Classification, and Systems of Supports

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Intellectual Disability: Definition,
Classification, and Systems of Supports
(11th Edition)

Marc J. Tassé, PhD

Director, Nisonger Center
-

UCEDD

Professor, Department of Psychology & Psychiatry

The Ohio State University

Columbus, OH USA



December 11, 2009

Genoa, Italy

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The AAIDD
Ad Hoc
Committee

on Terminology and Classification


Robert L. Schalock
*


Sharon A. Borthwick
-
Duffy


Valerie J. Bradley


Wil H.E. Buntinx


David L. Coulter


Ellis M. (Pat) Craig


Sharon C. Gomez


Yves Lachapelle


Ruth Luckasson


Alya Reeve


Karrie A. Shogren


Martha E. Snell


Scott Spreat


Marc J. Tassé


James R. Thompson


Miguel A. Verdugo
-
Alonso


Michael L. Wehmeyer


Mark H. Yeager

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Why Change Terminology?

The term “Intellectual Disability” is preferred because:

a)
Is less offensive to persons with the disability.

b)
Is more consistent with international terminology.


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Definition of Intellectual Disability

Intellectual disability is characterized by significant
limitations both in intellectual functioning and in
adaptive behavior as expressed in conceptual,
social, and practical adaptive skills. This disability
originates before age 18. The following five
assumptions are essential to the application of this
definition.

5


Limitations in present functioning must be considered
within the context of community environments typical of the
individual’s age peers and culture.


Valid assessment considers cultural and linguistic diversity
as well as differences in communication, sensory, motor, and
behavioral factors.


Within an individual, limitations often coexist with strengths.


An important purpose of describing limitations is to develop
a profile of needed supports.


With appropriate personalized supports over a sustained
period, the life functioning of the person with intellectual
disability generally will improve.

5 Essential Assumptions

6


Limitations in present functioning must be considered
within the context of community environments typical of the
individual’s age peers and culture.


Valid assessment considers cultural and linguistic diversity
as well as differences in communication, sensory, motor, and
behavioral factors.


Within an individual, limitations often coexist with strengths.


An important purpose of describing limitations is to develop
a profile of needed supports.


With appropriate personalized supports over a sustained
period, the life functioning of the person with intellectual
disability generally will improve.

5 Essential Assumptions

7


Limitations in present functioning must be considered
within the context of community environments typical of the
individual’s age peers and culture.


Valid assessment considers cultural and linguistic diversity
as well as differences in communication, sensory, motor, and
behavioral factors.


Within an individual, limitations often coexist with strengths.


An important purpose of describing limitations is to develop
a profile of needed supports.


With appropriate personalized supports over a sustained
period, the life functioning of the person with intellectual
disability generally will improve.

5 Essential Assumptions

8


Limitations in present functioning must be considered
within the context of community environments typical of the
individual’s age peers and culture.


Valid assessment considers cultural and linguistic diversity
as well as differences in communication, sensory, motor, and
behavioral factors.


Within an individual, limitations often coexist with strengths.


An important purpose of describing limitations is to develop
a profile of needed supports.


With appropriate personalized supports over a sustained
period, the life functioning of the person with intellectual
disability generally will improve.

5 Essential Assumptions

9


Limitations in present functioning must be considered
within the context of community environments typical of the
individual’s age peers and culture.


Valid assessment considers cultural and linguistic diversity
as well as differences in communication, sensory, motor, and
behavioral factors.


Within an individual, limitations often coexist with strengths.


An important purpose of describing limitations is to develop
a profile of needed supports.


With appropriate personalized supports over a sustained
period, the life functioning of the person with intellectual
disability generally will improve.

5 Essential Assumptions

10

5 Essential Assumptions


Limitations in present functioning must be considered
within the context of community environments typical of the
individual’s age peers and culture.


Valid assessment considers cultural and linguistic diversity
as well as differences in communication, sensory, motor, and
behavioral factors.


Within an individual, limitations often coexist with strengths.


An important purpose of describing limitations is to develop
a profile of needed supports.


With appropriate personalized supports over a sustained
period, the life functioning of the person with intellectual
disability generally will improve.

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Diagnostic Criteria

Significant deficits in intellectual functioning:

“Significant limitations in intellectual functioning criterion for a
diagnosis of intellectual disability is an IQ score that is
approximately two standard deviations below the mean,
considering the standard error of measurement for the
specific instrument used and the instruments’ strengths and
limitations.”

