ID Assessment Issues Hou-Met 40 th Conference November 18, 2015 Kara Zwolinski, M.Ed. Education Specialist, Student Evaluation Region 4 Education Service Center 1
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 the this definition: 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 ID generally will improve. Intellectual disability is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. The following three criteria must be met: Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community. Onset of intellectual and adaptive deficits during the developmental period. 2
34 CFR 300.8 Child with a disability. (6) Intellectual Disability means significantly subaverage general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child's educational performance. 19 TAC 89.1040. Eligibility Criteria. (5) Intellectual disability. A student with an intellectual disability is one who has been determined to meet the criteria for an intellectual disability as stated in 34 CFR, 300.8(c)(6). In meeting the criteria stated in 34 CFR, 300.8(c)(6), a student with an intellectual disability is one who: (A) has been determined to have significantly sub-average intellectual functioning as measured by a standardized, individually administered test of cognitive ability in which the overall test score is at least two standard deviations below the mean, when taking into consideration the standard error of measurement of the test; and (B) concurrently exhibits deficits in at least two of the following areas of adaptive behavior: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety. 3
Genetic Factors Familial Factors Non-familial Factors Child s genetic makeup Father s IQ & Education Quality of School Mother s IQ & Education Teacher Characteristics Socioeconomic Status Culture Quality of Home Environment Quality of Community Prenatal & Early Development Environmental Toxins Sattler (2008) Assessment of Children-Cognitive Foundations, 5 th Edition Healthcare & Nutrition 4
Timing Type Prenatal Biomedical Perinatal Social Postnatal Behavioral Educational The various levels of severity area defined on the basis of adaptive functioning, and not IQ scores. 5
Difficulties learning academic skills involving reading, writing, math, time or money Executive function, short-term memory, and functional use of academic skills are impaired Concrete approach to problems and solutions Immature in social interactions and perceiving social cues Communication, conversation, and language are more concrete or immature that expected for age Limited understanding of risk in social situations May function age-appropriately in personal care Recreational skills resemble those of age-mates Employment is often achieved in jobs that do not emphasize conceptual skills Some support needed as an adult with complex daily living tasks and health care and legal decisions APA (2013) Diagnostic and Statistical Manual of Mental Disorders: DSM-5 Support is required for all use of academic skills in work and personal life Ongoing assistance needed to complete conceptual tasks of day-today life Marked differences from peers on social and communicative behavior, but social language is typically a primary tool Capacity for relationships is evident in ties to family and friends May not perceive or interpret social cues accurately Can care for personal needs involving eating, dressing, restrooming, and hygiene Participation in household tasks can be achieved Independent employment can be achieved if the job require limited conceptual or communication skills, but will require considerable support APA (2013) Diagnostic and Statistical Manual of Mental Disorders: DSM-5 6
Conceptual skills limited Little understanding of written language or of concepts involving numbers, quantity, time, and money Spoken language is limited in vocabulary and grammar Understand simple speech and gestural communication Requires support for all activities of daily living and requires supervision at all times Ongoing support and assistance for tasks at home, recreation, and work Cannot make responsible decisions APA (2013) Diagnostic and Statistical Manual of Mental Disorders: DSM-5 Conceptual skills involve the physical world May use objects in goal-directed fashion Very limited understanding of symbolic communication in speech or gesture Expresses desires and emotions mainly through nonverbal, nonsymbolic communication Enjoys relationships with well-known family members, caretakers, and familiar others Dependent on others for all aspects of daily physical care, health, and safety Recreational activities may involve listening to music, watching movies, going out for walks, or participating in water activities Co-occurring physical and sensory impairments are frequent barriers APA (2013) Diagnostic and Statistical Manual of Mental Disorders: DSM-5 7
Mental capacity for reasoning, learning, problem solving Broader than intellectual abilities or intelligence Includes reasoning, planning, solving problems, thinking abstractly, comprehending complex ideas, learning quickly, and learning from experience Single trait vs. multitrait vs. multiple intelligences? Until such measures of multiple intelligences can be assessed reliably and validly, it is the position of the AAIDD that intellectual functioning is best conceptualized and captured by a general factor of intelligence (g). AAAID, p. 34 8
