Mental Retardation Determining Eligibility for Social Security Benefits (2002) / Chapter Skim
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5. The Relationship of Intelligence and Adaptive Behavior
5. The Relationship of Intelligence and Adaptive Behavior
Pages 208-244
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From page 208... ...
Information about each of these core dimensions is always incomplete and dependent on imperfect measures of the underlying constructs. Judgment is therefore necessary when making decisions about how best to assess intellectual and adaptive functioning and in interpreting the results; this chapter provides guidance for those judgments.
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From page 209... ...
Broad consensus exists throughout the developed world about the basic features of the conceptual definition of mental retardation: it involves significant limitations in the core dimensions of intellectual functioning and adaptive behavior. Most national and worldwide diagnostic systems use the term "mental retardation," and nearly all suggest that deficits in adaptive behavior arise because of limited intellectual functioning.
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From page 210... ...
As is shown later, the combined effects of different cutoff scores can drastically alter the number of people who can be considered for a diagnosis of mental retardation. Classification criteria also vary regarding the use of composite and part scores as well as the number of part scores that may be used from measures of adaptive and intellectual functioning.
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From page 211... ...
Before raising an alarm with this statistical information, however, it should be noted that no prevalence study of people identified as having mental retardation has ever approached the level of 5 percent of the general population, at least in part because of the necessity of a concurrent deficit in adaptive behavior. More commonly, investigations have yielded a prevalence of 1 to 1.5 percent.
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From page 212... ...
found that the stringency of the IQ criterion is not always related to the prevalence of students classified as having mental retardation and placed in special education. State-to-state variations in special education rules regarding conceptual definitions and classification criteria for mental retardation lead to large differences in prevalence and many inconsistencies in the diagnosis of mental retardation between such agencies as SSA and the public schools.
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From page 213... ...
mental retardation diagnostic system is the one exception to the general trend in diagnostic systems of avoiding precise specification of adaptive behavior cutoff scores to define mental retardation eligibility. The Division 33 scheme is explicit in recommending the use of a "comprehensive, individual measure of adaptive behavior" (p.
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From page 214... ...
The classification criteria governing diagnosis of mental retardation for special education services by state departments of education generally do not provide guidance regarding the use of adaptive behavior composites, part scores, or cutoff scores to determine eligibility. It is not surprising that the use of an adaptive functioning criterion in the schools is inconsistent and unpredictable (Reschly & Ward, 19911.
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From page 215... ...
She found that the number of adaptive behavior domains on which deficits must be shown had a marked effect on identification rates, with more individuals being identified as having mental retardation if only a single adaptive behavior domain had to meet a defined cutoff score than if two or more domains had to meet a cutoff score. Furthermore, the number of domains on which deficits could be measured had a modest but significant effect on identification rates: more individuals will be diag
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From page 216... ...
This led to the committee's recommendation, presented in Chapter 4, for revising the SSA adaptive behavior domains (see right side of Table 5-21. The SSA domain of concentration, persistence, and pace is not assessed by most adaptive behavior instruments, although these skills could be part of the work attitudes and skills domain recommended for adults.
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From page 217... ...
Daily living skills 5. Work the ones recommended by the committee to be adopted by SSA to guide decisions about diagnoses of mental retardation (the recommendation itself appears in Chapter 41.
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From page 218... ...
Decisions about performance in each of these areas therefore need to be based on the results of adaptive behavior instruments, to the extent that one or more instruments are appropriate for a given client, and a broad variety of other information. RELATIONSHIP OF ADAPTIVE BEHAVIOR AND INTELLECTUAL FUNCTIONING The relationship between measures of adaptive behavior and intellectual functioning is highly variable and has multiple influences.
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From page 219... ...
In contrast, the VABS domains of daily living skills, socialization, and motor skills have correlations with IQ that vary from about .20 to about .35. The relatively low correlations that many adaptive behavior measures have with IQ tests mean that many individuals low on one of the measures may not be low on the other, an outcome that has important implications for mental retardation diagnoses.
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From page 220... ...
. Generally, for individuals with low intellectual functioning, problems with intellectual measures are likely to be insufficient floors.
