a virtual environment harder (Constantino et al., 2020). Research is still required to evaluate user-differences across multiple levels of disability, socio-economic status, gender, age, and other relevant individual risk factors influencing the disproportionate distribution of use of virtual resources (Manzoor & Vimarlund, 2018). Other noteworthy concerns with virtual solutions include privacy breaches, inadequately defined legal and ethical obligations (Rosenbaum et al., 2020).

Addressing Inequities in Accessing Virtual Environments

Potential infrastructural, socio-technical, and legal hindrances need to be thoroughly considered in the implementation of these virtual solutions in relation to access to education, daily living conditions, community integration, and employment.

Figure 4. Illustration of equity. Source: Interaction Institute for Social Change | Artist: Angus Maguire

Evaluating the health of persons with DD using a life-course approach can better identify certain barriers to resources affecting health. Social and economic policies addressing barriers to employment and other resources in the society are needed to improve the wellbeing of individuals with DD (Khayatzadeh-Mahani et al., 2020). Policies are needed to guide employers’ and society’s behaviour towards persons with DD (Khayatzadeh-Mahani et al., 2020). Policies promoting equitable access to virtual solutions targeting better education and employment opportunities are necessary for improving the overall health of individuals with DD (Khayatzadeh-Mahani et al., 2020). In addition, mobility has been emphasized for persons with physical disabilities. However, more emphasis regarding mobility for individuals with DD is needed. Community mobility influences health and quality of life by fostering greater opportunities for social connections, health services access, and community integration (Pfeiffer et al., 2020). Access to mobility resources such as transportation, transit guides, and so on, encourages social inclusion by giving individuals with DD independent mobility (Pfeiffer et al., 2020). A lack or inadequacy of transportation limits the mobility of people with DD, thus negatively impacting quality of life. Virtual solutions like GPS customized for persons with DD, virtual reality training persons with DD to navigate the roads, interactive transit apps can improve community mobility of these persons (Manzoor & Vimarlund, 2018). With better resources and policies in place, mastery may be attained by individuals with DD, whereby these individuals are able to cultivate some level of independence in managing life circumstances, and better health (Richards & Hatch, 2011; Jones et al., 2019). Parents, program managers of disability services, the public, and policy-makers must collaborate to create more effective policies because these parties influence policies and allocation of resources which affect persons with DD (Rosenbaum et al., 2020). Better policies informing the implementation of virtual solutions including specifications on privacy policies, data security, could minimize some limitations of virtual solutions implementation in vulnerable populations and ensure the needs of these populations are adequately met (Manzoor & Vimarlund, 2018). Potential infrastructural, socio-technical, and legal hindrances need to be thoroughly considered in the implementation of these virtual solutions in relation to access to education, daily living conditions, community integration, and employment. Further research is therefore needed to better inform the integration of individuals with DD into virtual environments.

References

Constantino, J. N., Sahin, M., Piven, J., Rodgers, R., & Tschida, J. (2020). The impact of COVID-19 on individuals with intellectual and developmental disabilities: Clinical and scientific priorities. American Journal of Psychiatry, 177(11), 1091-1093. https://doi.org/10.1176/appi.ajp.2020.20060780

Gilson, C. B., Carter, E. W., Bumble, J. L., & McMillan, E. D. (2018). Family perspectives on integrated employment for adults with intellectual and developmental disabilities. Research and Practice for Persons with Severe Disabilities, 43(1), 20-37. https://0-doi-org.aupac.lib.athabascau.ca/10.1177%2F1540796917751134

Smedley, B. D., & Syme, S. L. (2000). Capitalizing on social science and behavioral research to improve the public's Health. Promoting health: intervention strategies from social and behavioral research, p. 43. Institute of Medicine (US) Committee: National Academies Press (US)

Jones, N. L., Gilman, S. E., Cheng, T. L., Drury, S. S., Hill, C. V., & Geronimus, A. T. (2019). Life course approaches to the causes of health disparities. American journal of public health, 109(S1), S48–S55. https://doi.org/10.2105/AJPH.2018.304738

Khanlou, N., Khan, A., Vazquez, L. M., & Zangeneh, M. (2020). Digital literacy, access to technology and inclusion for young adults with developmental disabilities. Journal of Developmental and Physical Disabilities, 1-25. https://doi.org/10.1007/s10882-020-09738-w

Khayatzadeh-Mahani, A., Wittevrongel, K., Nicholas, D. B., & Zwicker, J. D. (2020). Prioritizing barriers and solutions to improve employment for persons with developmental disabilities. Disability and rehabilitation, 42(19), 2696-2706. https://doi.org/10.1080/09638288.2019.1570356

Manzoor, M., & Vimarlund, V. (2018). Digital technologies for social inclusion of individuals with disabilities. Health and technology, 8(5), 377-390. https://doi.org/10.1007/s12553-018-0239-1

McMahon, D. D., Barrio, B., McMahon, A. K., Tutt, K., & Firestone, J. (2020). Virtual reality exercise games for high school students with intellectual and developmental disabilities. Journal of Special Education Technology, 35(2), 87–96. https://doi.org/10.1177/0162643419836416

Palisano, R.J., Di Rezze, B., Stewart, D., Rosenbaum, P.L., Hlyva, O., Freeman, M., Nguyen, T. and Gorter, J.W. (2017). Life course health development of individuals with neurodevelopmental conditions. Developmental Medicine & Child Neurology, 59(5), 470-476. https://doi.org/10.1111/dmcn.13402

Pfeiffer, B., Falo, K., Gallagher, L., Kaufmann, C., Li, J., & Yabor, F. (2020). Community mobility plans for individuals with developmental disabilities: A feasibility study. British Journal of Occupational Therapy, 83(5), 334–343. https://doi.org/10.1177/0308022619883486

Richards, M., & Hatch, S. L. (2011). A life course approach to the development of mental skills. The journals of gerontology. Series B, Psychological sciences and social sciences, 66 Suppl 1(Suppl 1), i26–i35. https://doi.org/10.1093/geronb/gbr013

Rosenbaum, P. L., Silva, M., & Camden, C. (2020). Let's not go back to 'normal'! lessons from COVID-19 for professionals working in childhood disability. Disability and rehabilitation, 1–7. https://doi.org/10.1080/09638288.2020.1862925