has been determined to have significantly sub-average intellectual functioning as measured by a standardized, individually administered test of cognitive ability in which the overall test score is at least two standard deviations below the mean, when taking into consideration the standard error of measurement of the test For Infants and Toddlers For 2+ Years of Age Battelle Developmental Inventory, Second Edition (BDI-2, 2004) Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III, 2005) Differential Ability Scales- Second Edition (DAS-II, 2007) Kaufman Assessment Battery for Children-Second Edition (KABC- II, 2004) Stanford-Binet Intelligence Scales, Fifth Edition (SB5, 2003) Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III, 2002) Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V, 2014) Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV, 2008) Woodcock Johnson Tests of Cognitive Abilities-Fourth Edition (WJ IV, 2014) Armstrong, Hangauer, & Nadeau (2012) Use of Intelligence Tests in the Identification of Children with Intellectual and Developmental Disabilities, Chapter 30 of Contemporary Intellectual Assessment Theories, Tests, and Issues, 3 rd Edition. 9
The SEM quantifies the variability that arises from potential sources of error (e.g., variations in test performance, examiner behavior, subject cooperation, person and environmental factors) and provides a statistical confidence interval within which a person s true score falls. The standard error of measurement (SEM) provides an estimate of the amount of error in an individual s observed test score. Some measurement error is associated with every test and there is always some uncertainty about an individual s true score. Large SEM reflect less stable measurements. Sattler ( Identify and eliminate areas of potential interference. Select tests and other assessment instruments wisely. Engage in informed score interpretation. Consider alternative explanations and co-occurring conditions. Floyd (2014) Identifying ID in the Era of RtI, Multiple Intelligences, & Disproportionality Modules 10
Use individually administered, standardized instruments that yield a measure of general intellectual functioning Select specific standardized measure(s) that accommodate the person s cultural and linguistic diversity Use the most recent norms of the assessment instruments selected and consider Flynn effects. Interpret the person s IQ score(s) considering a statistical confidence interval based on the standard error of measurement for the specific instrument used and the instrument s strengths and limitations. Consider any potential influences, both positive and negative, of personal characteristics, environmental factors, and practice effects on test results. 11
Group Profiles: Performance on CHC factor clusters was broadly consistent with the clusters g loadings Performance yielded relative strengths in Visual- Spatial Thinking and Auditory Processing clusters, and relative weaknesses in Comprehension-Knowledge and Long-Term Retrieval clusters Individual Profiles: Demonstrate wide range of performance across CHC broad abilities not similar to group profile Bergeron, R. & Floyd, R.G. (2006) Broad Cognitive Abilities of Children with Mental Retardation: An Analysis of Group and Individual Profiles Implications for Practice: Individual children will not likely display a flat cognitive profile Although knowledge of children s strengths and weaknesses gleaned from part scores measuring specific cognitive abilities may inform educational interventions or curriculum adjustments, denying SE eligibility or failing to make a diagnosis based on significant part score variability may do these children disservice. Bergeron, R. & Floyd, R.G. (2006) Broad Cognitive Abilities of Children with Mental Retardation: An Analysis of Group and Individual Profiles 12
Part scores are indexes, clusters, or factor scores. Part scores reflect the item content and the response processes - IQs measure global ability Part scores inherently have lower reliabilities than associated IQs Bergeron, R. & Floyd, R.G. (2013) Individual Part Score Profiles of Children with Intellectual Disability: A Descriptive Analysis Across Three Intelligence Tests Implications for practice: Should not expect children with ID to display flat part score profiles Findings indicate that the vast majority of children with ID would not be identified because they have one or more elevated part scores Interpreting both part scores and IQs sometimes lead to confusing results Bergeron, R. & Floyd, R.G. (2013) Individual Part Score Profiles of Children with Intellectual Disability: A Descriptive Analysis Across Three Intelligence Tests 13
Exchangeability refers to the assumption that the IQ a person receives will be reasonably constant no matter which intelligence test battery is used. Implications for Practice: IQs from different batteries demonstrate reasonably high exchangeability most tend to produce scores that are generally within the same range for the majority of individuals. IQs appear to be more exchangeable than more specific ability measures. Different intelligence test batteries do tend to produce (for a number of reasons) very discrepant scores for at least some individuals. Recommend careful selection of assessment methods, integration of different sources of information, and a good deal of clinical judgment. Floyd, R.G. & Clark, M.H. (2008) The Exchangeability of IQs: Implications for Professional Psychology 14
Range of everyday social and practical skills Three types of skills: Conceptual Social Practical Defined by Heber (1959) as the effectiveness with which the individual copes with the nature and social demands of his environment. It has two major facets: Degree to which the individual is able to function and maintain himself independently Degree to which he meets satisfactorily the culturally-imposed demands of personal and social responsibility. Concurrently exhibits deficits in at least two of the following areas of adaptive behavior Communication; Self-Care; Home Living Social/Interpersonal Skills Use of Community Resources; Self- Direction Functional Academic Skills Work; Leisure; Health and Safety 15