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Diagnostic Criteria

Significant deficits in adaptive behavior:

“Significant limitations in adaptive behavior’ criterion for a
diagnosis of intellectual disability is performance that is
approximately two standard deviations below the mean of
either (a) one of the following three types of adaptive
behavior: conceptual, social, or practical, or (b) an overall
score on a standardized measure of conceptual , social, and
practical skills. As with the intellectual functioning criterion,
the assessment instrument’s standard error of measurement
must be considered when interpreting the individual’s
obtained score.


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Defining Adaptive Behavior

Conceptual skills
: language, reading and writing, and money,
time, and number concepts.

Social skills
: interpersonal skills, social responsibility, self
-
esteem, gullibility, naïveté (i.e., wariness), follows
rules/obeys laws, avoids being victimized, and social
problem solving.

Practical skills
: activities of daily living (personal care),
occupational skills, use of money, safety, health care,
travel/transportation, schedules/routines, and use of the
telephone.


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The operational definition of “significant deficits”
is a performance that is approximately 2 standard
deviations or more below the population mean.


Reporting of IQ and AB scores with their
respective confidence intervals is a critical
consideration underlying the appropriate use of
measures of intelligence and adaptive behavior
-

and best practices; such reporting must be a part
of any decision concerning the diagnosis of
intellectual disability (95% confidence interval =
±

2 SEm).

“Significant Deficits”

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A notable change first included in the previous AAIDD
Manual (Luckasson et al., 2002) continues to be
emphasized in the 11
th

Edition (Schalock et al., 2010) with
regard to AB assessment.


“For the diagnosis of intellectual disability, significant
limitations in adaptive behavior should be established
through the use of standardized measures normed on the
general population…”




(p. 43
-

Schalock et al., 2010

“Significant Deficits in AB”

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Diagnostic Criteria

Age of onset:

“This disability originates before age 18.”


N.B. This does not imply that a diagnosis of ID cannot be
made for the first time beyond the age of 18 years of age. The
significant deficits in intellectual functioning and adaptive
behavior MUST have been present before age 18


not the
diagnosis.

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What are the causes of intellectual disability?

A multifactorial approach to the etiology of intellectual
disability is presented in the 11th edition. This
approach focuses on the types of
risk factors
(biomedical, social, behavioral, and educational)
and the timing of risk factors (prenatal, perinatal,
and postnatal).

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Classification

The primary purposes of classification in the field of
intellectual disability are grouping for funding,
research, provision of services and supports, and
communication about selected characteristics of
persons and their environments.

Classification is used today for more than its historic
purpose of grouping on the basis of IQ range bands
or adaptive behavior limitation scores.


AAIDD dropped (since 1992) the classification of the
condition based solely on IQ deficits.

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Classification

Professionals need to be familiar with the emerging
trends in the development and use of
multidimensional classification systems based on
the multidimensionality of human functioning that
involves:


Intellectual abilities

Adaptive behavior

Health

Participation

Context, and

Individualized supports

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Multi
-
dimensional Model of Human Functioning

I. INTELLECTUAL

ABILITIES

II. ADAPTIVE

BEHAVIOR


III. HEALTH


IV.
PARTICIPATION

V. CONTEXT

SUPPORTS

Individual

Functioning

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Intensity of Supports Needs

Supports are resources and strategies that aim to promote
the development, education, interests, and personal well
-
being of a person and that enhance individual functioning.



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Supports Needs

The support needs construct is based on the premise that
human functioning is influenced by the extent of
congruence between individual capacity and the
environments in which that individual is expected to
function.





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Supports Needs

Mismatch of
competency & demands


People with ID
experience a mismatch
between their personal
competency and
environmental demands.

Creates Support Needs

Improved
Personal
Outcome


Outcomes may
include more
independence,
enhanced
opportunities to
contribute to
society,
increased
participation in
school and/or
community
settings and
activities, and a
greater sense of
personal well
-
being/life
satisfaction.

Individualized
Supports


Thoughtful planning
& application of
individualized
supports

Provide Supports
Leading To:

Component 4: Monitor Progress

Component 3: Develop the

Individualized Support Plan

Component 1:

Identify desired life

experiences and goals


Component 2: Determine

the Intensity

of Support Needs


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Summary


Change in terminology from “Mental Retardation” to
“Intellectual Disability”.


Disability characterized by significant deficits in intellectual
functioning and significant deficits in conceptual, practical,
or social skills and the onset of these deficits originates
prior to the person’s 18
th

birthday.


Importance of understanding the person’s support needs.




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Intellectual Disability: Definition,
Classification, and Systems of Supports
(11th Edition)

Marc J. Tassé, PhD

Director, Nisonger Center
-

UCEDD

Professor, Department of Psychology & Psychiatry

The Ohio State University


Email: Marc.Tasse@osumc.edu



December 11, 2009

Genoa, Italy

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