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From page 221... ...
, particularly with young children, little difference exists between the constructs of adaptive and intellectual functioning. The relationship of adaptive and intellectual functioning measures is less certain with individuals functioning in the moderate and mild levels of mental retardation as defined by IQ.
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From page 222... ...
The magnitude of this relationship for people with the moderate level of mental retardation is less certain, but it appears to be slightly higher than for people without this disability. Sufficient evidence is not available regarding the intellectual functioning and adaptive behavior relationship for people in the mild range of mental retardation, although extrapolating the findings just cited for the profound, severe, and moderate levels leads to the conclusion that the relationship is either no higher or only very slightly higher than for people without cognitive disabilities.
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From page 223... ...
Classification agreement studies form part of the basis for determining appropriate cutoff scores on adaptive and intellectual functioning measures. The ideal data set would be large samples of people functioning in the range of borderline to the high end of moderate mental retardation.
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From page 224... ...
require that test publishers provide validity data supporting the recommended uses of a test. Simulations of /Q and Adaptive Behavior Classification Agreement Because of the dearth of data examining the relationship between various levels of IQ and scores on adaptive behavior measures, particularly for individuals in the mild mental retardation range, the committee used Monte Carlo models to project the proportion of people who would be expected to have IQ and adaptive behavior domain scores in specific ranges.
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From page 225... ...
aAdaptive behavior status refers to any one or any two of four part scores from the VABS or SIB-R. bAII persons with IQs below 60 are presumed eligible to be considered for a diagnosis of mental retardation according to current Social Security Administration criteria.
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From page 226... ...
bAII persons with IQs below 60 are presumed eligible to be considered for a diagnosis of mental retardation according to current Social Security Administration criteria. The proportions in this column show the proportions of individuals with IQs below 60 who also have adaptive behavior scores below different cutoff scores.
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From page 227... ...
Examination of other combinations of IQ and adaptive behavior scores further supports the use of caution in setting an adaptive behavior cutoff score. In column 4 of Table 5-3, an IQ between 60 and 70 and a stringent criterion of two adaptive behavior domains at or below 70 yields a hit rate of only 6 to 12 percent, a level that is far below the stipulation that most people with IQs at or below 70 should be eligible to be considered for a diagnosis of mental retardation.
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From page 228... ...
Nevertheless, a significant number of cases in the Monte Carlo simulation with IQs in the range of mental retardation do not have significant adaptive behavior deficits using the ABAS. The uncertainty regarding the effects of different adaptive behavior cutoff scores is further increased by comparing the results in Tables 4-3 and 5-4.
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From page 229... ...
Conclusions Caution in the adoption of precise adaptive behavior cutoff scores is warranted by the limited evidence on the classification agreement between IQ and adaptive behavior measures at varying cutoff scores. Monte Carlo simulations, conducted to estimate the probable effects of varying adaptive cutoff scores, yielded results indicating the classification agreement often was rather low using the best of the currently available adaptive behavior measures.
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From page 230... ...
It is the obligation of those gathering and interpreting adaptive behavior information to make a compelling case if it is warranted. SSI AND Dl ELIGIBILITY DECISIONS Only professionals who have extensive knowledge about mental retardation and its assessment and who are using extensive information about an individual from multiple sources and settings should formulate eligibility decisions, because they have such profound consequences for the lives of clients and their families.
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From page 231... ...
They must also understand the types of errors that are likely to occur in situations as complex and challenging as determination of mental retardation. Common Judgment Errors A confirmation bias can occur when a decision maker seeks information that confirms an already existing hypothesis or judgment (Evans, 19891.
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From page 232... ...
Physical, emotional, adaptive, and cognitive functioning must be considered, and current SSA guidelines are consistent with this principle. The tendency of clinicians engaged in evaluations of mental retardation to focus almost exclusively on intellectual and adaptive functioning, ignoring other important information on overall mental health and emotional adjustment, has been called "diagnostic overshadowing" (Reiss et al., 1982; Reiss & Szyszko, 1983 )
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From page 233... ...
