Véritables enjeux de santé publique, les adolescents et adultes avec déficience intellectuelle souffrent aujourd’hui de « surhandicaps », par des accompagnements parfois peu favorables à l’autonomisation et à de nouveaux apprentissages, indispensables à la vie en communauté. Leurs limites cognitives, en particulier au niveau des fonctions exécutives, seraient un frein à leur participation aux activités de vie quotidienne, par des difficultés de planification, d’anticipation, de flexibilité et de mémoire de travail. Ces fonctions mentales supérieures peuvent être exercées à l’aide de programmes tels que la CRT (Cognitive Remediation Therapy – Wykes and Reeder 2005) développés dans d’autres pathologies, à la condition de les adapter à l’âge de développement de la personne. Les bénéfices attendus par ce type d’accompagnement sont l’amélioration de l’autonomie, une meilleure participation aux activités de vie quotidienne et une estime de soi accrue, en résumé toutes les modalités nécessaires à une meilleure qualité de vie.

Teenagers and adults with intellectual disabilities are nowadays “over-handicapped”, often due to lack of care in self-sufficiency and continued learning, two essential domains for living in a community. Their cognitive limits, particularly on the executive functions, could be an obstacle to their involvement in the daily life activities, through their difficulties to plan, anticipate, shift and maintain information in working memory. These high level mental functions can be taught with the CRT program (Cognitive Remediation Therapy – Wykes and Reader 2005) developed in other pathologies and providing an adaptation regarding the developmental level of the person.

Firstly, it is essential to determine cognitive developmental levels of the teenager or the adult, using standard tools, such as Wechsler scales. Secondly, functional and/or adaptative levels have to be assessed using specific tools, such as the Vineland Adaptative Behavior Scale 2nd Edition (VABS-II, Sparrow et al., 2005) and the Functional Intervention Scale (EFI, Willaye et al., 2005). Finally, in order to clearly distinguish what are the preserved and impaired cognitive domains, standard tools assessing executive functions such as the Wisconsin Card Sorting Test, the Tower of London, Stroop Test and BADS are used if possible for the patient. The setting of cognitive remediation programs, previously developed for schizophrenic patients, requires adaptation for teenagers and adults with intellectual disabilities, taking into account the limitation of their cognitive abilities. In this paper, we will show that the CRT method for cognitive remediation is particularly relevant for subjects with intellectual disabilities. This method is hence focused on strategies and exercises to improve working memory, categorization and moreover executive functions. Of course this method might need adaptations, with examples based on simplification of the different tasks, notably for verbal materials, and with variations of the media used. These sessions will be part of a wider individualized caring project, allowing the person to transfer the cognitive acquisitions to his/her daily life.

The use of cognitive programs adapted to people with intellectual disabilities can provide benefits in the development of autonomy and daily life activities, leading to a better quality of life and self-esteem.