Structure and Organization of Sport for People With Intellectual Disabilities Across Europe.

Opportunities to participate and compete in sports for athletes with intellectual disability (ID) have increased; however, this group still encounters limitations in accessing a comprehensive range of sports. This study addressed the current knowledge on how sport for people with ID is organized and the relationships between the major sport organizations for people with ID across 10 European countries. The participants were 29 national sport organizations for people with ID. Data were collected using semistructured interviews with representatives from the key organizations and analyzed thematically. From the results, two major themes emerged: (a) connection and networking between sport organizations and (b) organizational landscape of each nation (i.e., ID, multidisability, or mainstream). The results of this study contribute to understanding how sport for people with ID is organized across the participating nations, demonstrating different models of development and examples of good practice.

A Systematic Review of Digital Interventions to Promote Physical Activity in People With Intellectual Disabilities and/or Autism.

This systematic review synthesized the literature on digital health interventions for the promotion of physical activity (PA) among people with intellectual disabilities and/or autism. From an initial screening of 553 records, 10 studies underwent full-text review. Data were extracted relating to study, intervention, and sample characteristics and PA-related findings. Methodological quality was evaluated using the Crowe Critical Appraisal Tool. There were mixed findings pertaining to the effectiveness of digital health interventions for promoting PA among these populations. Positive results were reported for three of five active-video-game interventions, two of three social-media-based interventions, and one of two e-learning/multicomponent interventions. Digital health interventions can potentially be effective for promoting PA among people with intellectual disabilities and/or autism. However, the large variation in the samples and intervention types and a reliance on pre- and quasi-experimental research designs suggest that inferences should be made with caution and additional research is needed.

Athletes with intellectual disability: The effects of cognitive deficits and sports practice on bipedal standing balance.

BACKGROUND: Athletes with intellectual disability represent a unique population who experiences the contrasting effects of cognitive deficits and benefits of sports on balance. This study investigated the combined impact of intellectual disability and sport practice on balance. METHOD: Center-of-pressure excursion in bipedal stance of 2 disability (with and without intellectual disability) × 2 sport practice (athlete and novice) participant groups was measured in several balance conditions. RESULTS: Sport practice exerted no significant effect on any of the center-of-pressure measures used. In contrast, intellectual disability's effects on balance, which were most apparent in challenging balance conditions, were significant (p < .05) and had large effect sizes (ηp 2 > 0.13). CONCLUSION: The negative effects of cognitive deficits on the balance of young adults with intellectual disability underscore the need for effective interventions. Although findings did not support sports' balance-remediating potential, the value of sport participation for individuals with intellectual disability cannot be fully dismissed just yet.

Cognitive-motor multitasking in athletes with and without intellectual impairment.

PURPOSE: We investigated cognitive-motor multitasking in 29 top athletes with intellectual impairment (II) recruited during the European Championship Games organized by Virtus (World Intellectual Impairment Sports) and 29 control (CT) athletes matched for age, sex, sports practiced, and lifetime accumulated practice hours. METHODS: Participants performed a cognitive task that required recognizing previously displayed visual objects among distractors. The motor task required maintaining a stable upright posture balancing on a rocking board placed atop a force plate which assessed center-of-pressure (COP) movement. Both tasks were performed separately (with participants seated for the cognitive single task) and concurrently under dual-task conditions, wherein participants memorized objects while balancing. We analyzed recognition accuracy, COP path length, and sample entropy of the COP trajectory as a measure for automaticity of postural control. RESULTS: As expected, CT-athletes outperformed II-athletes in the cognitive task but the two groups have comparable performance in the postural task under single- and dual-task conditions. When multitasking, CT-athletes switched to more automatic postural control and maintained their postural sway at single-task levels. II-athletes prioritized balance thereby successfully keeping COP excursion comparable to single-task conditions. However, this came with pronounced costs for memory performance, which was unaffected by multitasking in CT-athletes. CONCLUSION: The adaptive capacity observed in control athletes was not at the disposal of II-athletes who revealed pronounced sensitivities to multitasking interference. This sensitivity obviously was not compensated for by either athletic competence or potential transfer of athletic skill to domain-general cognitive functions.

Prevalence of diabetes in people with intellectual disabilities and age- and gender-matched controls: A meta-analysis.

