Mental Retardation Determining Eligibility for Social Security Benefits (2002) / Chapter Skim
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1. Introduction
1. Introduction
Pages 15-37
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From page 15... ...
It evaluates the existing disability determination process in the context of current scientific knowledge and clinical practice. Mental retardation, a condition characterized by deficits in intellectual capabilities and adaptive behavior, can be particularly difficult to diagnose in the mild range of the disability.
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Disability is defined similarly for both the DI and SSI programs. For all persons applying under the DI program and for adults applying under the SSI program, disability is defined as "the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairments which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months" (Social Security Administration, 2002, p.
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The claims representative will determine if the technical aspects of disability eligibility or entitlement are met. If the individual is eligible for benefits under the Title II program, or the Title XVI program, or both programs, the medical and vocational material is then forwarded to the state disability determination services (DDS)
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Some are inherent in the criteria for disability determination and the assessment instruments used to determine whether the client meets them.
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761. Children must also have significantly subaverage general intellectual functioning with deficits in adaptive behavior.
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In order to be found eligible for benefits due to mental retardation, adults must be mentally retarded as defined above, and must meet one of four requirements: · mental incapacity as evidenced by dependence upon others for personal needs (e.g., toileting, eating, dressing, etc.) and an inability to follow simple directions that is so severe that standardized measures of intellectual functioning cannot be administered; · valid verbal IQ (VIQj, performance IQ (PIQj, or full-scale IQ (FSIQ)
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. · det~c~enc~es In motor deve shipment, cogn~t~ve/commun~cat~ve functioning, or social functioning for infants and toddlers; and for children and adolescents, deficiencies in at least two areas that include cognitive/communicative functioning, social functioning, personal functioning, or deficiencies in concentration, persistence, or pace that result in failure to complete tasks in a timely manner; · a dependence on others for personal needs that is grossly in excess of age expectations, and an inability to follow directions that is so severe that standardized tests cannot be administered; · valid VIQ, PIQ, or FSIQ of 59 or below; · valid VIQ, PIQ, or FSIQ between 60 and 70 and a coexisting physical or other mental disorder that significantly impairs function~ng; · valid VIQ, PIQ, or FSIQ between 60 and 70 and, for infants and toddlers, the failure to attain development expectations for motor, cognitive/communication, and social functioning that is consistent with other children no more than two-thirds of their chronological age; for older children and adolescents, problems with cognitive/communicative function, social function, personal function, or problems with concentration, persistence, or pace; or
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HISTORY OF MENTAL RETARDATION DEFINITIONS The definition of mental retardation currently used by SSA differs from that used by other professional and health-relateu organizations. The concept of mental retardation, particularly a recognition that some portion of the population has cognitive deficits that significantly interfere with functioning, is an old one, although the ways in which this has been defined and measured have changed over time.
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This definition defined mental retardation as "subaverage general intellectual functioning which originates in the developmental period and is associated with impairment in adaptive behavior" (Jacobson, 19991. Subaverage intellectual functioning was defined as an IQ of 85 or less, with the developmental period extending only up to age 16.
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, melded the 1977 and 1992 AAMR definitions, retaining the severity levels from 1972 and adopting a list of adaptive behavior areas similar to those chosen by AAMR in 1992. The DSM-IV also kept the upper limit of intelligence at equal to or less than 70.
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, which monitors the prevalence of developmental disabilities, including mental retardation, among children 3 to 10 years of age in the metropolitan Atlanta region (Boyle et al., 19961. The study used the definition of mental retardation listed in the International Classification of Diseases, AL Revision, Clinical Modification (ICD-9)
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This suggests that between 2.8 million and 7.5 million individuals could be diagnosed as having mental retardation. In the Social Security System Individuals with a diagnosis of mental retardation constitute a significant number of all recipients of SSA disability benefits.
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ISSUES THAT PROMPTED THE CURRENT STUDY The current study was designed to assess SSA's disability determination process for mental retardation. The committee was asked to examine new scientific opportunities and associated practice techniques to improve the current determination process.
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This study was prompted by a number of issues, including: · the adequacy of SSA's definition of mental retardation, · questions about intellectual assessment, . issues raised by the assessment of adaptive behavior, · thinking about how to combine data from intellectual and adaptive behavior assessments, particularly in the mild range of mental retardation, to accurately diagnose the condition, and · issues related to distinguishing mental retardation from other diagnoses, particularly for children and adolescents.
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of the American Psychological Association. DSM-IV defines mental retardation as significantly subaverage intellectual functioning (i.e., IQ no higher than approximately two standard deviations below the mean)
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WHO and Division 33 advocate the use of a standardized measure of adaptive behavior functioning, while AAMR and the American Psychiatric Association allow for descriptors of functional deficits across different domains. Even with this latter approach, however, the number of areas in which functional limitations must be present also differs.
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in its regulations. While SSA encourages the use of any standardized tests to determine intellectual and adaptive behavior functioning, it does not require these tests.
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The committee was charged with determining if other instruments better assess young children's intellectual functioning. Adaptive Behavior Functioning and Its Assessment For individuals with an intelligence score greater than 59, SSA requires documentation of deficits in adaptive behavior and functioning in order for a classification of mental retardation to be made, as long as no other serious medical condition is present.
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The use of either descriptive evidence or standardized test results seems to reflect variations in practice throughout the field of mental retardation. AAMR and the American Psychiatric Association both allow for behavioral descriptors of adaptive behavior in order to diagnose mental retardation.
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Advances in the study of adaptive functioning have provided a more differentiated view of individual social and personal competence. Reviewing current thinking on the multiple dimensions of adaptive functioning could produce new models for such assessment or improve the utility of older assessments by identifying or updating appropriate cutoff scores for disability, or it may point to desirable and justified alterations of functional areas that are the focus of review in the eligibility determination process.
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This approach was designed to gather information from a wide range of sources and assess the strengths and weaknesses of various pieces of evidence, with a goal of finding convergence of information from descriptive and inferential data and theoretical and conceptual frameworks. Literature searches were conducted in peer-reviewed journals; technical manuals on intelligence and adaptive behavior measures were reviewed; papers were commissioned from experts on a number of topics central to the committee's work; and feedback was solicited from professional practice, advocacy, and other relevant groups.
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In focusing on specifying criteria for the determination of mental retardation for SSI/DI eligibility purposes, this report speaks to the intellectual and adaptive behavior criteria that should be used in making these determinations. The committee's findings, conclusions, and
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Committee members view the standards for intellectual functioning and adaptive behavior assessment outlined in this report as applicable to the redetermination process as well.
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