Mild Intellectual Disability – Research and Best Practices

1. Mild Intellectual Disability – Research and Best Practices Allyson G. Harrison, Ph. D., C. Psych. Alana Holmes, Ph. D., C. Psych. 13-May-2009

2. Mild Intellectual Disability (MID):A Question of Definition • Term coined by Ministry of Education (2001) to capture a group of students not falling into recognized disability categories, but still deemed in need of special education supports to succeed. • i.e., not Learning Disabled, not Intellectually Deficient

3. Term = Disability • The term MID is not in any recognized diagnostic codebook • If MID cannot be diagnosed by registered professionals how can it be considered disabling? • Furthermore, the Ministry of Education definition is of limited use with respect to diagnostic possibilities as it is bereft of operationally defined criteria. • Ministry leaves it to EACH school board to determine how they will actualize the term for use in identifying students within their board.

4. CONSIDER: CURRENT RANGE OF DEFINITIONS • Ministry of Education • Four different Ontario School Boards • Provinces of Alberta & BC • United States • College Committee on Disability Issues • American Medical Association • Diagnostic and Statistical Manual of Mental Disorders

5. How do you think the boards define MID?

6. Ministry of Education of Ontario (2001) MID is a learning disorder characterized by: • -an ability to profit educationally within a regular class with the aid of considerable curriculum modifications and supportive services; • -an inability to profit educationally within a regular class because of slow intellectual development; and • -a potential for academic learning, independent social adjustment, and economic self-support.”

7. London District Catholic School Board Criteria for identification of MID • Typically based on intellectual and achievement results within the 1st to 17th percentile range” • (that is, an IQ between 85-65)

8. RAINBOW DISTRICT SCHOOL BOARD Diagnosis of MID requires: • Assessment by regulated qualified professional • Mild level of general intellectual ability • Adaptive functioning and/or academic skills above lower cognitive ability • Difficulty learning and understanding new concepts • Able to meet limited Ontario curriculum expectations with support • Need for alternative curriculum • Potential for academic learning, social adjustment and economic support • Cognitive abilities within the 55 to 70 (+/- 5) range; academic and social skills >70 to 75 range

9. NORTHWEST CATHOLIC DSB Mild Intellectual Disability An intellectual assessment administered by a member of the College of Physicians and Surgeons or a member of the College of Psychologists that indicates full scale intellectual potential within the deficient range (i.e. below 70); An assessment report indicating the student’s adaptive functioning is within the deficient range; An educational assessment indicating that academic achievement is at or below the first percentile (i.e. 65); A speech/ language assessment and health history provided by a qualified medical practitioner may be considered.

10. Northeastern Catholic DSB says to identify a child as MID you need… Classroom documentation Educational Assessment indicating academic achievement in core subjects will be 2 or 3 grade levels below that expected based on chronological age • Psychological Assessment - indicating the student functioning in the mild to borderline (2nd to 8th percentile) intellectual range as measured by a WISC-III Students would have a modified program based on the Ontario Curriculum, have access to additional support in the classroom or require a small class setting for parts of the day. Behaviour is not the key focus for these students. Note: Interpretation of grade scores must be done within the context of general daily achievement.

11. Practices throughout Ontario Boards

12. And to add to the ambiguity…. One board calls them Mild Intellectual Exceptionality - General Learning Disabilities (Airy & Sabine District School Area, http://www.nexicom.net/~airy/Speced/specedrep06.pdf Durham District School Board calls MID a Mild Developmental Disability. http://ddsb.durham.edu.on.ca/Pdf/Spec_Ed_Plan_2005/B07_Categories%20and%20Definitions.pdf

13. WHAT DOES THIS TELL YOU? Why there is such variability in the academic outcomes of students labeled as MID at post-secondary level! No consistent way of determining who is MID or what characteristics they may have. Given measurement error, could have one child with IQ of 85 whose actual IQ was 90 (and who had no adaptive functioning deficits), and another child whose IQ was 65 (and who has severe impairments in all areas of adaptive functioning and required intensive support and course modification), both of whom were labeled MID. Of the boards who use IQ criteria, most are under 70.