AAIDD operational definition of ID for adaptive behavior is similar to that for IQ score: approximately 2 standard deviations below the mean considering the SEM 2008 Bergeron and Floyd reviewed eligibility guidelines across states and DC 11 had a criterion which was usually 2 SDs Vast majority of states did not specify Vineland Adaptive Behavior Scales, Second Edition (2006) Adaptive Behavior Assessment System, Third Edition (2015) Scales of Independent Behavior-Revised (1996) Inventory Client and Agency Planning (2015) Diagnostic Adaptive Behavior Scale (?) 16
Rating scales Interview Observation Review of records Adaptive behavior and IQ should be given equal consideration Adaptive behavior measures typical performance (not maximum) No instrument completely measures all adaptive behavior skills Problem behaviors are not considered to be a limitation Gullibility and naiveté are not usually measured Opportunity 17
Were the instruments completed by multiple informants who observed the individual in unique settings? Does the composite score or domain scores indicate development that deficit? Were the 95% confidence intervals considered in interpretation? Is there other evidence that the individual is delayed in important conceptual, practical, and social domains? Floyd (2014) Identifying ID in the Era of RtI, Multiple Intelligences, & Disproportionality Modules Use individually administered instruments that yield a measure of conceptual, social, and practical adaptive skills. Use direct observation(s) of adaptive behavior. Use trained professional interviewers and respondents who understand the principles of adaptive behavior, use age-peers who live in the community as the comparison group, know the person being assessed very well, and observe the person on daily or weekly basis across multiple environments. Employ adaptive behavior assessment instrument(s) that have been normed within community environments on individuals who are the same age as the individual being evaluated. Interpret the person s adaptive behavior score(s) considering a statistical confidence interval based on the standard error of measurement for the specific instrument used and the instrument s strengths and limitations. Schalock and Luckasson, Clinical Judgment-Second Edition, 2014, AAIDD 18
Use multiple types and sources of information to obtain convergence of information regarding limitations in comparisons to same-age peers. Use caution when there is conflicting information. Interpret results from direct observation with caution, as this might not be reflective of typical performance. Critically analyze all types of information for accuracy and pertinence Use clinical judgment. Adaptive behavior must be examined in the context of developmental periods. A continuing theme is the importance of the developmental relevance of specific skills. 19
IS NOT a substitute for insufficient data Rooted in clinical expertise & experience Emerges directly from extensive data IS NOT justification for abbreviated evaluation Clinical Judgment Systematic (organized, sequential, logical) Enhances the quality, validity & precision of diagnosis Transparent (apparent, communicated clearly) Formal (explicit, reasoned) Understand the questions related to diagnosis What is the referral question? What information is desired? Conduct a thorough history Interview Record review Four Clinical Judgment Strategies Conduct a broad-based assessment Synthesize the obtained information* 20
Clearly show that data are aligned with the referral question. Integrate information from multiple sources. Be aware of the factors that might inflate test scores. Be aware of potential false positive and false negative. Explore the possible reasons for differences in data. Recognize the effects of personal characteristics, environmental factors, and school-related factors. Recognize reasons that might explain the lack of an earlier diagnosis. 21
American Association on Intellectual and Developmental Disabilities. (2010) Intellectual Disability: Definition, Classification, and Systems of Supports-11 th ed. Washington DC: AAIDD American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, D.C.: American Psychiatric Association. Armstrong, K., Hangauer, J., Nadeau, J. (2012). Use of Intelligence Tests in the Identification of Children with Intellectual and Developmental Disabilities. In Contemporary Intellectual Assessment: Theories, Tests, and Issues (3rd ed.). New York: The Guilford Press. Bergeron, R. & Floyd, R.G. (2006). Broad Cognitive Abilities of Children with Mental Retardation: An Analysis of Group and Individual Profiles. American Journal on Mental Retardation, 111(6), 417-432. Bergeron, R. & Floyd, R.G. (2013). Individual Part Score Profiles of Children with Intellectual Disability: A Descriptive Analysis Across Three Intelligence Tests. School Psychology Review, 42(1), 22-38. Floyd, R.G. & Clark, M.H. (2008). The Exchangeability of IQs: Implications for Professional Psychology. Professional Psychology: Research and Practice, 39(4), 414-423. Floyd, R.G. (2014). Identifying Intellectual Disability in the Era of RtI, Multiple Intelligences and Disproportionality Modules. Research to Practice Sponsored by Indiana Effective Evaluation Resource Center and Indiana IEP Resource Center. Sattler, J. (2008). Assessment of Children-Cognitive Foundation, 5 th ed. San Diego: Jerome Sattler, Publisher Inc. Schalock, R. & Luckasson, R. (2014). Clinical Judgment, 2 nd ed. Washington DC: AAIDD Kara Zwolinski, M.Ed. Education Specialist, Student Evaluation Region 4 Education Service Center kara.zwolinski@esc4.net 713-744-6562 22