BACKGROUND: This meta-analysis aims to: (i) describe the pooled prevalence of diabetes in people with intellectual disabilities, (ii) investigate the association with demographic, clinical and treatment-related factors and (iii) compare the prevalence versus age- and gender-matched general population controls. METHODS: Pubmed, Embase and CINAHL were searched until 01 May 2021. Random effects meta-analysis and an odds ratio analysis were conducted to compare rates with controls. RESULTS: The trim- and fill-adjusted pooled diabetes prevalence amongst 55,548 individuals with intellectual disabilities (N studies = 33) was 8.5% (95% CI = 7.2%-10.0%). The trim- and fill-adjusted odds for diabetes was 2.46 times higher (95% CI = 1.89-3.21) (n = 42,684) versus controls (n = 4,177,550). Older age (R2  = .83, p < .001), smoking (R2  = .30, p = .009) and co-morbid depression (R2  = .18, p = .04), anxiety (R2  = .97, p < .001), and hypertension (R2  = 0.29, p < .001) were associated with higher diabetes prevalence rates. CONCLUSIONS: Our findings demonstrate that people with intellectual disabilities are at an increased risk of diabetes, and therefore routine screening and multidisciplinary management of diabetes is needed.

Conceptual model of sport-specific classification for para-athletes with intellectual impairment.

The present paper describes the conceptual basis of evidence-based classification of para-athletes with intellectual impairment (II). An extensive description of the theoretical and conceptual foundation of the system as currently conceived is provided, as are examples of its applications in the three sports included in the Paralympic programme for II-athletes in 2020 (i.e., athletics, swimming and table tennis). Evidence-based classification for II-athletes is driven by two central questions: i. How can intellectual impairment be substantiated in a valid and reliable way, and ii. Does intellectual impairment limit optimal sport proficiency? Evolution of the system and current best practice for addressing these questions are described, and suggestions for future research and development are provided. Challenges of understanding and assessing a complex (multifaceted and intersectional) impairment in the context of sport also are considered.

Comparison of Sport Competitive Anxiety Levels of Flemish athletes with and without intellectual disability.

BACKGROUND: High anxiety levels are common in people with intellectual disabilities (ID) and anxiety can affect sport performance, but sport competitive anxiety profiles in athletes with ID are unknown. METHODS: A total of 303 athletes; 116 with ID (33% female, M age = 22.64, SD = 3.94), and 187 without ID (54% female, M age = 21.81, SD = 3.23), completed the modified questionnaire Sport Anxiety Scale-2-FLemish-ID (SAS-2-FL-ID). RESULTS: The SAS-2-FL-ID was a valid tool to use in a population of athletes with ID. They had higher trait anxiety (9.36 ± 2.62) than peers without ID (7.58 ± 2.44), F = 26.95, p<.001. With respect to sport anxiety, they only scored higher on the "concentration disruption" subscale. Their overall level of competitive anxiety across all subscales (24.14 ± 7.73) was significantly lower compared to athletes without ID (26.51 ± 7.49), F = 27.10, p<.001. CONCLUSION: On the sporting field, athletes with ID worry less and feel less somatic anxiety compared to athletes without ID.

Cognitive-motor dual-task ability of athletes with and without intellectual impairment.

Cognition is important in many sports, for example, making split-second-decisions under pressure, or memorising complex movement sequences. The dual-task (DT) paradigm is an ecologically valid approach for the assessment of cognitive function in conjunction with motor demands. This study aimed to determine the impact of impaired intelligence on DT performance. The motor task required balancing on one leg on a beam, and the cognitive task was a multiple-object-tracking (MOT) task assessing dynamic visual-search capacity. The sample included 206 well-trained athletes with and without intellectual impairment (II), matched for sport, age and training volume (140 males, 66 females, M age = 23.2 ± 4.1 years, M training experience = 12.3 ± 5.7 years). In the single-task condition, II-athletes showed reduced balance control (F = 55.9, P < .001, η2 = .23) and reduced MOT (F = 86.3, P < .001, η2 = .32) compared to the control group. A mixed-model ANCOVA revealed significant differences in DT performance for the balance and the MOT task between both groups. The DT costs were significantly larger for the II-athletes (-8.28% versus -1.34% for MOT and -33.13% versus -12.89% for balance). The assessment of MOT in a DT paradigm provided insight in how impaired intelligence constrains the ability of II-athletes to successfully perform at the highest levels in the complex and dynamical sport-environment.

