Intellectual Disability: Definition, Classification, and Systems of Supports (11th Edition)

1. Intellectual Disability: Definition, Classification, and Systems of Supports (11th Edition) Marc J. Tassé, PhDDirector, Nisonger Center - UCEDDProfessor, Department of Psychology & PsychiatryThe Ohio State UniversityColumbus, OH USADecember 11, 2009Genoa, Italy

2. The AAIDD Ad Hoc Committeeon Terminology and Classification • Karrie A. Shogren • Martha E. Snell • Scott Spreat • Marc J. Tassé • James R. Thompson • Miguel A. Verdugo-Alonso • Michael L. Wehmeyer • Mark H. Yeager • Robert L. Schalock* • Sharon A. Borthwick-Duffy • Valerie J. Bradley • Wil H.E. Buntinx • David L. Coulter • Ellis M. (Pat) Craig • Sharon C. Gomez • Yves Lachapelle • Ruth Luckasson • Alya Reeve

3. Why Change Terminology? The term “Intellectual Disability” is preferred because: Is less offensive to persons with the disability. Is more consistent with international terminology. 3

4. Definition of Intellectual Disability Intellectual disability is characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before age 18. The following five assumptions are essential to the application of this definition. 4

5. Limitations in present functioning must be considered within the context of community environments typical of the individual’s age peers and culture. Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor, and behavioral factors. Within an individual, limitations often coexist with strengths. An important purpose of describing limitations is to develop a profile of needed supports. With appropriate personalized supports over a sustained period, the life functioning of the person with intellectual disability generally will improve. 5 Essential Assumptions 5

6. Limitations in present functioning must be considered within the context of community environments typical of the individual’s age peers and culture. Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor, and behavioral factors. Within an individual, limitations often coexist with strengths. An important purpose of describing limitations is to develop a profile of needed supports. With appropriate personalized supports over a sustained period, the life functioning of the person with intellectual disability generally will improve. 5 Essential Assumptions 6

7. Limitations in present functioning must be considered within the context of community environments typical of the individual’s age peers and culture. Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor, and behavioral factors. Within an individual, limitations often coexist with strengths. An important purpose of describing limitations is to develop a profile of needed supports. With appropriate personalized supports over a sustained period, the life functioning of the person with intellectual disability generally will improve. 5 Essential Assumptions 7

8. Limitations in present functioning must be considered within the context of community environments typical of the individual’s age peers and culture. Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor, and behavioral factors. Within an individual, limitations often coexist with strengths. An important purpose of describing limitations is to develop a profile of needed supports. With appropriate personalized supports over a sustained period, the life functioning of the person with intellectual disability generally will improve. 5 Essential Assumptions 8

9. Limitations in present functioning must be considered within the context of community environments typical of the individual’s age peers and culture. Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor, and behavioral factors. Within an individual, limitations often coexist with strengths. An important purpose of describing limitations is to develop a profile of needed supports. With appropriate personalized supports over a sustained period, the life functioning of the person with intellectual disability generally will improve. 5 Essential Assumptions 9

10. 5 Essential Assumptions Limitations in present functioning must be considered within the context of community environments typical of the individual’s age peers and culture. Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor, and behavioral factors. Within an individual, limitations often coexist with strengths. An important purpose of describing limitations is to develop a profile of needed supports. With appropriate personalized supports over a sustained period, the life functioning of the person with intellectual disability generally will improve. 10

11. Diagnostic Criteria Significant deficits in intellectual functioning: “Significant limitations in intellectual functioning criterion for a diagnosis of intellectual disability is an IQ score that is approximately two standard deviations below the mean, considering the standard error of measurement for the specific instrument used and the instruments’ strengths and limitations.” 11

12. Diagnostic Criteria Significant deficits in adaptive behavior: “Significant limitations in adaptive behavior’ criterion for a diagnosis of intellectual disability is performance that is approximately two standard deviations below the mean of either (a) one of the following three types of adaptive behavior: conceptual, social, or practical, or (b) an overall score on a standardized measure of conceptual , social, and practical skills. As with the intellectual functioning criterion, the assessment instrument’s standard error of measurement must be considered when interpreting the individual’s obtained score.” 12

