Timely Identification of Intellectual Disability and Why It Is Important

It’s a typical morning.  I’m prepared for the High School freshman who is about to receive his third formal Psycho-educational Assessment.  He has been classified as having a specific learning disability, and yet the previous evaluation doesn’t seem to fit the minimum criteria. Reports from the parents and teachers state that he has failed to make progress, he frequently sleeps during class, and requires constant prompting to stay on task.  His grades are barely passing and he has not been successful on any of the district or State assessments since elementary school.

 “Good-Morning”, I say as the student enters. I explain the assessment agenda.  The student politely replies, slumps down in the chair and pulls his hoodie over his head.  I attempt to establish a good rapport with the student by asking about his day, weekend, or interests.  His responses are short, simple and it appears he just wants to move on.  As the assessment begins, I find it necessary to begin the subtests in the range of suspected disability on the battery I am using.  His current eligibility of Specific Learning Disability soon fades from the reality of the student who is in front of me.  As the hours pass and we progress beyond small talk, he says he hates school, is having trouble with his parents, and doesn’t have any realistic plans for the future.  The student is aware that he is unable to keep pace with his typical peers, he’s frustrated, unsuccessful, and at risk for either dropping out of school or delinquency.

Throughout my career as an Educational Diagnostician I have encountered JR High and High School students meeting the criteria for Intellectual Disability, but have not received the eligibility.  Typically, these students are receiving Special Education services under other eligibilities such as Specific Learning Disability, ADHD, or Emotional Disability.  The students are placed in General Education classes while functioning 4, 5, or more grade levels below their typical peers with special education support.  Many times, the students’ performance on previous Cognitive Assessments are close to the 70-point cut off.  They present as lazy, obstinate, or the “cool rebel” to cover up the fact that they are so far behind their typically functioning peers. They are passed from grade to grade making little or no progress globally.

“Why does this happen?”, you may ask.  Here are some of the misconceptions by educators when defining Intellectual Disability.  A common error occurs if the student can function close to or within normal range in one or more areas. This functioning is thought to disqualify them as having an Intellectual Disability.  In this case, a student may be able to read words, recite math facts, or perform tasks that can be learned by repetition at the same rate as their typical peers.  Reading, spelling, and math fluency are examples of these tasks.  The key to evaluating this type of student is to examine their comprehension levels.  The student is able to read the words, but not understand what they “mean.”  The student is able to recall math facts but not apply formulas that require reasoning skills.  In other words, these students can memorize facts, but not apply them.

Another type of student that gets overlooked for Intellectual Disability are those with other eligibilities that present with behavioral issues such as Emotional Disability, ADHD and Autism.  Because of the underlying behavioral issues, the eligibility of Intellectual Disability is overlooked.  While it is prudent to apply caution when attaching a major eligibility to young students who are experiencing behavioral issues, once there have been two or three similar cognitive assessments with similar results, it’s safe to apply Intellectual Disability as an appropriate eligibility as long as the other criteria is met.  Consequently, once the intellectual profile is fully understood and the student is presented with the appropriate level of instruction, the behaviors often minimize.

So, how does one properly identify Intellectual Disability? There are three components: Age, IQ, and Adaptive Behavior.  The eligibility must present prior to the subjects’ 18^th birthday.  Secondly, the student’s performance on Cognitive assessments must be 70 (+/- 5 pts) on the full-scale intelligence quotient.  Note: There is a common misconception when reviewing the intelligence quotient (IQ) if one subcategory is above 70 the student is not considered Intellectually Disabled.  Having one or more areas above 70 is very common among persons with an intellectual disability.  When considering intellectual disability, it is important to look at global functioning or the full-scale intelligence quotient (FSIQ).  Unlike specific learning disabilities the student is not being assessed for strengths and weaknesses in cognitive functioning but how they function overall.  Current theory suggests that an IQ slightly above the 70 point threshold might be considered for a flexible cutoff, meaning that the practitioner is able to use professional judgement on scores up to 75.  Standard Error of measurement should be considered when evaluating a student.  Depending on the instrument being used in the assessment the variance can be +/- 2 to 5 points (reference: Flanagan, Dawn P. “Use of Intellectual Tests in the Identification of Children and Adolescents with Intellectual Disability” Contemporary Intellectual Assessment, Fourth Edition; The Guilford Press, 2018. Page 1343).

Once the student’s IQ has proven to be within the range of a person with an Intellectual Disability, Adaptive Behavior must be considered. The American Association on Intellectual and Developmental Disabilities (AAIDD) defines adaptive behavior as follows:

“Adaptive behavior is the collection of conceptual, social, and practical skills that are learned and performed by people in their everyday lives. 

• Conceptual skills—language and literacy; money, time, and number concepts; and self-direction.
• Social skills—interpersonal skills, social responsibility, self-esteem, gullibility, naïveté (i.e., wariness), social problem solving, and the ability to follow rules/obey laws and to avoid being victimized.
• Practical skills—activities of daily living (personal care), occupational skills, healthcare, travel/transportation, schedules/routines, safety, use of money, use of the telephone.

Standardized tests can also determine limitations in adaptive behavior.”

Determining cutoffs for adaptive behavior deficits can be confusing as there are no specific federal instructions defining this deficit.  In my State of Texas, the regulations require that the student must have a weakness in two areas of Adaptive Behavior.  Weaknesses are considered to be <85. The National Center for Biotechnology Information (NCBI) explains: “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, 1991). Moreover, enormous variations exist across the states and, in some instances, across local school districts within states.”

The adaptive behavior scales can be subjective and often there is a discrepancy between how the parent and teacher views the student’s abilities.  It is best to look to your State’s regulatory procedures for criteria for Adaptive Behavior cutoffs.

Informing parents that their student meets the criteria as a student with an intellectual disability can be a difficult and frequently an emotional conversation.  Reactions vary, sometimes the parent is relived to finally know why their student is not progressing despite all the support they are receiving at home and at school.  However, once eligibility for intellectual disability is met, the student and parents have access to many community resources and possible financial support.  In states such as Texas, waiting lists for special post high school programs are long and resources are limited.  It is important when considering a post high school transition that parents be informed on the importance of signing their child up for support programs early to ensure the resources will be available when they need them.

Making the determination of Intellectual Disability should not be taken lightly nor should it be avoided.  Students with an Intellectual Disability can flourish gaining self-esteem, and independence as functioning contributors to society if given the correct support and opportunities.  Without the disability determination and needed support system, this population is at risk for delinquent behaviors, depression, and a diminished lifestyle.

Author: S. Laura Flores, M.Ed.,NCED