Cognitive Predictors of Performance in Well-Trained Table Tennis Players With Intellectual Disability.

Evidence-based classification systems in Paralympic sport require knowledge of the underlying effect of impairment in a specific sport. This study investigated the relationship between cognition and tactical proficiency in 88 well-trained table tennis players with intellectual disability (ID; 29 women, 59 men, M ± SD IQ 59.9 ± 9.6). Data were collected at 3 competitions sanctioned by the International Federation for Para-Athletes with Intellectual Disabilities (INAS). A generic cognitive test consisting of 8 neuropsychological subtests was used to assess cognitive abilities relevant to sport (reaction time, processing speed, and decision speed; spatial visualization; fluid reasoning; memory; executive functioning; and visual processing). The backward stepwise-regression analysis model revealed that 18% of the variance in tactical proficiency was attributed to spatial visualization and simple reaction time. Applications of these findings resulted in an evidence-based classification system that led to the reinclusion of athletes with ID in Paralympic table tennis and provide the basis for future research in this important area.

Comparing technical proficiency of elite table tennis players with intellectual disability: simulation testing versus game play.

Technical skill proficiency among elite table tennis players with intellectual disabilities (ID) was investigated in this study using two approaches: an off-court simulation testing protocol and an on-court, standardized observational framework during game play. Participants included 24 players with ID (M age = 25 yr., SD = 6; M IQ = 61, SD = 9), the top 16 performers, 13 men and 11 women, at the International Federation for sport for para-athletes with an intellectual disability (Inas) World Championships. Self-reported table tennis training experience of the players was 13 +/- 5 yr. In the Simulation Testing condition, players were instructed to play five sets of basic and five sets of advanced skills, which were subsequently assessed by experts using a standardized and validated observational protocol. The same protocol was used to assess the same skills during Game Play. Ratings of overall technical proficiency were not significantly different between Simulation Testing and Game Play conditions. There was a strong positive correlation between technical proficiency measured during Game Play vs Simulation Testing for the variables flick, topspin forehand, and topspin backhand. No correlations were found for the variables contra, block, and push. Insight into this relationship is important for future development of classification systems for ID athletes in the Paralympic Games, because comparing competition observation with the athlete's potential shown during the classification session is essential information for classifiers to confirm the athlete's competition class.

"The show must go on": How Paralympic athletes safeguarded their mental well-being and motivation to train for the postponed Tokyo 2020 games.

Introduction: After the decision to postpone the Tokyo 2020 Games due to the COVID-19 pandemic, athletes had to adjust to a novel situation with feelings of uncertainty and insecurity. Grounded in Self-Determination Theory, this study was the first to examine whether different motivational profiles among Paralympic athletes can be identified, and to link these profiles with the athletes' emotional, cognitive, and performance-related outcomes in times of a pandemic. Methods: Five months before the start of the Paralympic Games, the participants (N = 32; mean age = 33.2 ± 6.8 years) completed an online questionnaire measuring their demographics, basic psychological needs, perceived stress, depressive symptoms, general well-being, and motivational self-regulation strategies. Two months after the Games, they completed a second online questionnaire measuring their actual and perceived performance at the past Games. Results: Through K-means cluster analysis, three distinct clusters were identified based on the athletes' dominant type of motivation, these are, dominantly amotivated (n = 11), autonomously motivated (n = 12), and controlled motivated (n = 9). Comparisons of athletes' emotional, cognitive, and performance-related outcomes depending on their motivational profile revealed that the athletes with a dominantly amotivated profile had the least adaptive outcomes (i.e., low need satisfaction, high need frustration, and more depressive symptoms). Athletes with a dominantly autonomously motivated profile made less use of controlling self-motivating strategies compared to the other two profiles. Moreover, their actual performance at the Paralympic Games was better. Discussion: Although none of the athletes were at severe risk for depression or showed extremely high levels of stress, these results confirm that improving the quality of athletes' motivation can safeguard their well-being and enhance performance in Paralympic Sports.

Scoping review of dual-task interference in individuals with intellectual disability.