Many persons with mental retardation are eligible for dual diagnoses, a simultaneous diagnosis of mental retardation and some other physical or mental disorder, such as depression, conduct disorder, or sensory impairment. It is crucial that clinicians evaluating individuals for the diagnosis of mental retardation also look for other emotional, mental, and physical disorders that may complicate adaptive and intellectual functioning and confer eligibility in other SSA categories (see Chapter 61.
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From page 234... ...
One adaptive behavior instrument has been normed with adults using a self-report format; however, no data were provided in the manual contrasting the self-report and third-party respondent results for persons with mild mental retardation (Harrison & Oakland, 2000a)
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From page 235... ...
Review of records is another data collection method with strong applicability to the determination of intellectual and adaptive behavior deficits. School records are especially useful if evaluators understand the nature of mental retardation, classification practices in schools, and subtle indicators of low functioning in classrooms and schools.
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From page 236... ...
Diligence in collecting and examining r ~ r ~ ~ ~ ~ ~ ~ information trom multiple settings Is very Important. The literature refers to so-called six-hour retarded children (President's Committee on Mental Retardation, 1970)
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From page 237... ...
Examiner Qualifications Individuals making mental retardation diagnoses must meet high standards regarding professional preparation and relevant experience. SSA disability examiners should have in-depth and up-to-date knowledge in the following areas: mental retardation theory, research, treatment, and best practices; mental retardation diagnostic construct; measurement of intellectual and adaptive functioning; assessment principles and best practices; mental disorders theory, research, and best practices; purposes and practices of multiple agencies, such as schools, law enforcement, and health care; knowledge of human development; and assessment of the individual's strengths and limitations in the context of multiple environments, including family, work, and community.
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From page 238... ...
information from Other Agencies As noted previously in this report, mental retardation diagnoses are made for many purposes by many different agencies, including schools, law enforcement, en cl health care agencies. Different agencies use different diagnostic systems and classification criteria, making cliagnostic disagreements among agencies perfectly legitimate.
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From page 239... ...
These changes are even more impressive because they occurred during a period when children and youth with moderate, severe, and profound mental retardation gained access to the public schools for the first time in many states and districts. Although the child count data do not differentiate levels of mental retardation, it is highly likely that the decline in mild mental retardation has been even greater than the overall decline in mental retardation, simply because those with more severe mental retardation are more obviously impaired in many areas and are therefore more likely to be correctly diagnosed with mental retardation.
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From page 240... ...
Studies in California confirm both the reluctance of school professionals to confer the diagnosis of mental retardation and the willingness to use other diagnoses for children with characteristics that meet mental retardation classification criteria (MacMillan, Gresham et al., 19961. This leads to concerns about the continued viability of the mild mental retardation diagnostic construct in special education and schools (MacMillan & Reschly, 1996; MacMillan, Siperstein, & Gresham, 19961.
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From page 241... ...
On the basis of the committee's knowledge of individuals with mental retardation as well as the relevant research literature, this outcome is undesirable. We, therefore, propose formal adaptive behavior assessment as part of a comprehensive evaluation for individuals with or suspected of having mental retardation and cutoff scores that are more lenient than those widely used for intellectual functioning.
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From page 242... ...
Recommendation: A diagnosis of mental retardation must be based on high-quality assessments of intellectual and adaptive functioning that meet the following criteria: · A broad variety of information on adaptive behavior and intelligence should be collected, including data on performance in different settings, from different sources, and using varying methods. Comprehensive, multifactored measures of intelligence and adaptive behavior should be used in mental retardation eligibility determination.
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From page 243... ...
· Decisions about mental retardation eligibility should be made by people with appropriate preparation in the areas of mental retardation and other disabilities and disorders, measurement of intellectual and adaptive functioning, knowledge of human development, and the influence of context on behavior. The committee's recommendations reflect concerns about the quality of the available evidence as well as the necessity to provide reasonable guidance to people making eligibility decisions regarding a diagnosis of mental retardation.
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From page 244... ...
. retardation than on adjusting cutoff scores, the committee recommends research on improving measures, especially adaptive behavior assessment, and on methods to combine information on adaptive and intellectual functioning in making eligibility decisions based on a diagnosis of mental retardation.
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