13. Defining Adaptive Behavior Conceptual skills: language, reading and writing, and money, time, and number concepts. Social skills: interpersonal skills, social responsibility, self-esteem, gullibility, naïveté (i.e., wariness), follows rules/obeys laws, avoids being victimized, and social problem solving. Practical skills: activities of daily living (personal care), occupational skills, use of money, safety, health care, travel/transportation, schedules/routines, and use of the telephone. 13

14. “Significant Deficits” The operational definition of “significant deficits” is a performance that is approximately 2 standard deviations or more below the population mean. Reporting of IQ and AB scores with their respective confidence intervals is a critical consideration underlying the appropriate use of measures of intelligence and adaptive behavior - and best practices; such reporting must be a part of any decision concerning the diagnosis of intellectual disability (95% confidence interval = ± 2 SEm).

15. “Significant Deficits in AB” A notable change first included in the previous AAIDD Manual (Luckasson et al., 2002) continues to be emphasized in the 11th Edition (Schalock et al., 2010) with regard to AB assessment. “For the diagnosis of intellectual disability, significant limitations in adaptive behavior should be established through the use of standardized measures normed on the general population…” (p. 43 - Schalock et al., 2010

16. Diagnostic Criteria Age of onset: “This disability originates before age 18.” N.B. This does not imply that a diagnosis of ID cannot be made for the first time beyond the age of 18 years of age. The significant deficits in intellectual functioning and adaptive behavior MUST have been present before age 18 – not the diagnosis. 16

17. What are the causes of intellectual disability? A multifactorial approach to the etiology of intellectual disability is presented in the 11th edition. This approach focuses on the types of risk factors (biomedical, social, behavioral, and educational) and the timing of risk factors (prenatal, perinatal, and postnatal). 17

18. Classification The primary purposes of classification in the field of intellectual disability are grouping for funding, research, provision of services and supports, and communication about selected characteristics of persons and their environments. Classification is used today for more than its historic purpose of grouping on the basis of IQ range bands or adaptive behavior limitation scores. AAIDD dropped (since 1992) the classification of the condition based solely on IQ deficits. 18

19. Classification Professionals need to be familiar with the emerging trends in the development and use of multidimensional classification systems based on the multidimensionality of human functioning that involves: Intellectual abilitiesAdaptive behaviorHealthParticipationContext, and Individualized supports 19

20. Multi-dimensional Model of Human Functioning I. INTELLECTUAL ABILITIES II. ADAPTIVE BEHAVIOR Individual Functioning III. HEALTH SUPPORTS IV. PARTICIPATION V. CONTEXT 20

21. Intensity of Supports Needs Supports are resources and strategies that aim to promote the development, education, interests, and personal well-being of a person and that enhance individual functioning. 21

22. Supports Needs The support needs construct is based on the premise that human functioning is influenced by the extent of congruence between individual capacity and the environments in which that individual is expected to function. 22

23. Supports Needs Improved Personal Outcome Outcomes may include more independence, enhanced opportunities to contribute to society, increased participation in school and/or community settings and activities, and a greater sense of personal well-being/life satisfaction. Creates Support Needs Mismatch of competency & demands People with ID experience a mismatch between their personal competency and environmental demands. Provide Supports Leading To: Individualized Supports Thoughtful planning & application of individualized supports 23

24. Component 2: Determine the Intensity of Support Needs Component 1: Identify desired life experiences and goals Component 3: Develop the Individualized Support Plan Component 4: Monitor Progress

25. Summary Change in terminology from “Mental Retardation” to “Intellectual Disability”. Disability characterized by significant deficits in intellectual functioning and significant deficits in conceptual, practical, or social skills and the onset of these deficits originates prior to the person’s 18th birthday. Importance of understanding the person’s support needs. 25

26. Intellectual Disability: Definition, Classification, and Systems of Supports (11th Edition) Marc J. Tassé, PhDDirector, Nisonger Center - UCEDDProfessor, Department of Psychology & PsychiatryThe Ohio State UniversityEmail: Marc.Tasse@osumc.eduDecember 11, 2009Genoa, Italy 26

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