Dual-task paradigms can provide insights on the structures and mechanisms underlying information processing and hold diagnostic, prognostic, and rehabilitative value for populations with cognitive deficits such as in individuals with intellectual disability (ID). In this paradigm, two tasks are performed separately (single-task context) and concurrently (dual-task context). The change in performance from single- to dual-task context represents dual-task interference. Findings from dual-task studies have been largely inconsistent on whether individuals with ID present with dual-task-specific deficits. The current review aimed to map the published literature on dual-task methods and pattern of dual-task interference in individuals with ID. A scoping review based on Arksey and O'Malley's five-stage methodological framework was performed. Seventeen electronic databases and registries were searched to identify relevant studies, including gray literature. Charted data from included studies were analyzed quantitatively and qualitatively. PRISMA guidelines informed the reporting of this review. Twenty-two studies involving 1,102 participants (656 with ID and 446 without ID) met the review's inclusion criteria. Participants in the included studies were heterogeneous in sex, age (range 3-59 years), etiology and ID severity. Included studies characterized their ID-sample in different ways, most commonly using intelligence quotient (IQ) scores. Other measures of intellectual function (e.g., mental age, ID severity, verbal and/or visuospatial ability scores) were also used, either solely or in combination with IQ. Methods of dual-task testing varied across studies, particularly in relation to dual-task combinations, equation of single-task performance between groups, measurement and reporting of dual-task performance for each single-task, and task priority instructions. Thematic content of the included studies were: (1) structural interference to dual-tasking; (2) etiology-based differences in dual-tasking; (3) gait and balance dual-task performance; (4) testing executive function using dual-task paradigms; and (5) training effect on dual-task performance. Although the evidence consistently supported the intact dual-tasking ability of individuals with ID, the pattern of dual-task interference was inconsistent. Likewise, the evidence was inconclusive regarding dual-task deficit specific to individuals with ID because of heterogeneity in dual-task study designs among included studies.

The Relationship between Motor Skills and Intelligence in Children with Autism Spectrum Disorder.

This study explored the association between intelligence and motor skills in children with ASD after controlling for Attention Deficit and Hyperactivity Disorder (ADHD) and the associations between motor impairment and intellectual disability (ID) in this population. In total, 120 children with ASD (3-16 years; 81.7% boys) completed a standardized intelligence test, the Movement Assessment Battery for Children and Beery-Buktenica Developmental Test of Visual-Motor Integration. Variance in performance IQ was associated with 20.8% of the variance in motor skills while significant associations were found between comorbid ID and motor impairment (ɸ = 0.304). Manual Dexterity and Balance are moderately influenced by performance IQ in children with ASD. Furthermore, presence of ID is also moderately associated with motor impairment in this population.

Evaluation of the Developmental Coordination Questionnaire (DCDQ) as a Screening Instrument for Co-occurring Motor Problems in Children with Autism Spectrum Disorder.

Although motor problems are highly prevalent in children with autism spectrum disorder (ASD), they remain underdiagnosed. Questionnaire-based screening for motor problems could optimize current clinical practice. This study aimed to examine the psychometric properties of the developmental coordination disorder questionnaire (DCDQ) to screen for co-occurring motor problems in individuals with ASD (n = 115; aged 5-15 years). Results indicated an excellent internal consistency; concurrent and discriminant validity with the Movement Assessment Battery for Children, second edition. Sensitivity was excellent, but specificity was lower. The positive and negative predictive values indicate that the DCDQ can be used to detect motor problems in children with ASD and can exclude the presence of developmental coordination disorder.

Physical activity correlates in children and adolescents, adults, and older adults with an intellectual disability: a systematic review.

PURPOSE: Understanding enablers of and barriers for physical activity (PA) participation in people with intellectual disability (ID) is an essential first step to develop effective interventions. This systematic review examined correlates of PA across the socio-ecological model (i.e., intra-personal, inter-personal, environmental and policy level) in people with ID across the lifespan. MATERIAL AND METHODS: Major electronic databases were searched from inception until 15 February 2021. Keywords included "physical activity" or "exercise" and "intellectual disability" or "mental retardation." A summary coding was used to analyze the data for adolescents (<18 years), adults (18 < 50 years), and older adults (50≤ years). RESULTS: Out of 83 PA correlates, retrieved from 39 studies (n = 26,456), only three consistent (i.e., reported in four or more studies) correlates were identified. In adults, older age (7/11, 64%), more severe ID (9/9, 100%) and the presence of physical mobility problems (3/4, 75%) were associated with decreased PA. From 38 correlates identified, no consistent correlates were identified for children and adolescents and older people. CONCLUSIONS: Despite the abundance of evidence of the PA benefits for people with ID, we only found consistent evidence for three correlates reliably being related to PA in adults with ID. More research, particularly among young and older people is urgently needed.IMPLICATIONS FOR REHABILITATIONMore severe intellectual disability is an important barrier for being active in adults with intellectual disability.Presence of physical health problems is an important barrier for being active in adults with intellectual disability.

