The Link Between Mental Retardation Diagnosis and Adaptive Functioning

Antonio E. Puente, Ph.D.Mental Retardation and Adaptive Functioning

North Carolina Advocates for Justice Raleigh, NC

05.21.10

In 1799, French physician Marc Itard worked with a child, “Victor”, in one of the first attempts to treat an individual with MR (Lane,1976).

In 1846, Dr. Buckminster Brown visited the Hospital for the Cure and Education of Cretins (Switzerland) where cretins” were treated with gymnastic exercise and isolation from population (Brown,1847).

In the past, the following terms were used to describe or refer to MR individuals as diagnostic and legal terminology (Volkmar & Dykens, 2002):

◦ Idiots◦ Fools◦ Morons◦ Imbiciles

Change from what a person cannot do to what a person can do.

There is a greater focus on inclusion instead of exclusion.

Treatment and assistance can help MR individuals to function in society

MR individuals is associated with cognitive deficits (IQ ≤ 70) and deficits in adaptive skills.

There are multiple definitions of MR with overlap.◦ World Health Organization (1996).◦ DSM-IV-TR (APA, 2000).◦ AAMR: 10th Edition (Luckasson et al., 2002).◦ AAIDD: 11th Edition (AAID, 2010).◦ Social Security Administration (2010)

According to the ICD-10 Guide For Mental Retardation (1996):

“Mental retardation is a condition of arrested or incomplete development of the mind, which is especially characterized by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence, i.e., cognitive, language, motor, and social abilities” (p.9).

Source: http://whqlibdoc.who.int/hq/1996/WHO_MNH_96.3.pdf

“This disorder is characterized by significantly subaverage intellectual functioning (an IQ of approximately 70 or below) with onset before age 18 years and concurrent deficits or impairments in adaptive functioning. Separate codes are provided for Mild, Moderate, Severe, and Profound Mental Retardation, and for Mental Retardation, Severity Unspecified” (p.39).

“Mental retardation is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, practical adaptive skills. The disability originates before age 18” (p.18).

The term “Intellectual disability” is synonymous & generally replacing the term “mental retardation”.

According to the President’s Committee for People with Intellectual Disabilities:◦ Estimated of seven to eight million Americans

experience some kind of ID◦ Affect 10% of the families in the U.S.

Source: http://www.aaidd.org/content_96.cfm?navID=20

According to AAIDD:

“Intellectual disability is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills. This disability originates before the age of 18”


Refers to general mental capacity (learning, reasoning, problem solving, etc).

Intellectual functioning usually measured with IQ test scores.

Usually, IQ score between 70 & 75 indicates limitation in intellectual functioning- borderline.


Adaptive behavior includes three skills: Conceptual skills

◦ Language & literacy; money, time, and number concepts, & self-direction.

Social Skills◦ Interpersonal skills, social responsibility, self-

esteem, gullibility, social problem solving, ability to follow rules/laws, etc.

Practical skills◦ daily living activities, personal care, occupational

skills, healthcare, use of $, travel/transportation, etc. ◦ Source: http://www.aaidd.org/content_100.cfm?navID=21

Used for death penalty cases

Based on Supreme Court decision – Atkins

State based

Two criteria;◦ Quantitative◦ Qualitative

“Significantly subaverage general intellectual functioning with deficits in adaptive functioning initially manifested during the developmental period, i.e., the evidence demonstrates or supports onset of the impairment before age 22”.

Severity determined when requirements A, or B, or C, or D are satisfied.

Source: http://www.socialsecurity.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm#12.05%20Mental%20Retardation

A. Dependence of others for personal needs & inability to follow directions.

B. A valid verbal, performance, or full scale IQ of ≤ 59.

C. A valid verbal, performance, or full scale IQ of 60- 70 & a physical or other mental impairment imposing an additional and significant work-related limitation of function.


D. A valid verbal, performance, or full scale IQ of 60 -70, resulting in ≤ 2 of the following: ◦ 1. Marked restriction of activities of daily living; or ◦ 2. Marked difficulties in maintaining social

functioning; or ◦ 3. Marked difficulties in maintaining

concentration, persistence, or pace; or ◦ 4. Repeated episodes of decompensation, each of

extended duration


Concentration, persistence or pace refers to the ability to maintain focused attention & concentration sufficiently long to permit the timely & appropriate task completion commonly found in work settings.

Limitations in concentration, persistence, or pace may also be reflected by limitations in other settings (i.e., social settings).

