Download (2010, May). The link between mental

Antonio E. Puente, Ph.D.
Mental Retardation and Adaptive Functioning
North Carolina Advocates for Justice
Raleigh, NC
05.21.10
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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).
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In the past, the following terms were used to
describe or refer to MR individuals as
diagnostic and legal terminology (Volkmar &
Dykens, 2002):
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Idiots
Fools
Morons
Imbiciles
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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
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MR individuals is associated with cognitive
deficits (IQ ≤ 70) and deficits in adaptive
skills.
There are multiple definitions of MR with
overlap.
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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)
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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
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“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).
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“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).
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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
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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
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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 functioningborderline.
Source: http://www.aaidd.org/content_100.cfm?navID=21
Adaptive behavior includes three skills:
 Conceptual skills
◦ Language & literacy; money, time, and number
concepts, & self-direction.
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Social Skills
◦ Interpersonal skills, social responsibility, selfesteem, gullibility, social problem solving, ability to
follow rules/laws, etc.
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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
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Used for death penalty cases
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Based on Supreme Court decision – Atkins
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State based
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Two criteria;
◦ Quantitative
◦ Qualitative
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“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-MentalDisordersAdult.htm#12.05%20Mental%20Retardation
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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/12.00MentalDisorders-Adult.htm#12.05%20Mental%20Retardation
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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-MentalDisordersAdult.htm#12.05%20Mental%20Retardation
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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-MentalDisordersAdult.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.
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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)
Beta III
1934
31 (0)
8 (24)
Kaufman
1993
29 (1)
38(1)
Reynolds
1998
25 (4)
39 (0)
CTONI
1996
-
25 (14)
30 (9)
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,
2003
Harcourt
Assessment, Inc.
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.
BirthMaturity/low
functioning
adults.;
To diagnose
individuals who may be experiencing
complications with the daily
adaptive skills necessary for
functioning, planning
interventions. Also used to measure
individual’s level of function without
the assistance of others.
0-5
5-21
2-5
5-21
16-89
ABAS
3 to 12-11
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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)
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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
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“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
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Limits Placed on by Social Security
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Use of Collateral Interviews
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Focus on History
◦ Records (especially educational and vocational)
◦ Patterns
◦ Contextual history
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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)
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Questions?
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Contact Information
Antonio E. Puente, Ph.D.
[email protected]