Effect of Sildenafil Citrate on Exercise Capacity in Athletes With Spinal Cord Injury.

PURPOSE: Ingestion of sildenafil citrate has performance-enhancing effects at high altitudes above 3800 m in able-bodied individuals. It is unknown whether it can improve the performance of athletes with spinal cord injury (SCI) at moderate altitudes (<2200 m), relevant to Paralympic competitions. As most men with SCI suffer from erectile dysfunction of neurologic origin and use sildenafil on a regular basis, it seems important to study the impact of sildenafil on exercise capacity. The outcome of this study is also relevant to the antidoping community. METHODS: Twenty-seven healthy male wheelchair athletes with a motor-complete SCI participated in this prospective double-blind, randomized, placebo-controlled study. The participants performed arm cranking exercise to exhaustion at sea level and moderate altitude (2200 m) after ingestion of 50 mg sildenafil citrate or a placebo. Peak power output, peak oxygen uptake, peak heart rate, rating of perceived exertion, oxygen saturation, and lactate concentrations at exhaustion were measured. RESULTS: Friedman analysis showed that peak power output at sea level was significantly higher (P = .004) under placebo treatment (median [minimum; maximum]: 120 W [35; 170]) compared with sildenafil (115 W [40; 165]). Blood oxygen saturation under sildenafil treatment at sea level (98% [81; 100]) was significantly higher (P = .006) compared with sildenafil treatment at moderate altitude (94% [85; 100]). All other parameters revealed no impact of sildenafil or altitude. CONCLUSIONS: In this study, the ingestion of sildenafil citrate in athletes with SCI demonstrated no positive effects on peak arm-cranking-exercise capacity compared with placebo either at sea level or at moderate altitude.

Reliability of center of pressure excursion as a measure of postural control in bipedal stance of individuals with intellectual disability: A pilot study.

The high prevalence of postural instability in individuals with intellectual disability (ID) warrants the need for reliable and practical postural control assessments. Stabilometry is a postural control assessment that has been widely used for clinical populations. However, the scant systematic knowledge about the reliability of stabilometric protocols for adults with ID renders results questionable and limits its value for clinicians and researchers. The study's purpose was to develop a stabilometric protocol for adults with and without ID based on optimal combinations of shortest necessary trial durations and the least number of trial repetitions that guarantee sufficient reliability. Participants performed six trials of bipedal standing in 2 vision (eyes open vs eyes closed) x 2 surface (solid vs compliant) conditions on a force platform. Several parameters were calculated from the first 10-, 20-, and 30-s interval of every center-of-pressure (COP) trial data. For different trial durations, we identified the number of trials that yielded acceptable relative (intraclass correlation coefficient ≥ 0.70) and absolute (standard error of measurement < 20%) reliability using the Spearman-Brown prophecy formula. To determine the optimal combination of trial duration and number of repetition for each COP parameter, we implemented a two-step process: 1) identify the largest number of repetition for each of the three trial durations and then 2) select the trial duration with the lowest number of repetition. For both ID- and non-ID groups, we observed a trend whereby shorter trial durations required more repetitions and vice versa. The phase plane and ellipse area were the most and least reliable center-of-pressure parameter, respectively. To achieve acceptable reliability, four 30-s trials of each experimental condition appeared to be optimal for testing participants with and without ID alike. The results of this research can inform stabilometric test protocols of future postural control studies of adults with ID.

Athletic identity and self-esteem among active and retired Paralympic athletes.