14. IDENTIFICATION OF MID IN OTHER JURISTICTIONS: Alberta Ministry of Education definition: Mild Intellectual Disability is a categorization of students Overall IQ score falls between 50 and 70

15. BRITISH COLUMBIA MINISTRY OF EDUCATION DEFINES MID AS: Intellectual functioning is 2.01 to 3.00 standard deviations below the norm (i.e. 55-70) on an individually administered psychological assessment, and there is a delayed adaptive behavior and functioning of similar degree. Students with MID may require specific instruction for the acquisition of gross and fine motor skills, communication skills, assistance with development of social skills, including personal independence, social responsibility and life skills, as well as with reasoning skills, memory, problem solving and conceptualization skills.

16. United States Varying by state, MID is referred to as: • mild intellectual disability • educable mental retardation • mild cognitive disability • developmental disability These labels typically refer to children with IQ’s between 50-75

17. College Committee on Disability Issues • Students entering college with identifications of Mild Intellectual Disability have IQ’s between 70-79 (2nd to 8th percentile) • These students may also have been referred to as having Borderline Intellectual Functioning or being a slow learner • Such students are eligible for accommodations

18. Borderline Intellectual Functioning • A classification of mental ability covering persons with I.Q. scores in the range of 71 to 84, with only slight impairments in adaptive behavior • Also called, borderline mental retardation The American Medical Association Encyclopedia of Medicine, 1989

19. Borderline Intellectual Functioning • The DSM-IV includes Borderline Intellectual Functioning, but as a “V” code on Axis II, which means that it is not a recognized clinical disorder. • Within the V-Codes, Borderline Intellectual Functioning is defined by DSM-IV as follows: • This category can be used when the focus of clinical attention is associated with borderline intellectual functioning, that is, an IQ in the 71-84 range”, and is coded on Axis II American Psychiatric Association, 1994

20. Range of Definitions Where is the overlap? • Use of IQ scores What are the gaps? • Identification vs diagnosis • Range of IQ scores • Measures of adaptive functioning • Measures of academic skills • Vulnerable to feigning

21. What is a disability and does MID qualify as one? • Students with disabilities are entitled to reasonable and appropriate accommodations at the post-secondary level (Ontario Human Rights Code, 2004) • The OHRC defines a disability as: • (b) a condition of mental impairment or a developmental disability, • (c) a learning disability, or a dysfunction in one or more of the processes involved in understanding or using symbols or spoken language, • (d) a mental disorder

22. What is a disability and does MID qualify as one? • It would therefore appear that, depending on the way that MID is defined, it may qualify as a disability. • This is a grey area!! • The OHRC does not specify how one defines a mental impairment. • No consensus on how to define MID • In Canada at present, no one has dealt with the issue of determining how severe an impairment must be relative to the general population before it can be construed as a disability • Hence, difficult to address issue of whether MID qualifies as a disability.

23. Where to begin? • How do we determine what policies and supports should be put in place if we can’t even agree on who they are? • Start with a general understanding regarding how post-secondary institutions are defining this group • what documentation they are requiring regarding disability • the types of programs into which they are going • the typical supports they are using and whether course content is being modified • their success in completing programs at the post-secondary level

24. What to do? • A survey was undertaken to investigate these questions • It is assumed that appropriate policies and services can be developed only after service providers have a better understanding of the nature of the issues faced by such students, and when an agreed-upon way to identify these students is determined

25. The Survey • Survey link e-mailed to all heads of Disability Services Offices (DSO’s) in Ontario in the fall of 2008. • Of the 50 publicly funded institutions in Ontario: • 28 are 2-year colleges • 22 are 4 year universities

26. The Survey . . .cont’d A 20 item questionnaire to determine: • number of students with MID served at each institution • information about the objectives outlined for this survey. • a general understanding regarding definitions used for this group of students • documentation required regarding this “disability” • types of programs these students enter • typical supports these students are using • whether course content is being modified • success of these students in completing programs at the post-secondary level

27. Demographics: Response rate = 68% (34 institutions of 50 surveyed) • Colleges = 82% (23/28) (12 with CICE programs) • Universities = 50% (11/22) All sizes of institutions, primarily urban, all areas

28. DEMOGRAPHICS: 61.8% of respondents served 500-1,000 disabled students/year 38.2% of respondents served >1,000 disabled students/year

29. How many (estimated) students with MID? • Colleges reported a range from 8-100 students with MID/year (or this year) • Universities reported <6/year except one, which reported 20-25 • So, higher incidence in colleges but, still <10% of all students with disabilities served

