The Link Between Mental Retardation Diagnosis and Adaptive Functioning

1. 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

2. Early Days of Mental Retardation • 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).

3. Early Days MR • 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

4. MR…. Today • 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

5. What is MR • 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)

6. WHO: Mental Retardation • 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

7. DSM-IV TR (APA, 2000) • “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).

8. AAMR: Luckasson et al., 2002 • “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).

9. AAIDD (2010) • 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

10. AAIDD: Intellectual Disability • 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” Source: http://www.aaidd.org/content_100.cfm?navID=21

11. AAIDD: Intellectual Functioning • 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. Source: http://www.aaidd.org/content_100.cfm?navID=21

12. AAIDD: Adaptive Behavior 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

13. Atkins Definition • Used for death penalty cases • Based on Supreme Court decision – Atkins • State based • Two criteria; • Quantitative • Qualitative

14. Social Administration Disability • “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

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

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

17. SSA: Part B • 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

18. IQ: Test Usage Studies • 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.

19. IQ: Tests • WAIS • WISC • Stanford Binet • Beta • Kaufman • Reynolds • C-TONI

20. IQ Tests: Pub. Info

21. IQ Tests: History

22. IQ Tests: Application

23. IQ Bell Curve

24. Measuring Adaptive Functioning Two commonly used tests: • Vineland • ABAS

25. Adaptive Functioning Tests: Pub. Info

26. Adaptive Functioning Tests: History

27. Adaptive Functioning Tests : Application

28. Basic Standards for Testing • 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)

29. Interfacing IQ with Adaptive Deficits: Social Security Disability • 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

30. Interfacing IQ with Adaptive Deficits: Social Security Disability • “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

31. Interfacing IQ with Adaptive Deficits: Social Security Disability • Limits Placed on by Social Security • Use of Collateral Interviews • Focus on History • Records (especially educational and vocational) • Patterns • Contextual history

32. Future Directions • 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)

33. Thank you • Questions? • Contact Information Antonio E. Puente, Ph.D. puente@uncw.edu