Athletic identity (AI) has been suggested as a variable that can have an impact on the psychological health of the athletes upon retirement. The aim of this study was to provide more insight on the transition out of elite sport by assessing and comparing the extent of AI and self-esteem in an active group (AG) and a retired group (RG) of Paralympic athletes. Perceived stress and depressive symptoms were additionally assessed in the AG and RG, respectively. A non-probability sampling method was used to recruit active and retired Paralympic athletes (AG, n = 43; RG, n = 41, where 35 retired voluntarily and 6 retired involuntarily) with visual or physical impairments, from Dutch-, English-, Portuguese- and Spanish-speaking countries. Participants completed an electronic survey with questionnaires to assess the study variables mentioned above. Descriptive analysis, comparisons (Mann-Whitney U test and t-test) and Spearman's correlation coefficient were performed for the statistical analysis. Scores of AI were significantly lower in the RG (44.6 ± 9.6) compared to the AG (49.4 ± 8.9); t(82) = 2.36, p = .021, d = 0.51. No differences in self-esteem were found between RG and AG; however, within the RG, athletes who involuntarily retired (21 ± 7.1) had significantly lower self-esteem scores than those who retired voluntarily (25.2 ± 4.2); t(39) = 2.04, p = .049, d = 0.73. In conclusion, free choice upon retirement can positively influence the athletes' self-esteem, whereas a strong AI may negatively influence the retirement process, as it was positively correlated with depressive symptoms (ρ = .409, p = .008). These findings can have practical implications for sport psychologists to better support their athletes.

Pacing Ability in Elite Runners with Intellectual Impairment.

PURPOSE: To understand how athletes invest their energy over a race, differences in pacing ability between athletes with and without intellectual impairment (II) were explored using a novel field test. METHODS: Well-trained runners (n = 67) participated in this study, including 34 runners with II (age = 24.4 ± 4.5 yr; IQ = 63.1 ± 7.7) and 33 runners without II (age = 31.4 ± 11.2 yr). The ability to perform at a preplanned submaximal pace was assessed. Two 400-m running trials were performed on an athletics track, with an individually standardized velocity. In the first trial, the speed was imposed by auditory signals given in 20-40 m intervals, in combination with coach feedback during the initial 200 m. The participant was instructed to maintain this velocity without any feedback during the final 200 m. In trial 2, no coach feedback was permitted. RESULTS: Repeated-measures analyses revealed a significant between-group effect. II runners deviated more from the target time than runners without II. The significant trial-group interaction effect (F = 4.15, P < 0.05) revealed that the ability to self-regulate the pace during the final 200 m improved for runners without II (trial 1, 1.7 ± 1.0 s; trial 2, 0.9 ± 0.8 s), whereas the II runners deviated even more in trial 2 (4.4 ± 4.3 s) than that in trial 1 (3.2 ± 3.9 s). CONCLUSION: Our findings support the assumption that intellectual capacity is involved in pacing. It is demonstrated that II runners have difficulties maintaining a preplanned submaximal velocity, and this study contributes to understanding problems II exercisers might experience when exercising. With this field test, we can assess the effect of II on pacing and performance in individual athletes which will lead to a fair Paralympic classification procedure.

Cognitive profile of young well-trained athletes with intellectual disabilities.

BACKGROUND: Previous research has shown that cognitive and motor skills are related. The precise impact of cognitive impairment on sport proficiency, however, is unknown. AIMS: This study investigated group and individual differences in cognitive profiles in a large cohort of track and field athletes, basketball players, swimmers and table tennis players with (N=468) and without (N=162) intellectual disabilities (ID). METHODS AND PROCEDURES: Based on the Cattell-Horn-Carroll Theory of Cognitive abilities, eight subtests were selected for inclusion in a generic cognitive test (GCT) to assess executive functions and cognitive abilities relevant to sport, i.e., fluid reasoning, visual processing, reaction and decision speed, short-term memory and processing speed. OUTCOMES AND RESULTS: Reliability coefficients for the subtests ranged between 0.25 and 0.88 respectively. Factor analysis revealed two clusters of subtests, i.e., a speed-based factor (simple and complex reaction time and simple and complex visual search) and a performance-based factor (Corsi Memory, Tower of London, WASI Block Design and Matrix Reasoning). After controlling for psychomotor speed, the group of ID-athletes scored significantly lower than athletes without ID on all the GCT subtests, except the complex visual search test. When cognitive profiles of individual ID- athletes were examined, some obtained higher scores than the average norm values in the reference population. CONCLUSIONS AND IMPLICATIONS: The GCT is currently administered as part of the classification process for athletes with ID who compete in the Paralympic Games. The results of this study indicate that the complex visual search and Tower of London test in the GCT should be reconsidered.