30. HOW DID THE INSTITUTIONS DEFINE MID?

31. Do you require any other proof of impairment other than IQ scores?

32. Diagnosis made in documentation

33. DOCUMENTATION : • Psychoeducationalreports most often use the terms “diagnosis” of MID, borderline intellectual functioning, or LD. • Individual Education Plans (IEP’s) use descriptions of exceptionality like below average, limited intellectual ability, or slow learner. • Documentation provides a diagnosis • 33% of universities • 70% of colleges

34. Services and supports provided to students with MID Modifications • Provision of modifications of both course AND admission requirements: • 0 universities • 1 college

35. Accommodations :commonly provided by both colleges & universities • Referral to mainstream campus study skills/supports • 70% of universities; 82.6% of colleges • Tutoring, referral to ESF LS supports, AT on campus, BSWD for technology • 40-60% of universities; 69.6-91.3% of colleges • Extra time on exams, separate space, scribe/reader • 50-70% of universities provided extra time or separate space, 10% provided a scribe/reader; 56.5-100% of colleges did so • Approval of P/T study, approval of 40% load for OSAP, and BSWD for assessment • 50-60% of universities; 82.6-91.3% of colleges

36. Accommodations :provided Differently by colleges & universities Universities: • No clarification of exam questions; 10% (n=1) provided educational assistants in class/lab and tutoring >3hrs./week/course, and 20% approved BSWD for coaching or learning strategies. Colleges: • 34.8% of colleges provided clarification of exam questions; 34.8% reported providing tutoring in > 3 hrs/week/course, 8.7% provided educational assistants and BSWD for coaching; 34.8% reported approving BSWD for a learning strategist.

37. Success rates How many succeed? _% say less than 10% succeed 40% __% say 10-25% succeed 35% __% say 26-50% succeed 10% __%say 50-75% succeed* 15%

38. Comments offered by respondents: • Students with MID who succeed: • are generally highly motivated • have realistic goals • good organization and study skills • seek assistance and support • and take a reduced course load • Although students with MID often ask for course modifications, these are almost always refused • A significant increase in students with MID has been observed

39. OTHER COMMENTS Often they complete after a prolonged period and with much support from our office. Difficulties due to over-accommodating/modifying in high school. Very hard transition to postsecondary. Sometimes receive grade 12 college English credit, but aren't working at the level. We have only had 2 students over the last 10 years to my knowledge, both only lasted one semester and then dropped out Complete program when in less demanding academic areas and commit to additional time

40. SUMMARY • MID area is presently in a state of disorder. No consistently used or applied definition in Ontario. Much heterogeneity. • Definition used by CCDI differs from school boards & from other areas of Canada and the USA. • Assessors use different labels and different criteria.

41. SUMMARY cont’d Students with a label of MID represent less than 10% of students being served by disability offices in Ontario’s colleges and universities. 75% of respondents estimated that one quarter or fewer of MID students are successful in post-secondary school. The chance for failure appears heightened for this group of students. What of the 25% or so who are successful in their bid for post-secondary credentials? Perhaps group who are defined differently by various boards? Highlights need to determine who these successful students are and what characteristics help them to succeed.

42. SUMMARY cont’d • While both colleges and universities are servicing this population, colleges do so to a much greater extent • Universities and colleges provide similar types of accommodation, but colleges do so to a greater extent • Both sectors approve BSWD funds and partial course loads for this group, but colleges do so more frequently • Universities take a more conservative approach to the documentation of MID, requiring supplementary information regarding functional implications in addition to IQ scores to determine MID • Universities offer fewer accommodations and supports

43. Next Steps: • Need an agreed upon and operationalized definition of the group of traits currently being labeled MID (IQ and adaptive functioning, evidence of longstanding nature of impairments) • Investigate characteristics of those who succeed vs. those who do not. • Best practice guidelines with respect to assessment are needed as well as an emphasis on the need for good background documentation • Would it be useful to conduct a similar survey with Ontario’s school boards to gain an estimate of how many students with MID are likely to be graduating in the next few years with intent to enroll in post-secondary education? • Should Ontario school boards be polled to determine what supports (other than modifications) have enabled these students to succeed in an educational setting?