Source: http://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm#12.05%20Mental%20Retardation

◦ Camara, Nathan, & Puente (2000).- Compared test usage of clinical psychologists & neuropsychologists from NAN & APA.

Lazarus & Puente (2009).- Compared test usage of neuropsychologists in the U.S.

Ojeda’s thesis (2010).- Developed a comprehensive and current list neuropsychological and psychological tests available in Spanish.

WAIS WISC Stanford Binet Beta Kaufman Reynolds C-TONI

Test Author Publisher Year

WAIS IV Wechsler, D. Pearson 2008

WISC IV Wechsler D. Pearson 2003

Stanford Binet Roid, G. (V Eds.) Riverside Publishing

2003

Beta III Kellogg, C & Morton, N.

Pearson 1999

Kaufman Kaufman, A. & Kaufman, N.

Pearson 1993

Reynolds Reynolds, C. & Kamphaus, R.

Psychological Assessment and Resources, Inc.

2003

CTONI-II Hammill, D., Pearson, N. & Wiederholt, J. L.

PRO-ED 2010

Test First Published

Lazarus Ranking/(freq.)

Ojeda Ranking

WAIS IV 1939 1 (29) 26 (13)

WISC IV 1971 13 (17) 13 (21)

Stanford Binet 1916 28 (2) 30 (9)

Beta III 1934 31 (0) 8 (24)

Kaufman 1993 29 (1) 38(1)

Reynolds 1998 25 (4) 39 (0)

CTONI 1996 - 25 (14)

Test Used for Ages

WAIS IV Designed to assess cognitive ability of adolescents and adults.

16-0 to 90-11

WISC IV Assess cognitive ability in children. 6-0 to 16-11

Stanford Binet

Designed to assess intelligence and cognitive abilities

2-0 to 89-11

Beta III Provides a quick measure of nonverbal intellectual ability

16 to 89

Kaufman An individually administered measure of general intelligence

11 to 85+

Reynolds Designed to assess verbal and nonverbal intelligence and memory

3 to 94

CTONI-II Constructed to measure non verbal intellectual abilities

6-0 to 18-11

Two commonly used tests: Vineland ABAS

Test Author Publisher Year

Vineland Sparrow, S. S., Bella, D. A., & Cicchetti, D. V.

Pearson: American Guidance Service, Inc.

2008

ABAS II Harrison, P. L. & Oakland

PsychCorp, Harcourt Assessment, Inc.

2003

Test First Published

Lazarus Ranking

Ojeda Ranking

Vineland 1985 21(9) 9 (23)

ABAS 2000 - 24 (14)

Test Used for Ages

Vineland To assess of an individual’s daily functioning and adaptive behavior in individuals with intellectual disabilities. Also used for development of educational programs and research.

Birth-Maturity/low functioning adults.;

3 to 12-11

ABAS To diagnoseindividuals who may be experiencing complications with the dailyadaptive skills necessary for functioning, planning interventions. Also used to measure individual’s level of function without the assistance of others.

0-55-212-55-2116-89

The Standards encourage test developers and users to become familiar with federal, state, and local laws, etc that regulate testing of individuals with disabilities.

Accommodations, modifications, or adaptations minimize impact of attributes no related to construct of interest.

i.e., modifying instructions & response formats, timing, test setting, using only portions of test, using alternate tests.

Source: Standards for Educational and Psychological Testing (1999)

The definition of disability under SS is different than other programs.

"Disability" under SS is based on inability to work. Considered disabled if: ◦ Cannot do work as before; ◦ Cannot adjust to other work because of medical

condition(s); and◦ Disability has lasted or is expected to last for at

least one year or to result in death.

Source: http://www.socialsecurity.gov/dibplan/dqualify4.htm

“This is a strict definition of disability. Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers' compensation, insurance, savings and investments”.

Source: http://www.socialsecurity.gov/dibplan/dqualify4.htm

Limits Placed on by Social Security

Use of Collateral Interviews

Focus on History◦ Records (especially educational and vocational)◦ Patterns◦ Contextual history

Working with mental health professionals Working with SSA Working with Spanish speakers Which test should one use Importance of Part B & Adaptive Deficits Possibility of alternative explanations of

intelligence (e.g., the Hopkins project)

Questions?

Contact Information

Antonio E. Puente, [email protected]

Documents

The Link Between Mental Retardation Diagnosis and Adaptive Functioning